Aim: The main objective of this study was to assess knowledge, attitude and practice of participants in and around Setit Humera towards cystic echinococcus.

Subject and methods: A cross-sectional study was conducted from January to August 2019. Overall, a total of 305 participants were interviewed. In all cases differences observed were considered statistically significant when p < 0.05.

Result: with regard to the levels of KAP survey, the study showed that only 36.39% (111/305) respondents had good level of knowledge, 28.20% (86/305) respondents had good attitude towards hydatidosis and 34.43% (105/305) of respondents were at good practice level. Out of 305 respondents, only 2% had ever heard hydatid disease, only 15% have seen CE in humans and 53% had seen the CE in animals. (98%) participants had indicated that they practice backyard slaughtering. Most importantly, 73% of the respondents reported that they simply throw away the offal of animals that die on their own. About 70% of the participants did not perceive themselves at risk of being infected. The overall KAP of the community was found to be 33% (101/305). The questionnaire survey clearly indicated that there is knowledge gap about hydatidosis. Some risky practices are practiced by the respondents that can predispose to hydatidosis infection.

Conclusion: Therefore, it is concluded that there is a need for an increased public education and awareness creation on Hydatid cyst and the associated risks.

• Attitude

• Humera

• Hydatidosis

• Knowledge

• Practice

Belay ZN, Kassaye E, Kebede E (2024) Knowledge, Attitude and Practice of Society towards Bovine Hydatidosis in and Around Setit Humera, Tigray Region, Northern Ethiopia. J Vet Med Res 11(1): 1265.

Echinococcosis is a neglected tropical disease, which affects the poorest population living in remote, rural areas, urban slums and in conflict zones. It has an important public health importance and can cause substantial economic losses. As the case with other neglected tropical diseases, echinococcosis has a low profile and status in public health priorities [1]. Cystic echinococcosis is caused by a species of Echinococcus, namely, Echinococcus granulosus, whose definitive hosts are the carnivores such as dogs. Usually dogs become infected with Echinococcus granulosus by eating infected internal organs such as liver and lungs from dead animals that tape worm embryos. The dogs pass out tapeworm eggs in their stool, which can cause infection in other animals and/or in humans who accidentally swallow the eggs [2]. In humans, Echinococcus granulosus forms slow-growing cysts (called hydatid cysts) in different organs of the body which can be very difficult to remove or treat in some cases [3].

In Ethiopia, hydatidosis has been known and documented as early as 1970s. Hydatidosis is the major cause of organ condemnation in most Ethiopian abattoirs and leads to huge economic losses [4-7]. However, knowledge, attitudes, and practices of communities towards hydatidosis is not well studied in Ethiopia except some studies conducted in Asella and Adama [8] and in Ayssaita of Afar region [9].

Increased awareness creation of zoonotic infections and continuous education given to butchers, abattoir workers and dog owners as to the danger of the Hydatid cyst to humans and animals has been found to play a significant role in the control of the disease by breaking its lifecycle. In addition, training of the health workers on the use of ultrasound for early diagnosis of CE is paramount [3]. Similarly, an adequate information on knowledge, attitudes, and practices of communities towards hydatidosis and prevailing risk factors in an area is important to develop and implement disease prevention and control strategies [8]. Humera is located in the Western Zone of the Tigray Regional state, Northern Ethiopia. Extensive system of livestock management predominate the area and dogs are commonly used for control and guarding of herds of cattle and flocks of sheep and goats [10].

In Humera, there was no known research undertaken on the knowledge, attitudes, and practices of communities towards hydatidosis. The wide spread of backyard slaughtering practices, the absence of meat inspection procedures, huge consumption of vegetation in the study area, and the peculiar geographic feature of Humera due to the presence of Tekeze River and bushy areas along the riverside is an ideal home for many foxes and hyenas. These are all causes of concern for human and animal hydatidosis. Hence, additional surveys are required to assess knowledge, attitudes, and practices of society towards hydatidosis. 

Objectives of the Study

It was against this background that the objectives of the study were designed to assess the knowledge, attitudes, and practices of society towards bovine hydatidosis in and around setit humera, Tigray region, northern Ethiopia.

Research Questions

? What are the risk factors for the transmission of CE in cattle and humans in the study area?

? Do People in the study area have knowhow on Cystic echinococcus

Significance of the Study

Provide baseline information on KAP of Bovine Hydatidosis in and around Setit Humera 

The study has brought veterinarians and medical professionals to work together for effective control of Zoonotic diseases.

