Comparative knowledge, attitudes, and practices regarding anthrax, brucellosis, and rabies in three districts of northern Tanzania

Associations of community knowledge, perceptions, and practices related to zoonotic disease with sociodemographic factors in and around Chiro Town, Eastern Ethiopia: a cross-sectional study

BACKGROUND

Zoonoses are infectious diseases that are transmitted from animals to humans. Studying the knowledge, perceptions and practices of communities related to zoonoses and the associated risk factors is crucial for effective control and prevention. This study aimed to assess the knowledge, perceptions, and practices of respondents on zoonoses and the associated risk factors in and around Chiro town, Ethiopia. Zoonotic diseases, such as rabies, anthrax, bovine tuberculosis, and brucellosis, pose a direct threat to health and livelihoods in the communities where they occur. These diseases emerge due to a combination of human-animal interactions, migration, and contact with wildlife and their respective parasites and vectors. Hence, recognizing residents' perceptions, knowledge, and practices is crucial for effectively minimizing risks.

METHODS

A cross-sectional study was conducted from January 2020 to July 2021 in and around Chiro town using a pretested close-ended questionnaire. A total of 350 respondents were selected using simple random sampling methods. The questionnaire included information on the sociodemographic status of the respondents and questions concerning the knowledge, perceptions, and practices of the participants regarding the selected zoonotic diseases. The associations of knowledge, perceptions, and practices related to zoonoses with zoonotic risk factors were analysed using chi-square tests.

RESULTS

The study revealed that 82.9% of the respondents had knowledge of bovine tuberculosis, followed by knowledge of rabies (80%), knowledge of anthrax (45.1%), and knowledge of brucellosis (24.3%). Males had greater knowledge of bovine tuberculosis (84.8%), followed by rabies (79.8%) and anthrax (48.6%), while females had greater knowledge of brucellosis (23.6%). The most cited source of information was radio (68%). Most respondents mentioned the outbreaks of rabies (62.5%), bovine tuberculosis (53.2%), anthrax (35.6%), and brucellosis (15.7%). Respondents with higher educational levels and urban residents had more knowledge of zoonoses. More than 75% of respondents had a good perception of the transmission of zoonotic disease from animals, and the practice of consuming raw milk or raw/undercooked meat and sharing the same house with animals was high.

CONCLUSION

The majority of respondents reported that they had knowledge of bovine tuberculosis and rabies, but lower knowledge and perceptions were reported for anthrax and brucellosis. These findings illustrate the need for collaboration among animal, human and environmental health offices in one health approach to prevent and control zoonotic disease.

Pastoralism and Resulting Challenges for National Parks in Afar, Ethiopia

Pastoralists and national parks are key stakeholders in the management and conservation of natural and protected habitats. In Ethiopia, Afar pastoralists migrate seasonally with their livestock in search for grazing and water areas. Livestock are also a source of infectious diseases that can spread into wildlife populations when pastoralists encroach into unfenced national parks. The interactions between pastoralists and national parks, as well as the subsequent impacts, remain insufficiently understood in Afar. Two structured questionnaire surveys were conducted in 2021, including 300 pastoralist households in seven woredas of Afar, and 58 staff from three national parks (Awash, Alidegi and Yangudi Rassa). They captured pastoralist movements and livestock diseases as well as the perception of national park staff regarding challenges resulting from pastoral encroachment into parks. Among the pastoralists, 74.7% migrated with their livestock for a mean 3.5 months per year, during which time, 90% of respondents reported contact with other livestock herds, and over 80% with wildlife. A third (34.2%) reported disease outbreaks in their village prior to migration. Pastoralists traveled long distances, crossing woreda, regional or national boundaries. All 58-park respondents reported pastoralists with livestock inside their park and their close contact with wildlife. Additionally, 69% reported the presence of domestic dogs. Wildlife displacement, habitat loss and dog attacks on wildlife were perceived as the main threat caused by the presence of pastoralists, whereas diseases were only mentioned by 15.5%. Overall, park staff showed poor disease knowledge. They reported poor disease surveillance and no disease response. Within pastoral contexts, improved collaboration between wildlife and livestock authorities regarding land use, disease awareness and surveillance is needed to balance the needs of both wildlife and pastoralist's livestock development and mitigate threats to wildlife habitats.

Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar

Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.53 per 100 person-years, 95% CI: 0.31-0.85) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09-0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (89.5%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33-3.26) and living in central area (OR = 1.91, CI = 1.22-3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98-7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14-4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination.

