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Knowledge, attitude and practices relating to zoonotic diseases among livestock farmers in Punjab, India
Acta Tropica 189 (2019) 15–21
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Acta Tropica journal homepage: www.elsevier.com/locate/actatropica
Knowledge, attitude and practices relating to zoonotic diseases among livestock farmers in Punjab, India
T
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B.B. Singha, , R. Kaura, G.S. Gilla, J.P.S. Gilla, R.K. Sonib, R.S. Aulakha a b
School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, Punjab, India Dayanand Medical College & Hospital, Ludhiana 141004, Punjab, India
A R T I C LE I N FO
A B S T R A C T
Keywords: Awareness India KAP Knowledge Livestock farmer Practice Punjab Zoonoses
Zoonotic diseases cause significant health and economic impact in developing countries such as India. Many zoonotic diseases are prevalent in the livestock and as an occupational zoonosis in the livestock farmers in India. Lack of knowledge on the disease transmission, prevention and control measures is a potential high risk for the occurrence of zoonotic diseases in the livestock and its keepers in India. We conducted this study to understand knowledge, attitude and practices of livestock farmers regarding zoonoses. Five villages from each of the 22 districts of the state were conveniently selected (n = 110). Farmers available at village community sites were enrolled in the study and requested to complete a custom designed questionnaire (n = 558). In addition, livestock farmers attending basic livestock husbandry training were also surveyed (n = 301). Data from questionnaires was used to create three index variables: (a) knowledge score; (b) attitude score and (c) practice score. Association between demographic and other explanatory variables with knowledge score was evaluated using linear regression analyses. Similarly, the association between knowledge and attitude score with practice score was evaluated. Of the 859 participants, 685 (80%) livestock farmers had heard the term ‘zoonoses’ but only 345 (40%), 264 (31%) and 214 (25%) farmers were aware of the zoonotic nature of tuberculosis, Japanese encephalitis and taeniosis, respectively. For practices, 23% farmers reported consumption of raw milk and only 10% and 8% livestock farmers ever got their animals tested for brucellosis and tuberculosis, respectively. The low level of education and being a cattle farmer were negatively associated with the farmer’s knowledge on zoonotic diseases. The attitude score was positively associated with the practice score of the participants. The results indicate need for educating the livestock farmers particularly those with a low level of education to reduce the health and economic impact of zoonotic diseases in India.
1. Introduction Livestock is one of the most important assets of the poor to meet livelihood needs (Perry and Grace, 2009). Animal diseases including zoonoses are crucial constraints in enhancement of livestock-production systems (FAO, 2002). Transboundary, zoonotic and foodborne diseases negatively impact poor populations and national economies (Gall and Leboucq, 2003). Huge losses have been reported in livestock sector due to diseases such as brucellosis and cystic echinococcosis in India (Singh et al., 2014, 2015). Zoonotic diseases cause significant health and economic burden in developing countries (Halliday et al., 2015). Many zoonotic pathogens are a serious animal and public health concern in India. For example, about 20,000 deaths due to rabies (Knobel et al., 2005) and 2.2 million new cases of tuberculosis (WHO, 2013) occur every year in the human
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populations in India and human neurocysticercosis-associated active epilepsy causes 2.10 million disability adjusted life years in India (Singh et al., 2017). Many zoonotic diseases are also considered as significant occupational health hazards (Battelli, 2008). Livestock owners have different type and intensity of human–livestock contacts which may result in transmission of microorganisms and associated zoonoses (Klous et al., 2016). Livestock farmers are exposed to a number of zoonotic pathogens such as Coxiella burnetti and Toxoplasma gondii (Thomas et al., 1999). In the US, zoonoses are an important occupational hazard and a health concern for livestock workers (Lejune and Kersting, 2010). In Italy, occupational exposure to zoonotic agents such as Coxiella burnetti and Leptospira species among agricultural workers have been reported (Tabibi et al., 2013). There are number of zoonotic diseases prevalent as occupational
Corresponding author. E-mail address: [email protected] (B.B. Singh).
https://doi.org/10.1016/j.actatropica.2018.09.021 Received 1 December 2017; Received in revised form 7 July 2018; Accepted 23 September 2018 Available online 27 September 2018 0001-706X/ © 2018 Elsevier B.V. All rights reserved.
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the training programs. The villages were conveniently selected, for example, those closer to the main roads. The unit of study was an individual livestock farmer.
zoonosis in livestock farmers in India. The brucellosis sero-prevalence between 0.9%–18.1% with a high risk in veterinarians and farm attenders has been reported from India (Seleem et al., 2010; Agasthya et al., 2007; Mantur and Amarnath, 2008). The zoonotic Giardia duodenalis Assemblage A1 has been detected in both calves and dairy workers in West Bengal, India (Khan et al., 2011). Punjab is an agrarian state of Northern India (Latitude of 30°4′N and Longitude 75° 5′ E) with a human population of 27,704,236 and 63% of its population reside in rural areas (Census of India., 2011). The state has the highest per capita milk availability (932 gm/person/day) in the country with a cattle and buffalo population of 2.42 and 5.16 million, respectively (BAHS, 2014). There are 128 534 sheep, 327 272 goat and 32 221 pigs in Punjab (BAHS, 2014). The state is home to 737 352 backyard poultry consisting of fowls and chicken below 5 months of age (BAHS, 2014). There are 4 610 921 households/household enterprises owning animals/poultry birds in Punjab state of India (BAHS, 2014). There are 718 cattle, 1543 buffaloes, 39 sheep, 97 goat and 7 pigs per thousand households in the rural areas of Punjab (BAHS, 2014). The official estimates indicate the presence of 100 991 stray cattle in the state (BAHS, 2014). Over 70% of the households own livestock in the rural areas (Ali, 2007). The animal husbandry and crop agriculture are intrinsically linked and important for overall food security in the state (DAHDF, 2017). Mixed farming is commonly practiced in Punjab, India. Based on their occupation, there are three categories of people keeping livestock in the state a) crop farmers keeping livestock b) livestock farmers growing crops or involved in other secondary activities c) People primarily involved in non-agriculture activities but raise livestock at home. Many zoonotic diseases such as brucellosis, tuberculosis, rabies, taeniosis, ringworm and toxoplasmosis are endemic in Punjab state of India (Dhand et al., 2005; Brookes et al., 2018; Singh et al., 2010). In addition, human cases of swine flu and japanese encephalitis have been reported from other states of India (Prakash et al., 2011; Tiwari et al., 2012). Knowledge on zoonotic disease transmission, prevention and control measures is a must for livestock farmers. It will help prevent and control zoonotic diseases as an occupational hazard and reduce the incidence of zoonotic diseases in human as well as livestock populations. Therefore, the current study was planned to assess knowledge, attitude and practices (KAP) relating to zoonotic diseases among livestock farmers for policy development and to help formulate and improve existing zoonotic disease educational programs.
2.2. Sampling procedure As per the Census of India. (2011) there are 12,581 villages (assumed equivalent to animal herds) in Punjab state of India. We selected 110 villages representing approximately 1% of the total villages. Assuming that 50% of the farmers would have knowledge about zoonotic diseases, a sample size of 534 was required to estimate the knowledge proportion with 5% precision and 95% confidence assuming a response rate of 70% and a population of 13 114 farmers in the 110 villages selected (Dhand and Khatkar, 2014). As per the National sample survey office data, the total operational holdings for all the livestock classes in Punjab have been reported to be 1 499 900 (NSSO, 2013). By assuming that livestock operational holdings will be uniformly distributed across whole of the state, we estimated that there will be 13 114 livestock operational holdings in the 110 villages selected in the study. The research team visited the selected villages and requested livestock farmers at community sites to participate in the study. In addition, livestock owners attending livestock husbandry trainings GADVASU were requested to participate in the study. The participant information statement explaining the purpose of study was provided to all the participants and a written consent was obtained from the participants indicating their willingness to participate in this study. After this, the participants were asked to complete a questionnaire to assess their KAP relating to zoonotic diseases. The participants were offered the questionnaire either in English or in the local language (Punjabi). After completion of the questionnaire, participants were provided with information brochures explaining prevention and control measures of important zoonotic diseases. 2.3. Questionnaire design and data collection The questionnaire was developed to collect detailed demographic information and related to KAP of livestock farmers about zoonotic diseases. The demographic information collected included age, gender, family size, and the educational qualifications. The livestock farm associated details included years in livestock farming, number and species of the animal present at the farm. For knowledge assessment of the livestock farmers, the basic questions were asked about endemic or historically important zoonotic diseases such as brucellosis, rabies, tuberculosis, plague, swine flu, taeniosis, hydatidosis, toxoplasmosis and ringworm. Initially, the farmers were asked if they have heard about these diseases and were later told to identify animal hosts associated with the transmission of these zoonotic pathogens. The answer was only considered ‘correct’ if the farmer was able to correctly identify at least one of the animal hosts; however additional selection of an animal host not related to the disease was considered as an incorrect reply. Information related to practices included animal deworming practices, habit of consuming raw milk, washing hands after contact with animals, the habit of walking bare feet at home or at the farm and testing of the herds for brucellosis or tuberculosis. The attitude related information for disposal of carcasses and deworming practices were also collected.
