Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
Animal Medicine Department, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
Transbound Emerg Dis. 2019 Nov;66(6):2383-2401. doi: 10.1111/tbed.13295. Epub 2019 Aug 5.
Brucellosis is a highly contagious zoonosis affecting humans and a wide range of domesticated and wild animal species. An important element for effective disease containment is to improve knowledge, attitudes and practices (KAP) of afflicted communities. This study aimed to assess the KAP related to brucellosis at the human-animal interface in an endemic area of Egypt and to identify the risk factors for human infection. A matched case-control study was conducted at the central fever hospitals located in six governorates in northern Egypt. Face-to-face interviews with cases and controls were conducted using a structured questionnaire. In total, 40.7% of the participants owned farm animals in their households. The overall mean practice score regarding animal husbandry, processing and consumption of milk and dairy products were significantly lower among cases compared with controls (-12.7 ± 18.1 vs. 0.68 ± 14.2, respectively; p < .001). Perceived barriers for notification of animal infection/abortion were predominate among cases and positively correlated with participants' education. The predictors of having brucellosis infection were consumption of unpasteurized milk or raw dairy products and practicing animal husbandry. Applying protective measures against infection significantly reduced its risk. A model predicting risk factors for brucellosis among those who own animal showed that frequent abortions per animal increased the chance for brucellosis infection among human cases by 50-fold (95% CI: 8.8-276.9), whereas the use of protective measures in animal care reduced the odds (OR = 0.11 [95% CI: 0.03-0.45]). In conclusion, consumption of unprocessed dairy products was equally important as contact with infected/aborted animals as major risk factors for Brucella spp. infection among humans in Egypt. There is poor knowledge, negative attitudes and risky behaviours among villagers which can perpetuate the risk of brucellosis transmission at the human-animal interface. This supports the need for integrating health education into the national brucellosis control programme.
布鲁氏菌病是一种高度传染性的人畜共患病，影响人类和广泛的家养和野生动物物种。有效控制疾病的一个重要因素是提高受影响社区的知识、态度和实践（KAP）。本研究旨在评估埃及流行地区人与动物界面布鲁氏菌病相关的 KAP，并确定人类感染的风险因素。在埃及北部六个省的中心发热医院进行了匹配的病例对照研究。通过结构化问卷对病例和对照进行面对面访谈。共有 40.7%的参与者在其家庭中拥有农场动物。与对照组相比，病例组在动物饲养、加工和牛奶及乳制品消费方面的总体平均实践评分明显较低（-12.7 ± 18.1 对 0.68 ± 14.2；p < 0.001）。病例组中，对动物感染/流产的通报存在明显的感知障碍，且与参与者的教育程度呈正相关。感染布鲁氏菌的预测因素是食用未经巴氏消毒的牛奶或生乳制品以及从事畜牧业。采取保护措施预防感染可显著降低其风险。预测那些拥有动物的人患布鲁氏菌病感染的危险因素的模型表明，每只动物频繁流产会使人类病例感染布鲁氏菌病的机会增加 50 倍（95%CI：8.8-276.9），而在动物护理中使用保护措施则降低了感染的几率（OR=0.11 [95%CI：0.03-0.45]）。总之，食用未加工乳制品与接触感染/流产动物一样，是埃及人类布鲁氏菌属感染的主要危险因素。村民的知识水平低、态度消极、行为风险大，这可能使人间布鲁氏菌病传播的风险持续存在。这支持在国家布鲁氏菌病控制规划中纳入健康教育的必要性。
