A cross-sectional study has been conducted in Jinka Town to assess the knowledge, attitude, and practices of the community on milk-borne Zoonotic diseases. As a result, a total of 395 study participants from the different socio-demographic backgrounds were randomly selected and voluntarily filled out the semistructured questionnaire which was distributed to gather the required information from the respondents. The findings show that 60.51% of the respondents knew that milk born zoonotic diseases could be acquired through the consumption of raw milk whereas 36.96% of the respondents prefer to consume unpasteurized milk. Of the total respondents, 34.94 % still have no idea about the preventive measures of milk born zoonotic diseases. 74.94% of respondents in this study did not receive formal training on milk-borne zoonotic diseases. Statistically, there was a strong association of respondents on milk-borne zoonosis (p<0.05) between the educational level and KAP. About (11.90 %) of the respondents shared the same house with the animals. Besides, around (36.96%) of respondents were accustomed to using the raw milk, and about (36.71%) were habitual in giving the children raw milk. According to the study, the overall knowledge, attitude, and practice of milk-borne zoonotic diseases in the study site is not adequate. Thus, community education and awareness-raising programs are therefore needed to further improve the community’s knowledge, attitude, and practice on milk-borne zoonotic diseases.

• Attitude; Jinka; Knowledge; Milk Borne Zoonosis; Respondents; Practices

Abebe F, Getachew S, Hailu T, Fesseha H (2020) Assessment of Community Knowledge, Attitude, and Practice on Milk Borne Zoonotic Diseases in Jinka, Southern Ethiopia. Myth or Fact. Ann Public Health Res 7(2): 1096

Livestock production is one of the main ways to achieve improved living standards in many developing countries [1,2]. Globally, livestock is highly dynamic, accounting for 40 percent of global agricultural production and supporting livelihoods and food security for nearly a billion people [3]. In sub-Saharan Africa, production of livestock plays a vital role in the national economy, and in rural areas, it also improves the livelihood of the communities [4].

Ethiopia has the largest livestock population in Africa estimated at 59.5 million heads of cattle, 1.21 million camels, 30.7 million sheep, 30.20 million goats, 5.53 million chicken, 2.16 million horses, 8.44 million asses, and 0.41 million of mules [5]. Despite the country’s abundant livestock, it`s sub-sector is generally less productive. In terms of capacity, and it`s a direct contribution to the national economy is limited [6,7]. According to CSA (2017), the average daily milk yield per cow is 1.37 liters. of all the milk produced in Ethiopia less than 1% are consumed after pasteurization [5,8].

Milk is very nutritious and a principal source of nutrients for the offspring of mammalians before they eat other foods [9]. It is composed of approximately 87.2 % water, 3.7 % fats, 3.5% protein, 4.9% lactose 0.7% ash, and has a pH of 6.8 [10]. It is also known around the world for its nutritional value as a complete diet [11]. Due to its nutritional balance, milk is a good medium that facilitates the growth of a variety of microorganisms [12]. Besides, animals also play an important role in transmitting several zoonotic diseases in nature [13,14].

Whatever infectious disease that can be transmitted from both wild and domestic animals to humans and vis versa could be defined as zoonotic infections [15]. Zoonotic diseases are the main challenge to human health all over the world till now. It is estimated that up to 68% of deaths from infectious diseases in Africa, especially in vulnerable groups, for instance, people who are ill or immunocompromised [15,16].

Consumption of infected milk is the most source for milkborne zoonotic disease. This zoonosis has both public health and economic importance. In addition to causing significant economic losses to milk producers, they are also a major obstacle to trade in livestock and livestock products. To control animal diseases these countries have limited financial resources, Insufficient infrastructure, and limited financial resources. Furthermore, in many countries, the economic and public health importance of zoonotic diseases are low for farmers, making it difficult for them to control the disease [17,18].

