Acta Tropica 189 (2019) 15–21

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Acta Tropica
journal homepage: www.elsevier.com/locate/actatropica

Knowledge, attitude and practices relating to zoonotic diseases among T

livestock farmers in Punjab, India
⁎
B.B. Singha, , R. Kaura, G.S. Gilla, J.P.S. Gilla, R.K. Sonib, R.S. Aulakha
a
School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana 141004, Punjab, India
b
Dayanand Medical College & Hospital, Ludhiana 141004, Punjab, India

A R T I C LE I N FO A B S T R A C T

Keywords: Zoonotic diseases cause significant health and economic impact in developing countries such as India. Many
Awareness zoonotic diseases are prevalent in the livestock and as an occupational zoonosis in the livestock farmers in India.
India Lack of knowledge on the disease transmission, prevention and control measures is a potential high risk for the
KAP occurrence of zoonotic diseases in the livestock and its keepers in India. We conducted this study to understand
Knowledge
knowledge, attitude and practices of livestock farmers regarding zoonoses. Five villages from each of the 22
Livestock farmer
Practice
districts of the state were conveniently selected (n = 110). Farmers available at village community sites were
Punjab enrolled in the study and requested to complete a custom designed questionnaire (n = 558). In addition, live-
Zoonoses stock farmers attending basic livestock husbandry training were also surveyed (n = 301). Data from ques-
tionnaires was used to create three index variables: (a) knowledge score; (b) attitude score and (c) practice score.
Association between demographic and other explanatory variables with knowledge score was evaluated using
linear regression analyses. Similarly, the association between knowledge and attitude score with practice score
was evaluated. Of the 859 participants, 685 (80%) livestock farmers had heard the term ‘zoonoses’ but only 345
(40%), 264 (31%) and 214 (25%) farmers were aware of the zoonotic nature of tuberculosis, Japanese en-
cephalitis and taeniosis, respectively. For practices, 23% farmers reported consumption of raw milk and only
10% and 8% livestock farmers ever got their animals tested for brucellosis and tuberculosis, respectively. The
low level of education and being a cattle farmer were negatively associated with the farmer’s knowledge on
zoonotic diseases. The attitude score was positively associated with the practice score of the participants. The
results indicate need for educating the livestock farmers particularly those with a low level of education to
reduce the health and economic impact of zoonotic diseases in India.

1. Introduction populations in India and human neurocysticercosis-associated active

Livestock is one of the most important assets of the poor to meet
livelihood needs (Perry and Grace, 2009). Animal diseases including
zoonoses are crucial constraints in enhancement of livestock-produc-
tion systems (FAO, 2002). Transboundary, zoonotic and foodborne
diseases negatively impact poor populations and national economies
(Gall and Leboucq, 2003). Huge losses have been reported in livestock
sector due to diseases such as brucellosis and cystic echinococcosis in
India (Singh et al., 2014, 2015).
Zoonotic diseases cause significant health and economic burden in
developing countries (Halliday et al., 2015). Many zoonotic pathogens
are a serious animal and public health concern in India. For example,
about 20,000 deaths due to rabies (Knobel et al., 2005) and 2.2 million
new cases of tuberculosis (WHO, 2013) occur every year in the human
epilepsy causes 2.10 million disability adjusted life years in India (Singh
et al., 2017).
Many zoonotic diseases are also considered as significant occupa-
tional health hazards (Battelli, 2008). Livestock owners have different
type and intensity of human–livestock contacts which may result in
transmission of microorganisms and associated zoonoses (Klous et al.,
2016). Livestock farmers are exposed to a number of zoonotic patho-
gens such as Coxiella burnetti and Toxoplasma gondii (Thomas et al.,
1999). In the US, zoonoses are an important occupational hazard and a
health concern for livestock workers (Lejune and Kersting, 2010). In
Italy, occupational exposure to zoonotic agents such as Coxiella burnetti
and Leptospira species among agricultural workers have been reported
(Tabibi et al., 2013).
There are number of zoonotic diseases prevalent as occupational

