Factors influencing knowledge and practices for prevention of bovine tuberculosis amongst workers at Abattoir in Karachi

Present study was designed to investigate the level of knowledge and practices for prevention of Bovine Tuberculosis amongst workers at two abattoirs in Karachi. The Data was collected from the herdsman and abattoirs worker at two abattoirs namely City Abattoir Cattle Colony in Landhi and New Karachi slaughterhouse (kamailas) which were working under Karachi Municipal Corporation.120 abattoir workers were interviewed and information was obtained, while frequency counts, percentages and independent sample ttest were used to analyze data. Data indicates the ratio of respondent including herd man and abattoirs workers having no knowledge to those having knowledge was 85:15 Statistical analysis revealed that level of education is potential factor influencing risk of BTB zoonoses amongst abattoir workers Educated respondent were having twice higher knowledge than un educated (OR 0.454, 95% CI 0.236-0.872 P < 0.024).Educated workers demonstrated three time higher practices for preventive measures than non-educated (OR 0.607, 95% CI 0.3351.102, P< 0.133). Despite having awareness amongst abattoirs worker there was lower level of good practices It was therefore concluded that along with launching awareness program from government organizations it must be ensure practical application of WHO and FAO guidelines for TB free world under one health program ending 2030.


Introduction
Bovine tuberculosis (BTB) is an important zoonotic disease. Especially in developing countries, its harmful is still serious caused by Mycobacterium tuberculosis. Amongst domestic animals cattle is the primary host of the M. bovis from where it is transmitted to the human and causes zoonotic TB [1]. Millions of deaths in human are being reported. As per data collected by World Health Organization (WHO) worldwide, during 2015about 10.4 million people developed T.B due to M. bovis and it was ranked amongst top 10 causes death. In 2016, an estimated 147,000 new human cases of zoonotic TB and 12,500 deaths due to the disease occurred globally [2]. Transmission of M. bovis to human may occur either directly by use of contaminated animal products such as milk and meat [3] or direct contact with or inhalation of the bacteria in air exhaled by infected animals during the course of slaughter [4]. M. bovis is frequently isolated from various animal organs/tissues such as lesions in the lungs and lymph nodes at slaughterhouses gestures that the disease can spread through both direct and indirect modes to human [5]. Even though direct transmission from animals to humans through the air is thought to be rare, M. bovis can be transmitted directly from person to person when people with the disease in their lungs cough or sneeze [6]. M. bovis has been incriminated together with MTC species as the cause of tuberculous lymphadenitis in humans [7]. Occupational exposures to M. bovis have been reported in many countries including Australia [8].
Karachi is thickly populated metropolitan city of Pakistan. There are officially two government approved and registered abattoirs. One is located in the Cattle Colony in Landhi and other at New Karachi where about 1,200 cows and buffaloes and around 3,000 to 4,000 smaller animals, such as goats and sheep are slaughtered on an average each day. Since the knowledge of potential risk factors of transmission of bovine tuberculosis and its preventive measures by occupation worker in slaughter house plays an important role in controlling it transmission amongst worker and also reduce implication health risk to consumers of meat. Present study was conducted assess socio demography level of awareness and practices of safety measures for preventing risk of bovine tuberculosis by occupational workers working at Abattoirs of Karachi

Material and methods Study site and population
The study was carried out at two abattoirs namely City Abattoir Cattle Colony in Landhi and New Karachi slaughterhouse (kamailas) which were working Karachi Municipal Corporation. A whole of a hundred twenty (n=120) employee working at abattoirs were chosen as respondents furnishing data for the study.

Study design
This study primarily based on quantitative questionnaires to reply questions on focus and workout with suppose about to hygiene among abattoir workers. Awareness and attention have been decided by way of the use of structured interview and through direct observations of the hygienic frame and practices through abattoir workers.

Data collection
Data was collected from the respondent (abattoir workers) through direct interview and information was recorded on pre structured questionnaire. The questionnaire consisted of three sections; 1) Sociodemographic socio-demographic characteristics such as age, gender, level of education, experience; 2) knowledge of awareness safety practices (workers self and slaughter house); 3) Utilization or practice of safety measures (worker self and slaughter house. Respondent answer was recorded as "yes", "no" Statistical analysis Data collected was transferred in excel sheet and analyzed using Excel Stat statistical software. The odd values and ratios were calculated to determine difference between the strength of groups in variables. Probability values were also calculated at 95 % CI to determine the significance levels.