The most common bacteria that can be responsible for milkborne diseases. Escherichia coli which are normal flora in the intestines of animals and humans, his recovery from food may be an enteropathogenic and/or toxigenic strains may be a public health concern. and/or which lead to severe gastrointestinal disturbance [19]. One of the most common bacterial foodborne illness in the world is Salmonellosis [20]. It is the second most common foodborne illness in most developed countries, causing vomiting, cramps, diarrhea, and fever. In developing countries, from neglected foodborne illness salmonellosis the one. Also, it has been acquired through incorrectly processed milk [21].

Brucellosis is the standard example of milk infections, since the appearance and the taste of the milk are rarely affected by the presence of the bacteria, and Brucella spp is transmitted from the goats to humans either through direct contact or through the milk of the infected animal. Once humans acquired the infection, Brucella has responsible for a type of granulation or acute febrile disease in which the disease can persist and progress with severe complications [22]. Another disease transmitted through raw milk is tuberculosis [23]. Contaminated dairy cattle appear to be the most continuous source of disease, although wild oxen, goats, sheep, and camels can likewise pass on the microscopic organisms [24].

The udder can be infected by a series of pathogenic fungi, which is excreted to large quantities in the milk. Bovine mastitis was shown to be due to nocardial asteroids [25]. It is responsible for other fungal species such as Nocardia brasiliensis, Candida tropicalis, Candida albicans, and Candida krousei and thus that they may pass on to men through incorrectly processed milk, which poses a threat of fungal infection, mainly in immunesuppressed patients [26-30].

A few other parasites such as Taenia spp as well as Toxoplasma gondii can sometimes contaminate milk and transmit on to people [31,32]. Hepatitis A virus (HAV) and hepatitis E (HEV), in particular, tick-borne viruses and also polioviruses that were linked to milk contamination during the pre-vaccination period. These are the majority of pathogens that can be pathogens from milk [33-36].

Over the last decade, the Ethiopian dairy industry is expanding very rapidly, while the safety of milk and milk products manufactured by farmers and milk processors has been a little emphasis. To establish a suitable public health intervention for the community, baseline information on the impact of milk-borne zoonotic pathogens should be properly documented. The conduct of a KAP survey is one of several mechanisms developed for such information. Currently, insufficient information is available on our community’s knowledge, attitude, and practice of food-borne zoonotic diseases in general and milk-borne zoonotic diseases in particular. Thus, this study aimed to assess the community’s knowledge, attitudes, and practice on milk-borne diseases in Jinka town South Omo, Ethiopia.

Study Area

The study was conducted in Jinka which the capital city of South Omo Zone. Jinka is a town in the southern part of Ethiopia, located in southern nation nationalist and people regional state. It is located in the hills north of the Tama Plains, currently, Jinka is the center of Jinka town administration. It has a latitude and longitude of 5°47′N 36°34′E Coordinates and an elevation of 1490 meters above sea level. The average annual temperature and precipitation are 21.1 0 C and 1274 mm, respectively It is 750 KM south of the main capital city of the country, Addis Ababa, and 550Km away from the regional capital, Hawassa. The climatic condition ranges from Dega to Kola which constituted 34.4% of the zonal climatic condition [37,38].

Study Population

The study population included individuals who were resident in Jinka town with different Socio-demographic characteristics. This study includes individuals of both sex, different age categories, different occupation, different marital status, and those which were found on different educational levels. Besides, the target populations were interviewed with specific questions related to Knowledge, Attitude, and Practice of the community.

Study Design

A cross-sectional questionnaire survey was carried out from November 2019 to March 2020 to assess the awareness of the community’s knowledge, attitude, and practice of integrated one health approach to control milk born zoonotic disease. The study was conducted within the seven -locality of Jinka town and its surroundings that were considered during the study. Accordingly, all individuals who live within seven - localities were randomly selected.