⁎
Corresponding author.
E-mail address: bbsdhaliwal@gmail.com (B.B. Singh).

https://doi.org/10.1016/j.actatropica.2018.09.021
Received 1 December 2017; Received in revised form 7 July 2018; Accepted 23 September 2018
Available online 27 September 2018
0001-706X/ © 2018 Elsevier B.V. All rights reserved.
B.B. Singh et al.
zoonosis in livestock farmers in India. The brucellosis sero-prevalence
between 0.9%–18.1% with a high risk in veterinarians and farm at-
tenders has been reported from India (Seleem et al., 2010; Agasthya
et al., 2007; Mantur and Amarnath, 2008). The zoonotic Giardia duo-
denalis Assemblage A1 has been detected in both calves and dairy
workers in West Bengal, India (Khan et al., 2011).
Punjab is an agrarian state of Northern India (Latitude of 30°4′N and
Longitude 75° 5′ E) with a human population of 27,704,236 and 63% of
its population reside in rural areas (Census of India., 2011). The state
has the highest per capita milk availability (932 gm/person/day) in the
country with a cattle and buffalo population of 2.42 and 5.16 million,
respectively (BAHS, 2014). There are 128 534 sheep, 327 272 goat and
32 221 pigs in Punjab (BAHS, 2014). The state is home to 737 352
backyard poultry consisting of fowls and chicken below 5 months of age
(BAHS, 2014). There are 4 610 921 households/household enterprises
owning animals/poultry birds in Punjab state of India (BAHS, 2014).
There are 718 cattle, 1543 buffaloes, 39 sheep, 97 goat and 7 pigs per
thousand households in the rural areas of Punjab (BAHS, 2014). The
official estimates indicate the presence of 100 991 stray cattle in the
state (BAHS, 2014). Over 70% of the households own livestock in the
rural areas (Ali, 2007). The animal husbandry and crop agriculture are
intrinsically linked and important for overall food security in the state
(DAHDF, 2017). Mixed farming is commonly practiced in Punjab, India.
Based on their occupation, there are three categories of people keeping
livestock in the state a) crop farmers keeping livestock b) livestock
farmers growing crops or involved in other secondary activities c)
People primarily involved in non-agriculture activities but raise live-
stock at home.
Many zoonotic diseases such as brucellosis, tuberculosis, rabies,
taeniosis, ringworm and toxoplasmosis are endemic in Punjab state of
India (Dhand et al., 2005; Brookes et al., 2018; Singh et al., 2010). In
addition, human cases of swine flu and japanese encephalitis have been
reported from other states of India (Prakash et al., 2011; Tiwari et al.,
2012).
Knowledge on zoonotic disease transmission, prevention and con-
trol measures is a must for livestock farmers. It will help prevent and
control zoonotic diseases as an occupational hazard and reduce the
incidence of zoonotic diseases in human as well as livestock popula-
tions. Therefore, the current study was planned to assess knowledge,
attitude and practices (KAP) relating to zoonotic diseases among live-
stock farmers for policy development and to help formulate and im-
prove existing zoonotic disease educational programs.
2. Methods
The necessary ethical permission for the conduct of this study was
obtained from the Institutional Ethics Committee, Dayanand Medical
College & Hospital, Ludhiana, Punjab (Ethics approval number: DMCH/
R&D/2016/372).
The study was conducted as a cross-sectional study between 2015
and 2016.
2.1. Target and study population
The target population comprised of livestock (cattle/buffalo/sheep/
goat/pig) farmers residing in the rural areas of Punjab. The study po-
pulation was the farmers belonging to 110 villages of Punjab re-
presenting all the 22 districts (5 villages from each district) of Punjab as
well as those attending livestock trainings at Guru Angad Dev
Veterinary & Animal Sciences University (GADVASU). The basic train-
ings are being conducted by the Department of Veterinary and Animal
Husbandry Extension Education, GADVASU. The trainings are orga-
nised across the year and usually 30–50 participants are enrolled in
batches. These trainings are advertised on the University website and
farmers are nominally charged for such trainings. As these trainings are
organised on-campus, more farmers from the nearby districts enrol in
16
Acta Tropica 189 (2019) 15–21
the training programs. The villages were conveniently selected, for
example, those closer to the main roads.
The unit of study was an individual livestock farmer.
2.2. Sampling procedure
As per the Census of India. (2011) there are 12,581 villages (as-
sumed equivalent to animal herds) in Punjab state of India. We selected
110 villages representing approximately 1% of the total villages. As-
suming that 50% of the farmers would have knowledge about zoonotic
diseases, a sample size of 534 was required to estimate the knowledge
proportion with 5% precision and 95% confidence assuming a response
rate of 70% and a population of 13 114 farmers in the 110 villages
selected (Dhand and Khatkar, 2014). As per the National sample survey
office data, the total operational holdings for all the livestock classes in
Punjab have been reported to be 1 499 900 (NSSO, 2013). By assuming
that livestock operational holdings will be uniformly distributed across
whole of the state, we estimated that there will be 13 114 livestock
operational holdings in the 110 villages selected in the study.
The research team visited the selected villages and requested live-
stock farmers at community sites to participate in the study. In addition,
livestock owners attending livestock husbandry trainings GADVASU
were requested to participate in the study. The participant information
statement explaining the purpose of study was provided to all the
participants and a written consent was obtained from the participants
indicating their willingness to participate in this study. After this, the
participants were asked to complete a questionnaire to assess their KAP
relating to zoonotic diseases. The participants were offered the ques-
tionnaire either in English or in the local language (Punjabi). After
completion of the questionnaire, participants were provided with in-
formation brochures explaining prevention and control measures of
important zoonotic diseases.
2.3. Questionnaire design and data collection
The questionnaire was developed to collect detailed demographic
information and related to KAP of livestock farmers about zoonotic
diseases. The demographic information collected included age, gender,
family size, and the educational qualifications. The livestock farm as-
sociated details included years in livestock farming, number and species
of the animal present at the farm. For knowledge assessment of the
livestock farmers, the basic questions were asked about endemic or
historically important zoonotic diseases such as brucellosis, rabies, tu-
berculosis, plague, swine flu, taeniosis, hydatidosis, toxoplasmosis and
ringworm. Initially, the farmers were asked if they have heard about
these diseases and were later told to identify animal hosts associated
with the transmission of these zoonotic pathogens. The answer was only
considered ‘correct’ if the farmer was able to correctly identify at least
one of the animal hosts; however additional selection of an animal host
not related to the disease was considered as an incorrect reply.
Information related to practices included animal deworming practices,
habit of consuming raw milk, washing hands after contact with animals,
the habit of walking bare feet at home or at the farm and testing of the
herds for brucellosis or tuberculosis. The attitude related information
for disposal of carcasses and deworming practices were also collected.
2.4. Data handling and statistical analysis
The analyses were conducted using IBM SPSS Statistics for
Windows, Version 22.0 statistical software (released 2013. © 2013,
Armonk, NY: IBM Corp).
2.5. Explanatory and outcome variables
We used demographic characteristics and whether the livestock
owner came for basic husbandry training as explanatory variables. A
B.B. Singh et al. Acta Tropica 189 (2019) 15–21

