Knowledge, attitude and practices (KAP) towards Anthrax among livestock farmers in selected rural areas of Bangladesh

Abstract Background Bacillus anthracis is a zoonotic bacterium that affects wide numbers of vertebrate animals and man and has life threating potential both in animal s as well as humans. Methods A cross sectional study was conducted to assess the knowledge about, attitudes towards, and practices addressing (KAPs) anthrax among community members in selected upazillas’ of Meherpur and Sirajgonj districts for the prevention and control of anthrax using a structured questionnaire. Results A total of 424 community members were considered in this study irrespective of their age and sex. Most of the respondents were female (57.54%) and about half were illiterate (47.40%). Most of the respondents (86.32%) were self‐employed with crop and livestock farming. Among the self‐employed farmers, cattle (63.73%) were the highest reared animals. Among the respondents, 37.26% had no knowledge about anthrax. On the other hand, among the existing knowledge level, 46.69% received information of anthrax from neighbour, 74.05% and 56.82% were concerned about the mode of transmission of anthrax from animal to human through eating, handling and soil. Respondents usually collected vaccine from quack (58.25%) and vaccination status was highest in Kamarkhand (52.03%) and lowest in Gangni upazilla (10.82%). Overall 62.74% community members considered that anthrax is a fatal disease for livestock and 82.54% people disposed carcass in buried method. Conclusion The study findings indicated that the community members had average knowledge on cause, symptoms, transmission and prevention of anthrax. The supplied vaccine was found negligible with the number of livestock in the studied upazilas. Veterinary and Medical health planners should design and implement interventions for awareness building on anthrax under One Health (OH) approach for educating the community people on anthrax control and prevention.


INTRODUCTION
Anthrax is a zoonotic disease that affects humans, livestock, companion animals and wild-lives (Fasanella et al., 2010). It is a rare disease in developed countries (Dragon & Rennie, 1995), but still an endemic disease in developing countries (Shivachandra et al., 2016). The causal agent of anthrax, B. anthracis establishes a bimodal lifecycle where spore form is developed in the environment and vegetative form within the host. The spores can survive in the environment at adverse condition for several years and initiate infection when favourable conditions are provided (Raymond et al., 2010). The livestock sector is an important sector to improve the livelihood of the majority of rural people in many developing countries (Dey et al., 2020). They provide food, companionship, socio-cultural activities and are a source of income in various ways as they have an important economic role by sale and services of these animals and their products .
This dependence on livestock makes people vulnerable to zoonotic diseases. Anthrax is considered as the second prioritized zoonotic disease in Bangladesh . Livestock rearing system plays a vital role in transmitting anthrax from animal to human where there is a close contact between animals and owners. Cattle are mainly affected by anthrax among other herbivores due to its grazing nature. Bovine anthrax outbreak and mortality are four times and thirteen times more than sheep anthrax outbreak and mortality, respectively. Along with animal anthrax, about 20,000-100,000 incidence of human anthrax occur per year globally with significant economic loss (Dutta et al., 2011). Since  .Outbreak of animal anthrax in a particular area mostly associated with ecological, demographic, and sociocultural factors (Sitali et al., 2018). Human anthrax is very much linked with animal anthrax. Human anthrax infection has been categorized into Agricultural and Industrial. Human get infection from infected or dead animals accidentally, during slaughtering (agricultural) or from cleaning or processing of infected animal products and byproducts such as contaminated meat, hair, wool, hides and skin (industrial) (Bischof et al., 2007).

Ethical statement
Ethical approval was obtained from concerned authority, that is, ERB of AIUB, during data collection. Respondent's dignity and respects were maintained and interviews were taken with strict privacy. There were no potential risks that might cause any harm to study respondent. They were ensured that their personal identity was kept confidential and the data will be used only for study purpose. Moreover, respondents were allowed to withdraw themselves at any stage of the study.

Study design and location
A cross-sectional descriptive study was conducted in Meherpur and Sirajgonj District for the period of 6 months from September, 2019 to February, 2020. Six upazilla (small administrative area) including Shahajadpur, Ullahpara, Kamarkand, Belkuchi, Raiganj, Sirajgonj sadar from Sirajgonj district and one upazilla including Gangni were considered for this study ( Figure 1).

Study population
Purposive sampling was conducted to identify respondents. The purpose of collecting this information was to compare level of knowledge, attitudes and practices among community members who raised livestock. After explaining the purpose of the study and obtaining verbal consent, face-to-face interview was taken using the questionnaire.
Respondents were provided with a detailed explanation of each question in a language in which they are conversant. They were assured that the supplied information will be kept confidential and will be used only for the study purpose.

Sample size calculation
In order to generate sufficient information of the knowledge, attitudes and practices regarding anthrax among community members in Meherpur and Sirajgonj, sample size was determined by the

Development of research instrument
Self-structured questionnaires were used for data collection from com-

Data analysis
At the end of each day of data collection, all questionnaires were handed over and reviewed by the investigator to ensure that all variables had been correctly filled. Data from household questionnaires were entered into Excel spreadsheet, scored and further exported to SPSS for descriptive analysis. Data collected through key informant interviews was analysed using thematic analysis procedures.
The data were used to compliment and elaborate quantitative findings and clarify relevant aspects of anthrax related practices and behaviour.

