Zoonotic Diseases Risk Perception and Infection Prevention and Control Practices Among Poultry Farmers in the Buea Health District: a One Health Perspective

doi:10.21203/rs.3.rs-1594726/v1

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Zoonotic Diseases Risk Perception and Infection Prevention and Control Practices Among Poultry Farmers in the Buea Health District: a One Health Perspective

https://doi.org/10.21203/rs.3.rs-1594726/v1

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Background

Livestock are associated with pathogenic microbes and farm workers play a significant role in the transmission of zoonotic diseases (ZDs). Lack of awareness of exposure risk among farmers may influence their farm practices thereby enhancing the spread of diseases in farms and to the community. This study aimed at evaluating the knowledge, risk perception and prevention and control practices of ZDs among poultry farmers in order to baseline data for establishing a one health practical approach to reducing zoonotic disease transmission in poultry farms.

Methods

A community-based cross-sectional study involving poultry farmers was carried out in the Buea Health District from April to July 2021, using a multi- stage sampling technique. Six feed-producing mills were used as focal points to meet farmers and the snowball technique was used to trace the farms. Questionnaires were used to collect data related to participants’ knowledge, risk perception and preventive and control practices of ZDs. Data analysis was done using SPSS version 25.

Results

In all, 183 poultry farms and 207 workers were enrolled in the study. Despite being aware that animal diseases can be transmitted to humans, most participants showed poor knowledge, poor risk perception and poor prevention/control practices on ZDs. Majority did not consider coming in contact with bird’s blood/body fluid or apparently healthy birds to be a risk of infection. More participants with small farm size (< 500 birds) had low risk perception to ZDs than those with larger farms (> 1000 birds) (P = 0.03). Furthermore, most participants reported practicing hand washing but they neither used protective devices such as gloves and face mask and > 50% would not invite veterinary professionals to their farms. There was significant association between risk perception and knowledge (P = 0.007; CI = 1.257–4.200) as well as between risk perception and prevention/control practice (P = 0.002; CI = 1.451–4.867).

Conclusion

Poultry farm workers in Buea have poor knowledge and perception on zoonotic disease risk and this has contributed to their poor prevention/control practices in the farms. Enhanced informal education of farm owners and workers through training workshops and seminars will improve on their knowledge and skills on zoonotic disease transmission risk and prevention.

Zoonotic diseases

risk perception

knowledge

prevention practice

Poultry farmers

Buea municipality

Zoonotic diseases (ZDs) or Zoonoses are diseases that are transmitted between animals and humans[1]. The close proximity of humans and animals as pets, livestock rearing and game-hunting may increase the possibility of transmission of ZDs to humans. It is estimated that more than 6 out of 10 infectious diseases originate from animals and 3 out of 4 new or emergent infectious diseases in human comes from animals [2]. Most animals serve as reservoir for the emergence or re-emergence of pathogenic microbes. Most of these microbes dwell in the gastrointestinal tract of these animals as commensals but may become pathogenic when transmitted to a suitable human host. ZDs are among the most recurrent and feared risks to humans. The emergence and re-emergence of zoonoses and its devastating impact on human health is a growing concern around the globe [3].

Globally, 2.5 billion cases are estimated to be related to zoonotic infections yearly, resulting in 2.7 million deaths [4]. ZDs account for about 25% of the infectious disease burden in low-income countries [4]. A combined disease burden is observed on people in tropical and subtropical Africa, where there is the likelihood of zoonotic diseases coinfection with other infectious diseases, such as malaria, tuberculosis and HIV. These associated factors may increase the severity of diseases and the susceptibility of individuals to zoonotic agents, thus enhancing their spread at the community level [5]. Central Africa has been identified as a hotspot for emerging infectious diseases (EIDs); including ZDs, perhaps as a result of many factors, including population growth, urbanization, political and social disruption, agriculture and livestock intensification, deforestation, and climate change [6].

