Knowledgeof anthrax infection prevention and its associated factors among livestock owners in Sekotazuria district, Wag-himra zone, northeast, Amhara region Ethiopia: Cross Sectional Study

Anthrax is an infectious bacterial disease transmitted from infected animal to human by direct or indirectcontact with their products like hides or wool. The most efficient ways of anthrax infection preventions are vaccination of livestock, surveillance, and proper disposal of livestock carcasses in domestic herd.Recently, anthrax infection in humans has been reported from several districts spreadcountrywide and becomes a major public health problem of animals-humans in Amhara region (the study area).Objective This study aimed at determining knowledge of anthrax infection prevention and its associated factors among livestock owners in Sekotazuria district.Method Community based cross-sectional quantitative study was conducted from April to May, 2018, at Sekotazuria district, Northeast Ethiopia. A total of 844 live-stoke owners were selected from Sekotazuria district using simple random sampling technique. Data were collected using a structured self-administered questionnaire and data were cleaned, coded, and entered into Epi-info version 3.5.3, and transferred into SPSS version 20 for further statistical analysis. A p-value of less than 0.05 at multiple logistic regression analysis was considered statistically significant.Results The study revealed that good knowledge of anthrax prevention among livestock owners was 55.8% (95%CI: 54.2, 57.4%). According to multivariable logistic regression analysis, secondary and above educational levelAOR=2.97, 95% CI: 1.07, 8.20, age range of 42 – 80 AOR=1.47, 95% CI: 1.04, 2.07, and health education about anthrax AOR=4.25, 95% CI: 2.51, 7.17were found significantly associated with good knowledge of anthrax infection

category 42-80 years, and health education about anthrax were factors associated with knowledge of anthrax infection prevention. Therefore, health education about anthrax shall be strengthening.

Background
Anthrax is a zoonotic infectious disease caused by Ba cillus anthraci, a gram positive, nonmotile, spore forming rod shape bacteria which primarily affect herbivorous, wildlife and livestock's [1][2][3].Anthrax spores can remain viable for decades and this remarkable stability of the spores makes them an ideal bioweapon [4,5].Anthrax is transmitted to human via direct or indirect contact with infected animals and their products like hides or wool,though skin contact,ingestion, and inhalation of spores [6].Human anthrax usually develops after exposure to infected animals and their tissues [7]. Anthrax is globally distributed disease, reported from all continents that are populated heavily with animals and humans. It continues to persist globally with an estimated 20,000 to 100,000 incidence cases yearly, and it is highly affecting rural areas in developing nations [8,9].It hasa great impact on livelihood of livestock farmers by affecting their health and reducing the quantity and quality of animal products thereby causing huge economic loss, that further resulted impaired economy and loss of livestock product market because of decreased consumer confidence [10,11] .
Anthrax is a serious disease of major health or economic importance and it is estimated that about 1.83 billion people live within regions of anthrax risk areas [12]. Literatures reported that adequate knowledge on anthrax prevention is considered as one of the strategy for anthrax prevention in humans [13,14]. However, lack of awareness among livestock owners contributed for the burden of the problem and it is also an important hurdle in controlling zoonotic diseases [15]. A study conducted in Bangladesh, 56.67% people had no knowledge about anthrax disease, its outbreak and the consequences, and 50.83% people did not have knowledge on the proper process of carcass disposal [16].
In Ethiopia, human anthrax becomes a great concern for the public and occurs in several

Study design and setting
A community-based cross-sectional quantitative study was conducted from April to May, 2018, in Sekotazuria district, Northeast Ethiopia. Sekota is located 462 km far from Bah Dar, the capital city of Amhara region to the North, and 460 Km from Addis Ababa (the capital city of Ethiopia). Sekotazuria district established with 35 rural Kebeles. In 2018, the district population estimated to be a total of 173,026.

Study Participants,sample size, and sampling procedure
A total of 844 live stoke owners were selected from Sekotazuria district using simple random sampling technique. Sample size was calculated using the single population proportion formula, considering the following assumptions: 50.8 % the prevalence of Knowledge related to prevention and control anthrax disease from recent community based cross sectional survey in Oromia region [19], 95% level of confidence and 5% margin of error and 5% of non-response rate and 2 design effect. Finally, a minimum sample size of 844 was obtained.

Data collection tool and procedure
Data were collected using a pretested structured questionnaire. To maintain its consistency, the questionnaire was first translated from English to Amharic (the native language of the study) and retranslated to English by a professional translator and public health experts. Data were collected by an interview-administered structured questionnaire. One day intensive training on the objective of the study, and the confidentiality of information was given to data collectors and supervisors.