2. Methods The necessary ethical permission for the conduct of this study was obtained from the Institutional Ethics Committee, Dayanand Medical College & Hospital, Ludhiana, Punjab (Ethics approval number: DMCH/ R&D/2016/372). The study was conducted as a cross-sectional study between 2015 and 2016. 2.1. Target and study population The target population comprised of livestock (cattle/buffalo/sheep/ goat/pig) farmers residing in the rural areas of Punjab. The study population was the farmers belonging to 110 villages of Punjab representing all the 22 districts (5 villages from each district) of Punjab as well as those attending livestock trainings at Guru Angad Dev Veterinary & Animal Sciences University (GADVASU). The basic trainings are being conducted by the Department of Veterinary and Animal Husbandry Extension Education, GADVASU. The trainings are organised across the year and usually 30–50 participants are enrolled in batches. These trainings are advertised on the University website and farmers are nominally charged for such trainings. As these trainings are organised on-campus, more farmers from the nearby districts enrol in
2.4. Data handling and statistical analysis The analyses were conducted using IBM SPSS Statistics for Windows, Version 22.0 statistical software (released 2013. © 2013, Armonk, NY: IBM Corp). 2.5. Explanatory and outcome variables We used demographic characteristics and whether the livestock owner came for basic husbandry training as explanatory variables. A 16
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knowledge score index (range 0–22) was prepared by summing up participant’s knowledge of the term zoonoses, routes of transmission of the above mentioned zoonotic diseases. The practice score (range 0–7) was prepared by summing up participant’s animal deworming practices, habit of consuming raw milk, washing hands after contact with animals, the habit of walking bare feet at home or at the farm and testing of the herds for brucellosis or tuberculosis. The attitude score (range 0–2) consisted of the attitude towards disposal of carcasses and for the deworming practices. Each correct answer was awarded a score of 1.0 and no score was awarded for an incorrect reply. Data were entered into Excel sheet and descriptive analyses were carried out. Frequency variables of important explanatory and outcome variables were prepared.
Table 1 Frequency table for demographic variables in a KAP study relating to zoonotic diseases among livestock owners in India. Variable
Enrolment Category
Survey (%)
Training (%)
Total (%)
Age (Years)
11–20 21–30 31–40 41–50 51–60 60+
50 (8.96) 84 (15.11) 109 (19.53) 132 (23.66) 107 (19.17) 76 (13.62)
55 (18.3) 127 (42.19) 62 (20.6) 36 (11.96) 15 (4.98) 6 (2.0)
105 (12.22) 211 (24.56) 171 (19.90) 168 (19.55) 122 (14.20) 82 (9.54)
Gender
Male Female
507 (90.9) 51 (9.1)
255 (84.7) 46 (15.3)
762 (88.70) 97 (11.29)
Level of Education
Illiterate 10th 12th Graduate Postgraduate
78 (14.0) 271 (48.6) 156 (28.0) 42 (7.5) 11 (2.0)
7 (2.3) 49 (16.3) 161 (53.5) 65 (21.6) 19 (6.3)
85 (9.89) 320 (37.25) 317 (36.90) 107 (12.45) 30 (3.49)
Primary occupation
Crop farming Dairy farming Any other
438 (78.5) 20 (3.6)
218 (72.4) 33 (11.0)
656 (76.36) 53 (6.16)
100 (17.92)
50 (16.6)
150 (17.46)
Secondary occupation
Crop farming Dairy farming Any other/ None
14 (2.5) 24 (4.3)
11 (3.7) 27 (9.0)
25 (2.91) 51 (5.93)
520 (93.19)
263 (87.3)
26 (3.02)
Number of members in the household
1–5 6–10 11–15 16–20
306 (54.84) 230 (41.22) 20 (3.58) 2 (0.03)
155 (51.5) 141 (46.84) 5 (1.66) 0 (0.0)
461 (53.66) 371 (43.18) 25 (2.91) 2 (0.23)
Years since farming
0–5 5–10 10–15 15–20 20+
42 (7.5) 38 (6.8) 29 (5.2) 51 (9.1) 398 (71.3)
64 56 47 41 93
(21.3) (18.6) (15.6) (13.6) (30.9)
106 (12.33) 94 (10.94) 76 (8.84) 92 (10.71) 491 (57.15)
Number of animals in the household
0–5 6–10 11–15 16–20 20+
362 (64.87) 130 (23.3) 38 (6.81) 9 (1.61) 19 (3.40)
156 (51.83) 76 (25.25) 33 (10.96) 18 (5.98) 18 (5.98)
518 (60.30) 206 (23.98) 71 (8.26) 27 (3.14) 37 (4.30)
3. Results
Owns cattle
Yes No
555 (99.5) 3 (0.5)
288 (95.7) 13 (4.3)
843 (98.13) 16 (1.86)
3.1. Distribution of participants
Presence of sheep or goat
Yes No
25 (4.5) 533 (95.5)
14 (4.7) 287 (95.3)
39 (4.54) 820 (95.45)
We contacted 585 livestock farmers in the survey and 558 consented to participate with a response rate of 95%. Overall, the participants included 558 livestock owners residing in 110 villages in Punjab, India in addition to 301 livestock owners representing more than 50% of the livestock owners across the state attending basic animal husbandry training at GADVASU, Ludhiana were enrolled in the study. The detailed demographic profile of the participants has been presented in Table 1.
Presence of pet animal (dog or cat)
Yes No
177 (31.7) 381 (68.3)
123 (40.9) 178 (59.1)
300 (34.92) 559 (65.07)
District
Gurdaspur Amritsar Pathankot Tarntaran Jalandhar Kapurthala Hoshiarpur Rupnagar SBS Nagar SAS Nagar Mansa Moga Ludhiana Fazilka Ferozepur Faridkot Barnala Sangrur Patiala Fatehgarh sahib Bathinda Muktsar
17 (3.0) 30 (5.4) 30 (5.4) 34 (6.1) 33 (5.9) 18 (3.2) 24 (4.3) 25 (4.5) 25 (4.5) 22 (3.9) 31 (5.6) 20 (3.6) 32 (5.7) 12 (2.2) 32 (5.7) 32 (5.7) 28 (5.0) 8 (1.4) 34 (6.1) 23 (4.1)
16 (5.3) 3 (1.0) 1 (0.3) 3 (1.0) 11 (3.7) 16 (5.3) 2 (0.7) 4 (1.3) 7 (2.3) 24 (8.0) 3 (1.0) 138 (45.8) 8 (2.7) 11 (3.7) 5 (1.7) 11 (3.7) 8 (2.7) 11 (3.7) 3 (1.0)
33 (3.84) 33 (3.84) 31 (3.60) 37 (4.30) 44 (5.12) 34 (3.95) 26 (3.02) 29 (3.37) 32 (3.72) 22 (2.56) 55 (6.40) 23 (2.67) 170 (19.79) 20 (2.32) 43 (5.00) 37 (4.30) 39 (4.54) 16 (1.86) 45 (5.23) 26 (3.02)
16 (2.9) 32 (5.7)
6 (2.0) 10 (3.3)
22 (2.56) 42 (4.88)
2.6. Association of demographic variables with knowledge score The unconditional association between each explanatory variable and knowledge score was determined using univariable linear regression analyses. The preliminary analysis was conducted using demographic data as explanatory variables and knowledge score as the outcome variable. The explanatory variables with univariable p-value of < 0.25 (based on the F test statistic) were considered for multivariable model building. Explanatory variables showing statistical significance (p-value < 0.25) in univariable analyses were tested in the final multiple linear regression model using a forward stepwise approach. Explanatory variables with a univariable p-value > 0.25 were also retested after including in the final model. Standardized and studentized residuals were used to test the overall fitness of the final model. The regression coefficients, the standard errors of the coefficients, and the statistical significance levels of the coefficients were estimated. The adjusted R2 was used to assess how well the model accounts for the outcome of the data. 2.7. Association of knowledge and attitude score with practice score In this analysis, knowledge and attitude scores were included as explanatory variables and the practice score was used as an outcome variable
3.2. Knowledge on zoonotic diseases Of the 859 livestock farmers, 685 (80%) had heard the term ‘zoonoses’. Of the farmers, 345 (40%) were aware of the zoonotic nature of tuberculosis, 391 (45%) about plague, 788 (92%) about rabies, 264 (31%) about japanese encephalitis and 214 (25%) about zoonotic nature of taeniosis. The detailed information related to knowledge, attitude and practices of farmers on zoonotic diseases are mentioned in Table 2. As far as knowledge related to animals responsible for transmission of zoonotic diseases were concerned (Table 3), most of the farmers accurately identified dog as an important source for transmission of rabies, however only 11% identified dog as responsible for transmitting hydatidosis. Interestingly, 53% of farmers believed 17
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Table 2 Frequency table for knowledge, attitude and practices of livestock owners relating to zoonotic diseases in Punjab, India. Enrolment Variable
Response
Survey (%)
Training (%)
Total (%)
Knowledge Do you know about the zoonotic diseases? (Total population)
Yes
401 (71.86)
284 (94.35)
685 (79.74)
No Yes
157 (28.13) 141 (25.27)
17 (5.64) 204 (67.77)
174 (20.25) 345 (40.16)
No Yes No Yes No Yes No Yes No Yes
417 (74.73) 240 (43.01) 318 (56.99) 515 (92.29) 43 (77.06) 142 (25.45) 416 (74.55) 252 (45.16) 306 (54.84) 90 (16.13)
97 (32.23) 151 (50.17) 150 (49.83) 273 (90.7) 28 (9.30) 122 (40.53) 179 (59.47) 198 (65.78) 103 (34.22) 124 (41.20)
514 (59.83) 391 (45.51) 468 (54.48) 788 (91.73) 71 (8.26) 264 (30.73) 595 (69.26) 450 (52.38) 409 (47.61) 214 (24.91)
No Yes
468 (83.87) 63 (11.29)
177 (58.80) 113 (37.54)
645 (75.08) 176 (20.48)
No Yes No Yes
495 (88.71) 138 (24.73) 420 (75.27) 38 (6.81)
188 (62.46) 127 (42.19) 174 (57.81) 92 (30.56)
683 265 594 130
No Yes
520 (93.19) 250 (44.80)
209 (69.44) 220 (73.09)
729 (84.86) 470 (54.71)
No
308 (55.20)
81 (26.91)
389 (45.28)
Yes No Yes
136 (24.37) 422 (75.63) 462 (82.79)
223 (74.09) 78 (25.91) 263 (87.37)
359 (41.79) 500 (58.20) 725 (84.40)
No
96 (17.20)
38 (12.62)
134 (15.59)
Yes No Yes No Yes No Yes No Yes No Yes No Yes No
142 (25.45) 416 (74.55) 539 (96.59) 19 (3.41) 263 (47.13) 295 (52.87) 270 (48.39) 288 (51.61) 428 (76.70) 130 (23.30) 48 (8.60) 510 (91.40) 41 (7.35) 517 (92.65)
59 (19.60) 242 (80.4) 281 (93.36) 20 (6.64) 91 (30.23) 210 (69.77) 125 (41.53) 176 (58.47) 195 (64.78) 106 (35.22) 39 (12.96) 262 (87.04) 31 (10.30) 270 (89.70)
201 (23.39) 658 (76.60) 820 (95.45) 39 (4.54) 354 (41.21) 505 (58.78) 395 (45.98) 464 (54.01) 623 (72.52) 236 (27.47) 87 (10.12) 772 (89.87) 72 (8.38) 787 (91.61)
Have you heard about the disease called T.B. which can spread to humans through aerosols, raw milk, raw/uncooked meal/polluted environment? Have you heard about the disease called Plague which can spread to humans by biting of flea? Have you heard about the disease called Rabies which can spread to humans and livestock by biting of a rabid dog? Have you heard about the disease called Japanese encephalitis which can spread to humans by biting of culex mosquito? Have you heard about the disease called Swine flu which can spread to humans by eating pork/chicken? Have you heard about the disease called Taeniosis which can spread to humans and cattles by eating raw/uncooked pork and fruits/vegetables infected with eggs of parasites in excreta of human? Have you heard about the disease called Hydatidosis which can spread to humans by having food infected with eggs of parasites in excreta of dogs? Have you heard about the disease called Ringworm which can spread to humans by direct contact with dogs and cats? Have you heard about the disease called Toxoplasmosis which can spread to humans and sheeps/goats through cat’s excreta? Do you think, abortion during six to eight months of pregnancy, in-fertilization of animal, less milk production, swelling of testis, in-ability of reproduction are the main signs of Brucellosis? Attitude Do you think animal died with disease should be dumped in land covered with lime? Do you think animal should have to be dewormed? If yes, after how much time Practices Do you drink raw milk? Do you wash your hands after having contact with animals? Do you prefer walking bare feet at home? Do you prefer walking bare feet at farm or garden? Have you ever done deworming of your animal? Have you ever tested your animals for Brucellosis? Have you ever tested your animals for T.B.?