Zoonoses are caused by a range of pathogens such as viruses, bacteria, fungi and parasite. Some bacterial zoonoses include anthrax, botulism, plague and tularemia, which are listed in category A warfare agents [7, 8], meanwhile, category B agents include brucellosis, foodborne agents (E. coliO157:H7, salmonellosis and shigellosis), glanders, psittacosis, melioidosis, Q-fever, and typhus fever [8]. Zoonotic pathogens such as Campylobacter, Salmonella, Listeria monocytogenes and the Enterobacteriaceae family are frequently found in livestock (avian, bovine, caprine, equine, ovine and porcine) as well as in wild animals, pets and rodents, causing foodborne diseases [8]. The majority (70%) of emerging viral diseases represent zoonoses, with such prominent examples being HIV/AIDS influenza, West Nile virus encephalitis, SARS, Ebola virus disease, Marburg virus disease, hantavirus pulmonary syndrome and the most recent SARS-COV-2 virus (causative agent of the on-going COVID-19 pandemic) [9, 10].

The transmission of zoonotic diseases can be through direct contact, indirect contact, Vector-borne, Foodborne, and Water borne [3, 11]. Foodborne zoonoses may be transmitted across the food chain; notably, during slaughtering, meat processing, and handling of food products of animal origin [4, 7]. Zoonotic diseases prevention methods differ for each pathogen. However, several practices have shown to be effective in reducing risk at the community and personal levels [11, 12]. Safe and appropriate guidelines for animal care in the agricultural sector help to reduce the potential for foodborne ZD outbreaks through foods such as meat, eggs, dairy or even some vegetables [11, 12, 13]. Standards for clean drinking water and waste removal, as well as protections for surface water in the natural environment are also important and effective [14, 15]. Education campaigns to promote handwashing after contact with animals and other behavioural adjustments can reduce community spread of zoonotic diseases when they occur. [14, 15].

The livestock population of Cameroon is estimated at over 90 million and includes over 72 million poultry, 9 million small ruminants, 5 million cattle, and 3 million swine [16]. It is estimated that over 70% of the population is engaged in small-scale livestock agriculture (which contributes approximately 20% to the national Gross Domestic Product); with the majority being poultry farmers [16]. The poultry industry in Cameroon has experienced substantial growth perhaps due to the ban on importation of chicken [17]. This has led to the creation of many poultry farms managed by unskilled workers. In such a resource-scarce setup where access to health and veterinary services are limited, inappropriate farm practices may be associated with an increased likelihood of exposure to zoonotic pathogens and outbreaks of ZDs. Despite these risks, not much has done to monitor or curb the spread of ZDs especially as there is yet to be a national surveillance system in Cameroon [16, 18]. Although there are many poultry farms in the South west region and in the Buea Health District (BHD) in particular, much is not known about ZDs and farm practices especially as the livestock sector has received very little attention. Therefore, this study was designed to evaluate the knowledge, risk perception and prevention/control practices of ZDs among poultry farmers in the BHD and to elucidate the relationship between these factors. Identifying the level of awareness and preventive measures of ZDs among farmers in a semi-urban resource-limited community will be helpful in providing baseline information for establishing one health practical approaches to reducing zoonotic disease transmission in poultry farms as well as to the community.

2.1 Aim: The aim of the study was to determine the knowledge, risk perception and prevention and control practices of ZDs among poultry farmers in the Buea Heath District and to assess the relationship between these factors.

2.2 Study design

The study was a descriptive cross-sectional quantitative study carried out among poultry farmers between April 2021 and July 2021.

2.3 Study setting

This study was carried out in the Buea Health District (BHD) which is made up of seven health areas (HAs) namely: Bokwoango, Bova, Buea road, Buea town, Molyko, Muea, and Tole (Figure 1). These areas represent the rural and semi-urban communities of the City of Buea. Buea is a cosmopolitan city made of about 67 villages with a surface area of 870 Sq.km [19]. It consists of a heterogeneous community with a mixture of urban, semi urban, and rural neighborhoods. Buea is bound to the north by the tropical forest on the slope of Mount Cameroon which extends to the Atlantic Ocean. The town also shares boundaries with other major towns like the City of Limbe to the Southwest, Tiko municipality to the Southeast, Muyuka municipality to the east and Idenau district to the West. The dominant economic activity is agriculture which forms the backbone of the local economy. The inhabitants are engaged in both crop cultivation and livestock rearing, including animals such as chicken, pigs, cows, goats and rabbits.

2.4 Target Population

The target population is made up of all poultry farmers including farm owners and workers in the study area who carry out daily farm procedures within the study period. Participants with a minimum flock size of 100 birds who consented were included in the study. Meanwhile, participants whose farms are located in inaccessible areas were excluded.

