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Mazar L, Nasirzadeh M, Salim Abadi Y. Knowledge, Attitude, and Perceived Threat of Butchers in Rafsanjan City concerning Brucellosis in 2020-2021. J Occup Health Epidemiol 2021; 10 (2) :93-98
URL: http://johe.rums.ac.ir/article-1-430-en.html

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1- MSc Student, Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
2- Assistant Prof, Dept. of Health Education and Health Promotion, School of Health, Occupational Health and Safety Research Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
3- Assistant Prof, Dept. of Health Services and Health Promotion, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. , yasernls@gmail.com
Article history
Received: 2021/05/10
Accepted: 2021/06/21
ePublished: 2021/10/30
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Introduction
Brucellosis is one of the common infectious diseases between humans and animals, which in addition to the economic losses caused by high mortality in domestic livestock, imposes many social problems on human communities [1]. Its causative agent is transmitted to humans through animals or their products infected. The most important routes of its transmission to humans include the consumption of raw milk and dairy products and contact with infected animal blood and secretion via wounds and scratches, as well as the inhalation of suspended particles in the air where animals are kept [2,3]. Most cases of Brucellosis are among people who deal with domestic animals, such as ranchers, butchers, and veterinarians; thus, it is considered an occupational disease [2]. Annually, more than 500,000 new cases of the disease are reported worldwide; however, this number is 10 to 25 times lower than the actual number in communities [4-6]. According to the results of studies, the seroprevalence of human Brucellosis in Iran is 1% to 2%; also, the status of the disease in the country varies in different regions based on climatic conditions, access to pasteurized products, animal species, animal health level, and diagnostic tests [7, 8]. In Kerman province, a moderate incidence of this disease has been shown [9]. Brucellosis occurs in acute, sub-acute, and chronic forms with nonspecific symptoms in humans, similar to those of the flu, including intermittent fever and chill, weakness, sweat, anorexia, joint pain, headache, and fatigue; therefore, it is difficult for physicians to diagnose it [1, 10, 11]. This disease is of great social and economic importance in humans and animals. Livestock disease affects the economy of livestock farmers and imposes high medical costs on the infected people [12]. Although the control and elimination of this disease in humans largely depends on vaccination, health measures, and its reduction in the livestock population, observing personal hygiene, preventing the spread, and performing preventive behaviors are the most significant points in protecting human health [8]. Studies conducted in Iran have shown that a lack of knowledge about Brucellosis transmission routes and preventive measures is one of the leading causes of the disease incidence [13]. Aminshokravi et al. reported a low level of knowledge and attitude of the villagers of Gilane Gharb city in this regard, making it difficult to tackle the disease [14]. In the study of Asadpour et al., the attitude of butchers in Rafsanjan city regarding Crimean-Congo Hemorrhagic Fever (CCHF) was favorable; however, their knowledge was unfavorable and moderate [15]. Due to the many problems related to the diagnosis of Brucellosis and its particular importance in animal agriculture, as well as considering that butchers are one of the high-risk groups and no study has been conducted on this medically-veterinary important disease up to date in Rafsanjan, the current survey aims at investigating the knowledge, attitude, and perceived threat of butchers in Rafsanjan city regarding Brucellosis.
 
Materials and Methods
The present descriptive correlational study was conducted to survey the knowledge, attitude, and perceived threat of butchers in Rafsanjan city concerning Brucellosis using a census method on 130 participants in 2020-2021.
The data collection tool was a standard questionnaire taken from the study of Ramezankhani et al. [16], the validity of which was confirmed using the relevant experts' opinions. To measure the reliability, Cronbach's alpha method for questions of knowledge, attitude, and perceived threat was calculated at 0.86%, 0.85%, and 0.55%, respectively. The questionnaires were completed in the workplace using a self-report method. The inclusion criteria were willing to participate in the study, filling the questionnaire completely, as well as having at least primary education, minimum of one year of work experience, and no history of febrile illness in the past. Moreover, the exclusion criterion was the unwillingness to cooperate. The first part of the questionnaire was related to demographic information (age, marital status, work experience, education level). The second part of the questionnaire (62 questions) was associated with the knowledge about Brucellosis, including symptoms, preventive measures, and transmission routes, on a 3-point Likert scale with "Yes," "No," and "I do not know." Score 2 was given to the correct answer, score 0 to the wrong answer, and score 1 to "I do not know." The scores of this part ranged from 0 to 124. The third part of the questionnaire (20 questions) was related to attitude on a 5-point Likert scale, including definitely agree (score 5) to definitely disagree (score 1). The range of scores in this part was from 20 to 100, reported as a percentage as well.  The fourth part of the questionnaire (12 questions) was associated with the perceived threat on a 5-point Likert, similar to the attitude part. In this part, the scores ranged from 12 to 60. This study was approved by the Vice-Chancellor for Research and Technology of Rafsanjan University of Medical Sciences with an ethics code: IR.RUMS.REC.1397.004.
Data analysis was performed by SPSS software version 20 using statistical tests of one-way ANOVA, Independent t-test, and Pearson correlation at a significance level of less than 0.05.
 
