Anthrax remains a neglected tropical disease that seldom receives attention by the government and researchers in Africa, including Nigeria. The re-emergence of the disease in 2023 has re-emphasized the need for the country to scale up integrated surveillance and monitoring frameworks and systems for transboundary animal infectious diseases and zoonoses occurring at the animal-human-environment interface. Having robust, well-structured, and efficient surveillance and reporting systems enhances early detection and management of potential outbreaks [20]. In addition, improved One Health implementation, diagnostic capabilities, resources (infrastructure, personnel, and funding), literacy advocacy, and border control policies or legislations are crucial for prompt disease intervention. The present study investigated potential gaps in knowledge, practice, and perception about anthrax among the high-risk working groups in AB and SH in Nigeria.
The demographics from this study showed the majority of AB and SH workers with the highest risk of exposure to anthrax were males and those with primary school and no formal education. These findings are consistent with previous studies conducted in Nigeria [21–24], Ethiopia [25–27], Bangladesh [9], and Malaysia [28]. Animal handling and slaughtering are demanding activities and maybe the reasons there were more male than female workers at the ABs and SHs. Also, with the poor level of education, it is not surprising to observe low awareness level about anthrax among the study participants except in categories with diplomas or tertiary education. Education plays a key role in how people access, process, and comprehend information including health messages [14].
Adequate knowledge, practice, and perception of AB and SH workers about anthrax are crucial to their overall health and safety as well as the general consumers of meat and meat products. It is known that disease transmission including anthrax is influenced by societal human behaviour, which correlates with the level of knowledge, attitudes, and practices of the public [8, 9]. With the present outbreaks of anthrax in West Africa, it is critical to generate scientific data to explain the knowledge, practice, and perception levels of AB and SH workers to promote a framework for policy decisions, and behavioural modifications through literacy programmes to prevent and control their exposure to the disease.
In general, the knowledge about anthrax among the participants was inadequate as less than one-third indicated the knowledge of the disease, its causative agent, clinical signs/symptoms in animals and humans, transmission pathways (such as consumption, processing, touching, or handling of infected animals or animal products e.g. cow skin (“ponmo”), and vaccination of animals as a preventive measure against infection in humans. The finding revealed that there may have been a lack of targeted sensitization or health education response to create awareness to lower the risk of exposure and protect workers' health despite the outbreaks within neighboring countries. In selected agricultural settings in Uganda, inadequate knowledge about anthrax, especially the clinical manifestation and modes of transmission in humans and animals, and preventive measures (vaccination in animals) were documented [8]. Although a study in Bangladesh reported more livestock farmers being aware of anthrax, and correctly describing one or more symptoms of animal and human anthrax, farmers had limited knowledge of the mode of transmission of anthrax and the preventive method, which is vaccination. Furthermore, in Kenya, household communities had insufficient information about the disease with approximately half of the respondents reported needing more literacy about the disease [15]. However, the majority of the study population had heard of anthrax and identified it as a zoonosis, knew the transmission sources, and that bleeding from body orifices is one of the clinical signs in animals [15]. Another similar study conducted among household communities in Ethiopia showed that a higher proportion of respondents Stated that they knew the disease, but most of them could not identify the causative agent and clinical signs/symptoms in animals and humans [14]. It is critical to emphasize that targeted literacy programmes regarding this disease are essential for workers at ABs and SHs to support early detection, notification, and prevention of disease outbreaks in animals and humans. Expanding health knowledge about the disease among these categories of individuals, especially using the top preferred channels (veterinary professionals, radio, and internet/social media) are desirable to promote understanding and the adoption of rapid health responses to prevent and control exposures. These recommendations are strongly supported by a previous study among pastoral communities in Ethiopia [29] and the present study findings, which highlighted possessing a high level of education and being in veterinary-related professions as significant factors for increased knowledge about anthrax.