(79.51) (30.84) (69.15) (15.13)
Table 3 Frequency distribution (Relative frequency %) of livestock farmer’s knowledge for transmission routes of common zoonotic diseases in Punjab, India. Name of the disease
Rabies Brucellosis AIDS TB Plague Swine Flu Taeniosis Hydatidosis Toxoplasmosis Ringworm Cancer
Reservoir host species Dog
Cat
Buffalo
Cow
Rat
Pig
Horse
Mosquito
None of these
828 (96.39) 65 (7.56) 34 (3.95) 79 (9.19) 42 (4.88) 29 (3.37) 36 (4.19) 97 (11.29) 53 (6.16) 307 (35.73) 50 (5.82)
138 (16.06) 51 (5.93) 20 (2.32) 63 (7.33) 26 (3.02) 20 (2.32) 34 (3.95) 47 (5.47) 143 (16.64) 263 (30.61) 52 (6.05)
159 (18.50) 458 (53.31) 31 (3.60) 279 (32.47) 22 (2.56) 32 (3.72) 83 (9.66) 53 (6.16) 54 (6.28) 112 (13.03) 142 (16.53)
147 (17.11) 139 (16.18) 30 (3.49) 271 (31.54) 29 (3.37) 30 (3.49) 87 (10.12) 49 (5.70) 56 (6.51) 92 (10.71) 146 (16.99)
36 (4.19) 28 (3.25) 29 (3.37) 40 (4.65) 481 (55.9) 26 (3.02) 21 (2.44) 13 (1.51) 16 (1.86) 25 (2.91) 16 (1.86)
33 (3.84) 57 (6.63) 28 (3.25) 63 (7.33) 42 (4.88) 475 (55.29) 145 (16.88) 29 (3.37) 24 (2.79) 35 (4.07) 29 (3.37)
41 36 11 27 10 21 25 18 11 26 21
31 18 76 47 24 85 17 18 12 17 14
11 (1.28) 294 (34.22) 695 (80.90) 472 (54.94) 308 (35.85) 297 (34.57) 596 (69.38) 635 (73.92) 622 (72.40) 447 (52.03) 637 (74.15)
18
(4.77) (4.19) (1.28) (3.14) (1.16) (2.44) (2.91) (2.09) (1.28) (3.02) (2.44)
(3.60) (2.09) (8.84) (5.47) (2.79) (9.89) (1.97) (2.09) (1.39) (1.97) (1.62)
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applied. More than 80% of the farmers believed that animals should be regularly dewormed (Table 2). As far as common practices were concerned, 23% admitted consumption of raw milk and 46% preferred prefer walking bare feet at the farm or garden. For disease testing, only 10% and 8% livestock owners tested their animals for brucellosis and tuberculosis, respectively (Table 2).
Table 4 Univariable linear regression analysis, demonstrating the influence of explanatory variables on the outcome variables. Variable
b
P-value
Adjusted R2
Dependent variable: Knowledge score Enrolment (Survey versus training) Age (years) Sex (male versus female) Number of family members in the household Number of animals Owns cattle (yes versus no) Rearing sheep or goat Having a pet or not Number of cattle Number of sheep and goat Number of pets
−0.357 −0.295 −0.158 −0.061 0.053 −0.148 0.018 0.218 0.051 −0.029 0.102
< 0.001 < 0.001 < 0.001 0.074 0.121 < 0.001 0.591 < 0.001 0.138 0.860 0.079
0.127 0.086 0.024 0.003 0.002 0.021 −0.001 0.046 0.001 0.00 0.007
District Referent: Mukatsar Gurdaspur Amritsar Pathankot Tarantaran Jalandhar Kapurthala Hoshiarpur Rupnagar SBS Nagar SAS Nagar Mansa Moga Ludhiana Fazilka Ferozepur Faridkot Barnala Sangrur Patiala Fatehgarh Sahib Bathinda
0.182 −0.115 −0.220 −0.121 −0.151 −0.067 −0.041 −0.017 0.037 −0.10 −0.049 −0.021 0.274 0.221 −0.062 0.072 −0.024 0.070 −0.061 0.005 0.005
< 0.001 0.001 < 0.001 < 0.001 < 0.001 0.051 0.232 0.617 0.284 0.003 0.150 0.538 < 0.001 < 0.001 0.070 0.036 0.476 0.041 0.073 0.893 0.874
0.032 0.012 0.047 0.014 0.022 0.003 0.001 0.00 0.00 0.009 0.001 0.00 0.074 0.048 0.003 0.004 0.00 0.004 0.003 0.00 0.00
Primary occupation Referent: any other occupation Crop farming Livestock farming
−0.015 0.118
0.657 0.001
0.001 0.013
Secondary occupation Referent: any other occupation Crop farming Livestock farming
0.061 0.121
0.072 < 0.001
0.003 0.014
Level of education Referent: Post-graduate Illiterate Matric 12th Graduate
−0.217 −0.251 0.243 0.158
< 0.001 < 0.001 < 0.001 < 0.001
0.046 0.062 0.058 0.024
Years since rearing Less than 5 years 5–10 years 11–15 years 16–20 years
0.160 0.122 0.066 0.067
< 0.001 < 0.001 0.054 0.051
0.025 0.014 0.003 0.003
Dependent variable: Practice score Knowledge score Attitude score
−0.024 0.112
0.476 0.001
0.001 0.011
3.4. Univariable analyses The results of univariable analysis are presented in Table 4. The farmers covered under survey had lower knowledge on zoonoses as compared to farmers who came to attend basic livestock training at the University (P= < 0.001). Increase in participant’s age (P= < 0.001), being a male (P= < 0.001) and rearing cattle (P= < 0.001) were negatively associated with the zoonotic disease knowledge. The participants with their primary occupation as ‘livestock farming’ had more knowledge on zoonotic diseases (P= < 0.001), whereas low levels of education were negatively associated with zoonoses knowledge. Keeping a pet (dog or cat) was found to be positively associated with the zoonosis knowledge. The attitude score was positively associated with the practice score of the participants. Low levels of disease awareness were observed in some of the districts (Tables 4 and 5) as compared to others indicating a need to direct education programs in such areas. 3.5. Multivariable analyses The results of multivariable analysis are presented in Table 5. The level of education, being a cattle farmer and whether the farmer came for a basic livestock training or was covered under survey were the significant parameters found associated with the zoonoses knowledge. In addition, being a resident of district Gurdaspur, SBS Nagar, Ludhiana, Fazilka, Faridkot and Bathinda was found to be positively associated with zoonotic disease knowledge among the participants (Table 5). 4. Discussion We assessed knowledge, attitude, practices and level of understanding of the livestock farmers relating to zoonotic diseases in Punjab state of India. Results of the study indicated that most of the farmers are not aware of the transmission, prevention and control of zoonosis such as toxoplasmosis, taeniosis/cysticercosis, hydatidosis and ringworm in Punjab state of India. Previous studies also indicate low to medium knowledge of farmers relating to zoonotic diseases in Punjab, India (Hundal et al., 2016). Similarly, Babu et al. (2015) found that Table 5 Multivariable linear regression analysis, demonstrating the influence of explanatory variables on the outcome variables. Variable Dependent variable: Knowledge score Covered under survey or came for training Owns cattle District Referent: Mukatsar Gurdaspur SBS Nagar Ludhiana Fazilka Faridkot Bathinda Level of education Referent: Post-graduate Illiterate Matric 12th
brucellosis to be transmitted by buffalo as compared to 16% who identified cow as responsible for transmitting brucellosis. For toxoplasmosis, 16% identified cat as a reservoir host. More than 25% of the farmers had a lack of knowledge and believed cancer to be transmitted by different livestock species. 3.3. Attitude and practices of participants on zoonotic diseases For practices, 359 (42%) farmers believed that an animal died due to disease should be buried and disinfectants such as lime should be 19
St. β
P-value
−0.211 −0.172
0.001 0.001
0.195 0.180 0.227 0.150 0.170 0.104
< 0.001 < 0.001 < 0.001 0.002 0.001 0.034
−0.224 −0.280 −0.170
< 0.001 < 0.001 0.08
Adjusted R2 0.333
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Competing interests