2.5 Sample Size Calculation

The sample size for the number of farmers to be enrolled in the study was determined using the formula

Where; Z= 1.96; confidence level; which is 95%; p= 0.25; the proportion gotten from a previous study [21]; q= 1-p; e= 5% or 0.05; which is the level of precision.

Therefore, the estimated minimum sample size for this study was 207.

2.7 Sampling Technique

A multi-stage sampling method was used in this study. Six main feed production sites in Muea, Great Soppo, Bonduma, Bwitingi and Mile 16 (Figure 1) were selected conveniently on the bases of their high turnout of poultry farmers. All the poultry farmers who visited the feed shops during the study area were enrolled in the study. The snowball technique was then used to trace the farmers to their various farms where data was collected.

2.8 Data collection procedure

Data was collected using open-ended and closed-ended questionnaires by well-trained personnel. The questionnaires were structured to reflect the following objectives:

2.8.1 Socio-demographic and farm characteristics

This section comprised of 11 questions reflecting the sociodemographic characteristics of the participants and various farm attributes. The farm characteristics evaluated were farm size, duration of being a poultry farm worker, current size of flock, yearly flock capacity of farm, Number of birds put averagely in year, type of birds in farm, mixed farming, and position of participant in the farm.

2.8.2 Knowledge of zoonotic diseases

To evaluate participants’ knowledge on ZDs, seven questions related to type, symptoms and transmission of ZDs were assessed. Each question had a score of “1” for correct response and “0” for a wrong response. A knowledge score was developed as previously reported [22, 23] based on participants’ responses to the 7 questions. The maximum score for knowledge was 7 and the mean score was 4.87 ± 1.56. Scores above the mean (>4.87) were categorised as “good knowledge” while mean scores and below the mean (≤4.87) were classified as “poor knowledge”.

2.8.3 Risk perception on zoonotic diseases among poultry farmers

A group of 8 questions were used to determine participants’ risk perception on ZDs. These questions were based on participant’s ability to identify their likelihood of exposure to ZDs, their concern of them or their colleagues, clients or family members contracting a ZD and their awareness of biosecurity guidelines in poultry farming. A risk perception score was developed based on participants’ responses as previously reported [22, 23]. The responses were categorized as follows: ability to identify their likelihood of exposure to ZDs (very likely = 3, likely = 2, A little likely =1, Not likely = 0) from various procedure, their level of concerned (“very concern” scored 3, “concerned” scored 2, “a little concerned” scored 1 and “not concerned” scored 0) of them or colleague or clients or family members could contract a ZD and their awareness of biosecurity guidelines in poultry farming (“Yes” scored 1 and “No” scored 0). The maximum score was 15 and the mean score was (6.58±4.39). Scores ≤6.58 were considered “low risk perception” while those >6.58 were considered “high risk perception”.

2.8.4 Infection prevention and control practices in poultry farms

To assess participants’ prevention and control practices, 11 questions were asked. These include aspects on hand hygiene, use of personal protective equipment, actions undertaken when birds are either sick or dying in large numbers, regularity of veterinary visits or control in their farms and action taken on dead birds. A prevention and control practice score was developed based on participant’s response to all the questions, as previously reported [22, 23]. The responses were categorised as follows: frequency of hand hygiene practice and use of PPE (glove, face mask, protective boot, overall) (“Always”=2, “sometimes”=1, “Never”=0); and control measures; correct actions taken when the birds are sick or die in their numbers; visit and control by veterinary technician or doctor (“Yes”=1 and “No”=0) and frequency of their visit and control (“Frequently or more frequently”=1 and “less frequently”=0); what do you do with the dead birds? (“burn and burry”=1 and “eat or sell or throw in the bin or backyard”=0). The maximum score was 13 and the mean score was 6.21±2.67. Prevention/control practice scores were categorised in to “good” when scores are >6.21 or “poor” when scores are ≤6.21.