Sample Size Determination

The study population of the current study comprised of randomly selected students of different educational levels (elementary, high schools, colleges), farmers, and governmental and self-employees that are found in Jinka town and its surroundings. Thus, the required sample size for this study was estimated by considering the formula given by Yemane [39] for the questionnaire survey. A 95% confidence interval was considered to calculate the sample size. A total of 395 study participants were selected to increase precision.

n= N/ (1+N*(e)2 )

where n -sample size,

N-population size = 30,000 Jinka Population

e-acceptable sampling error

*95% confidence level and p= 0.05 are assumed. Hence, the total sample size was calculated to be 395.

Method of Data Collection

A questionnaire was presented to each randomly selected individual. A structured questionnaire was prepared to assess the knowledge, attitude, and practice of the community settled on urban and peri-urban areas of the study areas. Also, the sociodemographic history of each respondent was recorded. The target groups of the study were randomly selected individuals who live within the different locality of the study areas. The questionnaire was developed to addressed issues related to knowledge, attitude, and practice of the community on causes, prevention, training, source, perception on how they use milk, and also quality control.

The questionnaire was administered to the population who live within Jinka town and properly translated to the most common local language in which 80 to 85% of residence use ‘Amharic’ during the interview. Besides, they were briefed about the objective of the survey and asked for their consent before the interview was commenced. it was carried out by interviewing individuals.

Data Management and Statistical Analysis

All collected data were entered into the Microsoft Excel 2016 spreadsheet and imported to STATA version-13 statistical software for descriptive statistical analysis, and test of association between different risk factors and outcome variables. Pearson’s Chi-square test was used to detect the existence of an association between variables. Besides, a p-value of less than 0.05 was considered to be statistically significant.

Socio-Demographic Status of Respondents

A total of 395 respondents were included in this survey study. Most of the respondents in the current study were females (58.23%) and most of the respondents were Illiterate 34.68%. About 38.73% were between 31-50 years of age which is the most productive age. The majority of the respondents’ residence were from urban (85.06%). Farmer and merchants (33.16%) were the most respondents during the study (Table 1).

Table 1: Socio-demographic characteristics of respondents in Jinka.

Knowledge of the Respondents on Milk-borne Zoonotic Disease

In this study, 60.51% of the respondent knew the disease is transmitted through milk, While, only 25.06% of the respondent took formal training on milk-borne zoonosis. Out of the total, 39.39% knew about Tuberculosis followed by Brucellosis 33.33%. However, none of the respondents knew about typhoid.

Regarding prevention methods, 80.16 % thought boiling as the best prevention method. Since 64.30% of respondents knew that the consumption of raw milk can cause a serious health problem. About 13.16% of the respondent experienced milk born zoonosis from which 34.62% experienced Brucellosis. Of the total of respondents, 34.18% of them do not know who is the responsible body for controlling milk born zoonosis (Table 2).

Table 2: Knowledge of the Respondents on Milk borne Zoonotic Disease in Jinka.

Attitude of the Respondents on Milk born Zoonotic Disease

The majority of the respondent about 59.75 % disagree with raw milk is healthier and nutritious than pasteurized or boiled milk. And about 95.95 % of the respondent believes only sick cattle could be a source of milk born zoonotic diseases. whereas about 39.49% thought, there is no risk of disease in giving raw milk to children. From the entire respondent, about 75.19% have no idea on milk born zoonotic disease wither it is fatal or not (Table 3).

Table 3: The attitude of the Respondents on Milk-borne Zoonotic disease in Jinka.

The practice of the Respondents on Milk born Zoonotic Disease

The majority of the respondents about (36.96%) consume raw milk. while about 34.18% and 28.86% of the respondents consume after boiling and other processing methods, respectively. From the total respondent, only 0.51% of them have the habit of checking the quality of milk. besides, about 50.00% of the respondents use boiling tests and the rest 50.00% use Alcohol tests. And also about 11.90% of respondents share the same house with their animals (Table 4)

Table 4: The practice of the Respondents on Milk borne Zoonotic Disease.