respondents had little knowledge of zoonoses except rabies in Andhra Pradesh, India. People primarily involved in livestock farming had better knowledge on zoonotic diseases as compared to others. This might be due to the fact that they are more likely to be in contact with veterinary personnel or other sources of information associated with livestock farming. Similarly, Swai et al. (2010) found higher knowledge on zoonotic diseases in smallholder dairy as compared to traditional livestock keepers in Tanzania. The zoonotic disease knowledge was negatively associated with increase in the age of participants. This might be due to improvement of education system in the Punjab state of India. Livestock farmers belonging to bigger households had poor knowledge as compared to others. This might be due to the fact that large households have limited resources resulting in lower level of education in such families. On the other hand, non-significant associations between age, level of education, herd size have also been reported (Hundal et al., 2016). The farmers coming for training scored better than those recruited in villages. This might be due to the fact that they were more progressive or aware than others. The attitude and practices of livestock farmers present several potential risks. For example, consumption of raw milk from infected animals is a potential risk for transmission of brucellosis and tuberculosis. Similarly, walking barefoot in the field or garden could serve as a potential risk for cutaneous larvae migrans. Non-disposal of infected carcasses could serve as an important source for diseases such as tuberculosis, brucellosis and many other zoonotic infections. Globally, research indicates that livestock farmers have a poor knowledge relating to zoonotic pathogens. Lindahl et al. (2015) found that 85% of the respondents in Tajikistan were not aware of brucellosis and respondents with low knowledge are at high risk of being infected. In Turkey, only 2% of livestock farmers had sufficient knowledge relating to zoonotic diseases (Cakmur et al., 2015). Although all the livestock keepers were aware of brucellosis in Jordan, most of them were not known to transmission routes of the disease (Musallam et al., 2015). Similarly, moderate overall knowledge of brucellosis among the participants from Uganda has been reported (Kansiime et al., 2014). In Zimbabwe, Chikerema et al. (2013) found awareness level of rabies, anthrax and brucellosis among farmers to be 9%, 72%, and 21%, respectively. For leptospirosis, significantly lower prevention practice scores have been reported among agricultural workers in Philippines (Arbiol et al., 2016). Cediel et al. (2012) found that immigrants from Asia had high frequency of risky behaviours and low knowledge relating to zoonotic diseases. The study has many limitations. Farmer’s KAPs related to many other zoonotic diseases such as leptospirosis could not be ascertained. The number of villages per district varies from 124 to 1532 in Punjab state of India (ESOP, 2011). This might have led to overrepresentation of the selected villages from smaller districts. The participants might have gained some knowledge about zoonotic diseases after reading the questionnaire and this could have biased their response. The present analysis found the level of education of the livestock farmers to be significantly associated with their zoonoses knowledge. Previous studies indicate that health education intervention significantly improved the knowledge and attitudes towards Taenia solium control among pig farmers in Tanzania (Ngowi et al., 2011). We recommend an on-going occupational health and food safety educational program for the farming community in Punjab state of India. Veterinarians, public health and agriculture development officers could substantially contribute to update farmer’s knowledge on important zoonotic diseases. Additionally, mass media communications such as radio and television talks, and newspaper articles on the prevention and control of zoonotic diseases could also improve livestock farmer’s knowledge and practices relating to zoonotic diseases. The persons with low levels of education and involved in livestock rearing should receive additional zoonotic disease education training programs.
None declared. Acknowledgements The authors wish to thank the Department of Science and Technology, Government of India for financially supporting this study under the research project “Community awareness project for prevention and control of zoonoses” in Punjab, India. The authors also wish to thank S. Manjit Singh, School of Public Health and Zoonoses for his valuable help in the conduct of this study. References D.A.H.D.F, 2017. Department of Animal Husbandry, Dairying and Fisheries Annual Report 2016–17. Pp. 1–162. Available at:. Published by Department of Animal Husbandry, Dairying and Fisheries, Government of India. http://dahd.nic.in/sites/ default/files/Annual%20Report%202016-17.pdf. ESOP, 2011. Punjab at a Glance, 2011. Pp. 1–96. Available at:. Published by Economic and Statistical Organisation, Government of Punjab. http://www.pbplanning.gov.in/ pdf/PunjabGlance2011CompleteVD%20Graphs.pdf. NSSO, 2013. Livestock Ownership in India (70th Round). Pp. 1–293. Available at:. Published by National Sample Survey Office, Ministry of statistics and program implementation, Government of India. http://mospi.nic.in/Mospi_New/upload/nss_ rep_572.pdf. Agasthya, A.S., Isloor, S., Prabhudas, K., 2007. Brucellosis in high risk group individuals. Indian J. Med. Microbiol. 25 (1), 28–31 PubMed: 17377349. Ali, J., 2007. Livestock sector development and implications for rural poverty alleviation in India. Livest. Res. Rural Dev. 19 (2), 1–15. Arbiol, J., Orencio, P.M., Romena, N., Nomura, H., Takahashi, Y., Yabe, M., 2016. Knowledge, attitude and practices towards leptospirosis among lakeshore communities of Calamba and Los Baños, Laguna, Philippines. Agriculture 6, 18. Babu, A.J., Ramya, P., Rao, L.V., Swetha, C.S., Sudhanthiramani, , Rao, K.V., 2015. A study on the awareness and knowledge of zoonotic diseases among the public in and around Proddatur-YSR Kadapa district, Andhra Pradesh, India. Int. J. Recent Sci. Res. 6 (7), 5131–5138. BAHS, 2014. Basic Animal Husbandry Statistics. Department of Animal Husbandry, Dairying & Fisheries, Ministry of Agriculture, Government of India. Battelli, G., 2008. Zoonoses as occupational diseases. Vet. Ital. 44 (4), 601–609. Brookes, V.J., Gill, G.S., Singh, C.K., Sandhu, B.S., Dhand, N.K., Singh, B.B., Gill, J.P.S., Ward, M.P., 2018. Exploring animal rabies endemicity to inform control programmes in Punjab, India. Zoonoses Public Health 65 (1), e54–e65. https://doi.org/10.1111/ zph.12409. Cakmur, H., Akoglu, L., Kahraman, E., Atasever, M., 2015. Evaluation of farmer’s knowledge, attitude and practices about zoonotic diseases in Kars. Turkey. Kafkas. J. Med. Sci. 5 (3), 87–93. Cediel, N., Conte, V., Tomassone, L., Tiberti, D., Guiso, P., Romero, J., Villamil, L.C., De Meneghi, D., 2012. Risk perception about zoonoses in immigrants and Italian workers in Northwestern Italy. Rev. Saúde Pública 46 (5), 850–857. Census of India., 2011.Available at: http://censusindia.gov.in/2011-prov-results/ indiaatglance.html. Chikerema, S.M., Matope, G., Pfukenyi, D.M., 2013. Awareness and attitude toward zoonoses with particular reference to anthrax among cattle owners in selected rural communities of Zimbabwe. Vect. Borne Zoonot. Dis. 13 (4), 243–249. https://doi. org/10.1089/vbz.2011.0916. Dhand, N.K., Khatkar, M.S., 2014. Stimulator: an online statistical calculator. Sample Size Calculator for Estimating a Single Proportion. Accessed 1 December 2017 at. http:// statulator.com/SampleSize/ss1P.html. Dhand, N.K., Gumber, S., Singh, B.B., Aradhana, Bal, M.S., Kumar, H., Sharma, D.R., Singh, J., Sandhu, K.S., 2005. A study on the epidemiology of brucellosis in Punjab (India) using survey toolbox. Rev. Sci. Tech. OIE 24 (3), 879–885. FAO, 2002. Socio-economic consequences for poor livestock farmers of animal diseases and VPH problems (chapter 1). Improved Animal Health for Poverty Reduction and Sustainable Livelihoods. FAO Animal Production and Health Paper 153, 2002. Published by FAO, Rome 2002. Gall, F.L., Leboucq, N., 2003. The role of animal disease control in poverty reduction, food safety, market access and food security in Africa. Compendium of Technical Items Presented to the International Committee or to Regional Commissions. Published by OIE, Paris 2003, Pp 87–106. Available at: http://www.oie.int/doc/ ged/D2959.PDF. Halliday, J.E.B., Allan, K.J., Ekwem, D., Cleaveland, S., Kazwala, R.R., Crump, J.A., 2015. Endemic zoonoses in the tropics: a public health problem hiding in plain sight. Vet. Record 176, 220–225. https://doi.org/10.1136/vr.h798. Hundal, J.S., Sodhi, S.S., Gupta, A., Singh, J., Chahal, U.S., 2016. Awareness, knowledge, and risks of zoonotic diseases among livestock farmers in Punjab. Vet. World 9 (2), 186–191. Kansiime, C., Mugisha, A., Makumbi, F., Mugisha, S., Rwego, I.B., Sempa, J., Kiwanuka, S.N., Asiimwe, B.B., Rutebemberwa, E., 2014. Knowledge and perceptions of brucellosis in the pastoral communities adjacent to Lake Mburo National Park, Uganda. BMC Public Health 14 (242). https://doi.org/10.1186/1471-2458-14-242.