Operational definition and study variables
Knowledge: respondents to know causes, symptoms, mode of transmission and prevention methods of anthrax disease.

Good knowledge toward anthrax infection prevention: respondents answered equal
to or more than 50% of knowledge measuring questions.

Data processing and analysis
Data were entered into Epi-info version 7 and exported to a statistical package for social science (SPSS) version 20 for further analysis. Data cleaning was done by running frequencies. Descriptive statistics, including frequencies, and proportions were computed to summarize the variables. The logistic regression model was used in the process. A pvalue of less than 0.05 at the multivariable logistic regression analysis was considered statistically significant.

Results
Socio-demographic characteristics of respondents A total of 800 livestock owners were participated in the study with response rate of 94.8%. More than three-fourth of study participants were males (78.5%), farmers (88.9%) and lived in rural residence (87%) (Table1).  Regarding with the sign of disease in animals, most respondents observes sudden death (67%) and local swelling on the ventral side of the body parts (56.5%) (Figure3).  Multivariable binary logistic regression result showed that respondents whose educational level, peopleswho got health educationabout anthrax and ageof respondents were significantly associated with knowledge of anthrax prevention.
The finding of this study shows that the overall practice of respondents towards anthrax disease prevention was found to be twenty five point four(25.4%). This finding was lower than study done in turkey 51.9% [17], and Zimbabwe 86% [18]. This implies, despite 55.8% of respondents having good knowledge about anthrax disease prevention only 25.4% of respondents were changed their knowledge to practice. This may be due to economic discrepancy between them; the district was one of the food in secured from Wag-Himra Zone.
In this study finding more than half of study participants (55%)know anthrax was transmitted from animal to human in line with this study conducted in India 56% [19].
Transmission through the consumption of infected meat was mentioned by 48% of the respondents, contact 6.5% and fly 0.3% This in line with study done inEthiopia [23] 54.9%ingestion, 14.3% contact and Zimbabwe [26] Arusha and 33%from Tanga [20].

Factors Associated with good Knowledge of Anthrax infection prevention
Based on this finding educational level of respondent's was correlated with knowledge of respondents towards anthrax prevention. Respondents who attend high school and above were 2.97 times more likely to have good knowledge on anthrax disease prevention as compared to respondentswho can't read and write. This finding was in line with study done Zambia [19] Turkey [17]and Kenya [25]that reported when the level of education increases the knowledge of respondents found to be significantly increased.
Respondents who got health education about anthrax disease were 4.25 times more likely to have good knowledge of anthrax disease prevention than respondents who couldn't get health education. This finding was in line with other study done in Zimbabwe that indicates low level of knowledge of respondents associated with limited access to health education about anthrax disease prevention [26]. This may be due to the fact that having information about the disease was enhanced the knowledge of respondents towards prevention of the disease.
In this study age of respondents was significantly associated with good knowledge of anthrax disease prevention. The Odds of good knowledge about anthrax prevention among respondents whose age 42 -80 years was 1.47 times higher than respondents whose age was between 18 and 41years.This finding was different from other study done in Turkeyand Kenya, that reveals age is not associated with their knowledge of anthrax disease prevention [17,25].This difference might be due to; in the study area residents gain their knowledge of the disease from their life experience.

Conclusion
More than half percent (55.8%) of live stock owners had good knowledge on anthrax infection prevention; the contributing factorsfor good knowledge among livestock owners on anthrax infection prevention are educational level is secondary and above, age range of 42 -80 and health education about anthrax. Therefore health education about anthrax shall be strengthening.

Ethics approval and consent to participate
Ethical clearance was secured from the ethical review board of university of Gondar.
Before the initiation of data collection permission from all concerned body was obtained based on the letter obtained from university of Gondar. After getting support letter from Sekotazuria district administrative office and veterinary clinic, and kebele administrators, the purpose and objective of the study was informed for all participants and oral informed consent was obtained from each participant to initiate data collection.

Consent for publication
Not applicable

Availability of data and materials
Data will be available upon from the request of the corresponding author

Competing interests
The authors declare no competing interests

Funding
This research received no specific grant from any funding agency in the Public, commercial or not-for-profit sectors.

Authors' contributions
KS, TD and AMS were involved in the conception, design, data Collection, analysis and report writing. TD and AMS assisted with the Design, approved the proposal with some revisions, and participated in data analysis and manuscript preparation.
All authors read and approved the final manuscript.