JINKA UNIVERSITRY

COLLEGE OF AGRICUTURAL AND NATURAL RESOURCE

DEPERATMENT OF VETERINARY SCEINCE

STUDY ON ASSESSMENT OF COMMUNITY KNOWLEDGE, ATTITUDE AND

PRACTICES TOWARD BOVINE TUBERCULOSIS IN JINKA TOWN,
SOUTHERN ETHIOPIA
BY
SULTAN MOHAMMED
ALEMITU KETEMA
METADEL MOLTO

MAY, 2023
JINKA, ETHIOPIA
 Jinka University
College of Agricultural and Natural Resource
Department of Veterinary Science
By
Sultan Mohammed
Alemitu Ketema
Metadel Molto
A study on Assessment of Community Knowledge, Attitude and Practices Toward
Bovine Tuberculosis in Jinka Town, Southern Ethiopia

A Thesis Submitted to College of Agricultural and Natural Resource, Department of

Veterinary Science, Jinka University

Advisor (s): Dr. Asrat Solomon Signature________________ Date_____________

Evaluator (s)
Name Signature Date
1.___________________________________ _____________ ______________
2.___________________________________ _____________ ______________
3.___________________________________ _____________ ______________
May, 2023
Jinka, Ethiopia
AKNOWLEDGEMENT

First of all, our thanks go to the almighty GOD who is the beginning and final of all
things. We would again thank our advisor Dr. Asrat Solomon for his intellectual
guidance, correction and suggestion in writing this paper and the staff members of Jinka
University Department of Veterinary Science.

i
TABLE OF CONTENTS
PAGE
AKNOWLEDGEMENT ...................................................................................................... i
LIST OF TABLES ............................................................................................................ iv
LIST OF ABBREVIATIONS .............................................................................................v
LIST OF FIGURES .......................................................................................................... vi
LIST OF ANNEXES........................................................................................................ vii
Abstract ............................................................................................................................ viii
1. INTRODUCTION....................................................................................................... 1
1.1. Background of the Study ................................................................................... 1
1.2. Statement of Problem......................................................................................... 3
1.3. Objective of the Study ........................................................................................ 4
1.3.1. General Objective ......................................................................................... 4
1.3.2. Specific Objective.......................................................................................... 4
2. LITERATURE REVIEW ........................................................................................... 5
2.1. Tuberculosis ........................................................................................................ 5
2.2. Etiology................................................................................................................ 5
2.3. Transmission ....................................................................................................... 5
2.4. Pathogenesis ........................................................................................................ 6
2.5. Clinical Signs ...................................................................................................... 7
2.6. Diagnosis ............................................................................................................. 7
2.6.1. Tuberculin skin test ....................................................................................... 7
2.6.2. Acid-fast Staining .......................................................................................... 8
2.6.3. Enzyme-Linked Immuno Sorbent Assay (ELISA) .......................................... 9
2.7. Treatment ............................................................................................................ 9
2.8. Public Health Importance ................................................................................. 9
2.9. Economic Important of Bovine Tuberculosis ................................................ 10
2.10. Control and prevention ................................................................................ 10
3. MATERIALS AND METHODS .............................................................................. 12
3.1. Description of the Study Area ......................................................................... 12
3.2. Study Population .............................................................................................. 12

ii
 3.3. Study Design ..................................................................................................... 12
3.4. Sample Size Determination ............................................................................. 13
3.5. Method of Data Collection .................................................................................. 13
3.5.1. Questionnaire Survey ...................................................................................... 13
3.5.2. Retrospective Data .......................................................................................... 14
3.6. Data management and Analysis ...................................................................... 14
4. Result ........................................................................................................................ 15
4.1. Socio Demographic Characteristics of Respondents in Jinka Town ............... 15
4.2. Knowledge of Respondents on Bovine Tuberculosis..................................... 16
4.3. Relation-Ship Between Knowledge about Bovine Tuberculosis and the
Independent Variables ................................................................................................ 17
4.4. Attitudes Toward Disease prevention ............................................................ 18
4.5. The Relation Ship Between Educational Level and Preventive Practices .. 18
4.6. Relation Ship Between Consumption of Raw Milk and Independent
Variables ...................................................................................................................... 20
4.7. Retrospective Data Results .............................................................................. 21
4.7.1. Trend of Pulmonary and Extra Pulmonary TB in Human .......................... 23
5. DISCUSSION ........................................................................................................... 24
6. CONCLUSION AND RECOMMENDATIONS ...................................................... 29
7. REFERENCES ......................................................................................................... 30
8. ANNEX 1 .................................................................................................................. 38

iii
LIST OF TABLES
Table1: Socio demographic characteristics of respondents----------------------------------15

Table 2: Knowledge of respondents regarding to BTB---------------------------------------16

Table 3: Relationship between Knowledge and the variables--------------------------------17

Table 4: Relationship between education and preventive----------------------------------19

Table 5: Relationship between consumption of raw milk and variables--------------------20

Table 6: Retrospective data result based on sex groups---------------------------------------21

Table 7: Retrospective data result of pulmonary and extrapulmonary TB based on sex

and age groups -------------------------------------------------------------------------------------22

iv
LIST OF ABBREVIATIONS

AIDS: Human Immuno Deficiency Syndrome

BTB: Bovine Tuberculosis
CSA: Central Statistical Agency
GC: Gregorian Calender
HIV: Human Immuno Deficiency Virus
KAP: Knowledge, Attitude, Practice
KM: Kilometer
OIE: Office of International des Epizootics
SITT: Single Intra Dermal Tuberculin Skin Test
WHO: World Health Organization

v
LIST OF FIGURES

Figure 1: Trend of pulmonary and extrapulmonary TB----------------------------------23

vi
LIST OF ANNEXES
Annex 1 Questionnaire------------------------------------------------------------------------38

vii
ABSTRACT

Bovine tuberculosis (BTB) is yet a major public health problem through out the world,
including African countries like Ethiopia. This is due to lower knowledge, attitude, and
practice (KAP) of the people about the disease. A cross-sectional study was carried out
from March 2023 to May 2023 to assess the community knowledge, attitude, and practice
on Bovine Tuberculosis in Jinka Town. Questionnaire survey and retrospective data were
used as a tool for data collection. Among 382 respondents, 254 (66.5%) knew about
BTB, where as 128 (33.5%) respondents did not have any idea about the disease. Except
sex, other predictors like age, marital status, educational level and occupation were
significantly associated with knowledge and preventive practices towards BTB.
Respondents had misconceptions on zoonotic importance of the disease and 95 (24.87%)
respondents consume raw milk. Regarding retrospective data result, among 1278 patients
examined for TB, 316 (24.7%) and 5 (0.39%) were positive for pulmonary and extra
pulmonary TB in 2020 G.C. During 2021 G.C, among 1066 patients examined for TB,
190 (17.8%) and 12 (1.12%) patients were positive for pulmonary and extra pulmonary
TB respectively. Number of patients for pulmonary and extrapulmonary were increased
to 18.25% and 4% respectively in 2022 G.C. Since there were misconceptions among the
respondents, awareness creation and detailed investigation on the status of Bovine and
human TB was recommended.