Dog ecology and rabies knowledge, attitude and practice (KAP) in the Northern Communal Areas of Namibia

In 2021, a comprehensive dog demographic questionnaire combined with a KAP survey were conducted in the northern communal areas (NCAs) of Namibia with the aim of gaining a better understanding of dog populations, owner behaviour, and knowledge, attitudes and practices (KAP) relating to rabies. The survey of 3,726 households across the eight regions of the NCAs provided insights that will inform interventions in order to improve human rabies prevention and Namibia's dog rabies control strategy. The results showed a relatively low average human/dog ratio (HDR) of 5.4:1 indicating a surprisingly high dog population of at least 272,000 dogs in the NCAs, 93% of which appear to be owned but are free-roaming. Data analysis revealed opportunities but also highlighted needs for improvements in rabies surveillance and mass dog vaccinations. Although knowledge, attitude, and practice scores towards epidemiologic and clinical aspects, human rabies prevention, and dog rabies vaccination were deemed to be acceptable, the survey nevertheless revealed deficiencies in certain aspects in some of the population. Interestingly, data seemed to indicate relatively high dog bite incidences per 100,000 people, ranging between 262 and 1,369 and a certain number of unreported human rabies cases. Despite the very high number of dogs, only 50% of dog-owning households reported having vaccinated their dogs. In order to address these issues, the planning, announcement, and implementation of mass dog vaccination campaigns needs to be adapted to achieve adequate vaccination coverage. Another focus needs to be on rabies awareness and education if Namibia is to be significantly contributing to the global goal of "Zero by 30".

Knowledge, perceptions, and practices around zoonotic diseases among actors in the livestock trade in the Lake Victoria crescent ecosystem in East Africa

Background

Zoonotic diseases such as anthrax, rabies, brucellosis, and Rift Valley fever pose a direct threat to health and undercut livelihoods in the communities in which they occur. A combination of anthropogenic and animal activities like migration and interaction with wildlife and their respective parasites and vectors drives the emergence and re-emergence of zoonotic diseases. Consequently, One Health interdisciplinary approaches that incorporate social scientists can provide key insights into complex local perceptions. The approach calls for collaboration between the human and animal health sectors, including the sharing of disease surveillance data necessary to alleviate disease impacts. Livestock traders interact closely with livestock, which puts them at elevated risk of infection and creates conditions by which they may spread zoonotic disease. It is thus essential to examine practices among actors involved in the livestock trade to understand the most appropriate ways to mitigate these risks.

Methods

A qualitative study was conducted among the actors in the livestock trade in Busia County on their knowledge and perceptions of zoonotic diseases and practices that may contribute to the spread, control, and prevention of zoonotic disease transmission. A thematic analysis framework was used to categorize and synthesize data from in-depth interviews (IDIs), key informant interviews (KIIs), and structured observations.

Results

Whereas participants could list livestock diseases, they could not identify which ones were zoonoses, demonstrating insufficient knowledge of zoonosis. They identify sick animals by checking for dropped ears, excess mucus production, diarrhea, bloody urinal discharge, and general animal activity levels. To prevent the spread of these diseases, they wash their animals, isolate sick animals from the rest of the stock, and vaccinate their animals. They seek help from animal health professionals for sick animals as part of curative practices. This shows that they perceive the diseases as serious and that they need to be attended to by professionals. The results also show that they perceive animals from outside the region to be more vulnerable to diseases compared to those from within. The actors in the livestock trade engage in practices like skinning dead animals before burying them; to them, this is a normal practice. Some also consume dead carcasses. These increase the risk of zoonotic disease transmission.

Conclusion

The actors involved in the livestock trade are critical in the prevention and elimination of zoonotic diseases; hence, they need to be involved when developing intervention programs and policies for animal health extension services. Training them as a continuum of animal health workers blends lay and professional knowledge, which, alongside their intense contact with large numbers of animals, becomes a critical disease surveillance tool. Increasing awareness of zoonoses by using multi-disciplinary teams with social scientists is urgently needed so that practices like skinning dead animals before disposing of them and consumption of dead carcasses can be minimized.

Living Safely With Bats: Lessons in Developing and Sharing a Global One Health Educational Resource

As part of a public health behavior change and communication strategy related to the identification of a novel ebolavirus in bats in Sierra Leone in 2016, a consortium of experts launched an effort to create a widely accessible resource for community awareness and education on reducing disease risk. The resulting picture book, Living Safely With Bats, includes technical content developed by a consortium of experts in public health, animal health, conservation, bats, and disease ecology from 30 countries. The book has now been adapted, translated, and used in more than 20 countries in Africa and Asia. We review the processes used to integrate feedback from local stakeholders and multidisciplinary experts. We also provide recommendations for One Health and other practitioners who choose to pursue the development and evaluation of this or similar zoonotic disease risk mitigation tools.