knowledge score index (range 0–22) was prepared by summing up Table 1

participant’s knowledge of the term zoonoses, routes of transmission of Frequency table for demographic variables in a KAP study relating to zoonotic
the above mentioned zoonotic diseases. The practice score (range 0–7) diseases among livestock owners in India.
was prepared by summing up participant’s animal deworming prac- Variable Enrolment
tices, habit of consuming raw milk, washing hands after contact with
animals, the habit of walking bare feet at home or at the farm and Category Survey (%) Training (%) Total (%)
testing of the herds for brucellosis or tuberculosis. The attitude score
Age (Years) 11–20 50 (8.96) 55 (18.3) 105 (12.22)
(range 0–2) consisted of the attitude towards disposal of carcasses and 21–30 84 (15.11) 127 (42.19) 211 (24.56)
for the deworming practices. Each correct answer was awarded a score 31–40 109 (19.53) 62 (20.6) 171 (19.90)
of 1.0 and no score was awarded for an incorrect reply. Data were 41–50 132 (23.66) 36 (11.96) 168 (19.55)
51–60 107 (19.17) 15 (4.98) 122 (14.20)
entered into Excel sheet and descriptive analyses were carried out.
60+ 76 (13.62) 6 (2.0) 82 (9.54)
Frequency variables of important explanatory and outcome variables
were prepared. Gender Male 507 (90.9) 255 (84.7) 762 (88.70)
Female 51 (9.1) 46 (15.3) 97 (11.29)