Keywords: Attitude, Bovine Tuberculosis, Jinka town, Knowledge, Practice

viii
1. INTRODUCTION

1.1.Background of the Study

In many developing countries, livestock rearing/raising is one of the most important

strategies to improve the living standards of the people (Gebeyaw, et al.,2020). More
over, Livestock production is important to the national economy in Sub-Saharan
Africa, and it improves community livelihoods in rural areas (Fesseha, et al.,2020).

Ethiopia boasts Africa's greatest animal population, with 59.5 million cattle, 1.21
million camels, 30.7 million sheep, 30.20 million goats, 5.53 million chickens, 2.16
million horses, 8.44 million asses, and 0.41 million mules (CSA, 2017). Despite the
abundance of cattle in the country, the livestock sub-sector is generally less
productive, its capacity is small, and its direct contribution to the national economy is
minimal (Shitaye, et al.,2007).

In Ethiopia, the endemic nature of tuberculosis in cattle has been long reported,
indicating tuberculosis was widespread in both human and cattle population
According to (Ejeh et al,.2013), the surveys in Ethiopia on the socio-economic
conditions indicated that low standard in the living areas for both animals and humans
was having a significant contribution to TB transmission between human to human,
human to cattle, and vice versa.

Bovine Tuberculosis (TB) infection is generally defined by the formation of tubercles, which
are distinct granulomatous lesions in affected organs and tissues with variable degrees of
calcification, necrosis, and encapsulation (Thakur, Sood, and Gupta 2020).

Bovine tuberculosis (BTB) is known to have a public health importance being

transmitted from infected animals to humans through close contact and ingestion of
raw animal products (Ashford et al., 2001, Pal et al., 2014). The disease has remained
as a major public health concern globally and responsible for poor health condition
suffered among millions of People every year.

This disease is the second main cause of death from an infection disease world-wide,
after the human immunodeficiency virus (HIV). Tuberculosis (TB) is one of the most
serious public health issues in the world, infecting billions of people each year and
ranking as the second highest cause of death from an infectious disease behind
1
HIV/AIDS. In 2013, about 9 million new TB cases and 1.5 million TB deaths were
estimated. About 85 percent of the disease burden is found in Asia and Africa (WHO,
2014). The TB situation has worsened over the last three decades, which can be
attributed to the HIV/AIDS pandemic (Getahun et al., 2010).

Drinking raw milk is a primary route of M. bovis infection of humans; hence, the
occurrence of human tuberculosis is most commonly in the extrapulmonary form,
particularly resulting in the cervical lymphadenitis (Ayele et al., 2004).

Ethiopia has one of the world's highest rates of human tuberculosis, which is
primarily caused by Mycobacterium tuberculosis. The country remains a hotspot for
zoonotic illnesses like bovine tuberculosis, putting public health and the cattle
industry at risk (Pal, et al.,2014). The standard method for detection of tuberculosis is
the tuberculin test, where a small amount of antigen is injected into the skin, and the
immune reaction is measured. Single intra dermal tuberculin skin test (SITT) is the
test that bovine tuberculin injection can be at the site of hairless area of caudal fold to
observe the skin reaction against M.bovis (Gizaw, et al.,2020).

It is imperative that tuberculosis positive animals must be slaughtered (culled);

hygienic measures to prevent the spread of infection should be instituted as soon as
the first group of reactors is removed. Feed troughs should be cleaned and thoroughly
disinfected with hot, 5% phenol. In general terms, control measures of bovine
tuberculosis in the traditional extensive production systems are more difficult and
complex (OIE, 2009).

2
1.2.Statement of Problem

Bovine tuberculosis is a zoonotic disease transmitted from animal human. It makes a

significant economic impact. The economic impact comes from high cost of
eradication programs and has serious consequences for movements of animals and
their products, biodiversity, public health and significant economic effect (Le Roex et
al., 2013, Rodriguez-Campos, et al., 2014). Zoonotic tuberculosis incidence is higher
in some regions and countries than others, particularly where there is a close
association between number of cattle (the major source of M. bovis) and people where
milk and dairy products are often consumed unpasteurised (Kock, et al., 2021).

Ethiopia is one of the African countries where BTB is considered as protruding

disease in animals. Detection of BTB in Ethiopia is carried out most commonly on the
basis of tuberculin skin testing, abattoir meat inspection and rarely on bacteriological
techniques (Ameni et al., 2003). But various studies have indicated a critical
knowledge gap towards bovine tuberculosis in Ethiopia (Ameni et al., 2011).
Researchers conducted milk borne zoonosis so far in Jinka town indicated that there is
still a gap in KAP towards the zoonotic diseases. The KAP towards BTB alone was
not studied in Jinka town and that is why the current research was contemplated in the
study area. Therefore, the objective of this study was to assess the knowledge, attitude
and practices toward Bovine tuberculosis in Jinka town of southern, Ethiopia.

3
1.3.Objective of the Study

1.3.1. General Objective

❖ The aim of this research was to determine the level of knowledge, attitude and
preventive practice on bovine tuberculosis in Jinka town, SNNP State.

1.3.2. Specific Objective

➢ To assess the knowledge, attitude, and practices toward BTB in Jinka town
➢ To determine the socio-demographic Characterstics the community in Jinka town.
➢ To determine the level of knowledge on human and animal BTB
➢ To determine the predictors of knowledge, attitude and preventive practice

4
2. LITERATURE REVIEW

2.1. Tuberculosis

Bovine Tuberculosis (BTB) is an important zoonotic disease caused by

Mycobacterium bovis, known to exist in all parts of the world (Rahman et al., 2008,
Samad, 2011). Tuberculosis is an important bacterial disease in humans and animals
world wide (Uduak, 2015). WHO classified bovine tuberculosis among seven
neglected zoonotic diseases having potential to infect human (Ereqat et al.,2013).