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https://doi.org/10.4172/jaa.1000028. Seleem, M.N., Boyle, S.M., Sriranganathan, N., 2010. Brucellosis: a re-emerging zoonosis. Vet. Microbiol. 140 (3–4), 392–398. Singh, B.B., Sharma, R., Sharma, J.K., Juyal, P.D., 2010. Parasitic zoonoses in India: an overview. Rev. Sci. Tech. OIE 29 (3), 629–637. Singh, B.B., Dhand, N.K., Ghatak, S., Gill, J.P.S., 2014. Economic losses due to cystic echinococcosis in India: need for urgent action to control the disease. Prev. Vet. Med. 113 (1), 1–12. Singh, B.B., Dhand, N.K., Gill, J.P.S., 2015. Economic losses occurring due to brucellosis in Indian livestock populations. Prev. Vet. Med. 119, 211–215. Singh, B.B., Khatkar, M.S., Gill, J.P.S., Dhand, N.K., 2017. Estimation of the health and economic burden of neurocysticercosis in India. Acta Trop. 165, 161–169. https:// doi.org/10.1016/j.actatropica.2016.01.017. Swai, E.S., Schoonman, L., Daborn, C.J., 2010. Knowledge and attitude towards zoonoses among animal Health workers and livestock keepers in Arusha and Tanga, Tanzania. Tanzan. J. Health Res. 12 (4), 282–288. Tabibi, R., Baccalini, R., Barassi, A., Bonizzi, L., Brambilla, G., Consonni, D., Melzi d’Eril, G., Romanò, L., Sokooti, M., Somaruga, C., Vellere, F., Zanetti, A., Colosio, C., 2013. Occupational exposure to zoonotic agents among agricultural workers in Lombardy Region, northern Italy. Ann. Agric. Environ. Med. 20 (4), 676–681. Thomas, D.R., Salmon, R.L., Coleman, T.J., Morgan-Capner, P., Sillis, M., Caul, E.O., Morgan, K.L., Paiba, G.A., Bennett, M., Ribeiro, D., Lloyd, G., Kench, S.M., Meadows, D., Softley, P., Chalmers, R.M., 1999. Occupational exposure to animals and risk of zoonotic illness in a cohort of farmers, farmworkers, and their families in England. J. Agric. Saf. Health 5 (4), 373–382. https://doi.org/10.13031/2013.5695. Tiwari, S., Singh, R.K., Tiwari, R., Dhole, T.N., 2012. Japanese encephalitis: a review of the Indian perspective. Braz. J. Infect. Dis. 16 (6), 564–573. WHO, 2013. Global Tuberculosis Report 2013. World Health Organization, Geneva 2013.
Khan, S.M., Debnath, C., Pramanik, A.K., Xiao, L., Nozaki, T., Ganguly, S., 2011. Molecular evidence for zoonotic transmission of Giardia duodenalis among dairy farm workers in West Bengal, India. Vet. Parasitol. 178 (3–4), 342–345. Klous, G., Huss, A., Heederik, D.J.J., Coutinho, R.A., 2016. Human–livestock contacts and their relationship to transmission of zoonotic pathogens, a systematic review of literature. One Health 2, 65–66. Knobel, D.L., Cleaveland, S., Coleman, P.G., Fèvre, E.M., Meltzer, M.I., Miranda, M.E., Shaw, A., Zinsstag, J., Meslin, F.X., 2005. Re-evaluating the burden of rabies in Africa and Asia. Bull. World Health Organ. 835, 360–368. Lejune, J., Kersting, A., 2010. Zoonoses: an occupational hazard for livestock workers and a public health concern for rural communities. J. Agric. Saf. Health 16 (3), 161–179. Lindahl, E., Sattorov, N., Boqvist, S., Magnusson, U., 2015. A study of knowledge, attitudes and practices relating to brucellosis among small-scale dairy farmers in an urban and peri-urban area of Tajikistan. PLoS One 10 (2), e0117318. https://doi.org/ 10.1371/journal.pone.0117318. Mantur, B.G., Amarnath, S.K., 2008. Brucellosis in India – a review. J. Biosci. 33 (4), 539–547. Musallam, I.I., Abo-Shehada, M.N., Guitian, J., 2015. Knowledge, attitudes, and practices associated with brucellosis in livestock owners in Jordan. Am. J. Trop. Med. Hyg. 93 (6), 1148–1155. Ngowi, H.A., Mkupasi, E.M., Lekule, F.P., Willingham III, A.L., Thamsborg, S.M., 2011. Impact of farmer education on their knowledge, attitudes, and practices in southern Tanzania: a case for Taenia solium control. Livest. Res. Rural Dev. 23 #2. Retrieved January 22, 2017, from. http://www.lrrd.org/lrrd23/1/ngow23002.htm. Perry, B., Grace, D., 2009. The impacts of livestock diseases and their control on growth and development processes that are pro-poor. Philos. Trans. R. Soc. Lond. B Biol. Sci. 364 (1530), 2643–2655. Prakash, N., Devangi, P., Madhuuri, K., Khushbu, P., Deepali, P., 2011. Phylogenetic analysis of H1N1 swine flu virus isolated in India. J. Antivir. Antiretrovir. 3, 11–13.
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Knowledge, attitude and practices relating to zoonotic diseases among livestock farmers in Punjab, India
T
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B.B. Singha, , R. Kaura, G.S. Gilla, J.P.S. Gilla, R.K. Sonib, R.S. Aulakha a b
School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, Punjab, India Dayanand Medical College & Hospital, Ludhiana 141004, Punjab, India
A R T I C LE I N FO
A B S T R A C T
Keywords: Awareness India KAP Knowledge Livestock farmer Practice Punjab Zoonoses
Zoonotic diseases cause significant health and economic impact in developing countries such as India. Many zoonotic diseases are prevalent in the livestock and as an occupational zoonosis in the livestock farmers in India. Lack of knowledge on the disease transmission, prevention and control measures is a potential high risk for the occurrence of zoonotic diseases in the livestock and its keepers in India. We conducted this study to understand knowledge, attitude and practices of livestock farmers regarding zoonoses. Five villages from each of the 22 districts of the state were conveniently selected (n = 110). Farmers available at village community sites were enrolled in the study and requested to complete a custom designed questionnaire (n = 558). In addition, livestock farmers attending basic livestock husbandry training were also surveyed (n = 301). Data from questionnaires was used to create three index variables: (a) knowledge score; (b) attitude score and (c) practice score. Association between demographic and other explanatory variables with knowledge score was evaluated using linear regression analyses. Similarly, the association between knowledge and attitude score with practice score was evaluated. Of the 859 participants, 685 (80%) livestock farmers had heard the term ‘zoonoses’ but only 345 (40%), 264 (31%) and 214 (25%) farmers were aware of the zoonotic nature of tuberculosis, Japanese encephalitis and taeniosis, respectively. For practices, 23% farmers reported consumption of raw milk and only 10% and 8% livestock farmers ever got their animals tested for brucellosis and tuberculosis, respectively. The low level of education and being a cattle farmer were negatively associated with the farmer’s knowledge on zoonotic diseases. The attitude score was positively associated with the practice score of the participants. The results indicate need for educating the livestock farmers particularly those with a low level of education to reduce the health and economic impact of zoonotic diseases in India.
1. Introduction Livestock is one of the most important assets of the poor to meet livelihood needs (Perry and Grace, 2009). Animal diseases including zoonoses are crucial constraints in enhancement of livestock-production systems (FAO, 2002). Transboundary, zoonotic and foodborne diseases negatively impact poor populations and national economies (Gall and Leboucq, 2003). Huge losses have been reported in livestock sector due to diseases such as brucellosis and cystic echinococcosis in India (Singh et al., 2014, 2015). Zoonotic diseases cause significant health and economic burden in developing countries (Halliday et al., 2015). Many zoonotic pathogens are a serious animal and public health concern in India. For example, about 20,000 deaths due to rabies (Knobel et al., 2005) and 2.2 million new cases of tuberculosis (WHO, 2013) occur every year in the human
⁎
populations in India and human neurocysticercosis-associated active epilepsy causes 2.10 million disability adjusted life years in India (Singh et al., 2017). Many zoonotic diseases are also considered as significant occupational health hazards (Battelli, 2008). Livestock owners have different type and intensity of human–livestock contacts which may result in transmission of microorganisms and associated zoonoses (Klous et al., 2016). Livestock farmers are exposed to a number of zoonotic pathogens such as Coxiella burnetti and Toxoplasma gondii (Thomas et al., 1999). In the US, zoonoses are an important occupational hazard and a health concern for livestock workers (Lejune and Kersting, 2010). In Italy, occupational exposure to zoonotic agents such as Coxiella burnetti and Leptospira species among agricultural workers have been reported (Tabibi et al., 2013). There are number of zoonotic diseases prevalent as occupational
Corresponding author. E-mail address: [email protected] (B.B. Singh).
https://doi.org/10.1016/j.actatropica.2018.09.021 Received 1 December 2017; Received in revised form 7 July 2018; Accepted 23 September 2018 Available online 27 September 2018 0001-706X/ © 2018 Elsevier B.V. All rights reserved.
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the training programs. The villages were conveniently selected, for example, those closer to the main roads. The unit of study was an individual livestock farmer.
zoonosis in livestock farmers in India. The brucellosis sero-prevalence between 0.9%–18.1% with a high risk in veterinarians and farm attenders has been reported from India (Seleem et al., 2010; Agasthya et al., 2007; Mantur and Amarnath, 2008). The zoonotic Giardia duodenalis Assemblage A1 has been detected in both calves and dairy workers in West Bengal, India (Khan et al., 2011). Punjab is an agrarian state of Northern India (Latitude of 30°4′N and Longitude 75° 5′ E) with a human population of 27,704,236 and 63% of its population reside in rural areas (Census of India., 2011). The state has the highest per capita milk availability (932 gm/person/day) in the country with a cattle and buffalo population of 2.42 and 5.16 million, respectively (BAHS, 2014). There are 128 534 sheep, 327 272 goat and 32 221 pigs in Punjab (BAHS, 2014). The state is home to 737 352 backyard poultry consisting of fowls and chicken below 5 months of age (BAHS, 2014). There are 4 610 921 households/household enterprises owning animals/poultry birds in Punjab state of India (BAHS, 2014). There are 718 cattle, 1543 buffaloes, 39 sheep, 97 goat and 7 pigs per thousand households in the rural areas of Punjab (BAHS, 2014). The official estimates indicate the presence of 100 991 stray cattle in the state (BAHS, 2014). Over 70% of the households own livestock in the rural areas (Ali, 2007). The animal husbandry and crop agriculture are intrinsically linked and important for overall food security in the state (DAHDF, 2017). Mixed farming is commonly practiced in Punjab, India. Based on their occupation, there are three categories of people keeping livestock in the state a) crop farmers keeping livestock b) livestock farmers growing crops or involved in other secondary activities c) People primarily involved in non-agriculture activities but raise livestock at home. Many zoonotic diseases such as brucellosis, tuberculosis, rabies, taeniosis, ringworm and toxoplasmosis are endemic in Punjab state of India (Dhand et al., 2005; Brookes et al., 2018; Singh et al., 2010). In addition, human cases of swine flu and japanese encephalitis have been reported from other states of India (Prakash et al., 2011; Tiwari et al., 2012). Knowledge on zoonotic disease transmission, prevention and control measures is a must for livestock farmers. It will help prevent and control zoonotic diseases as an occupational hazard and reduce the incidence of zoonotic diseases in human as well as livestock populations. Therefore, the current study was planned to assess knowledge, attitude and practices (KAP) relating to zoonotic diseases among livestock farmers for policy development and to help formulate and improve existing zoonotic disease educational programs.