Results
In the present study conducted to investigate the knowledge, attitude, and perceived threat of butchers in Rafsanjan city regarding Brucellosis, all butchers (130 people) participated. The mean age of the participants was 39.68 ± 11.23; also, 97 participants (75.2%) were married, and 91 of them (70%) had the highest education level (secondary school and diploma). The mean work experience was 17.85 years (maximum 40 years and minimum 1 year) (Table 1). 

  
Table 1. The mean score of knowledge, attitude, and perceived threat in terms of butchers' demographic variables

Variable

Status

N(P)

Knowledge

Attitude

Perceived Threat

M±SD

M±SD

M±SD

Age categories

15-24y

16(12.3)

87.06±8.78

78.66±7.93

47.20±4.84

25-44y

82(63.1)

89.60±10.86

79.48±12.2

47.89±6.71

45-64y

29(22.3)

94.10±13.03

75.24±11.85

45.20±6.42

>65y

3(2.3)

83.00±2.00

77.66±7.50

44.33±2.88

P-value of One-way ANOVA

0.043

0.419

0.234

Education

Primary school

32(24.6)

87.71±12.29

76.71±11.24

45.68±6.52

Secondory school

49(37.7)

90.65±10.66

79.83±12.20

47.85±6.73

Diploma

42(32.3)

91.45±11.49

79.29±10.61

47.95±5.94

Academic

7(5.3)

85.28±9.32

70.71±14.37

43.71±5.99

P-value of One-way ANOVA

0.342

0.197

0.184

Marital status

Single

32(24.8)

86.37±10.15

77.51±9.55

46.83±5.88

Married

97(75.2)

91.08±11.53

78.70±12.36

47.19±6.68

P-value of Independent t-test

0.042

0.621

0.790

Work experience

<10y

44(34.6)

86.95±10.44

77.76±10.10

47.39±5.82

11-20y

49(38.6)

90.91±10.58

80.59±13.27

48.20±7.00

21-30y

21(16.5)

92.57±12.82

79.19±11.30

47.80±6.54

>31y

13(10.2)

92.61±14.6

72.07±10.32

41.38±3.84

P-value of One-way ANOVA

0.158

0.130

0.007

 

The mean score and standard deviation of butchers' knowledge, attitude, perceived threat concerning Brucellosis was 89.90 ±11.31 (out of 124), 78.39±11.67 (out of 100), and 47.12±6.45 (out of 60), respectively (Table 2).

 
Table 2. Mean and standard deviation of knowledge, attitude, and perceived threat of butchers in Rafsanjan concerning Brucellosis

