Crimean-Congo hemorrhagic fever is an acute, feverous disease(Messina et al., 2015) caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family(Duh et al., 2007). It is an arboviral disease that is transmissible from arthropods(Gozel et al., 2014) and is transferred from hard-bodied ticks from the genus Hyalomma to humans(Tahmasebi et al., 2010; Telmadarraiy et al., 2010). Crimean-Congo hemorrhagic fever was first diagnosed in the Crimean Peninsula, Ukraine, in 1944; a decade later, a similar disease with the same symptoms was reported in the Republic of the Congo in 1956, hence the name of the disease as Crimean-Congo hemorrhagic fever (Casals et al., 1969; Chinikar et al., 2010; Hoogstraal et al., 1979). The disease suddenly starts with a high fever as the main symptom. The initial symptoms of the disease are fever, severe muscular pain especially backache, weakness, anorexia, irritability, vomiting, stomachache and diarrhea. The disease then starts to progress with the following symptoms: leukopenia (a decrease in the number of white blood cells), leukocytosis (an increase in the number of white blood cells), thrombocytopenia (a decrease in the number of platelets), Mucosal bleeding, petechiae and ecchymosis (Gandhi et al., 2011; Ozer et al., 2010; Yilmaz et al., 2010).
One of the most frequent types of transmission for the disease is tick bites. It can also be transmitted to humans by direct contact with the blood and tissues of infected livestock, person-to-person contact with the excretory secretions of infected people or their belongings in hospitals. The majority of patients suffering from this disease are butchers, slaughterhouse workers, farmers, veterinarians and hospital staff (Chinikar et al., 2012). Sheep, cow and other domestic animals are the reservoirs of the virus which are either not infected themselves or if infected, they show no clear symptom, hence the difficulty of the diagnosis of the disease in animals. The geographical distribution of the disease depends on the distribution of the vector: hard-bodied tick Hyalomma (Abdollahi et al., 2015). This virus has been reported in more than 30 African, Eastern European, Middle Eastern and Asian countries(Ali et al.,2013) including Iran’s neighboring countries such as Afghanistan, Pakistan, Iraq, Turkey, Arabian countries as well as Kazakhstan and Uzbekistan(Owaysee et al., 2008). According to a report by the World Health Organization in 2008 and the geographical dispersion map of the disease in 2015, Iran is located in the endemic belt for the disease(Ahmadkhani et al., 2018; WHO., 2008).
The highest incidence of the disease has been reported in spring and summer, especially in July due to the activity of the vector ticks, and the lowest incidence has been reported in autumn (Saghafipour et al., 2019). Based on standard health protocols, repulsive substances and safe acaricides are used (Asl et al., 2018; Vatandoost et al., 2012). Observing health regulations and exhibiting healthy behaviors result from proper education and awareness and can prevent Crimean-Congo hemorrhagic fever (Asl et al., 2018). The health belief model can help understand preventive behaviors better and be employed as an effective model in educational pogroms for occupational injuries(Tabatabaei et al., 2007). Based on this model, people display appropriate behaviors and reactions to health regulations and preventive measures only when they feel they are exposed to a real danger (perceived susceptibility) and this danger is seriously threatening them (perceived severity); thus, they start to believe that changing their behavior is beneficial (perceived benefits) and that they are able to remove barriers in their way of exhibiting correct health behaviors (perceived barriers). Self-efficacy means how a person judges and evaluates their own abilities to perform a task. Although a few studies have been carried out in Iran on health workers’ awareness and performance regarding Crimean-Congo hemorrhagic fever(Cagdas et al., 2012; Salimi et al., 2016), no study has specifically focused on butchers’ health beliefs and preventive behaviors in terms of Crimean-Congo hemorrhagic fever. Hence, given the importance of their behavior in preventing Crimean-Congo infection, this study aimed to investigate butchers’ preventive behaviors regarding Crimean-Congo hemorrhagic fever in Ardabil Province.