Community knowledge, attitudes and practices on bovine tuberculosis

Veterinaria, Vol. 67, No. 1, 2018 Research - Full Paper

Community knowledge, attitudes and practices on bovine tuberculosis and associated risk factors in Gambella Regional State Lare Woreda, South West Ethiopia Getahun Asebe*, Eshetu Gudina Abstract Bovine tuberculosis (BTB) is known to be transmitted from infected animals to humans through close contact and ingestion of raw animal products. This study was conducted to assess knowledge, attitude and practice within community regarding BTB and associated risk factors in Lare Woreda, South West Ethiopia. A cross-sectional study was conducted between November, 2014 and June, 2015 at selected kebeles’ of Lare Woreda. A structured questionnaire was designed, pretested and self-administered by the consented study participants in the area. A total of 384 respondents (37.8% males and 62.2% females) participated having at least one cattle in their homes, mainly kept for the purposes of milk and meat production, and ritual activities. About 43.0% of the participants have the habit of drinking raw milk, yet none of them eat raw meat. Only 31.0% of the participants heard about BTB (locally called ‘Keil’), and 26.1% was familiar with the etiology of disease. From those who heard about the disease, 25.2% had a misconception about the causative agent as being genetically transferred from their parents, while 48.7% of the respondents did not know the causative agent. About 44.5% of participants remarked that tuberculosis could be transmitted from the cattle to human. Of all participants, 19.3 % witnessed TB among their family members. Veterinarians and human health care service organizations should improve their focus on community with more attention to the awareness creation programs through various activities to raise knowledge about BTB. Key words: BTB, awareness, knowledge, attitude, milk, meat Gambella University, College of Agriculture and Natural Resource, Department of Animal Science, Ethiopia *Corresponding author: [email protected]

Introduction Tuberculosis (TB) is among the top public health threats globally (WHO, 2014). It is a disease of mammalian species including humans, caused by a group of bacteria called Mycobacterium tuberculosis complex (Pal et al., 2014). Bovine tuberculosis (BTB) is known to have a public health importance being transmitted from infected animals to humans through close contact and ingestion of raw animal products (Ashford et al., 2001; Cosivi et al., 1998; Pal, 2007; Pal et al., 2014). Also, it represents a financial burden due to the loss of productivity of livestock i.e. the reduction of milk production and carcass condemnation (Girmay et al., 2012). The global prevalence of human tuberculosis due to M. bovis is estimated at 3.1% of all human tuberculosis cases accounting for 2.1% and 9.4% of pulmonary and extrapulmonary TB, respectively in an early estimate by Cosivi et al. (1998). Drinking raw milk is a primary route of M. bovis infection of humans; hence, the occurrence of human tuberculosis is most commonly in the extrapulmonary form, particularly resulting in the cervical lymphadenitis (Ayele et al., 2004).

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In Ethiopia, the endemic nature of tuberculosis in cattle has been long reported (Hailemariam, 1975), indicating tuberculosis was widespread in both human and cattle population (Ameni, 1996; Kiros, 1998). According to Ameni et al. (2010) and Ejeh et al.(2013), the surveys in Ethiopia on the socio-economic conditions indicated that low standard in the living areas for both animals and humans was having a significant contribution to TB transmission between human to human, human to cattle, and vice versa. Human infection due to M. bovis is mainly through drinking of contaminated or unpasteurized raw milk and eating undercooked meat. Shitaye et al. (2007) suggested the probable increase in transmission rates was due to the high prevalence of TB in cattle, close contact of cattle and humans, the habit of raw milk and meat consumption, and the increasing prevalence of HIV in humans. Human tuberculosis of animal origin is an important public health concern in developing countries. African countries are greatly challenged in TB control because of the difficulties in implementation of public health control measures for cattle and animals’ products coupled with

Community Knowledge, attitudes and practices on Bovine tuberculosis and associated risk factors in Gambella Regional State Lare Woreda, South West Ethiopia —28/35

a high prevalence and incidence of HIV in the human population (Eric et al., 2006). The southwestern Ethiopia, particularly Gambella, is known to have huge livestock population of especially cattle and goat. This study was conducted in the area, and it assessed the knowledge, attitudes and practices (KAP) of the community towards bovine tuberculosis as well as the status of risk factors in cattle and cattle owners. BTB is among the most prevalent diseases that affect the poor nations worldwide. In our country, people and domestic animals live closely together, and the consumption of raw animal products and by-products presents a potential risk factor to acquire BTB. Impacts and information regarding BTB in Ethiopia in general, particularly in the Gambella Region, have not been clearly identified.