2.2. Etiology

Genus Mycobacterium is characterized phenotypically as non-motile, no capsular,

non-spore forming, obligate aerobic, thin rod usually straight or slightly curved
having 1 - 10 μm length and 0.2 - 0.6 μm width, facultative intracellular microbe and
has a slow generation time about 15 - 20 hours (Zenebe et al.,2014)

Mycobacterium bovis belongs to the Mycobacterium tuberculosis complex (MBTC)

group that also comprises M. tuberculosis, M. caprae, M. microti, M. africanum, M.
canettii, M. pinnipedii, M. bovis BCG, M. leprae, and the recently identified M.
mungi. These pathogens has the same 16S rRNA sequence and up to 99.9%
nucleotide identity (Borham et al.,2022)

M. bovis may persist in the environment for several months, especially in cold, dark,
and wet circumstances. The survival time varies from 18 to 332 days at 12°C-24°C
(54°F-75°F) depending on sunshine exposure (Verma et al,.2014).

2.3. Transmission

Bovine tuberculosis is transmitted from animals to humans through the consumption

of raw animal products and uncooked meat, which can affect the gastrointestinal tract
and spread to other organs. It is also transmitted from contaminated animals to others
through the air or contaminated feed, as well as when the animals’ materials are
contaminated (WHO 2013).

5
The likelihood of transmission is influenced by the likelihood of contact with
someone who has an infectious form of tuberculosis, the intimacy and length of that
contact, the degree of infectiousness of the case, and the divided environment in
which the encounter occurs (Nicas et al., 2005)
Animals transmit infection to each other through ingestion of urine, faeces and lymph,
wound discharge, infected milk along with food and water.

Transmission could have been by aerosols or contamination of fodder due to

indiscriminate spitting. Milk and meat are one of the most important links between
bovine tuberculosis and human beings especially children (Leite et al.,2000). Bovine
tuberculosis can be transmitted through air that exhaled, sputum, urine, feces as well
as pus (Phillips et al., 2003).

Vertical transmission can also occur in infected females. The uterus may serve as a
portal for foetal infection and surviving calves commonly develop liver and spleen
lesions (Biberstein et al.,1999) People working in animal husbandry, slaughterhouse
workers, veterinarians, and people in close contact with possibly-infected animals are
at a higher risk for M. bovis infection (Cousinis et al,.1998).

2.4. Pathogenesis

The bacteria usually enter the respiratory system of a cow and settle in the lungs.
Macrophages in lungs are then responsible for phagocytizing the organism. When
bacterium enters a herd of cattle through aerosolized droplets or ingestion, it becomes
entrenched. The incubation period can range from months to years with the severity
depending on the immune system of each individual animal (Jemberu et al.,2015).
The organism replicates intracellular after it has been taken up by the macrophages. A
granuloma or tubercle forms as the body tries to wall off the infected macrophages
with fibrous tissue. The granuloma is usually 1 - 3 cm in diameter, yellow or gray,
round and firm. On cut section, the core of the granuloma consists of dry yellow,
gaseous, or necrotic cellular debris. The infection can spread hematogenously to
lymph nodes and other areas of the body and cause smaller, 2 – 3 mm in diameter,
tubercles. The formation of these smaller tubercles is known as “military
tuberculosis” (OIE 2009).

6
2.5. Clinical Signs

The classic clinical features of bovine tuberculosis include chronic cough, sputum
production, appetite loss, weight loss, fever, night sweats and hemoptysis (Lawn et
al.,2011). The generalized clinical signs, such as progressive emaciation, lethargy,
weakness, anorexia and fluctuating fever also noticed. Localized disease can affect
the lymph nodes, skin, bones, and joints, genitor urinary system, meanings or
respiratory system (Gordon et al., 2011)
Animals infected with M. bovis have low-grade fever, chronic intermittent hacking
cough and associated pneumonia, breathing difficulties, weakness and loss of
appetite, emaciation and swelling of superficial body lymph nodes (Herenda et
al.,2001). Early clinical features of BTB include chronic cough, sputum production,
decreased appetite, weight loss, fever, night sweats and hemoptysis. Common clinical
symptoms include persistent irritability, weakness, anorexia and flu-like fever. Local
diseases can affect the lymph nodes, skin, bones and joints, the genitourinary
system, the definition or the respiratory system (Ameni et al,.2011).

2.6. Diagnosis

2.6.1. Tuberculin skin test

The skin tests are the international standard for ante mortem diagnosis of bovine TB
in cattle herds and individual animals. They are based on eliciting a delayed-type
hypersensitivity response to the intradermal injection of tuberculin, a crude protein
extract from supernatants of mycobacterial cultures and in short, the glycerol extract
of pure liquid cultures of tubercle bacilli is called purified protein derivative
tuberculin is used in countries world-wide (Anon et al,.2004).

This test is the standard method for detection of bovine tuberculosis. It involves
measuring skin thickness, injecting bovine tuberculin intradermally into the measured
area and measuring any subsequent swelling at the site of injection 72 hours later. The
comparative intradermal tuberculin test with bovine and avian tuberculin is primarily
used to distinguish between M. bovis infected animals and those sensitized to
tuberculin due to exposure to other mycobacteria single intra dermal tuberculin skin
test (SITT) is the test that bovine tuberculin related genera.

7
Definitive diagnosis is made by culturing the bacteria in the laboratory, a process that
takes at least eight weeks (Kwaghe et al.,2011).