2.2. Sampling procedure As per the Census of India. (2011) there are 12,581 villages (assumed equivalent to animal herds) in Punjab state of India. We selected 110 villages representing approximately 1% of the total villages. Assuming that 50% of the farmers would have knowledge about zoonotic diseases, a sample size of 534 was required to estimate the knowledge proportion with 5% precision and 95% confidence assuming a response rate of 70% and a population of 13 114 farmers in the 110 villages selected (Dhand and Khatkar, 2014). As per the National sample survey office data, the total operational holdings for all the livestock classes in Punjab have been reported to be 1 499 900 (NSSO, 2013). By assuming that livestock operational holdings will be uniformly distributed across whole of the state, we estimated that there will be 13 114 livestock operational holdings in the 110 villages selected in the study. The research team visited the selected villages and requested livestock farmers at community sites to participate in the study. In addition, livestock owners attending livestock husbandry trainings GADVASU were requested to participate in the study. The participant information statement explaining the purpose of study was provided to all the participants and a written consent was obtained from the participants indicating their willingness to participate in this study. After this, the participants were asked to complete a questionnaire to assess their KAP relating to zoonotic diseases. The participants were offered the questionnaire either in English or in the local language (Punjabi). After completion of the questionnaire, participants were provided with information brochures explaining prevention and control measures of important zoonotic diseases. 2.3. Questionnaire design and data collection The questionnaire was developed to collect detailed demographic information and related to KAP of livestock farmers about zoonotic diseases. The demographic information collected included age, gender, family size, and the educational qualifications. The livestock farm associated details included years in livestock farming, number and species of the animal present at the farm. For knowledge assessment of the livestock farmers, the basic questions were asked about endemic or historically important zoonotic diseases such as brucellosis, rabies, tuberculosis, plague, swine flu, taeniosis, hydatidosis, toxoplasmosis and ringworm. Initially, the farmers were asked if they have heard about these diseases and were later told to identify animal hosts associated with the transmission of these zoonotic pathogens. The answer was only considered ‘correct’ if the farmer was able to correctly identify at least one of the animal hosts; however additional selection of an animal host not related to the disease was considered as an incorrect reply. Information related to practices included animal deworming practices, habit of consuming raw milk, washing hands after contact with animals, the habit of walking bare feet at home or at the farm and testing of the herds for brucellosis or tuberculosis. The attitude related information for disposal of carcasses and deworming practices were also collected.
2. Methods The necessary ethical permission for the conduct of this study was obtained from the Institutional Ethics Committee, Dayanand Medical College & Hospital, Ludhiana, Punjab (Ethics approval number: DMCH/ R&D/2016/372). The study was conducted as a cross-sectional study between 2015 and 2016. 2.1. Target and study population The target population comprised of livestock (cattle/buffalo/sheep/ goat/pig) farmers residing in the rural areas of Punjab. The study population was the farmers belonging to 110 villages of Punjab representing all the 22 districts (5 villages from each district) of Punjab as well as those attending livestock trainings at Guru Angad Dev Veterinary & Animal Sciences University (GADVASU). The basic trainings are being conducted by the Department of Veterinary and Animal Husbandry Extension Education, GADVASU. The trainings are organised across the year and usually 30–50 participants are enrolled in batches. These trainings are advertised on the University website and farmers are nominally charged for such trainings. As these trainings are organised on-campus, more farmers from the nearby districts enrol in
2.4. Data handling and statistical analysis The analyses were conducted using IBM SPSS Statistics for Windows, Version 22.0 statistical software (released 2013. © 2013, Armonk, NY: IBM Corp). 2.5. Explanatory and outcome variables We used demographic characteristics and whether the livestock owner came for basic husbandry training as explanatory variables. A 16
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knowledge score index (range 0–22) was prepared by summing up participant’s knowledge of the term zoonoses, routes of transmission of the above mentioned zoonotic diseases. The practice score (range 0–7) was prepared by summing up participant’s animal deworming practices, habit of consuming raw milk, washing hands after contact with animals, the habit of walking bare feet at home or at the farm and testing of the herds for brucellosis or tuberculosis. The attitude score (range 0–2) consisted of the attitude towards disposal of carcasses and for the deworming practices. Each correct answer was awarded a score of 1.0 and no score was awarded for an incorrect reply. Data were entered into Excel sheet and descriptive analyses were carried out. Frequency variables of important explanatory and outcome variables were prepared.
Table 1 Frequency table for demographic variables in a KAP study relating to zoonotic diseases among livestock owners in India. Variable
Enrolment Category
Survey (%)
Training (%)
Total (%)
Age (Years)
11–20 21–30 31–40 41–50 51–60 60+
50 (8.96) 84 (15.11) 109 (19.53) 132 (23.66) 107 (19.17) 76 (13.62)
55 (18.3) 127 (42.19) 62 (20.6) 36 (11.96) 15 (4.98) 6 (2.0)
105 (12.22) 211 (24.56) 171 (19.90) 168 (19.55) 122 (14.20) 82 (9.54)
Gender
Male Female
507 (90.9) 51 (9.1)
255 (84.7) 46 (15.3)
762 (88.70) 97 (11.29)
Level of Education
Illiterate 10th 12th Graduate Postgraduate
78 (14.0) 271 (48.6) 156 (28.0) 42 (7.5) 11 (2.0)
7 (2.3) 49 (16.3) 161 (53.5) 65 (21.6) 19 (6.3)
85 (9.89) 320 (37.25) 317 (36.90) 107 (12.45) 30 (3.49)
Primary occupation
Crop farming Dairy farming Any other
438 (78.5) 20 (3.6)
218 (72.4) 33 (11.0)
656 (76.36) 53 (6.16)
100 (17.92)
50 (16.6)
150 (17.46)
Secondary occupation
Crop farming Dairy farming Any other/ None
14 (2.5) 24 (4.3)
11 (3.7) 27 (9.0)
25 (2.91) 51 (5.93)
520 (93.19)
263 (87.3)
26 (3.02)
Number of members in the household
1–5 6–10 11–15 16–20
306 (54.84) 230 (41.22) 20 (3.58) 2 (0.03)
155 (51.5) 141 (46.84) 5 (1.66) 0 (0.0)
461 (53.66) 371 (43.18) 25 (2.91) 2 (0.23)
Years since farming
0–5 5–10 10–15 15–20 20+
42 (7.5) 38 (6.8) 29 (5.2) 51 (9.1) 398 (71.3)
64 56 47 41 93
(21.3) (18.6) (15.6) (13.6) (30.9)
106 (12.33) 94 (10.94) 76 (8.84) 92 (10.71) 491 (57.15)
Number of animals in the household
0–5 6–10 11–15 16–20 20+
362 (64.87) 130 (23.3) 38 (6.81) 9 (1.61) 19 (3.40)
156 (51.83) 76 (25.25) 33 (10.96) 18 (5.98) 18 (5.98)
518 (60.30) 206 (23.98) 71 (8.26) 27 (3.14) 37 (4.30)
3. Results
Owns cattle
Yes No
555 (99.5) 3 (0.5)
288 (95.7) 13 (4.3)
843 (98.13) 16 (1.86)
3.1. Distribution of participants
Presence of sheep or goat
Yes No
25 (4.5) 533 (95.5)
14 (4.7) 287 (95.3)
39 (4.54) 820 (95.45)
We contacted 585 livestock farmers in the survey and 558 consented to participate with a response rate of 95%. Overall, the participants included 558 livestock owners residing in 110 villages in Punjab, India in addition to 301 livestock owners representing more than 50% of the livestock owners across the state attending basic animal husbandry training at GADVASU, Ludhiana were enrolled in the study. The detailed demographic profile of the participants has been presented in Table 1.