2.9 Data processing and analysis

Questionnaires were checked for proper completion upon collection from the participants. Questionnaires with > 20% unanswered questions were rejected. Data were summarized in to Microsoft Excel 2016 spreadsheet, exported and analyzed using SPSS version 25. Descriptive and analytic statistics were used to analyze variables with frequencies and proportions predominantly used to described the data. Independent variables were created from the socio-demographic and farm characteristics, knowledge, risk perceptions, and prevention and control practices. To create outcome variables, a unique score card was used for the responses. Each study participant was assigned a score that reflected the stringency of his or her response. To measure responses to these independent factors, the scoring system ranged between: 0 and 7 points for knowledge, 0 and 15 for risk perception and 1 and 13 for infection prevention and control. The score range was further categorized into ‘poor or low’ (≤ mean score) and ‘good or high’ (> mean score) to keep them as binary variables. Associations between the outcome and independent variables were first subjected to univariate analyses using Chi-square tests. All factors found to be statistically significant were subsequently analyzed using multivariate logistic regression models to control for confounding and test for effect modification. P values < 0.05 were considered statistically significant.

3.1. Socio-demographic data of farm workers and characteristics of farms

A total of 207 farm workers were enrolled in the study, majority were males (151, 72.9%) compared to the females (56, 27.1%). The majority (75, 36.2%) were within 26–35 years old with a mean age of 35.5 ± 10.48 years. Most of the respondents (98, 47.3%) had a university level of education and few (2, 1.0%) had no formal level of education. More than half (153, 73.9%) of the respondents have been working as poultry farmers for less than 5 years. Meanwhile, majority of the participants were farm owners (170, 82.1%) while the others were employees (30, 14.5%) and business partners (7, 3.4%).

Table 1 shows the characteristics of various farms. Most of the farms were located in Muea (56, 27.1%), Bova (46, 25.2%) and Buea Road (38, 20.8%) health areas. The total number of birds on the farms varied from 100 to more than 8,000 birds. Most farms (140, 67.6%) kept only chickens and majority (199, 96.1%) reared only broilers species for meat production. Some farms (67, 32.4%) practiced mixed farming with the predominant animals being pigs (55, 26.6%). Almost half of the respondents (102, 49.3%) had small farm house (< 500 birds). The average number of birds that were currently present in the farms was 519.47 ± 773.185 birds, while the average yearly production of birds was 3040.69 ± 3994.015 birds.

Table 1

Characteristics of poultry farms in the study area
Variables		Categories		Proportion of farm (%)	P value
Farm size		Large (above 1000)		44 (21.3)
		Medium (500–1000)		61 (29.5)	0.000
		Small (below 500)		102 (49.3)
Type of birds reared		Broilers		199 (96.1)	0.000
		Layers		3 (1.4)
		Panthalon		3 (1.4)
		Local fowls		1 (0.5)
		Mixed birds		1 (0.5)
Other animals in the farm		Pigs		55 (26.6)	0.000
		Goats		8 (3.9)
		Dog		2 (1.0)
		Others		2 (1.0)
		None		140 (67.6)
Location of farm	Bova		46 (25.2)		0.000
	Buea road		38 (20.8)
	Bokwango		10 (5.5)
	Molyko		16 (8.7)
	Muea		50 (27.3)
	Buea town		16 (8.7)
	Tole		7 (3.8)

3.2. Knowledge of zoonotic diseases among farm workers

In general, 113 out of 207 participants (54.6%) had poor knowledge about zoonotic poultry diseases as opposed to 94 (45.4%) with good knowledge. Although majority of the participants know how to identify sick birds (206, 99.5), know that infections could be gotten from sick birds (125, 60.4%), most of them (132, 63.8%) did not know that infections could be acquired from apparently healthy birds (Table 2)

Table 2

Distribution of responses to knowledge attributes among poultry farmers
Variables	Categories	Proportion of farmers (%)
Zoonotic disease definition	Yes	134 (64.7)
Zoonotic disease definition	No	73 (35.3)
Infection from apparently birds	Yes	75 (36.2)
Infection from apparently birds	No	132 (63.8)
Infection from sick bird	Yes	125 (60.4)
Infection from sick bird	No	82 (39.6)
Identify sick birds	Yes	206 (99.5)
Identify sick birds	No	1 (0.5)

Common signs/symptoms and poultry diseases reported by farm workers

The predominant signs and symptoms reported by participants included abnormal droppings (190/204, 93.1%), general inactivity (93/204, 45.6%), cough (90/204, 44.1%) and loss of appetite (71/204, 34.8%) (Fig. 2). In total, 12 poultry diseases were identified by farmers to be common in poultry farmers (Fig. 3). Salmonellosis commonly called white diarrhea (191/205, 93.2%) and Coccidiosis also known as brown diarrhea (180/205, 87.8%) were the most common.