Single Cervical Tuberculin (SCT) test:

The single cervical tuberculin test is a primary test used by intra-dermal injections of
0.1ml of PPD-B tuberculin in the mid cervical area with a reading by visual
observation and palpation at 72 hours following injection. The positive reaction
constitutes a diffuse swelling at the site of injection (Radostits et al,.2007)

Single Intradermal Comparative Cervical Test (SICCT):

It measures hypersensitivity to tuberculin (both for M. bovis and M. avian) injected

into the neck of cattle. The results are read after 72 hours. It compares the responses
of M. bovis and M. avium. It only assumes that infection with M. bovis promotes a
larger response to M. Bovis tuberculin than to M. avium tuberculin and that infection
with other types of mycobacterium promote the reverse relationship (Morrison et
al,.2000). When the change in skin thickness is greater at the avian PPD injection site,
the result is considered negative for BTB.
Thus, if increased in the skin thickness at the injection site for the bovine (B) is
greater than the increase in the skin thickness at the injection site at the avian (A) the
animal is positive for bovine TB (Rhodes et al,.2012).

2.6.2. Acid-fast Staining

M. bovis can be demonstrated microscopically on direct smears from clinical samples

or prepared tissue materials. The acid fastness of M. bovis is normally demonstrated
with the classic Ziehl Neelsen stain. The stained slides are observed with an ordinary
light microscope for the presence of acid-fast bacilli, which appear as red, colloidal or
bacillary cells 1-3 microns in length occurring singly or in clumps and it considered as
positive when 1 or more acid-fast bacteria were detected in at least 1 section of the
sample (Birhanu et al., 2015).

8
2.6.3. Enzyme-Linked Immuno Sorbent Assay (ELISA)

In the contest of tests based on cellular immunity, ELISA has proven to be the best
choice and can be a complement, rather than an alternative. It may be helpful in
anergic animals for detection of antibody (Lilenbaum et al,.2006). An advantage of
the ELISA is its simplicity, but both specificity and sensitivity are limited in cattle,
mostly due to the late and irregular development of the humoral immune response in
cattle during the course of the disease (OIE, 2009).

2.7. Treatment

The treatment of animals with tuberculosis is not a favored option in eradication in the
conscious countries, and is not considered economical. Furthermore, the long-term
therapy requirement of the disease can create the chances of development of
multidrug resistant (Waters et al,.2015). Isoniazid, streptomycin-para-aminosalicylic
acid, and other acids are commonly used in the treatment of human tuberculosis. The
need for long-term therapy for the condition can lead to the development of multidrug
resistant bacteria (Verma et al,.2014).

2.8. Public Health Importance

Mycobacterium bovis is not the major cause of human tuberculosis, but humans
remain susceptible to bovine tuberculosis (Bulto et al.,2012).
Humans can be infected primarily by ingesting the agent by drinking raw milk
containing the infective bacilli, secondly, by inhaling infective droplets when there is
close contact between the owner and his/her cattle, especially at night since in some
cases they share shelters with their animals. In some countries, it is estimated that up
to 10% of human tuberculosis are due to bovine tuberculosis (Gebremedhin et a.,
2014). Further more, M. bovis can infect by consuming raw meat and their products
from infected animals (Malama et al., 2013) or by inhaling infective droplets or direct
exposure to infected animals (Verma et al., 2014).

9
2.9. Economic Important of Bovine Tuberculosis

Tuberculosis is a major importance in dairy cattle due to high morbidity and loss of
production as infected animals lose 10%-25% of their productive efficiency (Verma et
al., 2014). Financial burden due to loss of productivity to the livestock sector can be
explained through reduction of milk production, carcass condemnation and death of
animals (Getachew et al.,2020).
The costs of disease control (testing and compensation fees, losses from animal
movement and sale restrictions), as well as lower milk and meat output, all result in
financial losses (Abebe et al.,2020). The disease is a barrier to socioeconomic
development; 75% of TB patients are between the ages of 15 and 54, when they are
most economically active. The national economy may suffer as a result (Kirubel et
al,.2021).

2.10. Control and prevention

Many developed countries have successfully controlled bovine tuberculosis through

the use of a test slaughter method in conjunction with milk pasteurization. The culling
of animals however, presents financial challenge for developing countries like
Ethiopia. As a result, the second option, pasteurization of milk, must be used as this
practice blocks the transmission path of M. bovis from animal to human with
minimum cost (Firdessa et al..2012). In developed countries, bovine tuberculosis has
nearly been eradicated or drastically reduced in farm animals to low levels by control
and eradication programs. These procedures, however, cannot be implemented in
Ethiopia due to a variety of factors, including a lack of understanding about the
disease's actual prevalence and the current technological situation and financial
limitations, lack of veterinary infrastructures, cultural and/or traditional beliefs and
geographical barriers, though certain control measures as a place (Neil et al,.2004)
Many developed countries have successfully controlled BTB through the use of a test
slaughter method in conjunction with milk pasteurization. Animal culling, on the
other hand, is a budgetary challenge for developing countries such as Ethiopia.
Food safety precautions such as drinking pasteurized milk and cooking meat
thoroughly will also help to prevent transmission at the animal-human interface.
Pasteurization of milk should be made mandatory because it is the most effective way
to reduce BTB’s public health impact.
10
Sanitary inspection of carcasses at abattoirs should be performed on a regular basis to
so that possibly contaminated animal products are removed and their origins tracked
back to potentially infected herds so that management methods can be implemented
(OIE 2018).

11
3. MATERIALS AND METHODS

3.1. Description of the Study Area

The study was conducted from March 2023 to May 2023 in Jinka town which is the
capital city of South Omo Zone. It is located in the hills north of the Tama Plains. Currently,
Jinka is the center of Jinka town administration. It has a latitude and Longitude of 5°47′N and
36°34′E Coordinates respectively and an elevation of 1490 meters above sea level. The
average annual temperature and precipitation are 21.1 0C and 1274 mm, respectively. It is 750
KM south of the main capital city of the country, Addis Ababa, and 550 Km away from the
regional capital, Hawassa. The climatic condition ranges from Dega to Kola which
constituted 34.4% of the zonal climatic condition (Fesseha and Abebe, 2020, Godana, 2013,).

The town has 40,311 cattle, 11,411 Goats, 2868 Sheep, 95,718 poultry, and 1402 equine
population (Jinka town administration Agriculture office, 2023).

3.2. Study Population

The study population were individuals who are resident in Jinka town with different
Socio-demographic characteristics. This study includes individuals of sex, different
age categories, different occupation, different marital status, and those, which were
found on different educational levels. Besides this, the target populations were
interviewed with specific questions related to knowledge, attitude, and practice of the
community toward Bovine Tuberculosis.