Limitations of the Study

It was also very hard to describe the disease to the participants, unless using pictures which could have compromised the response concerning the disease, thus subjective interpretations of CE could have introduced errors in the KAP study.

Operational Definitions

? Cystic Echinococcosis: Cystic echinococcosisis a disease caused by the larval cystic stage (called echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus) that may cause illness in intermediate hosts, generally herbivorous animals and people who are infected accidentally.

? Zoonosis: Zoonosis, also called zoonotic disease refers to diseases that can be passed from animals, whether wild or domesticated to humans.

? Attitude: The way a community thinks and behaves toward Cystic echinococcosis.

? Knowledge: It is the awareness of the community about Cystic echinococcosis.

? Practice: The habitual community involvement to prevent Cystic echinococcosis.

Description of the Study Area

The study was conducted in and around Setit Humera town. The study tabias include;Adebay,Baeker ,Dansha, Maykadra, Rawyan and Setit Humera. Setit Humera town is located in the Western Zone of the Tigray Regional state, Northern Ethiopia [Figure 1].

Figure 1: Map of the study area

It is the administrative center of the Western Zone of Tigray. It has latitude 14°17′N and longitude 036°39′E at an altitude of 637 m above sea level. The population of Rawyan, Maykadra and Adebay are predominantly recent settlers who have mainly returned from Sudan in 1993/1994 after the end of the civil war in the early 1990s.Repatriation of 14, 255 refugees from Saffawa and Umrakoba camps in eastern Sudan in 1993 and 1994 around Humera, resulted in an emergence of Rawyan (14°17′ 19″N, 036°37′18″E, 600 m a.s.l), May Kadra (14°08′ N, 036°34′ E, 612 ma.s.l), and Adebay (14°17′ 22 ″N, 036°38′E, 625 m a.s.l) towns [11].

The other town around Humera is Baeker which was a small village before Ethio-Eritrea war which displaced people from border areas around Humera and forced them to settle in Beaker. Adebay is located 25 km away from Humera to eastern direction. May Kadra is a town located 25 km South of Humera. Rawyan is found between May Kadra and Humera. Baeker is located east of May Kadra at 40 km or southeast of Humera, at 53 km. Dansha (13° 31′ 0 ″N, 37° 10′ 60 ″E, 892 m a.s.l) is another study area, a small town in Tsegde wereda [Figure 1]. Agriculture is the main occupation of the population of the area. The agricultural activities are mainly mixed type with cattle rearing and crop production under taken side by side. Extensive system of livestock management predominate the area and dogs are commonly used for control and guarding of herds of cattle and flocks of sheep and goats [10].

Main cattle breeds raised in the study district are the local Arado (in both high land and lowland areas) and Begait (Barka) cattle (in lowland areas). There is still very few number of cross breeds of cattle especially in the high land areas. Western zone of Tigray which includes; Kafta Humera,Tsegede and Welkayit woredas possess a total of 762,893 heads of Cattle. Kafta Humera woreda possess 237,307 heads of cattle, 103,616 head of goats, and 152,391 head of sheep. Of the 237,307 heads of cattle 62,808 are Begait cattle [10]. Welkayit woreda possess 316,513 heads of cattle, 110003 head of goats, 354 head of sheep, heads 8,597 of Donkey , 876 heads of mule, and 281 head of camel [12].Tsegede woreda possess 209,073 heads of cattle, 123,810 head of goats, 39,266 head of sheep, 12,062 heads of Donkey 1,412 head of camel, 184,945 poultry, 544 swine, 5,863 and 1,386 traditional and modern, respectively hive honeybee.Some1968 are Begait cattle [13].

Study Population

It comprised communities residing in Adebay, Baeker, Dansha, Maykadra, Rawyan and Setit Humera.

Study Design and Sampling Methodology

Study design: A cross sectional study design was employed from January 2019 to August 2019 to study KAP. For the KAP study a semi structured and pretested questionnaire was also developed and administered.

Sampling technique and sample size determination: For the KAP questionnaire survey sample size was calculated according to the formula of Yamane et al., [14].

A Stratified Random Sampling was applied to have a response. There are 21 Tabias in Kafta Humera Woreda. Four “Tabias” from Kafta Humera and Setit Humera city and one” Tabia” from Tsegede Woreda namely Dansha were selected for this research purpose. Those six “Tabias” were selected as they are potential source of cattle for the abattoir and access of transportation. The sample size in each” Tabia” was obtained, and then the researcher selected people in the household in each kebelle (village) from those Tabias (VCDs).

