Designing an intersectional interventions model for brucellosis
occurrence reduction in north-west of Iran
Damari B, MD-PhD 1,
Ahmadpour M, MSc 2*,
Hallajzadeh J, PhD 3,
Hoseini H, MSc 4, Safiri
S, PhD5, Ghaderpoori M, MSc6, Hashemi V, MSc 7
1- Assistant
Prof., National
Institute for Health Research,
Tehran University of Medical Sciences, Tehran, Iran.
2-Faculty
Member, Dept. of
Public Health, Maragheh University of Medical Sciences, Maragheh,
Iran.3-Assistant
Prof., Dept. of
Basic Sciences, Maragheh University of Medical Sciences, Maragheh,
Iran.4-Faculty member, Vector-borne
Diseases Research Center, North Khorasan University of Medical Sciences,
Bojnurd, Iran. 5-PhD in
Epidemiology, Road Traffic Injury Research
Center, Dept. of Statistics & Epidemiology, School of Public Health, Tabriz
University of Medical
Sciences, Tabriz, Iran. 6-
Student
of PhD, Student Research Office, Dept. of Environmental Health Engineering, School of Public Health
,Shahid Beheshti University of Medical Sciences, Tehran, Iran. PhD in
Environmental Health, Faculty of Health, Shahid Beheshti University of Medical
Sciences, Tehran, Iran. 7- Faculty Member, Dept. of |Basic Sciences, Maragheh University of Medical
Sciences, Maragheh, Iran.
Abstract
Received:
July
2015, Accepted: August
2015
|
Background: Brucellosis is a
bacterial infection mostly transmitted by animals to humans; thus,
consideration of sanitary instances is an important preventive method for
this disease. Therefore, we designed a study
in order to reduce the rate of brucellosis in Baneh County, Kurdistan
Province, Iran.
Materials and Methods: The
sources of data were the medical documents of patients diagnosed in health
centers and private laboratories during 2011–2012. Data were analyzed using
SPSS software, and chi-square and t-test) P > 0.05). In
addition, in the second section of the research, data on all
brucellosis patients and experts were used to design an intersectional
preventive interventions model for this county.
Results: A
total of 135 brucellosis patients
were surveyed in this study during 2011-2012, and
a total of 80 experts participated in this research. It was found that 43
patients (31.9%) lived in the city and 92 of them (68.1%) lived in a village;
and 71 of them (52%) were men and 64 (48%) were women. The most common way of
incurring the disease was drinking non-boiled milk [42 (31.11%)]. Moreover,
100% of the patients and 100% of the experts believed
that intersectional intervention is the best
prevention method for brucellosis.
Conclusions: Considering the results, it can be
concluded that the intersectional intervention with unique management is the
best way for reducing the incidence and
prevalence rate of brucellosisin in Baneh County.
|
Keywords:
Epidemiological study, Brucellosis, Malta fever, Iran.
Introduction
Brucellosis is a
bacterial zoonotic infection mostly transmitted by animals to humans. It is not
transmitted from one human to another, but
is a life threatening infection which represents a wide range of clinical
diseases in humans mainly caused by brucella melitensis-abortus (1-3).
Brucellosis was discovered by David Bruce, a
Scottish physician, in 1887, and due to the observation of its first case in
Malta Island, it has also been named Malta fever (2-4). In many countries, brucellosis
included of reportable diseases. Overall,
this disease has unfavorable effects on human and animal health and their
products. In animals, this disease is called fetus abortion (3, 5). This
disease has other names like Billowy fever, Mediterranean fever, and
mad fever. Human brucellosis, Malta
fever, is a serious public health risk in regions with infectious mutton and
goats and seen mostly in spring and summer, the seasons of offspring and
suckling of animals (5-7). There are various methods for controlling this
disease which are mainly based on prevention. Therefore, surveillance is a key
means of management of control, and prevention programs for this disease. Thus,
consideration of sanitary instances is an important method for its prevention,
and the background of this disease shows that different sectors should be
responsible for its incidence and prevalence
rate reduction. Based on the official data from the Ministry of Health,
Treatment, and Medical Education of Iran, the morbidity rate of brucellosis in
Iran, and Baneh County (Kurdistan Province, Iran), respectively, were 11635,354
and 28 cases in 2010 and 14128,536 and 65 cases in 2011. Hence, this data shows that the
prevalence rate of brucellosis disease has had an ascending trend in the
abovementioned places (7-9). Therefore, the present research was designed to
conduct an epidemiological survey and to design an
intersectional interventions model for incidence and prevalence rate reduction
of brucellosis in Baneh County during 2011-2012.
Material and Methods
This cross-sectional
and analytical study is based on several data sources such as all
documents in health center and private laboratories in Baneh County and its
districts. In addition, a valid
and unique questionnaire was used for gathering data. The
total number of brucellosis patients surveyed during 2011-2012 in this research
was 135 cases. Moreover, the total number of experts who participated in this
research was 80 individuals. The demographic and laboratory information of all
cases diagnosed during 2011-2012 were studied. These
patients were diagnosed using pathological tests in health care centers or
private medical centers. Finally, all patients were categorized using a
questionnaire based on age, gender, residential area, literacy level, job, the
kind of dairy products consumed by the patient, and etcetera.
Then, SPSS software (version 19, SPSS Inc., Chicago, IL, USA) and descriptive
analysis, chi-square, and t-test were used for the statistical analysis of the
cases) P
> 0.05). In the second section of the research, the demographic,
and viewpoints of all brucellosis patients and experts were
collected in order to design an intersectional interventions model to prevent
the incidence of and reduce the prevalence rate of brucellosis.