Material and Methods Study area The study is conducted in South West Ethiopia, Gambella Regional State LareWoreda from November, 2014 to June, 2015. This region is located 45 km away from the center of Gambella Town near the South Sudan border. Lare is one of the woredas inthe Gambella Region of Ethiopia. Part of the Nuer Zone, Lare is bordered on the south and east by the Anuak Zone, on the west by the Baro River separating it from Jikawo, and on the north by the Jikawo River separating it from South Sudan. Towns in Lare, among others, include Kuergeng. The livestock population of the area is estimated to be 40,012 sheep, 56,705 goats, and 100,952 poultry (CSA, 2012). The production system of the region mainly consists of livestock rearing and seldomly crop production. The majority of animals are reared by smallholder farmers within the extensive system. The livestock populations owned by the farmers are large in number. Study population The study was conducted at the household level with the households rearing either only cattle, or cattle and the other species of domestic animals. The households were sampled from Lareworeda of three kebeles with the relatively highest cattle livestock population. The required sample size was estimated to be 384 using the formula stated in Thrustfield (2007).

Where P= Proportion of people knowledgable of BTB. Since the prevalence of BTB in the area is not known, standard of P= 50% (i.e. 0,5) was used. Z= 1.96 at 95% confidence interval d= expected margin of errors, i.e. 0.05 N= required sample size In the Nuer Zone of the region, the most dominant livestock species is cattle, whereby the culture and tradition, husbandry practices and breed of cattle remain the same. Therefore, Lareworeda was selected based on accessibility while the other criteria remain the same. The study was conducted in Nuer Zone LareWoreda in three “kebeles’” (01, 02, and “kutogny”) selected. The kebeles were selected based on the number of cattle population and accessibility to transportation. Study design A cross-sectional study across selected “kebeles’” of LareWoreda was conducted to collect and analyze relevant information regarding BTB. A semi-structured questionnaire was prepared and administered to the cattle owners/herders to collect relevant information related to bovine tuberculosis and associated risk factors for the occurrence and spread of BTB among cattle, and between cattle and humans. Three hundred eighty- four cattle owners were interviewed within the purposefully selected three “kebeles” (01, 02 &“Kutogny”) of the “Lareworeda”. The questionnaire included both closed and open-ended questions on species of animals owned, livestock husbandry/management, and household characteristics such as a herd size and structure, presence of other livestock, presence of wild life in the surrounding area, mixing of cattle with other livestock, watering and feeding and production system. In addition, questions were asked about the habits of human consumption of animal products and by-products , contacts between humans and cattle, BTB knowledge and known current or previous history of TB status in their households. The collected data were entered into Microsoft Excel data sheets and analyzed using STATA 12 statistical software (STATA Corporation, College Station, TX version 12.0). Awareness of cattle owners was determined by dividing the proportion of people who knew or heard about BTB by the total number of respondents. Different statistical analysis calculations were conducted to generalize the effects of BTB in the area as well as the public awareness regarding the disease. A statistically significant association between variables was determined at the level of statistical significance of 5%. Ethical consideration and ethical clearance Ethical clearance for this study was obtained from the Research and Community Service Directorate of Gambella University, and the working permission was obtained from the respective governmental office of the studied woreda. Consent was obtained from the owners of animals.


Results Socio-demographic characteristics of the study participants In the current study, included were 145 (37.8%) males and 239 (62.2%) females. The age of the respondents ranged from 18-80 years, with a mean age (SD) of 32.72 (11.33) years. The majority were in the age range of 18-44 years. More than half (58.6%) of the respondents were engaged in a farming activity. Regarding the educational status, 161(41.9%) of them were unable to read and write (Table 1).

Livestock holding characteristics and husbandry practices In the study area, all 384 respondents had local cattle breeds, of these 216 (56.3%) held cattle, sheep, goats and poultry. The main purposes of keeping livestock were milk and meat production and rituals as shown in Table 2.

Table 1: Socio- demographic characteristics of the respondents

Characteristics

Frequency (N)

Percent (%)

Male

145

37.8

Female

239

62.2

Sex of the respondents

Marital status Married 320 Single 64 Occupation status of the respondents’ Farmer 225 Student 51 Employee 68 Jobless 40 Age of the respondents 18-44 305 45-64 78 >=65 1

83.3 16.7 58.6 13.3 17.7 10.4

Frequency (N) Educational status of the respondents’ Characteristics

Not writing and reading Writing and reading (informal education) Grades 1-4 Grades 5-7 Grades 8-12 Certificate or above Kebele of the respondents 01 kebele 02 kebele Kutogny Kebele

Percent (%)

161

41.9

16

4.2

16 17 128 46

4.2 4.4 33.3 12.0

147 147 90

38.3 38.3 23.4

79.43 20.31 0.26

Table 2: Species of animals owned and purpose of rearing cattle by the respondents in Lare Woreda.