Effect of Knowledge on milk born zoonotic disease with respect to Socio-demographic characteristics of respondents

Most of the respondents between the age of 31-50 well knew about the disease and transmitted through raw milk consumption (37.80%). While most of the respondents in this age thought raw milk has risky to drink (37.18%). However, the majority of the respondents (42.47%) had the habit of consuming raw milk.

The age of respondents was significantly associated with KAP of the respondents (p0.05) (Table 5).

Table 5: Association of age with KAP of the respondent on milk-borne zoonosis in Jinka.

Effect of educational level on KAP of the respondent in milk-borne zoonosis

In this study, about 37.80% of respondents knew about the prevention methods of milk born zoonosis, and the majority of the respondents from college/university consume boiled milk. While 60.14% of the illiterate did not know prevention methods of milk born zoonosis. Also, the majority of them (56.41%) have a lack of knowledge of milk born zoonotic disease. About 56.52% of them believe that there is no risk of disease from drinking raw milk right after milking.

In this study, there was the association between educational level and KAP of the respondents against zoonotic disease, with statistically significance difference (p0.05 (Table 6).

Table 6: Effect of Educational Level on KAP of respondents on milk-borne zoonosis disease.

Effect of sex on KAP of the respondents on milk-borne zoonosis

Most female respondents (55.52%) knew about the transmission of disease through milk consumption. Also, (60.25%) of them believe that drinking raw milk has a risk. While most male respondents (44.44%) had the habit of consuming boiled milk. There was no statistically significant association between sex and KAP of the respondent on milk born zoonosis disease. However, there was a statistically significant difference (p<0.05) in knowledge on prevention method of milk born zoonotic disease and sex of the respondent.

Table 7: Comparison of sex with the KAP of respondents regarding milk borne zoonotic disease.

Effect of residence on KAP of the respondent in milk born zoonosis

In this study, most of the respondents were from the urban areas, and in which about (84.82%) of the respondents knew about prevention methods of milk born zoonosis disease. Also about (84.44%) of them consume boiled milk. While 15.56% of respondents from the periurban area consume boiled milk. However, there was a statistically insignificant difference (p>0.05) between residence and KAP of respondents on milk born zoonotic disease (Table 8).

Table 8: Disease transmission through the milk.

The importance of milk in the human diet is well established, as it is considered as the best, ideal, and complete food for all age groups. However, in spite of being so, milk can also serve as a potential vehicle for the transmission of some diseases under certain circumstances. The present study showed the majority of (58.23%) participants handling milk were females. Similarly, a study done in Ghana by 2003, reported that 54% of respondents were females, and by the same year, 27% of the respondent were females Omore et al., [40] in Tanzania. However, the community of female respondents in the current study has been found with lower as compared to the previous report of Neeta et al., [41]. But this study contains a higher female respondent than the previous finding of Delelegn and Girma, [42] in Debre-Birhan Town.

In the present study, 34.68% of the respondents were illiterate whereas 27.34% of Colleges and, or university, 19.24% of elementary level, 14.73% of high school. This finding contradicted from the previous report of Delelegn and Girma,[42] in Debre-Birhan Town, report that 42.6% of the respondents were illiterate followed by 27% of elementary level, 15.2% of high school, and 15.2% of greater than high school. This descending of respondent percentage with increasing education level reflects the unwillingness of the educated society to participate in the dairy business.

In this study; knowledge towards milk born zoonotic disease related to age between 31-50 and male respondents has found 60.78% and 67.88%, respectively. Thus, the community in the current study has found with higher knowledge towards milk born zoonotic disease as compared to the previous report from Zimbabwe by Mosalagae et al., [13]. That reports 41.5% of respondents heard about milk born zoonotic disease. However, the current finding is lower than the previous finding of Delelegn and Girma, [42] from North Showa Zone, Ethiopia that reports 99.6% of respondents are heard about milk born zoonotic disease.