3.3. Study Design

A cross-sectional study was carried out from March 2023 to May 2023 to assess the
community knowledge, attitude, and practice on Bovine Tuberculosis in Jinka Town.
Accordingly, individuals will be select randomly.

12
3.4. Sample Size Determination

The study population of the current study was comprised of randomly selected
students of different educational levels (elementary, high schools, colleges), farmers,
a governmental and self-employee that are found in Jinka town and its surroundings.
Abebe et al., revealed KAP towards Tuberculosis as 39.39%. in 2020. Thus, the
required sample size for this study was estimated by considering the formula given by
Cochran (1977) sample size formula for categorical data (Bartlett, 2001). A 95%
confidence interval was considered to calculate the sample size.

n=t2*p (q)/d2

Where, t2= value for selected alpha level of 0.025 in each tail=1.96 at 95% degree of
confidence

P= population proportion of target population, q=1-p d = degree of accuracy required

n = the sample size

Q=0.6061 where P= 0.3939

n= 1.962* 0.3939*0.6061 / 0.052=367 to be precise, the sample size is increased to 382.

3.5. Method of Data Collection

3.5.1. Questionnaire Survey

A structured questionnaire was prepared to assess the knowledge, attitude, and

practice of the community settled on urban and peri-urban areas of the study area. In
addition, the socio-demographic history of each respondent was recorded. A
questionnaire was presented to each randomly selected individual. The target groups
of the study were randomly selected individuals who live within the different locality
of the study areas. The questionnaire was administered to the population by common
local language in (Amharic and Ari language) during the interview. There was a brief
discussion on the objective of the survey and respondents were asked for their consent
before the interview was commenced.

13
3.5.2. Retrospective Data

Data of the cases of Tuberculosis in 3 consecutive years namely, 2020, 2021, and
2022 G.C were collected from Jinka General Hospital in order to compare the
prevalence of the disease and the level of the knowledge in the town. It was also
important to have data of age-related cases of Tuberculosis.

3.6. Data management and Analysis

All collected data were entered into the Microsoft Excel 2010 spreadsheet and import
to STATA version-13 statistical software for descriptive statistical analysis. Pearson’s
chi-square (𝑥 2 ) test was used to access knowledge, attitude and practice with their
respective age, sex, education level, marital status and occupation towards bovine
tuberculosis disease. In all the analysis, confidence level was held at 95% and
statistical analysis was considered as significant at p<0.05.

14
4. RESULT

4.1. Socio Demographic Characteristics of Respondents in Jinka Town

Among the respondents, 284 (74.3%) and 98 (25.7%) were male and female
respectively. Among the age groups, adults were the dominating group with 292
(76.4%) and youths were 90 (23.6%). 268 (70.2%) were married and 114 (29.8%)
were unmarried. 50 (13.09%) were illiterate and 232 (86.92%) were considered as
educated.

Table 1 Socio Demographic Characteristics of Respondents in Jinka Town (n=382)

No Variables Frequency Percentage (%)

1 Sex Male 284 74.3

Female 98 25.7
Total 382 100
2 Age Youth (15-24 yrs) 90 23.6
Adult (>25 yrs) 292 76.4
Total 382 100
3 Marital Married 268 70.2
Status
Unmarried 114 29.8
Total 382 100
4 Educational Illiterate 50 13.09
level
Primary School 116 30.37
Secondary School 96 25.13
Diploma, degree and above 120 31.41
Total 382 100
5 Occupation Unemployed (merchants, 232 60.73
farmers, students, house wives)
Employed (Government 150 39.27
employers)
Total 382 100

15
4.2. Knowledge of Respondents on Bovine Tuberculosis

254 (66.5%) respondents in the study area knew about bovine tuberculosis where as
128 (33.5%) respondents did not hear about the disease. Among the knowledgeable
respondents, 213 (83.86%) knew that Bacteria causes Bovine tuberculosis. 80.31%
participants clearly mentioned emaciation as a clinical sign of BTB. Among the
respondents who know about BTB (n=254), 208 (81.89%) knew that Bovine
tuberculosis is zoonotic disease where as 46 (18.11%) did not have any idea about its
zoonotic importance. 147 (57.87%) respondents knew that consumption of raw milk
can transmit Bovine TB from animal to human.

Table 2 Knowledge of Respondents Regarding Bovine Tuberculosis (n=382)

No Variables Frequency Percentage (%)

1 Know BTB before Yes 254 66.5
No 128 33.5
Total 382 100
2 Knowledge on Bacteria 213 83.86
cause of the
disease (n=254) Parasite 11 4.33
Shortage of feed 12 4.72
Religion 18 7.09
3 Clinical signs of Lethargy 17 6.7
BTB (n=254)
Coughing 31 12.2
Lymph node enlargement 2 0.79
Emaciation 204 80.31
4 Zoonosis (n=254) Yes 208 81.89
No 46 18.11
5 Method of Consumption of raw milk 147 57.87
transmission to
Consumption of raw 62 24.41
human (n=254)
meat
Through cold air 26 10.24
I do not know 19 7.48
Total 254 100

16
4.3. Relation-Ship Between Knowledge about Bovine Tuberculosis and the
Independent Variables

Among 284 males and 98 females, 195 (68.79%) and 59 (60.2%) were
knowledgeable on BTB respectively. The remaining 31.33% males and 39.9%
females did not have idea about the disease. Regarding the age groups only 40%
youths knew about the disease and 74.66% of adults had good knowledge towards
BTB. Based on educational level, 78% of Illiterate respondents had poor knowledge
on the disease. Except sex, all independent variables (Age, Marital Status,
Educational Level and occupation) of the respondents were significantly associated
with the Knowledge of Bovine Tuberculosis (P<0.05).