Variable

Mean score

Standard deviation

Out of

Minimum score

Maximum score

Mode

Median

Range

Knowledge

89.90

11.31

124

69.00

120.00

95.00

89.00

49.00

Attitude

78.39

11.67

100

44.00

100.00

82.00

80.00

56.00

Perceived threat

47.12

6.45

60

28.00

60.00

49.00

47.00

32.00


Table 3 presents the correlation between the mean score of knowledge, attitude, and perceived threat of butchers in Rafsanjan city regarding Brucellosis. A positive and significant correlation was observed between the mean score of butchers' knowledge with attitude (p <0.001, r = 0.515) and perceived threat (p <0.001, r = 0.559) (Table 3). In the current research, one-way ANOVA test showed a significant difference between the mean scores of butchers' knowledge in terms of age (p = 0.043); further, the LSD post-hoc test revealed a significant difference between the mean score of knowledge of subjects aged 15-24years and 45-64 years (p = 0.01). This finding indicates that butchers aged 45 to 64 years had the highest level of knowledge about Brucellosis. The mean score of knowledge of married and single butchers' about Brucellosis was different based on the One-way ANOVA statistical test; this difference was significant (p = 0.042), indicating that married butchers' had more information about Brucellosis. There was a significant correlation between perceived threat and work experience (p = 0.007). The LSD post-hoc test showed a significant difference between the mean score of butchers' perceived threat and work experience with more than 31 years compared with other categories (less than 10 years, p = 0.003; 11-20 years, p = 0.001; 20-30 years, p = 0.004). This result shows that with the increase in work experience, the perceived threat of butchers regarding Brucellosis also increased (Table 1).

 
Table 3. Correlation between the mean score of knowledge, attitude, and perceived threat of butchers in Rafsanjan city regarding Brucellosis

Variable

Knowledge

Attitude

Perceived threat

Knowledge

1

 

 

Attitude

0.515**

1

 

Perceived threat

0.559**

0.877**

1

     ** The level of less than 0.01
 

Table 4 provides the educational priorities about knowledge, attitude, and perceived threat of butchers regarding Brucellosis. Therefore, the most important educational priority was "disease transmission through infected vegetables," "belief in death due to the disease," and "belief in disabilities caused by the disease" in relation to knowledge, attitude, and perceived threat, respectively.

 
Table 4. Educational priorities about knowledge, attitude, and perceived threat of butchers in Rafsanjan city regarding Brucellosis

Variable

Educational needs

Mean  score*

Standard deviation

Educational priority

Knowledge

Knowledge of the disease transmission through infected vegetables

0.31

0.660

1

Knowledge of the disease transmission through infected animal wool

0.46

0.769

2

Knowledge of the disease transmission through contaminated water

0.54

0.789

3

Knowledge of the disease transmission from human to human

0.60

0.877

4

Attitude

Belief in death due to the disease

3.45

1.41

1

Belief in disease prevention by keeping fresh cheese in salty water for 3 months

3.63

1.65

2

Belief in not consuming fresh colostrum for prevention

3.64

1.39

3

Belief in boiling milk for 3 to 5 min for prevention

3.79

1.21

4

Perceived threat

Belief in consequence of disability caused by the disease

3.14

1.40

1

Belief in social consequences (job loss) due to the disease

3.22

1.41

2

Belief in the psychological consequences of the disease

3.48

1.28

3

Belief in getting sick in the future

3.60

1.28

4

* In the knowledge section, the mean score is 2, and in the attitude and perceived threat sections, the mean score is 5.
 