Similarly, the levels of risk practices related to anthrax among the participants were high. For instance, the majority of the non-veterinary working categories such as butchers, meat processors, vendors, etc. still practised carrying carcasses on their heads or shoulders, splashing blood on carcasses, slaughtering sick and dying animals for human consumption, and poor waste and carcass disposal. Several of these risky and unsanitary practices are common practices in many Nigerian ABs and SHs [30, 31]. These practices do not only serve as potential sources of transmission and exposure to zoonotic diseases including anthrax but may also adversely impact food safety and meat consumers' health. From the present study, more participants strongly disagreed or disagreed that buying meat condemned of anthrax is forbidden (“taboo”). The practice and attitude of purchasing, consuming, and selling carcasses of animals that died from unknown causes, have been reported by other studies in Ghana and Zambia [32, 33]. Such meat is seen as serving as a source of inexpensive meat and an attractive option for the community [32]. Kamboyi and co-authors in a cross-sectional study of risk mapping and eco-anthropogenic assessment of anthrax in Zambia documented that 92.0% of participants self-reported within the questionnaire survey that the major method of disposal of anthrax carcasses was by consumption [34]. Furthermore, participants with no professional training in veterinary medicine (i.e. butchers, meat processors, meat vendors, cleaners, etc.) had high risk practices; thus, demonstrating poor preventive practices toward anthrax. This finding supports the fact that when people have adequate health knowledge, they execute good preventive practices and have the right perception toward health emergencies and responses to control and prevent an outbreak [35]. Health knowledge is a theoretical construct that includes providing detailed and specific information about etiology, prevalence, risk factors, prevention, transmission, symptomatology, and disease treatment, as well as on health services [35, 36]. Positive effects of appropriate levels of health knowledge have been shown to improve health behaviors and attitudes, which increase health promotion and disease prevention in a community. Besides, health knowledge promotes the acquisition of health practices and perceptions and reflects the efforts made by the health system, the government, and the community to combat the negative impact of zoonoses [35]. Improving targeted health knowledge about anthrax is therefore critical among the high-risk working groups in abattoirs and slaughterhouses for public health safety. To support this further, it was observed that positive knowledge increases positive practice, thus emphasizing the need for veterinary intervention, good extension services, and literacy programmes for ABs and SHs workers in Nigeria. Moreover, veterinary and para veterinarians who participated in this study underscored intensifying media publicity and awareness creation about anthrax. Other mitigation strategies including enforcement of vaccination policy for infection prevention in animals, implementation of effective surveillance systems for early detection and management, development, and execution of literacy programmes for AB/SH workers and communities, reformation of AB/SH, improved biosecurity on farms, and effective implementation of border control policies were recommended.
Annual and effective routine vaccination of animals especially, ruminants is the primary tool for mitigating animal anthrax [37] and should be prioritized in disease endemic African countries. It is not surprising to know that the majority of the participants were uncertain or disagreed that vaccination was required in animals to protect public health due to the poor health knowledge of the disease except those with veterinary backgrounds. The current vaccination status in animals in Nigeria is uncertain, though there may be an existing anthrax vaccination policy in the country. Internationally, the Bacillus anthracis attenuated Sterne-strain vaccine is used in animals [38]. In Nigeria, the National Veterinary Research Institute (NVRI) is saddled with the mandate to produce animal vaccines for animal health and welfare. During the outbreak in July 2023 in Nigeria, the National Veterinary Research Institute laboratory provided real-time laboratory testing and vaccines for ring vaccination of farms with suspected cases. However, there may be a need for the government and the animal sector to be more proactive than reactive to ensure that the anthrax vaccination policy, vaccine production, and campaign programmes are efficiently implemented and adequately funded to eliminate the persistence of the disease in Nigeria.
In addition, the anthrax outbreak stresses again the ‘One Health’ perception that human health is interconnected with animal and plant health and their shared environment [3]. To prevent further outbreaks in Nigeria, as well as other African countries, government efforts and advocacy by the one health sectors for the vaccination of animals are crucial to help prevent and reduce the likelihood of the spread of the disease to humans and individuals at the highest- risk [3]. The establishment of government-integrated zoonotic disease (including anthrax) surveillance systems and programmes for early detection, early response to future outbreaks, and long-term active and passive monitoring of diseases to facilitate informed policy decisions and implementations should be spotlighted. Ensuring an integrated platform for multidisciplinary, multisectoral, and interdisciplinary collaboration among physicians, veterinarians, other human and animal health workers, social workers, and the media in mitigating the anthrax outbreak in Nigerian communities is highlighted. One Health concept should be implemented in addressing the core sources of zoonotic spillovers at the human-animal interface. This approach will be more effective than individual sectors continuing to operate in silos thereby impacting unending cycles of outbreaks [39, 40].
Notwithstanding the findings above, this study had some limitations. One, assessment of risk practices was limited to questionnaire survey; on-the-spot assessment would have provided better insights into the participants’ level of risk of exposure to anthrax. Two, only seven of the 36 states including the Federal Capital Territory, Abuja were included in the study; larger sample size from higher number of states would have provided more robust data on the knowledge, risk practices and perception of abattoir and slaughterhouse workers in Nigeria. Despite these limitations, the present findings have provided critical baseline data required for informed control programmes and policy regarding anthrax in Nigeria.