Table 3 Relation Ship Between Knowledge on Bovine Tuberculosis and the Variables

No Variables Know About BTB X2 P-

value
Yes (%) No (%)
1 Sex Male (284) 195 89 2.3393 0.126
(68.67) (31.33)
Female (98) 59 (60.2) 39 (39.8)
2 Age Youth (15-24 yrs) (90) 36 (40) 54 (60) 37.0886 0.000
Adult (>25 yrs) (292) 218 74
(74.66) (25.34)
3 Marital Married (268) 206 62 43.5410 0.000
Status (76.87) (23.13)
Unmarried (114) 48 (42.1) 66 (57.9)
4 Educational Illiterate (50) 11 (22) 39 (78) 66.2325 0.000
level
Primary School (116) 66 (56.9) 50 (43.1)
Secondary School (96) 56 (58.33) 40
(41.67)
Diploma, degree and 109 11 (9.17)
above (120) (90.83)
5 Occupation Unemployed 123 (53) 109 (47) 48.2958 0.000
(merchants, farmers,
students, etc.) (232)

Government Employer 131 19

(150) (87.33) (12.67)

17
4.4. Attitudes Toward Disease prevention

Among the respondents, 137 (35.86%) considered the disease prevention status in
Jinka town as poor and 245 (64.14%) considered it as good. Among the 382
respondents, 233 (82.2%) had positive attitude towards the disease to prevent it and
the remaining 149 (27.8%) were remained with negative attitude towards BTB.

4.5. The Relation Ship Between Educational Level and Preventive Practices

All Practices such as consumption of milk, boiling of milk, Actions taken if animal
and human are affected with the disease were significantly associated with the
educational level of the respondents (P<0.05).

18
Table 4 Relation-Ship Between Educational Level and Preventive Practices toward BTB

No Variables Educational Level X2 P-value

Illiterate Primary Secondary Diploma
(50) school (116) school (96) and above
(120)
1 Consumption of raw milk No (287) 10 (20%) 96 (82.8%) 77 (80.2%) 104 (86.67%) 31.1480 0.000
Yes (95) 40 (80%) 20 (17.2%) 19 (19.8%) 16 (13.33%)

2 Boiling of milk before Yes (265) 37 (74%) 55 (47.4%) 64 (66.67%) 109 (90.8%) 52.1416 0.000
consumption prevent BTB
No (117) 13 (26%) 61 (52.6%) 32 (33.33%) 11 (9.2%)

3 Actions taken if human is Seek doctor (260) 40 (80%) 56 (48.28%) 58 (60.41%) 106 (88.33% 0.000
affected with TB
Seek traditional 7 (14%) 24 (20.69%) 18 (18.75%) 9 (7.5%)
healers (58)

No action (64) 3 (6%) 36 (31.03%) 20 (20.84%) 5 (4.17%)

4 Actions taken if animal is Seek veterinarian 39 (78%) 54 (46.55%) 58 (60.42%) 103 (85.83%) 51.7462 0.000
affected with BTB (39)

Seek traditional 8 (16%) 27 (23.28%) 20 (20.83%) 13 (10.83%)

healers (8)

No action (4) 3(6%) 35 (30.17%) 18 (18.75%) 4 (3.34%)

19
4.6. Relation Ship Between Consumption of Raw Milk and Independent
Variables

Age and marital status were not significantly associated with consumption of raw
milk. But Sex, Educational level and Occupation were among the factors significantly
associated with this practice.

Table 5 Relation Ship Between Consumption of Raw Milk and Independent Variables

No Variables Consumption of raw milk X2 P-

value
Yes (%) No (%)
1 Sex Male (284) 79 (27.82) 205 (72.18) 5.1484 0.023
Female (98) 16 (16.33) 82 (83.67)
2 Age Youth (15-24 20 (22.22) 70 (77.78) 0.4415 0.506
yrs) (90)
Adult (>25 yrs) 75 (25.7) 217 (74.3)
(292)
3 Marital Married (268) 71 (26.5) 197 (73.5) 1.0077 0.604
Status
Unmarried 24 (21.1) 90 (78.9)
(114)
4 Educational Illiterate (50) 40 (80) 10 (20) 31.1480 0.000
level
Primary School 20 (17.2) 96 (82.8)
(116)
Secondary 19 (19.8) 77 (80.2)
School (96)
Diploma, 16 (13.33) 104(86.67)
degree and
above (120)
5 Occupation Unemployed 77 (33.2) 155 (66.8) 25.8408 0.000
(merchants,
farmers,
students, house
wives) (232)
Employed 18 (12) 132(88)
(Government
employers)
(150)

20
4.7. Retrospective Data Results

Retrospective data on the prevalence of Pulmonary and extrapulmonary Tuberculosis

was collected from Jinka General Hospital. The data include 2020, 2021 and 2022-
year Registered disease report of the hospital. The data was classified in to different
age and sex groups. The data revealed higher prevalence of Human tuberculosis and
its prevalence was higher in males. Among 316 people which were positive for
pulmonary TB, 163 (51.6%) were males and 153 (48.4%) were females in 2020 G.C.
In 2021 G.C, there were 190 peoples from which 118 (62.1%) were males and 72
(37.9%) were females. This number was increased to 205 peoples in 2022 G.C,
among which 127 (61.95%) were males and 78 (38.05%) were females. The result
also indicated the presence of extrapulmonary TB in Jinka town. Accordingly, there
were 5, 12 and 45 peoples positive for this condition during 2020, 2021 and 2022 G.C
respectively (table 6).

Table 6 Retrospective Data Result Based on Sex Groups

Year Sex Type of TB

Male Female Pulmonary Extra Total

Pulmonary

2020 163 (51.6%) 153 (48.4%) 316 5 321

2021 118 (62.1%) 72 (37.9%) 190 12 202

2022 127 (61.95%) 78 (38.05) 205 45 250

Source: Jinka General Hospital, 2020

21
Table 7 Retrospective Data Result of Pulmonary and Extrapulmonary TB Based on Sex and Age Groups (Source: Jinka General
Hospital)

Year Sex and Age Groups Pulmonary TB Tota Tota

Total
l l
examined Male Male Male Male Male Male Femal Femal Female Female Female Fema
(Mal (Fe
for TB <1 1-4 5-14 15-29s 30-64 > 64 e <1 e 1-4 5-14 15-29 30-64 le
e) mal
year years years year years years year years years years years >64
e)

2020 1278 2 0 3 53 89 16 1 3 7 44 89 9 163 153

2021 1066 0 0 3 55 53 7 0 1 1 30 37 3 118 72

2022 1123 1 1 14 32 61 18 1 0 5 35 28 9 127 78

Year Total Extra Pulmonary TB Tota Tota

examined l l
Male Male Male Male Male Male Femal Femal Female Female Female Fema
for TB (Mal (Fe
<1 1-4 5-14 15-29s 30-64 > 64 e <1 e 1-4 5-14 15-29 30-64 le
e) mal
year years years year years years year years years years years >64
e)

2020 1278 0 0 0 0 1 0 0 0 1 0 3 0 1 4

2021 1066 0 0 0 1 3 0 0 1 0 2 3 1 4 8

2022 1123 0 3 0 7 11 2 1 0 0 5 5 1 23 22

22
4.7.1. Trend of Pulmonary and Extra Pulmonary TB in Human

The trend of the disease was not constantly changed, but shows some alternating
changes through out the mentioned years. It was higher during 2020 and then
decreased in 2021. But increased during 2022.