Discussion
Brucellosis is one of the most common infectious diseases in Iran that has many social and economic consequences [11]. In the present study, the overall score related to the butchers' knowledge was 70.07, the attitude score was 78, and the perceived threat score was 78.33 out of 100. Accordingly, it can be concluded that knowledge, attitude, and perceived threat of the butchers of Rafsanjan city concerning Brucellosis is acceptable and desirable. The findings of the present study were in line with those of other studies among butchers regarding Brucellosis. For example, in the study conducted by Prabhakar et al. [17] to investigate awareness regarding Zoonotic diseases among butchers, 60 % of them had an awareness of Zoonotic diseases, such as Brucellosis. Gorouhi et al. [18] performed a survey among butchers in Kerman city to evaluate their knowledge and attitude about CCHF and reported both to be very good. Musallam et al. [19] studied knowledge and attitude toward Brucellosis among livestock owners' in Jordan and indicated that the studied population was highly aware of Brucellosis. In the study conducted in Khash city by Shahnavazi et al. [12], the mean score of knowledge, perceived sensitivity, and perceived severity of ranchers concerning Brucellosis were higher than average [12]. In contrast, a poor level of awareness was found in Singh and Jindal's study, so that the knowledge and attitude of most butchers were very poor towards Zoonotic diseases [20]. Similarly, Cloete et al. showed poor knowledge among livestock farmers [21]; also, inadequate knowledge regarding Brucellosis was observed in a survey among cattle keepers [22].The reason for this difference in knowledge probably is due to the studied target groups.  In the studies with a target group of butchers, there was a higher level of awareness about disease compared to other target groups, which can be attributed to the regular participation of butchers in training courses by relevant health organizations. In the current investigation, no significant difference was observed between the mean score of butchers' knowledge, attitude, and perceived threat toward education level. Prabhakar et al. showed that individuals' education level predicted their perceptions about Zoonotic diseases, risk factors, transmission routes, and their life cycle [17]. Also, Alizadeh-Siuki et al. reported that farmers with higher education had a positive attitude towards preventive behaviors of Brucellosis [23]. The two latter studies were in contrast with the present work. In the present study, no significant correlation was observed between the mean scores of knowledge and attitude with work experience. However, in Prabhakar et al., butchers with more work experience had a higher level of knowledge regarding Zoonotic diseases and could easily identify the infected carcass to control infectious disease outbreaks [17]. Asadpour et al. reported that butchers' knowledge about CCHF had a direct and significant relationship with work experience [15]. There was no significant correlation between the mean scores of knowledge and attitude of butchers with work experience; however, a significant correlation was observed between perceived threat with work experience so that butchers with more than 31 years of work experience had more perceived threat compared with other groups. In this study, knowledge had a positive and significant correlation with attitude and perceived threat. Such a positive and significant correlation was also observed in the study of Babaei et al. conducted among livestock farmers in Charaoymaq County about Brucellosis [24]. Therefore, informing the community about the disease, especially at-risk groups, such as livestock farmers and butchers, can significantly reduce its prevalence. One of the important factors in preventing or tackling various diseases is people's attitude towards them. If people have a negative attitude towards health issues or diseases and see themselves at risk, it will be easier to tackle them. In the present study, the attitude was at a desirable level; however, in Alemayehu et al., livestock farmers had a weak attitude towards Zoonotic diseases [25]. The concept of perceived threat includes perceived severity and sensitivity [26]. In the present research, the perceived threat score was acceptable. High perceived sensitivity indicates that if butchers consider themselves susceptible to Brucellosis, they will adopt preventive behaviors. Understanding the severity of the disease and its impact on the butchers and their family members can also increase the adoption of preventive behaviors among them. In Shahnavazi et al., the perceived severity score was 10 out of a maximum of 15; this construct was directly related to preventive behaviors [12]. Indeed, by raising knowledge of people about the consequences of the disease in communities and families, their perceived severity of the disease can be increased. Increasing knowledge about Brucellosis in high-risk occupational groups plays an important role in effectively controlling the disease [4]. In the present work, the most important educational need of butchers in the knowledge construct was to create knowledge of not transmitting the disease through infected vegetables. Therefore, evaluating individuals' general knowledge about various dimensions of the disease can be the basis for developing and implementing more efficient health education activities. The main educational need of butchers in attitude was to create "belief in the death due to the disease," and in perceived threat was to create "belief in consequence of disability caused by the disease" in them. Hence, health education interventions can be effective when individuals' beliefs and perceptions about the susceptibility to Brucellosis and the severity of its consequences are identified. The limitation of the current survey was the unwillingness of some butchers to participate in the study; therefore, to solve this problem, the researcher tried to emphasize the importance of research and the necessity of accurate answers to questions.
 
Conclusion
In general, the knowledge, attitude, and perceived threat of the butchers in Rafsanjan city regarding Brucellosis were all favorable; however, the awareness of different routes of Brucellosis transmission and belief in its related consequence needs to be upgraded among butchers. For this purpose, training workshops and educational courses can be held based on the butchers' educational needs identified according to prioritization. Therefore, communication and cooperation between health sectors, education sectors, butchers, and other relevant occupational groups are beneficial and necessary to improve the knowledge of butchers to effectively control Brucellosis.
 
Acknowledgement
This study is the result of a research project approved by the Vice-Chancellor for Research and Technology of Rafsanjan University of Medical Sciences with an ethics code: IR.RUMS.REC.1397.004.
 
Conflict of interest: None declared.


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