Knowledge, Attitudes, Practices and Zoonotic Risk Perception of Bovine Q Fever (Coxiella burnetii) among Cattle Farmers and Veterinary Personnel in Northern Regions of Cameroon

A cross-sectional survey was conducted to investigate the knowledge, attitudes, practices and zoonotic risk perception of Q fever among 484 selected cattle farmers (438) and veterinary personnel (46) in three northern regions of Cameroon. Data collection was conducted using questionnaires and responses were recoded into binary scale. An ANOVA test was used to assess significant differences in mean knowledge, attitude, practice and zoonotic risk perception (KAPP) scores between regions, while Linear regression was done to explore the relationship between demographic characteristic and KAPP. Overall, surveyed had low mean scores for knowledge (0.02 ± 0.11), desirable attitude (0.30 ± 0.16), appropriate practice (0.43 ± 0.13) and negative perception of zoonotic risks (0.05 ± 0.11). The means knowledge, attitude, practice and risks perception scores of cattle farmers were lower than those of veterinary personnel. The nature of respondent was negatively associated to knowledge and risks perception, while regions were negatively correlated to attitude and practice. These results revealed significant knowledge gaps, low levels of desired attitudes, and high-risk behavioral practices. To improve awareness, control programs are needed to update knowledge on medical personnel and to prevent animal-to-human transmission.

Knowledge, attitudes, and practices associated with zoonotic disease transmission risk in North Sulawesi, Indonesia

BACKGROUND

Hunters, vendors, and consumers are key actors in the wildlife trade value chain in North Sulawesi, Indonesia, and potentially face an elevated risk of exposure to zoonotic diseases. Understanding the knowledge, attitudes, and practices (KAP) associated with the risk of zoonotic disease transmission in these communities is therefore critical for developing recommendations to prevent or mitigate zoonotic outbreaks in the future.

METHODS

Qualitative and quantitative methods were combined to understand KAP associated zoonotic diseases transmission risk in communities involved in the wildlife trade in North Sulawesi. Qualitative data were collected through semi-structured ethnographic interviews and focus group discussions (FGDs) while quantitative data were collected using questionnaires. We conducted 46 ethnographic interviews and 2 FGDs in 2016, and 477 questionnaire administrations in 2017-2018 in communities from five districts in North Sulawesi. We also collected biological specimens, including nasal swab, oropharyngeal swab, and blood, from 254 participants. The study sites were targeted based on known wildlife consumption and trade activities. The participants for qualitative data collection were purposively selected while participants for quantitative data collection were randomly selected. Biological samples were tested for five viral families including Coronaviridae, Filoviridae, Flaviviridae, Orthomyxoviridae and Paramyxoviridae.

RESULTS

Knowledge regarding disease transmission from animals to humans was similar across the participants in qualitative focus groups, including knowledge of rabies and bird flu as zoonotic diseases. However, only a small fraction of the participants from the quantitative group (1%) considered that contact with wild animals could cause sickness. Our biological specimen testing identified a single individual (1/254, 0.004%) who was sampled in 2018 with serological evidence of sarbecovirus exposure. Overall, participants were aware of some level of risk in working with open wounds while slaughtering or butchering an animal (71%) but most did not know what the specific risks were. However, significant differences in the attitudes or beliefs around zoonotic disease risk and health seeking behaviors were observed across our study sites in North Sulawesi.

CONCLUSIONS

Our study showed variable levels of knowledge, attitudes, and practices associated with the risk of zoonotic disease transmission among study participants. These findings can be used to develop locally responsive recommendations to mitigate zoonotic disease transmission.

First PCR Confirmed anthrax outbreaks in Ethiopia—Amhara region, 2018–2019

Background

Anthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region.

Methods

Following reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR).

Results

In Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR.

Conclusion

We report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage.