Poultry farmers in the study area had more than one place where they sourced for information about poultry diseases and zoonotic diseases with the most common sources being ‘other poultry farmers’ (93, 44.9%) and ‘media (TV, radio, internet)’ (87, 42%). (Fig. 4)

A bivariate analysis between demographic variables and knowledge of ZDs revealed significant differences knowledge and age (χ2 = 13.45; p = 0.009); level of education (χ2 = 19.76; p < 0.001) and position in the farm (χ2 = 8.14; p = 0.017). Generally, participants between the ages 26 and 55 years had better knowledge of ZDs than those < 26 years and those > 55 years. Meanwhile, participants with higher level of education (University) are more knowledgeable than the other groups. Also, more farm owners (85, 50.0%) have good knowledge than employees (7, 23.3%) (χ2 = 8.14; p = 0.017).

3.3. Risk perception of zoonotic diseases among poultry farmers

A total of 107 (51.7%) of participants had low perception while 100 (48.3%) had high risk perception of ZDs. Participants were asked to state their likelihood of exposure to ZDs when in contact with bird’s blood/body fluid, carcass, faeces, healthy and sick birds. Most participants did not consider coming in contact with bird’s blood/body fluid (141, 68.1%) or apparently healthy birds (159, 76.8%) to be a risk of infection. When asked “How concerned are you that you, your colleague, clients of family members could contract a ZD?” Most participants were less concerned or did not see any risk of them or others contracting a ZD. In addition, majority (170, 82.1%) of participants were not aware of biosecurity guidelines in poultry farming.

There was an association between participants’ risk perception and demographics; notably, level of education, position in farm and farm size (P < 0.05) (Table 3). Generally, participants who are farm employees had high risk perception compared to farm owners and business partners while those with University education had higher risk perception than participants with lower level of education. Furthermore, more participants with small farms (< 500 birds) had low risk perception of ZDs than those with large farms (> 1000 birds).

Table 3

Association between participants’ risk perception and demographic characteristics
Variables	Categories		Level of perception		p value
			Low (%)	High (%)
Age group	15–25		13 (37.1%)	22 (62.9%)	0.314
	26–35		39(52.0%)	36 (48.0)
	36–45		34 (58.6)	24 (41.4)
	46–55		14 (50.0)	14 (50.0)
	above 56		7 (63.6)	4 (36.4)
Gender	Female		33 (58.9)	23 (41.1)	0.204
	Male		74 (49.0)	77 (51.0)
Farm location	Bova HA		28 (51.9)	26 (48.1)	0.162
	Buea road HA		15 (35.7)	27 (64.3)
	Bokwango HA		6 (54.5)	5 (45.5)
	Molyko HA		12 (63.2)	7 (36.8)
	Muea HA		35 (62.5)	21 (37.5)
	Buea town HA		7 (38.9)	11 (61.1)
	Tole HA		4 (57.1)	3 (42.9)
Level of education	No formal level		1 (50.0)	1 (50.0)	0.000
	Primary school		22 (88.0)	3 (12.0)
	Secondary school		47 (57.3)	35 (42.7)
	University		37 (37.8)	61 (62.2)
Position in farm	Employee		8 (26.7)	22(73.3)	0.012
	Business partner		4 (57.1)	3 (42.9)
	Farm owner		95 (55.9)	75 (44.1)
Farm size	Large	16 (36.4)		28 (63.6)	0.030
	Medium	30 (49.2)		31 (50.8)
	Small	61 (59.8)		41(40.2)

3.5. Infection prevention and control practices among poultry farmers

Majority of the respondent (n = 112, 54.1%) had poor prevention and control practices about zoonotic poultry diseases. The poultry farmers attested using standard infection prevention practices including hand hygiene, change of clothes, foot baths and use of gloves, boots and masks in their farms. However, majority of farm workers do not use gloves (124, 59.9%) and face masks (138, 66.7%). Also, most (113, 54.6%) participants do not invite veterinary doctors or technicians to their farms.