To get sample size from the community population [14], formula was taken into consideration. Confidence level of 95% and 5% sampling error was considered.

Formula    n=N/(1+Ne)2

Where, n=Sample size or respondents for this research

N=a population size

e=the level of precision (A 95% Confidence level or 5% precision level, was assumed

n=1282/ [(1) +1282(0.05)2 ]

n=304.8751

n=305

It was decided to use 305 as a sample size from 1282 households that own both cattle and dog. The sample size was divided by the size of population and calculated in to percentage in order to get the sample size in each village development committees (tabias), which was 23.8% of households (gotten from [(305/1282) *100]. Calculation of sample size in each village development committees (tabias) as follows [Table 1].

Table 1 Calculation of Sample Size in each “Tabia”

Risk Factor Study: In the KAP study, a semi-structured and pretested questionnaire has been developed and administered in order to identify risk factors responsible for transmission and maintenance of CE in Western zone of Tigray. The study areas include; Adebay, Baeker, Dansha, Maykadra, Rawyan and Setit Humera. These study locations were selected as they are potential source of cattle for the abattoir and due to access for transportation.

KAP Scoring: This method was used based on the technique used by Alemu et al., [15]. For knowledge, each correct response was given a score of 1, while a wrong or unsure response was scored 0. The same is true for positive and negative attitudes and good and poor practices. Overall, there were 33 questions in the questionnaire. The total 33 points/questions were divided into three sections in which 10 points (30.9%) attributed to knowledge section, 3 points (9.1%) to attitude and 20 points (60.6%) to practices. Those respondents who obtained KAP score above 50 were considered as good level, while the scores less than 50 were considered as poor level.

Data Management and Analysis

The data were collected and recorded on Microsoft Excel. The STATA software version 13 program (2014) was applied for the statistical analysis of the data obtained from the study. Logistic regression was used to expressed results and compare risk factors. The statistical differences between respondents on the knowledge, attitude, and beliefs about echinococcosis were compared. Odds ratio and 95% confidence intervals were computed. A ???? value of 0.05 was considered st significant.

Knowledge, Attitude and Practice

Socio-demographic background: Table 2 presents percentages of socio-demographic factors. All participants were adults and 52.1% were with39-59 age group. Most of the participants were male with 68.2 % (208/305) while Orthodox were 82.6% (262/305) and Muslim with 8.5 %( 26/305) were the most predominant religions. Most of the study participants were from Dansha with 21.3 %( 65/305) and Maykadra with 20.3 %( 62/305). The major occupation of the participants was farmer with 82.6% (252/305) followed by business person with 11.1 %( 34/305). On education, 48.2 %( 147/305) of the participants had never attended any formal education, 42.6% had stopped in primary while 6.9% ,1.0% and 1.3% had attended secondary, college and university respectively [Table 2].

Table 2 Demographic Data of Respondents

Community KAP about hydatidosis in the study area: Thirty-three multiple choice questions were asked regarding to knowledge, attitude and practice for each respondent. In the study, the levels of KAP concerning hydatidosis showed that 111(36.39%) respondents had good level of knowledge, 86 (28.20%) respondents had good attitude towards hydatidosis and 105 (34.43%) of respondents were at good practice level. The overall KAP of the community were found to be 101(33%) as shown in Table 3.

Table 3 Overall Community KAP on Hydatid Cyst

Knowledge of the respondents on cystic echinococcus: Table 4 represents knowledge levels towards cystic echinococcosis. It can be seen that the knowledge about CE is still very low. Out of 305 respondents, only 1.64 % (5/305) had ever heard or seen hydatid disease (CE), only15.41 % have seen CE in humans and 52.79% had seen the CE in animals. CE being a zoonotic disease, people had little knowledge on zoonotic infections with only 31.15 % (n=305) having heard about or know what zoonoses are. Participants were aware of the dangers eating food contaminated by dog feces with 62.62 % (337/384), but none mentioned hydatidosis as one of the dangers [Table 4].

Table 4 Knowledge of the Respondents on Cystic Echinococcus

Knowledge score level was determined from several factors which included sex, age, address, position, educational status, occupation and religion of respondents. Among these factors, only religion i.e. being orthodox Christian associated with knowledge score level. The statistical analysis showed significant difference (P < 0.05). Orthodox Christians were more knowledgeable about CE (OR = 4.858, P= 0.038) than other religions. The statistical analysis showed that there was no significant difference (P > 0.05) among all other factors associated with Knowledge score level as indicated in Table 5.