Figure 1 Trend of Pulmonary and Extra Pulmonary TB

Trend of Pulmonary and Extra pulmonary TB

350

300

250

200

150

100

50

0
m f Pulmonary Extra pulmonary
sex Type of TB

2020 2021 2022

23
5. DISCUSSION

This study investigated the KAP of the community in Jinka Town in regard to Bovine
Tuberculosis. The socio demographic characteristics of the participants were 284
(74.3%) male and 98 (25.7%) were female. Among the age groups, adults were the
dominating group with 292 (76.4%) and youths were 90 (23.6%). 268 (70.2%) were
married and 114 (29.8%) were unmarried. 50 (13.09%) were illiterate and 232
(86.92%) were considered as educated.

Based on the detailed assessment of KAP towards BTB, 254 (66.5%) respondents in
the study area knew about BTB, while the remaining 33.5% respondents did not have
any idea about the disease. This finding is higher than the finding of Abebe et al.,
(2020) who revealed KAP towards BTB as 39.39% at Jinka town. This difference
might be due to increased provision of awareness to the community by the different
stake holders and those NGOs implementing their community services at the study
area and the surroundings. Even though, there is still a knowledge gap towards BTB,
the higher knowledge might be related with the recommendation of the previous study
of Abebe et al., (2020) who recommended awareness creation as a part of zoonosis
prevention. The current finding is lower than the study conducted in Jarso destrict
West Wollega zone, Oromia Region by Gemechu et al., (2022) who revealed that
100% participants defined TB as a disease of lung. Boshorum et al., (2020) revealed
almost similar finding in Gambia who reported that most participants had heard about
tuberculosis. Moreover, study conducted in Gambella by Bati et al., (2013) revealed
higher KAP than the current finding. Hailu et al., (2021) reported 57.2% respondents
were knowledgeable about TB in Bahirdar, Amhara region Ethiopia. Further more,
Zeru et al., 2014 revealed that 30.8% of the respondents have good knowledge about
BTB in Mekelle. This finding is lower than the current study. The difference of KAP
between different regions might be related with the difference of awareness level and
it might be due to difference in the study area. Since the studies were implemented in
different levels of urbanization where awareness creation level through media and
access to internet might by different.

The current study indicated that, among the knowledgeable respondents (n=254), 208
(81.89%) knew that BTB is a zoonotic disease.

24
This result was higher than the report of Gemechu et al., 2022 and Zeru et al., (2014)
who reported only 24.4% and 15% respondents agreed with the idea that tuberculosis
can be transmitted from animals to humans and vice versa respectively. Further more,
Wendmagegn, et al., (2016) reported that 48% of the respondents in Woldiya knew
that BTB is zoonotic. The inconsistency between different studies might be due to
differences in the level of awareness among the participants in the study areas of
concern.

The predictors of the knowledge were sex, age, marital status, educational level and
occupation. Males have higher knowledge (68.67%) towards BTB than females
(31.33%) but sex was the only factor not associated with the knowledge of BTB
(P>0.05). There is no difference between sex groups. The current study predicted that
knowledge is higher in older age groups than youths. This is inconsistent with the
finding of Hailu et al., 2021 who revealed as the age groups between 46 and 60 years
in Ethiopia. It might be suggested that elders have low level of knowledge level due to
limited access to training and awareness associated with BTB due to different reasons.
The current finding is consistent with the result of Hambolu et al., (2013) and Ismiala
et al., (2015) who reported that age groups greater than 58 years are knowledgeable
than the youngers in Nigeria. As Hailu et al., (2021), knowledge increases with years
of working experience. Similar study by Addo et al., (2011) in Ghana supported this
finding suggesting that herds men with long practical experiences had a greater
knowledge due to past experiences on TB in their herd. Ngoshe et al., (2023) also
suggested that despite their lower level of education, older farmers were more
knowledgeable on animal diseases compared to younger farmers.

In the current study, marital status is significantly associated (P<0.05) with the
knowledge towards TB. Among 268 married couples, 206 (76.87%) were
knowledgeable than the unmarried ones (42.1%). This might be due to previous
experience and exposure to training. As couples are two, one of them might have
awareness and they can share it together. In addition to this, in order to take care of
their children, married respondents might be likely to have more access to health
centers where awareness creation takes place than unmarried ones.

25
Regarding education, those who attend college (diploma level) and above have high
knowledge and practice on BTB as compared to those who attend primary and no
formal education. Similar findings were reported in Ethiopia by Asebe et al., (2018),
Kerorsa, (2019) and recently by Hailu et al., (2021).

The study conducted in Nigeria by Ismaila et al., (2015) revealed consistent result. As
stated by Asebe et al., (2018), providing education plays an important role in adding
knowledge. Moreover, Education is an important tool in increasing awareness towards
BTB among livestock owners and limited access to education results in low
awareness among the community. Further more, education was among the factors
associated with good level of preventive practice for BTB. This finding is consistent
with the finding of Hailu et al., (2021), who revealed education as a factor which is
associated with level of practice for BTB.

Regarding the causes of BTB, among the knowledgeable respondents (n=254) about
BTB, most of the respondents 213 (83.86%) knew that bacteria causes BTB. This
finding is similar to Buregyeya et al., (2011) in Ethiopia where 79.9% of the
respondents knew the source of TB. But the current study indicated that yet 7.09%,
4.33% and 4.72% have misconception that religion, parasite and shortage of feed
cause BTB respectively. Peggy et al., (2020) also revealed very similar result who
stated there was high misconception that cold air and dust cause TB.

The knowledge level was higher in government employers than the unemployed ones.
Almost 87.33% government employers knew about BTB. This might be the
educational level of the employers as government employers are mostly higher
educated ones. In addition to this, it might be the previous practical experiences which
can be related with their professions. Adesokan (2018) also reported higher
knowledge level (75.5%) among abattoir workers than herds men (32.1%) in Nigeria.