Ruminant farmers' knowledge, attitude and practices towards zoonotic diseases in Selangor, Malaysia

This study aimed to assess knowledge, attitude and practices about zoonotic diseases and associated factors among ruminant farmers in Selangor, Malaysia. A cross-sectional survey was conducted between January 2018 and December 2020. The survey was developed in English and Malay, validated, administered to ruminant farmers in Selangor. A total of 84 farmers completed the structured questionnaire. The data were analysed using descriptive statistics, principal component factor analysis and binary logistic regression models. Only 42 % (35/84) had heard of the term "zoonotic diseases" before this study but the majority of farmers (52/84; 61.9 %) were aware that certain diseases could be transmitted between humans and animals. A higher proportion was aware of rabies (20.8 %), followed by tuberculosis (17.8 %) and brucellosis (15.7 %), and most respondents identified the diseases as zoonotic. The majority of farmers stated (60 %) that zoonosis could be prevented and they preferred to learn more about such diseases through veterinary personnel. Higher proportions (>80 %) agreed to practices such as hand washing, proper cooking of meat, and keeping animal health records. However, the need to pasteurise milk before drinking and selling were the least items that farmers agreed to, which was reflected in their practices. Sixty-four per cent of the farmers had stray animals on their farm with dogs (45.5 %) being predominant. Overall, 34.5 % (29/84), 51.1 % (43/84), and 60.7 % (51/84) were considered to have satisfactory knowledge, attitude and practices regarding zoonotic diseases, respectively. Farmers with higher education (odds ratio; OR = 16.6; 95 % CI 3.7-71.4) and rearing exotic breeds of animals (OR = 6.0; 95 % CI 1.3-27.7) were more likely to have satisfactory knowledge about zoonoses, but less likely for those with small herd size (51-100 animals) (OR = 0.19; 95 % CI 0.04-0.95). The odds of having satisfactory attitude towards preventive measures against zoonoses were higher in farmers with higher education (OR = 3.2; 95 % CI 1.1-8.9). Farms with herd health programs were more likely to engage in satisfactory practices towards zoonoses (OR = 3.2; 95 % CI 1.2-10.0) relative to farms lacking programs. These areas might need to be considered by public health authorities to improve the current knowledge and attitude of ruminant farmers about zoonotic diseases in the Malaysian context.

Epidemiological Analysis of Rabies in Central China from 2013 to 2018

Objective

The study aimed to timely grasp the epidemiologic status of rabies in Central China from 2013 to 2018 and provide scientific evidence for the implementation of follow-up prevention and control measures.

Methods

We initiated a retrospective observational and descriptive study of bite-related injuries data and rabies disease data in Hubei province from 2013 to 2018, managed by the Center for Disease Control and Prevention.

Results

A total of 2,028,691 individuals were exposed to bites from 2013 to 2018, of which 221 were diagnosed with rabies and deceased. Among those cases, the incubation periods of rabies varied from 3 days to 18,406 days, which has been shown to be statistically associated with where the infected person was exposed and whether the wound care has been conducted.

Conclusion

Epidemiological studies have shown that from 2013 to 2018, the current situation of rabies in Central China is still severe. The case fatality rate keeps virtually 100%. The rural population is still the most vulnerable group to rabies, characterized by a high exposure ratio and low treatment rate as well as poor vaccination compliance. Hoewever, larger populations are warranted to validate our findings.

Conventional knowledge, general attitudes and risk perceptions towards zoonotic diseases among Maasai in northern Tanzania

Understanding factors influencing conventional medical knowledge (CMK), general attitudes and risk perceptions of zoonotic diseases among rural residents who face risk of exposure to such diseases is important for human, livestock, and wildlife health. Focusing on Maasai from Makame, Kiteto District (Tanzania) who largely maintained a semi-nomadic lifestyle, we evaluated respondents’ CMK of causes, symptoms, treatments, and prevention methods of rabies, brucellosis, and anthrax. In addition, we identified socio-demographic correlates of CMK with respect to the target zoonoses. Finally, we assessed the relative frequency of practices that increase the risk of pathogen transmission, and compared the risk perception of the three diseases. We conducted structured interviews with Maasai respondents (n = 46) in six sub-villages of Makame and considered education, gender, age, and wealth (indicated by standardized number of livestock) as potential correlates of CMK. Respondents had greater CMK of rabies and anthrax, but feared anthrax the most. Receiving formal education increased rabies CMK (p ≤ 0.05). The CMK of anthrax and brucellosis was not associated with any of the tested variables (p > 0.05). Risk perceptions were correlated with knowledge scores for rabies and anthrax (p ≤ 0.05), and multiple interviewees reported engaging in practices that potentially enhance pathogen transmission. Specific socio-demographic attributes (i.e., formal education) may explain the observed variation in CMK of zoonotic diseases. This information can be used to develop and tailor health education programs for specific at-risk groups.