Presence of pet animal (dog or cat)
Yes No
177 (31.7) 381 (68.3)
123 (40.9) 178 (59.1)
300 (34.92) 559 (65.07)
District
Gurdaspur Amritsar Pathankot Tarntaran Jalandhar Kapurthala Hoshiarpur Rupnagar SBS Nagar SAS Nagar Mansa Moga Ludhiana Fazilka Ferozepur Faridkot Barnala Sangrur Patiala Fatehgarh sahib Bathinda Muktsar
17 (3.0) 30 (5.4) 30 (5.4) 34 (6.1) 33 (5.9) 18 (3.2) 24 (4.3) 25 (4.5) 25 (4.5) 22 (3.9) 31 (5.6) 20 (3.6) 32 (5.7) 12 (2.2) 32 (5.7) 32 (5.7) 28 (5.0) 8 (1.4) 34 (6.1) 23 (4.1)
16 (5.3) 3 (1.0) 1 (0.3) 3 (1.0) 11 (3.7) 16 (5.3) 2 (0.7) 4 (1.3) 7 (2.3) 24 (8.0) 3 (1.0) 138 (45.8) 8 (2.7) 11 (3.7) 5 (1.7) 11 (3.7) 8 (2.7) 11 (3.7) 3 (1.0)
33 (3.84) 33 (3.84) 31 (3.60) 37 (4.30) 44 (5.12) 34 (3.95) 26 (3.02) 29 (3.37) 32 (3.72) 22 (2.56) 55 (6.40) 23 (2.67) 170 (19.79) 20 (2.32) 43 (5.00) 37 (4.30) 39 (4.54) 16 (1.86) 45 (5.23) 26 (3.02)
16 (2.9) 32 (5.7)
6 (2.0) 10 (3.3)
22 (2.56) 42 (4.88)
2.6. Association of demographic variables with knowledge score The unconditional association between each explanatory variable and knowledge score was determined using univariable linear regression analyses. The preliminary analysis was conducted using demographic data as explanatory variables and knowledge score as the outcome variable. The explanatory variables with univariable p-value of < 0.25 (based on the F test statistic) were considered for multivariable model building. Explanatory variables showing statistical significance (p-value < 0.25) in univariable analyses were tested in the final multiple linear regression model using a forward stepwise approach. Explanatory variables with a univariable p-value > 0.25 were also retested after including in the final model. Standardized and studentized residuals were used to test the overall fitness of the final model. The regression coefficients, the standard errors of the coefficients, and the statistical significance levels of the coefficients were estimated. The adjusted R2 was used to assess how well the model accounts for the outcome of the data. 2.7. Association of knowledge and attitude score with practice score In this analysis, knowledge and attitude scores were included as explanatory variables and the practice score was used as an outcome variable
3.2. Knowledge on zoonotic diseases Of the 859 livestock farmers, 685 (80%) had heard the term ‘zoonoses’. Of the farmers, 345 (40%) were aware of the zoonotic nature of tuberculosis, 391 (45%) about plague, 788 (92%) about rabies, 264 (31%) about japanese encephalitis and 214 (25%) about zoonotic nature of taeniosis. The detailed information related to knowledge, attitude and practices of farmers on zoonotic diseases are mentioned in Table 2. As far as knowledge related to animals responsible for transmission of zoonotic diseases were concerned (Table 3), most of the farmers accurately identified dog as an important source for transmission of rabies, however only 11% identified dog as responsible for transmitting hydatidosis. Interestingly, 53% of farmers believed 17
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Table 2 Frequency table for knowledge, attitude and practices of livestock owners relating to zoonotic diseases in Punjab, India. Enrolment Variable
Response
Survey (%)
Training (%)
Total (%)
Knowledge Do you know about the zoonotic diseases? (Total population)
Yes
401 (71.86)
284 (94.35)
685 (79.74)
No Yes
157 (28.13) 141 (25.27)
17 (5.64) 204 (67.77)
174 (20.25) 345 (40.16)
No Yes No Yes No Yes No Yes No Yes
417 (74.73) 240 (43.01) 318 (56.99) 515 (92.29) 43 (77.06) 142 (25.45) 416 (74.55) 252 (45.16) 306 (54.84) 90 (16.13)
97 (32.23) 151 (50.17) 150 (49.83) 273 (90.7) 28 (9.30) 122 (40.53) 179 (59.47) 198 (65.78) 103 (34.22) 124 (41.20)
514 (59.83) 391 (45.51) 468 (54.48) 788 (91.73) 71 (8.26) 264 (30.73) 595 (69.26) 450 (52.38) 409 (47.61) 214 (24.91)
No Yes
468 (83.87) 63 (11.29)
177 (58.80) 113 (37.54)
645 (75.08) 176 (20.48)
No Yes No Yes
495 (88.71) 138 (24.73) 420 (75.27) 38 (6.81)
188 (62.46) 127 (42.19) 174 (57.81) 92 (30.56)
683 265 594 130
No Yes
520 (93.19) 250 (44.80)
209 (69.44) 220 (73.09)
729 (84.86) 470 (54.71)
No
308 (55.20)
81 (26.91)
389 (45.28)
Yes No Yes
136 (24.37) 422 (75.63) 462 (82.79)
223 (74.09) 78 (25.91) 263 (87.37)
359 (41.79) 500 (58.20) 725 (84.40)
No
96 (17.20)
38 (12.62)
134 (15.59)
Yes No Yes No Yes No Yes No Yes No Yes No Yes No
142 (25.45) 416 (74.55) 539 (96.59) 19 (3.41) 263 (47.13) 295 (52.87) 270 (48.39) 288 (51.61) 428 (76.70) 130 (23.30) 48 (8.60) 510 (91.40) 41 (7.35) 517 (92.65)
59 (19.60) 242 (80.4) 281 (93.36) 20 (6.64) 91 (30.23) 210 (69.77) 125 (41.53) 176 (58.47) 195 (64.78) 106 (35.22) 39 (12.96) 262 (87.04) 31 (10.30) 270 (89.70)
201 (23.39) 658 (76.60) 820 (95.45) 39 (4.54) 354 (41.21) 505 (58.78) 395 (45.98) 464 (54.01) 623 (72.52) 236 (27.47) 87 (10.12) 772 (89.87) 72 (8.38) 787 (91.61)
Have you heard about the disease called T.B. which can spread to humans through aerosols, raw milk, raw/uncooked meal/polluted environment? Have you heard about the disease called Plague which can spread to humans by biting of flea? Have you heard about the disease called Rabies which can spread to humans and livestock by biting of a rabid dog? Have you heard about the disease called Japanese encephalitis which can spread to humans by biting of culex mosquito? Have you heard about the disease called Swine flu which can spread to humans by eating pork/chicken? Have you heard about the disease called Taeniosis which can spread to humans and cattles by eating raw/uncooked pork and fruits/vegetables infected with eggs of parasites in excreta of human? Have you heard about the disease called Hydatidosis which can spread to humans by having food infected with eggs of parasites in excreta of dogs? Have you heard about the disease called Ringworm which can spread to humans by direct contact with dogs and cats? Have you heard about the disease called Toxoplasmosis which can spread to humans and sheeps/goats through cat’s excreta? Do you think, abortion during six to eight months of pregnancy, in-fertilization of animal, less milk production, swelling of testis, in-ability of reproduction are the main signs of Brucellosis? Attitude Do you think animal died with disease should be dumped in land covered with lime? Do you think animal should have to be dewormed? If yes, after how much time Practices Do you drink raw milk? Do you wash your hands after having contact with animals? Do you prefer walking bare feet at home? Do you prefer walking bare feet at farm or garden? Have you ever done deworming of your animal? Have you ever tested your animals for Brucellosis? Have you ever tested your animals for T.B.?
(79.51) (30.84) (69.15) (15.13)
Table 3 Frequency distribution (Relative frequency %) of livestock farmer’s knowledge for transmission routes of common zoonotic diseases in Punjab, India. Name of the disease
Rabies Brucellosis AIDS TB Plague Swine Flu Taeniosis Hydatidosis Toxoplasmosis Ringworm Cancer
Reservoir host species Dog
Cat
Buffalo
Cow
Rat
Pig
Horse
Mosquito
None of these
828 (96.39) 65 (7.56) 34 (3.95) 79 (9.19) 42 (4.88) 29 (3.37) 36 (4.19) 97 (11.29) 53 (6.16) 307 (35.73) 50 (5.82)
138 (16.06) 51 (5.93) 20 (2.32) 63 (7.33) 26 (3.02) 20 (2.32) 34 (3.95) 47 (5.47) 143 (16.64) 263 (30.61) 52 (6.05)
159 (18.50) 458 (53.31) 31 (3.60) 279 (32.47) 22 (2.56) 32 (3.72) 83 (9.66) 53 (6.16) 54 (6.28) 112 (13.03) 142 (16.53)
147 (17.11) 139 (16.18) 30 (3.49) 271 (31.54) 29 (3.37) 30 (3.49) 87 (10.12) 49 (5.70) 56 (6.51) 92 (10.71) 146 (16.99)
36 (4.19) 28 (3.25) 29 (3.37) 40 (4.65) 481 (55.9) 26 (3.02) 21 (2.44) 13 (1.51) 16 (1.86) 25 (2.91) 16 (1.86)
33 (3.84) 57 (6.63) 28 (3.25) 63 (7.33) 42 (4.88) 475 (55.29) 145 (16.88) 29 (3.37) 24 (2.79) 35 (4.07) 29 (3.37)
41 36 11 27 10 21 25 18 11 26 21
31 18 76 47 24 85 17 18 12 17 14
11 (1.28) 294 (34.22) 695 (80.90) 472 (54.94) 308 (35.85) 297 (34.57) 596 (69.38) 635 (73.92) 622 (72.40) 447 (52.03) 637 (74.15)
18
(4.77) (4.19) (1.28) (3.14) (1.16) (2.44) (2.91) (2.09) (1.28) (3.02) (2.44)
(3.60) (2.09) (8.84) (5.47) (2.79) (9.89) (1.97) (2.09) (1.39) (1.97) (1.62)
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applied. More than 80% of the farmers believed that animals should be regularly dewormed (Table 2). As far as common practices were concerned, 23% admitted consumption of raw milk and 46% preferred prefer walking bare feet at the farm or garden. For disease testing, only 10% and 8% livestock owners tested their animals for brucellosis and tuberculosis, respectively (Table 2).