Socio-demographic characteristics of respondents
The data was collected from two abattoirs first city abattoir cattle colony and second new Karachi slaughter house (kamilas). A total of 120 respondents of first including 47 herdsmen (39.1%) and 73 abattoir worker (60.8 %) were interview through pre-prepared survey questionnaire. The data reveals that amongst respondents interviewed at both abattoirs percent of highest frequency of respondent were aged between 21-40 years (58%). Amongst workers higher number was having no formal education i.e. 71 (59.17) as compare to those having formal education 49 (40.83%).Majority of worker were married and having experience of above 20 years (Table 1).  Pakistan is one of the developing countries where majority of rural population have very close contact with animals due their animal housing system. Besides direct exposure of the animal to human there is contact of abattoir workers to the animals which are brought for slaughter. It was hypothesized that slaughter houses may be the site for high risk of transmission of BTB not only amongst the occupassional workers at abattoir but also to human population if preventive measures are not taken properly during slaughter procedures. Present study was designed to collect information regarding level of knowledge and Practice for preventive measures of zoonotic risk of BTB amongst abattoir workers and herdsman. In present study only 15 % including abattoir workers and herdsman were knowledgeable about BTB and on only 30 percent were found demonstrating practices to control zoonosis of BTB. [9] have reported that only 32.55% of the respondents (cattle owners) were aware of BTB and 23.25% recognized that BTB is zoonotic. The results of current study also shows the similar trend as observed by [9] that very less number of respondents were aware of the BTB and its potential risk of transmission to contact persons. It has been indicated by. [10, 11] such low level of awareness about zoonotic risk of BTB and potential risk factor such as consumption of infected food poor sanitary measures may be threat to public health. Awareness Personal safety measure amongst abattoir worker and its practice of is important to reduce risk of transmitting infection by contact with infected animals. During current study it was recorded that less than 40% workers had knowledge about their personal safety measure and amongst those only 2-3 percent were actually practicing. Wearing protective clothing within the slaughterhouse can protect meat handlers against directly transmitted zoonotic infections [12][13][14]. In present study the level of awareness and facilities available for sterilizing clothing, knives and other equipment by workers was less than 20 percent and only 0.6 percent practices were being carried out.
[15] also reported that workers at abattoir were very less aware that they protect themselves from risk of getting and transmitting M.bovis infection if they do not handle meat with bare hands or injured hands. They emphasized that abattoir workers should be educated and aware about zoonotic transmission of BTB through electronic media. Similar conditions are prevailing in Pakistan. The results of present study are in contrary to those of [16] who conducted study in Nigeria during 2015.They found that respondents were good in knowledge about zoonotic TB prevention but they avoid demonstrating good practice. The ration of good practice was almost half of the respondent knowledgeable. The livestock worker in developing countries does not care about their health [17,18]. In present study the responses of respondent towards knowledge was poor but amongst that good number were demonstrating practice to control zoonosis of BTB. Education level significantly influences the knowledge and practices for prevention of zoonotic TB. Present study showed that formally educated respondents were more aware and were demonstrating good practices than those having no education. [18] have reported that education level of the abattoir worker imposes great impact on their level of knowledge and practices to prevent themselves from BTB. Similar reports have been made in Edo and Zamfara States, Nigeria [19,20], Tanzania [22] as well as China [21], showing that education contributes significantly to knowledge and practices regarding TB. [22,23] found that livestock owners and workers living in rural areas which are very far from the cities have either no or less access to educational institutes therefore could not get chance to obtain education thus remain illiterate. Similar conditions are seen in our country. Majority of workers at abattoir are either from rural areas or belongs to poor families and their socioeconomic conditions and liabilities does not allow them to get even primary education so remain uneducated and they have remained mostly neglected by the policy makers.

Conclusion and recommendations
It was concluded from the results of present studies that there is lapse of awareness amongst herdsman and abattoir worker for control and prevention measure of zoonotic TB. Therefore it is recommended that Livestock department with help of meat inspectors should educate the butchers and their associated helping personals about risk of BTB transmission from animals to workers. The must be provided training for proper personal safety measure and slaughter procedures. Meat inspectors must ensure that contaminated meat parts and visceral organs must be properly disposed off and incinerated to avoid exposure of infection to surrounding human population.