In the present study, most (74.94%) respondents had no formal training in milk-borne zoonosis. In this study, most of the respondents were held by traditional beliefs and attitudes; not by scientific reason. A similar result was recorded in the previous findings from Debre-Birhan Town (92.2%) by Delelegn and Girma, [42]. This is due to the lack of awareness about the health risks of milk-borne diseases. Cause for having a low level of knowledge, attitude, and practice concerning milk-borne zoonosis.

In the present study from who take training about milk born zoonosis know more about Tuberculosis is 39.39%, Brucellosis is 33.33%, other milk born zoonosis is 19.19%, salmonellosis is 2.02%, Listeriosis is 1.01% and no respondent know about typhoid (0.00%) can be transmitted through milk. As compared to the previous report by Delelegn and Girma, [42] from North Showa Zone, Ethiopia, respondents knew concerning the existence of zoonotic diseases such as Tuberculosis (59.6%), Salmonellosis (53.3%), and Brucellosis (22.2%) so this shows the respondent in the current study area had more knowledge on salmonellosis. Addo et al., [43] from Ghana reported that TB was known by 88% of the respondents and brucellosis by 76% which is far from the findings of this study. This might be due to the educational status and life experience of the respondents in Ghana.

The current study was also lower than Amenu et al., [44] who reported and 57.1% of study participants from the ArsiNegele district had a habit of consuming raw, unpasteurized milk. And also Current study revealed that about 11.90% of the respondents were sharing the same shelter with their animals in the study area. This finding was also lower than that of Kuma et al., [45] who reported (18.8%) that sharing the same shelter with animals in the Mana and Limmukosa districts of Jimma Zone. This difference could be due to variation in the level of education of the respondents, and differences in awareness towards zoonotic disease. This implies the need for urgent dissemination of information about milk born zoonosis to the community via awareness creation and short-term training.

In this finding, about 40.25% of the respondents agree about raw milk is healthier and nutritious than pasteurized or boiled milk. This finding is lower than the previous finding of Delelegn and Girma, [42] from North Showa Zone, Ethiopia who report 65.8%. This shows that a considerable segment of the respondents had a low attitude towards pasteurized or boiled milk. Despite the absence of scientific evidence, most people still prefer raw milk to pasteurized one based on the belief that raw milk has enhanced nutritional quality, taste, and other health benefits [46].

A study was done in the USA in 2006, 42.3% of surveyed dairy producers reported taste and convenience as the primary reasons to consume raw milk [47]. The present study showed that 36.96% of participants consume raw milk, and very less reported convenience and taste as the primary reason. Consumption of raw milk is a preventable cause of food-borne illness, making pasteurization of raw milk an important public health tool for food-borne disease prevention. One way to approach this problem would be to develop educational outreach programs for dairy producers, as well as for the general public, that focuses on issues related to the consumption of raw milk. In this finding, about 80.16% of respondent uses boiling as a means of prevention. The current study has found higher than the previous report of Delelegn and Girma, [42] in Debre-Birhan Town who reports that 3.5% uses pasteurization as a means of prevention.

In this study survey, the respondent’s knowledge, attitude, and practice on milk-borne zoonosis were found lower. This was mostly due to the low level of educational status. Without information on milk-borne zoonosis. Moreover, the overall practice of the respondents of the study area on milk born zoonotic diseases was found to be poor who could predispose them to milk born zoonotic diseases. The common practices performed by the community include; consumption of raw and unpasteurized milk, sharing the same house with animals. Generally, the sampled population had a low level of awareness regarding milk-borne zoonosis. Thus, awareness about zoonotic disease and training on zoonotic risks of milk-borne diseases and their prevention methods should be given to people working with milk handling and processing. An extensive extension service must be launched to make the population and animal owners aware of milk born zoonotic disease.

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