Variable Owned domestic species of animals Cattle only Cattle & sheep Cattle & Goats Cattle, goats and poultry Cattle, sheep, goats and poultry Breed of cattle Local Purpose of cattle Milk All (milk, ritual, draft, and meat) Milk & ritual Milk, meat, ritual Number of cattle owned by the respondents Less than 10 Between 10-20 More than 20

Frequency (N)

Percent (%)

70 19 49 30 216

18.2 4.9 12.8 7.8 56.3

384

100

56 70 37 221

14.6 18.2 9.6 57.6

148 143 93

38.5 37.2 24.2


Table 3 depicts husbandry practices of cattle, showing that 100% (384) graze their animals freely in the fields. Three hundred seventy respondents mix their cattle with other domestic or wild animals. Areas where owners mix their cattle include grazing areas, water source- watering, grazing and market areas, and watering and grazing areas. Two hundred thirteen study participants responded that they shared the same watering point with cattle, while none of them shared the same house with animals. Regarding the wildlife-cattle interaction, 20.1% responded confirmatory.

Animal product consumption practices The result of the questionnaire survey showed that 43.0% of the household heads shared the habit of the raw milk consumption. Counter-wise, 40.1% boiled fresh milk before the consumption. Most respondents boiled milk being fearsome of the milk- borne diseases, while only 9.1% of the household heads boiled milk for the cultural practice reasons. Bringing milk to the market for the local population was practiced by 60.2 % of the respondents. (Table 4).

Table 3: Livestock husbandry practice in LareWoreda

Variable

Frequency (N)

Percent (%)

Free grazing system

384

100

Mixing of cattle with others Yes

370

96.4

No

14

3.6

Cattle mixing places Grazing field

137

37.0

Grazing system of cattle

Watering & grazing point Watering, grazing and market

101

27.3

132

35.7

Do you use the same watering point with animals? Yes

213

55.5

No

171

44.5

No

384

100

Do your cattle and wild life come in contact Yes

77

20.1

No

307

79.9

Do you share the same house with your animals

Table 4: Animal product consumption, behaviors and marketing practices in LareWoreda

Variable Habit of milk drinking (N=384) Raw Boiled Both Reason of Milk boiling (N=219) Fear of milk borne diseases Culture Habit of meat consumption (N=384) Cooked Do you sell milk (N=384) Yes No For whom do you sell milk (N=384) For local people

Frequency (N)

Percent (%)

165 154 65

43.0 40.1 16.9

199 20

90.9 9.1

384

100

231 153

60.2 39.8

231

100


Fortunately, all study participants responded they never ate raw meat as a preference (Table 4). Knowledge of participants about BTB From the total number of study participants, 69.0% had never heard about BTB (locally known as ‘Keil’). From those who heard about the disease, 25.2% had a misconception of etiology of the disease, and attributed it to genetic transfer from their parents. However, 48.7% of the respondents did not know the causative agent. About 44.5% of the participants mentioned that tuberculosis could have been transmitted from cattle to humans. Ingestion of the raw animal products (milk and meat) as the mode of BTB transmission to humans was indicated by 39.63% of participants, while 30.18% of them was not knowledgable of the transmission mode from animals to humans (Table 5). As shown in Table 6, knowledge about BTB was better in the age group of 18-44 years, and for female respondents

(60.5%). The knowledge variation across gender and age categories was not found statistically significant (P>0.05). However, as the level of education increased, the awareness about BTB increased significantly (P0.05

47(39.5%) 72(60.5%)

P>0.05

54(45.38%) 40(33.61%) 25(21.01%)

P>0.05

Age category 18-44 45-64 65-100 Gender Male Female Kebele 01 02 Kutogny Education level Not writing and reading Writing and reading Grade 1-4 Grade 5-7 Grade 8-12 Certificate or above

51(39.23%) 2 (18.18%) 2 (18.18%) 3 (30.0%) 33 (36.67%) 28 (77.78%)

P0.05), which is similar to Kidane et al. (2015) results. Study participants (19.3%) shared a thorough knowledge on TB in cases of having a diseased family member ,however, the rates were lower than those reported by Kidane et al. (2015) (21.7%). About 91.7% of the TB patients were treated with modern drugs in the health care service institutions, which is similar to the rate reported by Melaku et al. (2015) in Ethiopia. In this study, 44.5% of the respondents realized that BTB was a transmissible disease passing from animals to humans, which is in line with Romha et al. (2014). Similarly, more than 43.0 % of the respondents were consuming only the raw milk,

while 16.9 % drank both raw and boiled. Humans acquire the infection primarily by ingesting the agent in the raw milk and milk products, and secondly by inhalation through the close physical contact between the owner and his/her cattle (CFSPH, 2009) 2009. Habit of consuming the raw milk was reported as a risk factor for TB in different parts of the world (Cosivi et al., 1998; Kazwala et al., 1998; Kahla et al., 2011; Njarui et al., 2011; Pal et al., 2014). Fear of a milk-borne disease is the main reason (90.9%) for boiling the milk in the area, which proves knowledge among the people who practice boiling , at rates higher than those from the report of Kidane et al. (2015). Based on the respondents’ rates regarding their practice and level of awareness of the disease, the potential risk factors for the disease include the raw milk consumption and disease treatment practices , which was also mentioned by Ameni et al. (2003). Our study indicates that as the educational level increases, the level of awareness increases significantly (P