Table 4

Study participants’ prevention and control practices used towards mitigating zoonotic diseases during farming procedure
Variables	Categories	Proportion of farmers (%)
Veterinary doctor or technician visit and control	No	113 (54.6)
Veterinary doctor or technician visit and control	Yes	94 (45.4)
Frequency of visit	Less frequent	13 (13.8)
	Frequent	62 (66.0)
	More frequent	19 (20.2)
Frequency of Hand wash	Not at all	34 (16.4)
	Sometimes	28 (13.5)
	Always	145 (70.0)
Use of gloves	Not at all	124 (59.9)
	Sometimes	49 (23.7)
	Always	34 (16.4)
Use of face mask	Not at all	138 (66.7)
	Sometimes	41 (19.8)
	Always	28 (13.5)
Wearing of boot	Not at all	64 (30.9)
	Sometimes	37 (17.9)
	Always	106 (51.2)
Use of footbath	Not at all	98 (47.3)
	Sometimes	29 (14.0)
	Always	80 (38.6)
Change of clothes	Not at all	75 (36.2)
	Sometimes	43 (20.8)
	Always	89 (43.0)

Participants’ strategies to control the spread of diseases in the farms were evaluated by analysing their reactions towards sick and dead birds. The most common actions taken by participants with regard to sick birds are the use of antibiotics (205, 99%) and quarantine of sick birds (94, 45.4%); however, some participants will prefer to sell the sick birds (11, 5.3%). Only few farmers will report to the veterinary health authorities (5, 2.4%), vaccinate the birds (11, 5.3%) or disinfect poultry house and equipment (27, 13%) (Fig. 4).

Participants were also asked how they dispose of dead birds and their responses are recorded in Fig. 5. The most common response (107, 51.4%) was to bury the bird carcasses. However, some participants would sell the carcasses at cheaper prices (3, 1.4%) or eat them (36, 17.4%).

The relationship between participants’ risk perception, knowledge and prevention and control practices of zoonotic diseases were analysed using chi-square test and logistic regression as shown in Table 5. There was a significant association between risk perception and knowledge (P = 0.007; CI = 1.257–4.200) as well as between risk perception and prevention/control practice (P = 0.002; CI = 1.451–4.867). It was revealed that poultry farmers who have good knowledge of zoonotic diseases are about twice more likely to have high risk perception than those with poor knowledge. Also, farmers with high risk perception are about 2 times more likely to exhibit good farm practices than those with low risk perception.

Table 5

Association between participants’ risk perception, knowledge and prevention and control practices of zoonotic diseases
Variable	Category	Risk Perception (%)			P value	AOR	95% CI
		Low	High	Total			Lower	Upper
Knowledge	Poor	78 (69)	35 (31)	113	0.007	1.000	1.257	4.200
	Good	40 (42.5)	54 (57.5)	94		2.297
	Total	118	89	207		NA
Prevention and control practice	Poor	82 (69.5)	36 (30.5)	118	0.002	1.000	1.451	4.867
	Good	36 (40)	53 (60)	89		2.658
	Total	118	89	207		NA
CI: Confidence Interval; AOR: Adjusted Odds Ratio; NA: Not Applicable

The interaction between people, livestock and the environment are very close particularly in low income countries, since these animals act as sources of animal protein, aid in farming and bring about fuels [24]. Consequently, interface often lead to an increased risk of zoonotic diseases transmission from animal to human [4]. Furthermore, as most of the small-scale farmers live below the poverty limits, they may have little or no education or skills; this might result to inappropriate knowledge, awareness of raising livestock in a healthy manner and exposure to some potential risk factors associated with zoonotic diseases. The inadequate knowledge and low perception of the risk associated with zoonotic diseases may give room for poor preventive and control practices in the farms. The present study was initiated to determine the knowledge and risk perception of zoonotic diseases among poultry farm workers and how these factors contribute in the manner they adopt preventive and control practices in their various farms.

Data from the present study revealed that most poultry farmers in the study area are males within the youthful ages of 26 and 35 years and are University graduates. Since agriculture forms the backbone of most developing economies, it is common to find persons of working age engaging in agriculture for sustenance and or income generation [5, 6, 25]. However, in our setup, the majority of the farmers were farm owners who also serve as farm workers but with little or no experience. Lack of financial resources could account for the inability of the farm owners to hire trained personnel. Also, the most common birds kept by poultry farmers in the study area are broilers which are usually meant for meat production. Meanwhile, these farms are usually small in size with average flock capacity of about 500 and average yearly production of about 3000 birds. In order to meet the Sustainable Development Goal (SDG) to eradicate extreme poverty and hunger and to meet the increasing demand for poultry meat [26], there is need for more poultry farms with larger capacities to be established in this setup. Furthermore, the practice of mixed farming (with predominant animals being pigs) may enhance the development of antibiotic resistant strains [27].