Regarding consumption of raw milk, 95 (24.87%) of respondents consume raw milk.

This result is lower that the study conducted in South Gondar Zone by Alelign et al.,
(2019) who reported that 69% respondents consume raw milk and dairy products.
Similarly, Wario et al., (2018) showed that 66.2% respondents consume raw milk in
Yabello. Moreover, the finding of Arsi zone, Ethiopia by Tschopp et al., (2013)
revealed that 55.4% respondents consume raw milk.

26
The study conducted in Ghana by Addo et al., (2011) and by Ngoshe et al., (2023) in
Far Northern KwaZulu-Natal reported that 40% and 51.98% of the study participants
consume raw milk respectively. This might be associated with food consumption
behavior and geographical difference (Hailu et al., 2021). Unlike the current study,
most of the studies mentioned were conducted in rural and agro-pastoral areas, where
raw milk consumption is likely to be practiced. According to Ismaila, et al., (2015),
the inconsistency might be due to difference in knowledge on zoonosis and
consequence of raw food consumption. Educational level and occupation were among
the factors significantly associated with raw milk consumption (P<0.05). The
prevalence of raw milk consumption was 80%, 17.2%, 19.8% and 13.33% in illiterate,
primary, secondary and diploma and above educational levels respectively. This
indicates that as educational level of the respondent increases, awareness level on the
consequence of raw milk consumption also increases. Employment was another
associated factor with consumption of raw milk. The prevalence was lower in
government employed respondents (33.2%) when compared with unemployed ones
(66.4%). This might be related with difference in the level education among the
respondents.

Among 120 educated respondents, 109 (90.8%) considered boiling milk before
consumption as a preventive method of the transmission of BTB from animals to
humans. In another side, among 50 respondents who have no formal education, 74%
respondents considered it as preventive method. This result is almost similar to the
result of Hailu et al., (2021) who stated that 99% of the respondents knew boiling
milk before consumption can prevent the transmission of BTB to humans. The current
finding is different from that of Gemechu et al., 2022 and Bihon et al., (2021) who
indicated that more than 60% respondents disagree that pasteurization of milk before
consumption prevents TB. This difference might be due the difference in the
educational level of the respondents in the study areas.

Retrospective data result revealed that there was higher prevalence of Human
tuberculosis in Jinka town and its surroundings. This might be related with low
awareness towards TB. It might be also associated with poor husbandry, management
and high herd size which increases the prevalence of BTB (Redi, 2003). Further more,
more than half of the TB patients feel that TB treatment is unpleasant and takes long
time and interferes with work. So that they fail to seek treatment.
27
Almost 92% people do not come back to clinics for follow up after their first
treatment out of fear of what people will say about them (Peggy et al., 2020). This
increases the transmission rate of TB to susceptible ones. The prevalence of TB was
higher in males than females. Among 316 people which were positive for pulmonary
TB, 163 (51.6%) were males and 153 (48.4%) were females in 2020 G.C. In 2021
G.C, there were 190 peoples from which 118 (62.1%) were males and 72 (37.9%)
were females. This number was increased to 205 peoples in 2022 G.C, among which
127 (61.95%) were males and 78 (38.05%) were females. The higher prevalence of
human TB in male might be related with repeated consumption behavior of raw milk
than females. Occupationally, females remain in the home and have low exposure to
sick people and the risk factors associated with human TB than males.

28
6. CONCLUSION AND RECOMMENDATIONS

This study has identified that relatively there is good level of knowledge, attitude and
preventive practices yet there are misconceptions which require additional work to
minimize the gap of KAP among the community. The retrospective result also
revealed that there is high prevalence of human tuberculosis as a result of low
knowledge level on zoonotic importance of BTB, consumption of raw milk and poor
disease prevention strategy. The disease affects all age and sex groups.

Based on the above conclusion, the following recommendations are forwarded.

➢ There should be further investigation of the level of BTB

➢ Human TB should be investigated in detail
➢ Effective disease prevention strategy should be properly used
➢ Veterinarians and health professionals should work together towards the
prevention of Zoonotic diseases
➢ Regular awareness creation on BTB and Human TB should be commenced

29
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8. ANNEX 1

Jinka University Department of Veterinary Science

Questionnaire
Dear respondent;
This questionnaire is designed to address community of Jinka town in gathering data
to undertake problem-solving research required for taking the recommended action.
The research is on “Assessment of public knowledge, attitude and practices
towards Bovine Tuberculosis” confined only to community of Jinka town. Thus, the
researcher cordially asks your collaboration in filling the questionnaire. For your
information, all questions below do not require your name. Thus, responses will have
to be given anonymously and will be dealt with utmost confidentiality. I, in advance,
would like to extend my heartfelt gratitude for your support!
Instruction: - Please write down your opinion for questions that need a written
response & put check mark () in the box of your choice among the alternatives for
questions that require so.

1. Sex: male female

2. Age: 15-25yr 26-40yr 41-55 yr >55 yr
3. Educational level: illiterate primary school secondary school
diploma first degree and above
4. Marital status: Married Unmarried
5. What is your occupation?
Government employee Private employee Merchant
Unemployed House wife Farmer Student
6. Do you know the animal disease called Bovine Tuberculosis? Yes No
7. If your answer for question 9 is yes, what do you think is a cause of the disease?
Religion Shortage of feed Bacteria parasites I
do not know
8. Clinical signs (Check all): Coughing Emaciation Lymph node
enlargement Lethargy
9. Do you think that the disease can be transmitted to human? Yes No
If your answer for q 13 is yes, do you think that the affected animal/human will
die if not treated? Yes No
10. Do you consume raw milk? Yes No
11. Boiling milk before consumption prevents TB: Agree Disagree
12. What do you think is the mode of transmission of the disease? (Check all)
Consumption of raw milk Consumption of raw meat Trough air
I do not know
13. What are the actions you take if a human is affected with Bovine tuberculosis?

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 Seek a doctor Seek traditional healers Give traditional drugs
No action
14. What are the actions you take if your animal is affected with Bovine tuberculosis?

Seek a veterinarian Seek traditional healers I use traditional drugs

No action
15. Measures to be taken to prevent Tuberculosis in animals (check all)

Killing diseased animal Vaccination Awareness creation I do

not know

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