2.6. Association of demographic variables with knowledge score Level of Education Illiterate 78 (14.0) 7 (2.3) 85 (9.89)
10th 271 (48.6) 49 (16.3) 320 (37.25)
12th 156 (28.0) 161 (53.5) 317 (36.90)
The unconditional association between each explanatory variable Graduate 42 (7.5) 65 (21.6) 107 (12.45)
and knowledge score was determined using univariable linear regres- Post- 11 (2.0) 19 (6.3) 30 (3.49)
sion analyses. The preliminary analysis was conducted using demo- graduate
graphic data as explanatory variables and knowledge score as the Primary occupation Crop farming 438 (78.5) 218 (72.4) 656 (76.36)
outcome variable. The explanatory variables with univariable p-value Dairy 20 (3.6) 33 (11.0) 53 (6.16)
of < 0.25 (based on the F test statistic) were considered for multi- farming
Any other 100 (17.92) 50 (16.6) 150 (17.46)
variable model building.
Explanatory variables showing statistical significance (p-value < Secondary Crop farming 14 (2.5) 11 (3.7) 25 (2.91)
occupation Dairy 24 (4.3) 27 (9.0) 51 (5.93)
0.25) in univariable analyses were tested in the final multiple linear
farming
regression model using a forward stepwise approach. Explanatory Any other/ 520 (93.19) 263 (87.3) 26 (3.02)
variables with a univariable p-value > 0.25 were also retested after None
including in the final model. Standardized and studentized residuals Number of members 1–5 306 (54.84) 155 (51.5) 461 (53.66)
were used to test the overall fitness of the final model. The regression in the household 6–10 230 (41.22) 141 (46.84) 371 (43.18)
coefficients, the standard errors of the coefficients, and the statistical 11–15 20 (3.58) 5 (1.66) 25 (2.91)
significance levels of the coefficients were estimated. The adjusted R2 16–20 2 (0.03) 0 (0.0) 2 (0.23)

was used to assess how well the model accounts for the outcome of the Years since farming 0–5 42 (7.5) 64 (21.3) 106 (12.33)
data. 5–10 38 (6.8) 56 (18.6) 94 (10.94)
10–15 29 (5.2) 47 (15.6) 76 (8.84)
15–20 51 (9.1) 41 (13.6) 92 (10.71)
2.7. Association of knowledge and attitude score with practice score 20+ 398 (71.3) 93 (30.9) 491 (57.15)

Number of animals in 0–5 362 (64.87) 156 (51.83) 518 (60.30)

In this analysis, knowledge and attitude scores were included as the household 6–10 130 (23.3) 76 (25.25) 206 (23.98)
explanatory variables and the practice score was used as an outcome 11–15 38 (6.81) 33 (10.96) 71 (8.26)
variable 16–20 9 (1.61) 18 (5.98) 27 (3.14)
20+ 19 (3.40) 18 (5.98) 37 (4.30)