The level of knowledge of ZDs and adequate infection prevention and control practices in farms are crucial in curbing the spread of infectious diseases among high risk groups; a public health significance. Awareness of farm workers about possible transmission of pathogens from animals to humans is essential in adopting adequate preventive measures. The results of this study indicated poor knowledge of zoonotic diseases among farm workers and the findings are in agreement with some previous reports [22, 28]. Although majority of the participants knew that infections could be gotten from sick birds most of them did not know that infections could be acquired from apparently healthy birds. It is a fact that some microbes that occur as normal flora in birds and animals may become pathogenic in humans [7]. Consequently, the absolute unawareness of farm workers on potential infection transmission routes may present with high risk of exposure to ZDs in poultry farms.

Poultry diseases commonly reported by farmers were salmonellosis and coccidiosis; and the predominant signs and symptoms include abnormal droppings, general inactivity, cough and loss of appetite. Our results corroborate previous findings in which salmonellosis, avian influenza, Newcastle disease and campylobacteriosis were commonly reported [28, 29]. Contrarily, our poultry farmers were seemingly unaware of the zoonotic potential of foodborne pathogens such as Campylobacter spp. Furthermore, poultry farmers in the study area had more than one source where they could obtain information concerning poultry diseases and zoonotic diseases; the most common being from other poultry farmers and media such as television, radio and internet. These sources of information tend to be common for most aspects of daily life. However, information from these sources may be limited and non-specific. Sometimes, livestock farmers may need customized information related to their specific geographical settings. Such information can most likely be gotten from their local veterinary professionals or animal health workers; but this was not the case in our study. Thus, effective communication between farmers and veterinary professionals in the study area may help to improve risk perception and farm management practices. Evidence have shown that building partnerships with institutions providing services in communities and trusted sources of information for the target population to provide information and training are effective ways of engaging with health promotion activities in farming and rural communities [30]. Previous studies indicate that health education intervention significantly improved the knowledge farmers towards control of zoonotic diseases. [31]

Risk perception of ZDs was assessed by investigating participants’ feelings when exposed to potentially hazardous materials and their consciousness of getting infected in the farms. More than half of the farmers had low risk perception of ZDs. Most of the participants considered coming in contact with dead, sick birds or bird’s faeces as a possible source of zoonotic disease exposure or transmission. These results are similar to previous findings [33, 34] carried out among veterinary professionals. Nonetheless, majority of our participants did not consider contact with bird’s fluid or live birds as potential risk of infection. Such category of farmers are at high risk of acquiring and/or spreading ZDs since they will not see the need of wearing PPEs when handling live birds or during slaughter. Similar findings have been reported and this was attributed to poor knowledge of poultry diseases and potential sources of ZDs transmission in poultry [28].

The concern of the poultry farmers about them or their colleagues, clients or family members contracting a ZD may be a reflection on their awareness and respect of biosecurity guidelines. A considerable proportion of farmers in the present study were concerned; however, this proportion was lower than that reported by Dowd and colleagues [32] among veterinarians. Veterinarians are more likely to be educated or trained on aspects of ZD exposure, prevention and control compared to ordinary farmers. It was also noticed that more farm employees had high risk perception than farm owners and business partners while those with University education had high risk perception than participants with lower level of education. Meanwhile, more participants with small farms (< 500 birds) had low risk perception compared with their counterparts with large farms (> 1000).

Poultry farmers were interviewed on the preventive/control measures they use against ZDs in their various farms. Majority of participants had poor prevention and control practice level. This could be explained by the fact that most of the respondents were not aware of a possible transmission of a zoonotic infection from the live birds and other potentially contaminated poultry materials. A good proportion of the participants indicated they always wash their hands before and after contact with birds or poultry site and this is commensurate to previous findings [28, 34]. The importance of hand hygiene in reducing infectious disease risks among the farming community could be increased by encouraging farmers to wash their hands properly and at the correct time [30, 35]. However, a large proportion of farmers in our setup do not make use of basic prevention practices such as use of gloves, facemask and/or foot-bath. This could be explained by their unawareness of possible airborne or other means of transmission of diseases from birds to humans.