Table 5 Logistic regression analysis on respondents’ knowledge of hydatidosis in the study area

Attitude of the respondents on cystic echinococcus: Table 6 shows the assessment of people’s attitude towards CE. Attitude was assessed by asking relevant questions on how participants perceived the disease. Seventy percent (216/305) of the participants did not perceive themselves at risk of being infected by CE whereas only 20.98 %( 64/305) think that they can get hydatidosis from close association with dogs. There was a lot of stigma on people who would develop this condition with 80.66 %( 246/305) of the participants reporting not to associate with CE patients. This was assessed by showing participants pictures of people infected by CE. Respondents believe that the disease can only be treated using traditional means, like by washing holly water and they don’t believe that they could get the disease from close association with dogs [Table 6].

Table 6 Attitude of the Respondents towards Cystic Echinococcus

Attitude of respondents towards CE were determined from several factors which included Sex, age, address, position, educational status, occupation and religion of respondents. The statistical analysis showed that there was significant difference (P < 0.05) among sex, address, educational status, and occupation of respondents and their attitude towards CE. Statistically, females had more positive attitude (OR = 1.738, P= 0.038) than males. There was highly significant association among residents of Maykadra (OR = 15.203, P= 0.000) and Baeker (OR = 22.5, P= 0.000) and their attitude towards CE. People involved in off farm activities (OR = 3.94, P= 0.009) showed more positive attitude than other occupation categories. Education has showed statistical significance where, respondents with secondary school education (OR = 3.27, P= 0.013) had higher acceptable attitude scores than other educational categories summarized in Table 7.

Table 7 Logistic regression analysis on respondents’ Attitude towards hydatidosis in the study area

Practice of the respondents on cystic echinococcus: Table 8 shows the practices that are risk factors for CE from 305 respondents. These included presence of stray dogs (80%), close association with dogs (70.82%), grazing of livestock with dogs (83.28%). Others include lack of deworming of dogs (52.13%), home slaughtering of animals without meant inspection (98.69%), feeding dogs with uncooked infected organs (96.72%), no water boiling (95.08%), no hand washing when handling dogs (53.44%) and lack of meat inspection at the source of meat (84.92%).Some 61.31% of the respondents reported that there is no slaughter house in their surroundings ,the existing slaughter houses are still used by Christians only also in western part of Tigray there are no slaughter houses for small ruminants.

Most importantly 72.79 % of the respondents reported that they simply throw away the offal of animals that die on their own. In the same way, 66% of the respondents reported that their dogs have access to dead animals and their offal [Table 8].

Table 8 Selected Practices of respondents related to Hydatid disease

Likewise, practices were determined from several factors which included Sex, age, address, position, educational status, occupation and religion of respondents. Among these the residence/address and educational status of respondents have statistical association with CE practices of the respondents. Statistically residents of Maykadra (OR = 2.745, P= 0.010) and Setit Humera (OR = 3.158, P= 0.009) have good practices than other residents in the study area as indicated in Table 9.

Table 9 Logistic regression analysis on respondents’ practices towards hydatidosis in the study area

The current study sought to evaluate KAP towards CE. Results of the study revealed poor KAP towards CE, where only 36.39%, 28.20 %and 34.43 % knowledge, attitude and practice score levels were found.

Lack of knowledge about CE can be attributed to poor diagnosis as reported by medical and veterinary personnel. The disease is expensive to diagnose and treat and most of the time, individuals seek out for alternative medicine by going to traditional healers. Knowledge about the disease is very important if its prevention and control strategies are to be effective. With these low levels of knowledge of the disease, it means the population in and around setit humera is at risk of developing the disease. Only 1.64% of respondents had ever heard/seen Hydatid cyst and still 68.85 % of respondents don’t know what zoonotic diseases are. In agreement with the current study Gebremichael et al., [9], reported that there was a great deal of uncertainty about the disease with only less than 5% of respondents indicated that they have heard about the disease. In this study religion was the only significant factor associated the Knowledge score levels Orthodox Christians were more knowledgeable about CE (OR = 4.858, P= 0.038) than other religions This disagrees with several reports Gebremichael et al., [9], where they have justified that Islam communities do not keep dogs unlike the Christian values.