3. Results Owns cattle Yes 555 (99.5) 288 (95.7) 843 (98.13)
No 3 (0.5) 13 (4.3) 16 (1.86)
3.1. Distribution of participants Presence of sheep or Yes 25 (4.5) 14 (4.7) 39 (4.54)
goat No 533 (95.5) 287 (95.3) 820 (95.45)
We contacted 585 livestock farmers in the survey and 558 consented Presence of pet Yes 177 (31.7) 123 (40.9) 300 (34.92)
to participate with a response rate of 95%. Overall, the participants animal (dog or No 381 (68.3) 178 (59.1) 559 (65.07)
included 558 livestock owners residing in 110 villages in Punjab, India cat)

in addition to 301 livestock owners representing more than 50% of the District Gurdaspur 17 (3.0) 16 (5.3) 33 (3.84)
livestock owners across the state attending basic animal husbandry Amritsar 30 (5.4) 3 (1.0) 33 (3.84)
Pathankot 30 (5.4) 1 (0.3) 31 (3.60)
training at GADVASU, Ludhiana were enrolled in the study. The de-
Tarntaran 34 (6.1) 3 (1.0) 37 (4.30)
tailed demographic profile of the participants has been presented in Jalandhar 33 (5.9) 11 (3.7) 44 (5.12)
Table 1. Kapurthala 18 (3.2) 16 (5.3) 34 (3.95)
Hoshiarpur 24 (4.3) 2 (0.7) 26 (3.02)
Rupnagar 25 (4.5) 4 (1.3) 29 (3.37)
3.2. Knowledge on zoonotic diseases
SBS Nagar 25 (4.5) 7 (2.3) 32 (3.72)
SAS Nagar 22 (3.9) 22 (2.56)
Of the 859 livestock farmers, 685 (80%) had heard the term ‘zoo- Mansa 31 (5.6) 24 (8.0) 55 (6.40)
noses’. Of the farmers, 345 (40%) were aware of the zoonotic nature of Moga 20 (3.6) 3 (1.0) 23 (2.67)
tuberculosis, 391 (45%) about plague, 788 (92%) about rabies, 264 Ludhiana 32 (5.7) 138 (45.8) 170 (19.79)
Fazilka 12 (2.2) 8 (2.7) 20 (2.32)
(31%) about japanese encephalitis and 214 (25%) about zoonotic
Ferozepur 32 (5.7) 11 (3.7) 43 (5.00)
nature of taeniosis. The detailed information related to knowledge, Faridkot 32 (5.7) 5 (1.7) 37 (4.30)
attitude and practices of farmers on zoonotic diseases are mentioned in Barnala 28 (5.0) 11 (3.7) 39 (4.54)
Table 2. As far as knowledge related to animals responsible for trans- Sangrur 8 (1.4) 8 (2.7) 16 (1.86)
Patiala 34 (6.1) 11 (3.7) 45 (5.23)
mission of zoonotic diseases were concerned (Table 3), most of the
Fatehgarh 23 (4.1) 3 (1.0) 26 (3.02)
farmers accurately identified dog as an important source for transmis- sahib
sion of rabies, however only 11% identified dog as responsible for Bathinda 16 (2.9) 6 (2.0) 22 (2.56)
transmitting hydatidosis. Interestingly, 53% of farmers believed Muktsar 32 (5.7) 10 (3.3) 42 (4.88)

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B.B. Singh et al. Acta Tropica 189 (2019) 15–21

Table 2
Frequency table for knowledge, attitude and practices of livestock owners relating to zoonotic diseases in Punjab, India.
Enrolment

Variable Response Survey (%) Training (%) Total (%)