Socio-demographic characteristics of participants
The study area covered six upazillas in Shirajganj district and one upazilla in Meherpur district and a total of 424 participants were considered in different upazillas. The socio-demographic characteristics of the participants in the study area had been represented in the Table 1. All the participants were between 20 and 69 years of age, however, most of them were of middle age (30 and 49 years old-54.94%). The majority participants were female (57.54%). About half of the participants (47.42%) had no formal education and more than half of the participants were literate at different level such as primary level (32.78%), secondary level (8.49%) and tertiary level (11.32%).
According to occupation, participants mainly were based on agriculture (86.32%), that is, self-employed with crop and livestock farming, and only few were involved in household works (10.14%) and business (3.53%). In the study area, farmers predominantly reared cattle (63.73%) as the main source of income to increase their livelihood followed by goats (29.60%), sheep (6.39%) and buffaloes (0.28%).

Knowledge of participants towards anthrax
Responses of participants pertaining to their knowledge towards anthrax had been shown in the

Attitude and practices of respondents towards anthrax
Vaccination is one of the most important preventive measures in any infectious disease. The vaccination status of different upazillas was assessed according to data from register book of Govt. Veterinary Hospital. The highest vaccination status was found in Kamarkhand upazilla (52.03%) followed by Ullahpara (39.80%), Belkuchi (33.33%), Rajgonj (19.49%), Sirajgonj sadar (16.71%), Shahjadpur (12.53%) and Gangni (10.82%). In the study areas, most of the participants (58.25%) collected vaccine from quack followed by Govt. Veterinary Hospital (36.79%) and least of the participants collected vaccine from pharmacy (3.07%) and other source (1.88%). Only one-third (29.48%) participants were interested to vaccinate their animals against anthrax. Most of the

DISCUSSION
B. anthracis is a Gram-positive, spore-forming bacterium and remains an important global public health problem particularly in developing countries. Globally, there are around 1.83 billion people living within anthrax-risk areas, It may be categorized as emerging, re-emerging and neglected zoonotic disease (Ngetich, 2019) and a considerable economic loss for the smallholder farmers is associated with reduced performance and sudden death of animals by anthrax (Nayak et al., 2019). Limited general public awareness campaigns have been conducted across the globe.
Anthrax is most common in agricultural regions of Central and South America, sub-Saharan Africa, Central and Southwestern Asia and Southern and Eastern Europe (Sweeney et al., 2011). Globally, about 63.8 million poor farmers and 1.1 billion livestock were exposed to anthrax infection (Carlson et al., 2019). Among south Asian countries, Bangladesh and India are endemic for anthrax (Nayak et al., 2019). But in this endemic area, anthrax monitoring programs such as diagnosis, case recording and submission of the data to the central authority remain inadequate (Sahoo et al., 2020). Southeast Asian countries (Islam et al., 2013). In Bangladesh, due to cultural restriction of consuming dead animals, they slaughtered their animals when the animals are recumbent and involved in selling meat of slaughtered sick animal to recover at least their investment (Ngetich, 2019). Low socioeconomic status and poor education background combined with poor public health infrastructure creates critical conditions that are conducive for zoonotic transmission of anthrax to the human population (Patil, 2010).
Routine vaccination policy is one of the better strategies for prevention and control of anthrax (Kasradze et al., 2018;Mwakapeje et al., 2018;Traxler et al., 2019). The study areas are endemic for anthrax but the vaccination status in different upazillas were not satisfactory. The In this survey, about 47.41% participants were illiterate. Due to illiteracy, livestock farmers hiding the truth, especially where they were affected negatively or involved with inappropriate activities like slaughtering of sick animal and subsequent selling and consumption of meat from a suspected carcass or even did not report the cases to the relevant authority. Poor public health infrastructure in endemic districts exposes areas to higher anthrax risk (Bhattacharya & Pati, 2019;Patil, 2010;Pérez-Tanoira et al., 2017;Vaismoradi et al., 2013). However, proper, timely and efficient farmers' reporting of animals' sudden deaths, alongside accurate and robust diagnosis of anthrax put in place by the Veterinary services increased confirmed anthrax cases than expected in the rural communities. These findings are consistent with the previous findings of the researchers (Shabani et al., 2015) regarding KAP on Rift Valley Fever (RVF), which outlined that most participants were not sincere where they were affected negatively, and also where the outbreak was highly publicized with high morbidities and mortalities in both humans and animals.
Disposal of the carcass of animals is a source of concern for anthrax transmission. The preferred method of disposal of anthrax infected animal is incineration/buried in the most of the developing countries.
In Bangladesh, social-cultural activities do not allow to burn carcass.
In this study, 82.54% participants practice buried method but rest of the participants disposed carcass by throwing in water/roadsides and allowing cobbler for skinning. Carnivores and birds play a vital role to drag contaminated meat over the areas, thus, increasing ground contamination with anthrax spore. Dog itself is resistant to anthrax but acts as a mechanical vectors from field to household (Turnbull, 1998).
Proper and early diagnosis is one of the important components for treatment, prevention and control of anthrax. But diagnostic facilities were insufficient in the endemic districts, which is similar with the observations from other studies in Asia and Africa (P. P. Nayak et al., 2019;Vaismoradi et al., 2013). It was revealed that timely diagnosis can control the outbreak of anthrax (Sahoo et al., 2020).

CONCLUSIONS
To the best of our knowledge, this is the first study to address the perspectives of smallholder farmers regarding anthrax in Bangladesh.
The study revealed that majority of the community members had idea about anthrax and its symptoms in animals and humans. But about half of the participants did not know the mode of transmission of anthrax.
The vaccination status was below 50% within the studied area except Kamarkhand (52.04%) and also most of the farmers did not show interest to vaccinate their animals. Participants showed positive attitude in affected animal slaughtering and carcass management. It is necessary to ensure increased public awareness on vaccination of the livestock population along with sufficient coverage of the anthrax vaccine that will make a large contribution to the control of anthrax outbreaks.