Knowledge, attitudes and practices (KAPs) and risk factors of brucellosis at the human-animal interface in the Nile Delta, Egypt

Abstract

BackgroundBrucellosis is a highly contagious zoonosis affecting human and almost all domestic species. It is a multi-burdens disease leading to severe economic losses due to disability in humans in addition to abortion, infertility and reduced milk production in animals. An Important element for effective prevention and control of brucellosis is to improve knowledge, attitude and practices of the community.\n\nObjective(s)This study aimed to assess the knowledge, attitudes and practices (KAP) related to brucellosis at human-animal interface and to determine the risk factors for human infection in the Nile Delta, Egypt.\n\nMethodsA matched case-control study was conducted at the main fever hospitals located in 6 governorates in the Nile Delta, Egypt between June 2014 and June 2016. Face-to-face interviews with cases and controls was done using a structured questionnaire. Differences in proportions of KAP variables among the cases and controls were evaluated by Pearsons Chi square test and a p value <0.05 was set as a level of significance. A multivariate conditional logistic regression analysis was built to determine the risk factors for Brucella spp. infection among study participants.\n\nResultsA total of 217 cases and 434 controls matched for age, gender and sociodemographic characteristics were enrolled and interviewed. In total, 40.7% of the participants owned animals in their households and lived in shared accommodation with animals [48.8% of cases vs 36.9% of controls; (p= 0.003)]. The majority (78.1%) used to accommodate cows and buffaloes with sheep and goats. Human brucellosis cases experienced more animal abortions comparing to the controls [(23.5% vs 9.7%, respectively), (p= 0.0003)]. The majority of the participants (82.4%) did not notify authorities in case that abortion occurs in their owned animals. Apparently, 67.4% of the participants [(70.0% of the cases vs 66.1% of the controls) (p = 0.315)] had not ever heard about brucellosis. The overall mean practice score regarding animal husbandry, processing and consumption of milk and dairy products was significantly lower among cases comparing to controls (-12.7{+/-}18.1 vs 0.68{+/-}14.2 respectively; p<0.0001). Perceived barrier for notification of animal infection and/or abortion was significantly higher among cases (p= 0.034) and positively correlated with participants education. Results of univariate analysis showed that participants who have animals especially small ruminates were at a higher risk of getting Brucella spp. infection than others. In the proposed multivariate conditional logistic regression model, the predictors of having brucellosis infection were consumption of unpasteurized milk, having consumed dairy products in the last 3 months before the study, consumption of yoghurt or home-made cheeses and involvement in contact with animals [OR (95% CI) = 4.12 (1.62 - 10.75); 2.71 (1.06 - 6.93); 2.51 (1.21 - 5.24); 1.96 (1.17- 3.30), p<0.05; and 4.97 (2.84 - 8.72)], respectively. Participants who take more protective measures against infection were at a significant lower risk of being diseased with brucellosis; [OR (95% CI) = 0.23 (0.10 - 0.58); p<0.001], respectively. A model predicting risk factors for brucellosis among those who own animal showed that frequent abortions per animal increased the chance for brucellosis infection among human cases by 49.33 fold [(95% CI)= (8.79 - 276.91); p= 0.001] whereas the practice protective measures with animals was protective for humans as well [OR (95% CI)= 0.11 (0.03-0.45); p= 0.002].\n\nConclusionConsumption of dairy products stands side by side with the contact with infected animals particularly aborted ones as the major risk factors for Brucella spp. infection among humans in Egypt. On the other hand, there is a poor knowledge, negative attitudes and risky behaviors among villagers which increase the magnitude of the risk of brucellosis transmission at the human-animal interface. This supports the need for integrating health education in the national brucellosis control programs in Egypt with a special emphasis on hygienic animal husbandry, disease notification and benefits of animal vaccination.\n\nAuthor summaryZoonotic brucellosis has a vast global burden and remains neglected in many areas of the world despite notable advances in disease containment strategies. Despite the implementation of a national brucellosis control program in Egypt, the challenges for the disease eradication are intractable and multifaceted. We modeled in the present study the multivariate factors for brucellosis persistence in Egypt which apparently pointed to lack of basic understanding of the nature of brucellosis, traditional practices, beliefs and risky behaviors being undertaken on farms and at households across a wide region of the country. Predominantly, consumption of dairy products from unregulated sources; underreporting animal infection and abortion; underutilization of animal vaccination service; unsanitary disposal of abortus; use of milk of infected/aborted ruminants and lack of protective measure when practicing animal husbandry. Together, these conflict with disease intervention strategies and contribute to disease spread and re-emergence. The proposed model can provide a framework for future containment strategies that should be adopted to support and enhance the adherence to the current national brucellosis control program.