Sex, age, locality, position in the house hold, occupation and educational status of respondents did not significantly influence the knowledge about Hydatidosis. In agreement with this study Othieno et al., [3], reported that there was no statistical difference in the awareness about CE between male and female respondents in all the study participants (????> 0.05). In addition,attitude towards CE was also found lower in the study participants Perception about a disease can influence its epidemiology. If people perceive themselves at risk of acquiring the disease, they are more likely to guard against getting the disease and vice versa. Among 305 participants, 70.82 % did not perceive themselves at risk of being infected by CE whereas only 20.98 % think that they can get hydatidosis from close association with dogs. Therefore, peoples’ attitudes should be changed to influence disease dynamics. According to this study, education, occupation, address and sex of participants were key determinants of perception about the disease (P<0.05). However, through extensive literature review,no studies were found to report the relation of address and attitude towards the disease. In this study as well, people had no idea of other zoonoses from dogs such as CE.

Participants of the current study showed poor practice towards CE. Several potential risky practices have been underlined among the livestock farmer’s community interviewed in this study, notably practices related dog and livestock management and these practices are associated with Cystic Echinococcosis. As it was found out in this study, a high population of stray dogs (80 %) is a significant risk factor of CE. This put residents of the study area at risk of developing Cystic echinococcosis. This is coupled by a poor deworming culture of dogs (52.13%) where only 47.87% of 305 participants dewormed their dogs. This means that dogs remain as carriers of the adult worm, hence leading contamination of the environment with fecal matter.83.28% of participants reported that their livestock are grazing with dog. Deworming has been shown to significantly reduce the spread of the disease both in dogs and man [16]. The close association of people (70.82) with dogs especially children who can acquire this disease when they are still young and signs come later in life further exacerbates this factor. Still there is no hand washing after handling a dog in 53.44% of respondents.84.2 % of the participants also reported that there was no abattoir nearby. Hence, among 305, 98.69% were practicing home slaughtering.

With this practice, there is lack meat inspection in 84.92% of the respondents and the probability of feeding dogs with uncooked organs (96.72%) is very high. Home slaughtering has been described as one of the risk factors for cystic echinococcosis by authors like Nyakarahuka et al., [17].

Most importantly, 72.9% of the respondents indicated that they simply throw away the offal’s of dead animals and this can facilitate the cycle of the disease transmission. Eggs come out in to the environment from the feces of dog and taken up by cattle and the dog will eat the offal of the dead animals(entrails) containing the Hydatid cyst. Humans can be infected when they ingest contaminated water or vegetable that has E.granulosus egg.

Echinoccocosis or hydatidosis is a disease of considerable importance from both public and economic importance point of view. The present study has shown that there is poor knowledge, attitude and practices of the society in the study area.

Therefore; based on the above conclusion the following recommendations are forwarded:

? Stray dogs should be eliminated from pastures and places of slaughter house

? Regular deworming of dogs in the area to reduce environmental contamination by the parasite eggs.

? Proper and strict disposal of rejected/condemned organs due to hydatidosis to restrict dogs accessing them.

? Fencing off abattoirs to restrict access by dogs

? Backyard slaughtering of animal should be prohibited through designing and reinforcing of legislations, construction of the slaughter house which fulfill the necessary facilities

? Proper meat inspection services should be implemented.

? Continuous education should be given to butchers, abattoir workers, meat sellers and dog owners as to the danger of the hydatid cyst to humans and animals.

? Veterinarians and public health experts should work together to control zoonoses

? Public should be aware about the route of infection, to maintain personal hygiene, especially to wash hands after handling dogs and their feces.

? Increase public education and awareness on parasitic zoonoses and the risks associated with consuming uninspected meat

? Traceability study on the origin of the parasite could be important as the source can also be from wild carnivores like fox in addition to dog.

? Further study on molecular Genetic characterization of echinococcus isolates from various intermediate hosts is needed

This work was supported by Tigray Agricultural Research Institute. Author Z.N. has received research support from Tigray Agricultural Research Institute.

Conflict of Interests: The authors declare that they have no competing interests

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Zinabu Nigus Belay]. The first draft of the manuscript was written by [Zinabu Nigus Belay] and [Enquebaher Kassaye] designed methodology, analyzed, reviewed and edited final draft. [Etsay Kebede] Participated in conceptualization, methodology and edited final draft. [Enquebaher Kassaye] and [Etsay Kebede] commented on previous versions of the manuscript. All authors participated in its critical review and edited the manuscript. All authors read and approved the final manuscript.

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