Table 4 Univariable linear regression analysis, demonstrating the influence of explanatory variables on the outcome variables. Variable
b
P-value
Adjusted R2
Dependent variable: Knowledge score Enrolment (Survey versus training) Age (years) Sex (male versus female) Number of family members in the household Number of animals Owns cattle (yes versus no) Rearing sheep or goat Having a pet or not Number of cattle Number of sheep and goat Number of pets
−0.357 −0.295 −0.158 −0.061 0.053 −0.148 0.018 0.218 0.051 −0.029 0.102
< 0.001 < 0.001 < 0.001 0.074 0.121 < 0.001 0.591 < 0.001 0.138 0.860 0.079
0.127 0.086 0.024 0.003 0.002 0.021 −0.001 0.046 0.001 0.00 0.007
District Referent: Mukatsar Gurdaspur Amritsar Pathankot Tarantaran Jalandhar Kapurthala Hoshiarpur Rupnagar SBS Nagar SAS Nagar Mansa Moga Ludhiana Fazilka Ferozepur Faridkot Barnala Sangrur Patiala Fatehgarh Sahib Bathinda
0.182 −0.115 −0.220 −0.121 −0.151 −0.067 −0.041 −0.017 0.037 −0.10 −0.049 −0.021 0.274 0.221 −0.062 0.072 −0.024 0.070 −0.061 0.005 0.005
< 0.001 0.001 < 0.001 < 0.001 < 0.001 0.051 0.232 0.617 0.284 0.003 0.150 0.538 < 0.001 < 0.001 0.070 0.036 0.476 0.041 0.073 0.893 0.874
0.032 0.012 0.047 0.014 0.022 0.003 0.001 0.00 0.00 0.009 0.001 0.00 0.074 0.048 0.003 0.004 0.00 0.004 0.003 0.00 0.00
Primary occupation Referent: any other occupation Crop farming Livestock farming
−0.015 0.118
0.657 0.001
0.001 0.013
Secondary occupation Referent: any other occupation Crop farming Livestock farming
0.061 0.121
0.072 < 0.001
0.003 0.014
Level of education Referent: Post-graduate Illiterate Matric 12th Graduate
−0.217 −0.251 0.243 0.158
< 0.001 < 0.001 < 0.001 < 0.001
0.046 0.062 0.058 0.024
Years since rearing Less than 5 years 5–10 years 11–15 years 16–20 years
0.160 0.122 0.066 0.067
< 0.001 < 0.001 0.054 0.051
0.025 0.014 0.003 0.003
Dependent variable: Practice score Knowledge score Attitude score
−0.024 0.112
0.476 0.001
0.001 0.011
3.4. Univariable analyses The results of univariable analysis are presented in Table 4. The farmers covered under survey had lower knowledge on zoonoses as compared to farmers who came to attend basic livestock training at the University (P= < 0.001). Increase in participant’s age (P= < 0.001), being a male (P= < 0.001) and rearing cattle (P= < 0.001) were negatively associated with the zoonotic disease knowledge. The participants with their primary occupation as ‘livestock farming’ had more knowledge on zoonotic diseases (P= < 0.001), whereas low levels of education were negatively associated with zoonoses knowledge. Keeping a pet (dog or cat) was found to be positively associated with the zoonosis knowledge. The attitude score was positively associated with the practice score of the participants. Low levels of disease awareness were observed in some of the districts (Tables 4 and 5) as compared to others indicating a need to direct education programs in such areas. 3.5. Multivariable analyses The results of multivariable analysis are presented in Table 5. The level of education, being a cattle farmer and whether the farmer came for a basic livestock training or was covered under survey were the significant parameters found associated with the zoonoses knowledge. In addition, being a resident of district Gurdaspur, SBS Nagar, Ludhiana, Fazilka, Faridkot and Bathinda was found to be positively associated with zoonotic disease knowledge among the participants (Table 5). 4. Discussion We assessed knowledge, attitude, practices and level of understanding of the livestock farmers relating to zoonotic diseases in Punjab state of India. Results of the study indicated that most of the farmers are not aware of the transmission, prevention and control of zoonosis such as toxoplasmosis, taeniosis/cysticercosis, hydatidosis and ringworm in Punjab state of India. Previous studies also indicate low to medium knowledge of farmers relating to zoonotic diseases in Punjab, India (Hundal et al., 2016). Similarly, Babu et al. (2015) found that Table 5 Multivariable linear regression analysis, demonstrating the influence of explanatory variables on the outcome variables. Variable Dependent variable: Knowledge score Covered under survey or came for training Owns cattle District Referent: Mukatsar Gurdaspur SBS Nagar Ludhiana Fazilka Faridkot Bathinda Level of education Referent: Post-graduate Illiterate Matric 12th
brucellosis to be transmitted by buffalo as compared to 16% who identified cow as responsible for transmitting brucellosis. For toxoplasmosis, 16% identified cat as a reservoir host. More than 25% of the farmers had a lack of knowledge and believed cancer to be transmitted by different livestock species. 3.3. Attitude and practices of participants on zoonotic diseases For practices, 359 (42%) farmers believed that an animal died due to disease should be buried and disinfectants such as lime should be 19
St. β
P-value
−0.211 −0.172
0.001 0.001
0.195 0.180 0.227 0.150 0.170 0.104
< 0.001 < 0.001 < 0.001 0.002 0.001 0.034
−0.224 −0.280 −0.170
< 0.001 < 0.001 0.08
Adjusted R2 0.333
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Competing interests
respondents had little knowledge of zoonoses except rabies in Andhra Pradesh, India. People primarily involved in livestock farming had better knowledge on zoonotic diseases as compared to others. This might be due to the fact that they are more likely to be in contact with veterinary personnel or other sources of information associated with livestock farming. Similarly, Swai et al. (2010) found higher knowledge on zoonotic diseases in smallholder dairy as compared to traditional livestock keepers in Tanzania. The zoonotic disease knowledge was negatively associated with increase in the age of participants. This might be due to improvement of education system in the Punjab state of India. Livestock farmers belonging to bigger households had poor knowledge as compared to others. This might be due to the fact that large households have limited resources resulting in lower level of education in such families. On the other hand, non-significant associations between age, level of education, herd size have also been reported (Hundal et al., 2016). The farmers coming for training scored better than those recruited in villages. This might be due to the fact that they were more progressive or aware than others. The attitude and practices of livestock farmers present several potential risks. For example, consumption of raw milk from infected animals is a potential risk for transmission of brucellosis and tuberculosis. Similarly, walking barefoot in the field or garden could serve as a potential risk for cutaneous larvae migrans. Non-disposal of infected carcasses could serve as an important source for diseases such as tuberculosis, brucellosis and many other zoonotic infections. Globally, research indicates that livestock farmers have a poor knowledge relating to zoonotic pathogens. Lindahl et al. (2015) found that 85% of the respondents in Tajikistan were not aware of brucellosis and respondents with low knowledge are at high risk of being infected. In Turkey, only 2% of livestock farmers had sufficient knowledge relating to zoonotic diseases (Cakmur et al., 2015). Although all the livestock keepers were aware of brucellosis in Jordan, most of them were not known to transmission routes of the disease (Musallam et al., 2015). Similarly, moderate overall knowledge of brucellosis among the participants from Uganda has been reported (Kansiime et al., 2014). In Zimbabwe, Chikerema et al. (2013) found awareness level of rabies, anthrax and brucellosis among farmers to be 9%, 72%, and 21%, respectively. For leptospirosis, significantly lower prevention practice scores have been reported among agricultural workers in Philippines (Arbiol et al., 2016). Cediel et al. (2012) found that immigrants from Asia had high frequency of risky behaviours and low knowledge relating to zoonotic diseases. The study has many limitations. Farmer’s KAPs related to many other zoonotic diseases such as leptospirosis could not be ascertained. The number of villages per district varies from 124 to 1532 in Punjab state of India (ESOP, 2011). This might have led to overrepresentation of the selected villages from smaller districts. The participants might have gained some knowledge about zoonotic diseases after reading the questionnaire and this could have biased their response. The present analysis found the level of education of the livestock farmers to be significantly associated with their zoonoses knowledge. Previous studies indicate that health education intervention significantly improved the knowledge and attitudes towards Taenia solium control among pig farmers in Tanzania (Ngowi et al., 2011). We recommend an on-going occupational health and food safety educational program for the farming community in Punjab state of India. Veterinarians, public health and agriculture development officers could substantially contribute to update farmer’s knowledge on important zoonotic diseases. Additionally, mass media communications such as radio and television talks, and newspaper articles on the prevention and control of zoonotic diseases could also improve livestock farmer’s knowledge and practices relating to zoonotic diseases. The persons with low levels of education and involved in livestock rearing should receive additional zoonotic disease education training programs.
None declared. Acknowledgements The authors wish to thank the Department of Science and Technology, Government of India for financially supporting this study under the research project “Community awareness project for prevention and control of zoonoses” in Punjab, India. The authors also wish to thank S. Manjit Singh, School of Public Health and Zoonoses for his valuable help in the conduct of this study. References D.A.H.D.F, 2017. Department of Animal Husbandry, Dairying and Fisheries Annual Report 2016–17. Pp. 1–162. Available at:. Published by Department of Animal Husbandry, Dairying and Fisheries, Government of India. http://dahd.nic.in/sites/ default/files/Annual%20Report%202016-17.pdf. ESOP, 2011. Punjab at a Glance, 2011. Pp. 1–96. Available at:. Published by Economic and Statistical Organisation, Government of Punjab. http://www.pbplanning.gov.in/ pdf/PunjabGlance2011CompleteVD%20Graphs.pdf. NSSO, 2013. Livestock Ownership in India (70th Round). Pp. 1–293. Available at:. Published by National Sample Survey Office, Ministry of statistics and program implementation, Government of India. http://mospi.nic.in/Mospi_New/upload/nss_ rep_572.pdf. Agasthya, A.S., Isloor, S., Prabhudas, K., 2007. Brucellosis in high risk group individuals. Indian J. Med. Microbiol. 25 (1), 28–31 PubMed: 17377349. Ali, J., 2007. Livestock sector development and implications for rural poverty alleviation in India. Livest. Res. Rural Dev. 19 (2), 1–15. Arbiol, J., Orencio, P.M., Romena, N., Nomura, H., Takahashi, Y., Yabe, M., 2016. Knowledge, attitude and practices towards leptospirosis among lakeshore communities of Calamba and Los Baños, Laguna, Philippines. Agriculture 6, 18. Babu, A.J., Ramya, P., Rao, L.V., Swetha, C.S., Sudhanthiramani, , Rao, K.V., 2015. A study on the awareness and knowledge of zoonotic diseases among the public in and around Proddatur-YSR Kadapa district, Andhra Pradesh, India. Int. J. Recent Sci. Res. 6 (7), 5131–5138. BAHS, 2014. 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