Knowledge
Do you know about the zoonotic diseases? Yes 401 (71.86) 284 (94.35) 685 (79.74)
(Total population)
No 157 (28.13) 17 (5.64) 174 (20.25)
Have you heard about the disease called T.B. which can spread to humans through aerosols, raw milk, raw/uncooked Yes 141 (25.27) 204 (67.77) 345 (40.16)
meal/polluted environment?
No 417 (74.73) 97 (32.23) 514 (59.83)
Have you heard about the disease called Plague which can spread to humans by biting of flea? Yes 240 (43.01) 151 (50.17) 391 (45.51)
No 318 (56.99) 150 (49.83) 468 (54.48)
Have you heard about the disease called Rabies which can spread to humans and livestock by biting of a rabid dog? Yes 515 (92.29) 273 (90.7) 788 (91.73)
No 43 (77.06) 28 (9.30) 71 (8.26)
Have you heard about the disease called Japanese encephalitis which can spread to humans by biting of culex mosquito? Yes 142 (25.45) 122 (40.53) 264 (30.73)
No 416 (74.55) 179 (59.47) 595 (69.26)
Have you heard about the disease called Swine flu which can spread to humans by eating pork/chicken? Yes 252 (45.16) 198 (65.78) 450 (52.38)
No 306 (54.84) 103 (34.22) 409 (47.61)
Have you heard about the disease called Taeniosis which can spread to humans and cattles by eating raw/uncooked pork Yes 90 (16.13) 124 (41.20) 214 (24.91)
and fruits/vegetables infected with eggs of parasites in excreta of human?
No 468 (83.87) 177 (58.80) 645 (75.08)
Have you heard about the disease called Hydatidosis which can spread to humans by having food infected with eggs of Yes 63 (11.29) 113 (37.54) 176 (20.48)
parasites in excreta of dogs?
No 495 (88.71) 188 (62.46) 683 (79.51)
Have you heard about the disease called Ringworm which can spread to humans by direct contact with dogs and cats? Yes 138 (24.73) 127 (42.19) 265 (30.84)
No 420 (75.27) 174 (57.81) 594 (69.15)
Have you heard about the disease called Toxoplasmosis which can spread to humans and sheeps/goats through cat’s Yes 38 (6.81) 92 (30.56) 130 (15.13)
excreta?
No 520 (93.19) 209 (69.44) 729 (84.86)
Do you think, abortion during six to eight months of pregnancy, in-fertilization of animal, less milk production, swelling of Yes 250 (44.80) 220 (73.09) 470 (54.71)
testis, in-ability of reproduction are the main signs of Brucellosis?
No 308 (55.20) 81 (26.91) 389 (45.28)

Attitude
Do you think animal died with disease should be dumped in land covered with lime? Yes 136 (24.37) 223 (74.09) 359 (41.79)
No 422 (75.63) 78 (25.91) 500 (58.20)
Do you think animal should have to be dewormed? Yes 462 (82.79) 263 (87.37) 725 (84.40)
If yes, after how much time
No 96 (17.20) 38 (12.62) 134 (15.59)

Practices
Do you drink raw milk? Yes 142 (25.45) 59 (19.60) 201 (23.39)
No 416 (74.55) 242 (80.4) 658 (76.60)
Do you wash your hands after having contact with animals? Yes 539 (96.59) 281 (93.36) 820 (95.45)
No 19 (3.41) 20 (6.64) 39 (4.54)
Do you prefer walking bare feet at home? Yes 263 (47.13) 91 (30.23) 354 (41.21)
No 295 (52.87) 210 (69.77) 505 (58.78)
Do you prefer walking bare feet at farm or garden? Yes 270 (48.39) 125 (41.53) 395 (45.98)
No 288 (51.61) 176 (58.47) 464 (54.01)
Have you ever done deworming of your animal? Yes 428 (76.70) 195 (64.78) 623 (72.52)
No 130 (23.30) 106 (35.22) 236 (27.47)
Have you ever tested your animals for Brucellosis? Yes 48 (8.60) 39 (12.96) 87 (10.12)
No 510 (91.40) 262 (87.04) 772 (89.87)
Have you ever tested your animals for T.B.? Yes 41 (7.35) 31 (10.30) 72 (8.38)
No 517 (92.65) 270 (89.70) 787 (91.61)

Table 3
Frequency distribution (Relative frequency %) of livestock farmer’s knowledge for transmission routes of common zoonotic diseases in Punjab, India.
Name of the disease Reservoir host species