In this study, face-to-face and cumulative interviews were performed based on a
questionnaire with all experts and patients in
Baneh County. Then, through the aggregation of all of this data, an intersectional
interventions model was designed. All patients and experts were free to participate in or leave the
study. All participants remained in the study.
Results
The
demographic data
provided in table 1 show that 43 and 92 patients lived in the city and
villages, respectively. In addition, 52% of them were men and 48% were women.
The
results presented in table 2 illustrate that the most common cause of incurring
the disease was drinking non-boiled milk. Furthermore, the majority of cases of
morbidity occurred in spring and the lowest rate of morbidity was observed in
winter. In addition, 34.07% of patients were ranchers.
Discussion
The results of this study show that most cases of brucellosis were observed
in 2012 and in the 2 previous years (2010-2012). Brucellosis had a
fluctuating trend. A study performed in East
Azerbaijan, Iran, during 8 years (3)
and a study in Arak, Iran, during 10 years showed that the morbidity
rate had fluctuated (4). This fluctuation in the morbidity rates can have
several causes; for example, inaccuracy in reportage systems, some physicians
in certain wards have no commitment to reporting morbidity cases to the
responsible offices (5). Moreover, the quality of morbidity reports depends on
the related experts following health networks of government wards.
The majority of European countries control and maintain the morbidity trend
of brucellosis at a very low level in humans through surveillance systems
(6). Based on official data from the Ministry of Health,
Treatment, and Medical Education of Iran, the morbidity rate of brucellosis in
Iran, and Baneh County were 11635,354 and 28 cases in 2010 and 14128,536 and 65
cases in 2011, respectively. This shows an ascending trend in the prevalence
rate of brucellosis (7).
In this study, data were gathered from several data sources
based on a valid and unique questionnaire. A total
number of 135 brucellosis patients were surveyed during 2011-2012 in this
research and a total number of 80 experts participated in this research. The demographic
and laboratory information of all cases diagnosed during 2011-2012 were
studied. 31.90% and 68.10% of patients lived in the city and
villages, respectively. This result is similar to that of the epidemiological
study of brucellosis in Maneh and Semelghan, North Khorasan Province, Iran, in
2008-2009 by Shoraka et al.,(8) and the epidemiological
study of brucellosis in Kurdistan Province in 2006 by Esmaeilnasab
et al (9). The similarity of morbidity rates in men and women in villages can
be due to the similarity in jobs performed by men and women and this is also
true about city residents (9, 10).
The incidence of brucellosis in terms of gender was
different. the majority of brucellosis cases (52%) were men, and the rest (48%)
were women. These results were similar to that of studies conducted in Oromieh,
Ardabil, and Kurdistan Provinces, Iran (10).
This finding shows that villagers require more educational programs.
The most common cause of the disease was drinking non-boiled
milk (31.11%). Most of the morbidity cases were observed in spring (44.40%) and
the lowest rate in winter (11.10%) (11). Furthermore, most brucellosis patients were ranchers (34.07%) (12).
These results were similar to that obtained by Esmaeilnasab et al. and Sofizadeh
et al. (13). Nevertheless, in the epidemiological
studies of brucellosis by
Farahani et al. in
Arak, Iran, in 2001-2010 and Soleimani
et al. in East Azerbaijan, Iran, in 2001-2009, the most common cause of morbidity was consuming fresh
cheese (14). Moreover, these results were similar to that obtained
by Brak et al. in their epidemiological
study of brucellosis in Ardabil Province, Iran, in 2009
(15). This shows that in order to prevent
the incidence of and reduce the rate of brucellosis more
educational programs are required.
In this study, most of the patients were ranchers, which is
similar to the result of a study performed in Uzbekistan (95.1%) (16). The
second highest rate of patients were homemakers (20.74%), which is similar to
the result of a study performed in Kurdistan Province (20.8%) (8).
In this study, 44.4% of the morbidity cases occurred in
spring, but in the studies conducted in Kashan city and Yazd Province, Iran,
most morbidity cases had occurred in the summer (65.5%) (17).
In the present study, 72.3% of the
patients had a history of contact with an animal
with brucellosis. This rate is higher than that obtained in Yazd Province
(63%), and Babol city, Iran, (54.4%) (17).
In our study, 31.11% of the patients
had consumed non-boiled
(raw) milk and 21.59%, both fresh cheese and non-boiled milk. However, in Babol, 58.1% of
patients had consumed milk and cheese (17) and in
South Khorasan Province, Iran, 30.2% of the patients had consumed milk or
cheese (18).
86.7% of the patients selected the option of “intersectional cooperation under
unique management” as the best preventive method for
brucellosis in Baneh County. An example
of intersectional cooperation under unique management is
all offices, the actions of which are related to the prevention of
brucellosis, performing their duty within a common framework provided by the
common committee.
We found 100% unanimity among experts
regarding intersectional cooperation items for
brucellosis reduction in Baneh County.
It can be deduced that intersectional interventions under
unique management through consideration of the responsibility of all sectors is
the most important way for incidence and
prevalence rate reduction of brucellosis. This conclusion is similar to that reached by Mostafavi,
Forghani (17), Hatami (18),
and Tabatabaei in their studies (19).
Conclusion
It can be concluded that intersectional interventions under
unique management through consideration of all the sectors is the most
important way for incidence and prevalence rate
reduction of brucellosis.
Acknowledgment
We gratefully acknowledge all experts, physicians,
and patients who cooperated in this study. We sincerely thank the health
personnel of Baneh Health Center for their valuable cooperation in the study.
Conflict of interest: None declared
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