Although most farmers will treat their sick birds with antibiotics and/or separate (quarantine) them from healthy birds, some prefer to sell the sick or dead birds at a cheaper rate for consumption. Eating or handling of bird carcasses is a practice that could propagate the spread of diseases from the farms to the community; and it should be discouraged. Moreover, the fact that most farmers would not employ the services of veterinary experts during an outbreak is a cause for concern. A more worrying concern is the use of antibiotics by almost all the farmers. Worthy of mention is the fact that antibiotic use especially in the veterinary sector in Cameroon is seldom regulated. As a result, these antibiotics are readily availability at feed mills and veterinary stores at affordable prices. In such scenarios, antibiotics can easily be misused or overused and this might enhance the development and spread of antimicrobial resistance [36]. There is a need for a sentinel institution to be established in our setup, to regulate the use of antibiotics in farm animals as well as to set guidelines for farm practices in a bit to curb the spread of ZDs.

Significant relationships were observed between participants’ risk perception, knowledge and prevention and control practices of zoonotic diseases. Poultry farmers who have good knowledge of zoonotic diseases were about twice more likely to have high risk perception than those with poor knowledge. Also, farmers with high risk perception were about 2 times more likely to exhibit good farm practices than those with low risk perception. From a one health perspective, education and sensitization of poultry farmers in the study area through training workshops and constant follow-up by veterinary professionals will help boost farmers’ awareness of ZDs and improve on their mitigation practices.

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BHD

Buea Health District

FAO

Food and Agricultural Organization

Health Area

PPE

Personal Protective Equipment

SDG

Sustainable Development Goal

WHO

World Health Organization

Zoonotic Disease

ZDs

Zoonotic Diseases

Ethical approval and consent to participate

Ethical approval was obtained from the Ethics Committee of the Faculty of Health Sciences-Institutional Review Board of the University of Buea (IRB00008917-US Office for Human Research Protection (OHRP) IORG007426) protocol number 2021/1446-04/UB/SG/IRB/FHS. The Department of Public Health and Hygiene issued an authorization to conduct a research which was used to obtain an administrative clearance from the Regional Delegation for Public Health, South West Region and an authorization from the Regional Delegation for Livestock, Fishery and Animal Industry, South West region. A verbal authorization was also obtained from the owners of the feed producing stores. The consent of each participant was obtained by issuing a consent form.

Consent for publication

Not applicable.

Availability of data and materials

All datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interest

The authors declare that they have no competing interests.

Funding

The authors did not receive any funding for this study

Authors’ contribution

MAEB: Conception and design of the study, data validation, revision of manuscript, general supervision and final approval of the manuscript.

LNJC: Conception and design of the study, data collection, data processing and analysis, drafting of manuscript, revision of manuscript

EA: Data validation, revision of the manuscript, general supervision and final approval of the manuscript.

RBN: Data collection, data processing and analysis, drafting of manuscript, revision of manuscript

NT: Data analyses, data validation, general supervision and final approval of the manuscript.

Acknowledgements

Our gratitude goes to the Department of Public Health and Hygiene, for hosting this study. We are grateful to the owners and staff of the feed-production sites for providing a meeting point with the farmers. We also thank the poultry farmers for participating in the study.

No competing interests reported.

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Zoonotic Diseases Risk Perception and Infection Prevention and Control Practices Among Poultry Farmers in the Buea Health District: a One Health Perspective

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Abstract

Background

Methods

Results

Conclusion

Figures

1. Introduction

2. Materials And Methods

2.7 Sampling Technique

2.8 Data collection procedure

2.8.2 Knowledge of zoonotic diseases

2.8.4 Infection prevention and control practices in poultry farms

2.9 Data processing and analysis

3. Results

3.1. Socio-demographic data of farm workers and characteristics of farms

3.2. Knowledge of zoonotic diseases among farm workers

3.3. Risk perception of zoonotic diseases among poultry farmers

3.5. Infection prevention and control practices among poultry farmers

4. Discussion

5. Conclusion

References

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