Dog Cat Buffalo Cow Rat Pig Horse Mosquito None of these

Rabies 828 (96.39) 138 (16.06) 159 (18.50) 147 (17.11) 36 (4.19) 33 (3.84) 41 (4.77) 31 (3.60) 11 (1.28)
Brucellosis 65 (7.56) 51 (5.93) 458 (53.31) 139 (16.18) 28 (3.25) 57 (6.63) 36 (4.19) 18 (2.09) 294 (34.22)
AIDS 34 (3.95) 20 (2.32) 31 (3.60) 30 (3.49) 29 (3.37) 28 (3.25) 11 (1.28) 76 (8.84) 695 (80.90)
TB 79 (9.19) 63 (7.33) 279 (32.47) 271 (31.54) 40 (4.65) 63 (7.33) 27 (3.14) 47 (5.47) 472 (54.94)
Plague 42 (4.88) 26 (3.02) 22 (2.56) 29 (3.37) 481 (55.9) 42 (4.88) 10 (1.16) 24 (2.79) 308 (35.85)
Swine Flu 29 (3.37) 20 (2.32) 32 (3.72) 30 (3.49) 26 (3.02) 475 (55.29) 21 (2.44) 85 (9.89) 297 (34.57)
Taeniosis 36 (4.19) 34 (3.95) 83 (9.66) 87 (10.12) 21 (2.44) 145 (16.88) 25 (2.91) 17 (1.97) 596 (69.38)
Hydatidosis 97 (11.29) 47 (5.47) 53 (6.16) 49 (5.70) 13 (1.51) 29 (3.37) 18 (2.09) 18 (2.09) 635 (73.92)
Toxoplasmosis 53 (6.16) 143 (16.64) 54 (6.28) 56 (6.51) 16 (1.86) 24 (2.79) 11 (1.28) 12 (1.39) 622 (72.40)
Ringworm 307 (35.73) 263 (30.61) 112 (13.03) 92 (10.71) 25 (2.91) 35 (4.07) 26 (3.02) 17 (1.97) 447 (52.03)
Cancer 50 (5.82) 52 (6.05) 142 (16.53) 146 (16.99) 16 (1.86) 29 (3.37) 21 (2.44) 14 (1.62) 637 (74.15)

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B.B. Singh et al. Acta Tropica 189 (2019) 15–21

Table 4 applied. More than 80% of the farmers believed that animals should be
Univariable linear regression analysis, demonstrating the influence of ex- regularly dewormed (Table 2). As far as common practices were con-
planatory variables on the outcome variables. cerned, 23% admitted consumption of raw milk and 46% preferred
Variable b P-value Adjusted R2 prefer walking bare feet at the farm or garden. For disease testing, only
10% and 8% livestock owners tested their animals for brucellosis and
Dependent variable: Knowledge score tuberculosis, respectively (Table 2).
Enrolment (Survey versus training) −0.357 < 0.001 0.127
Age (years) −0.295 < 0.001 0.086
Sex (male versus female) −0.158 < 0.001 0.024 3.4. Univariable analyses
Number of family members in the household −0.061 0.074 0.003
Number of animals 0.053 0.121 0.002 The results of univariable analysis are presented in Table 4. The
Owns cattle (yes versus no) −0.148 < 0.001 0.021
farmers covered under survey had lower knowledge on zoonoses as
Rearing sheep or goat 0.018 0.591 −0.001
Having a pet or not 0.218 < 0.001 0.046 compared to farmers who came to attend basic livestock training at the
Number of cattle 0.051 0.138 0.001 University (P= < 0.001). Increase in participant’s age (P= < 0.001),
Number of sheep and goat −0.029 0.860 0.00 being a male (P= < 0.001) and rearing cattle (P= < 0.001) were ne-
Number of pets 0.102 0.079 0.007 gatively associated with the zoonotic disease knowledge. The partici-
District pants with their primary occupation as ‘livestock farming’ had more
Referent: Mukatsar knowledge on zoonotic diseases (P= < 0.001), whereas low levels of
Gurdaspur 0.182 < 0.001 0.032
education were negatively associated with zoonoses knowledge.
Amritsar −0.115 0.001 0.012
Pathankot −0.220 < 0.001 0.047 Keeping a pet (dog or cat) was found to be positively associated with
Tarantaran −0.121 < 0.001 0.014 the zoonosis knowledge. The attitude score was positively associated
Jalandhar −0.151 < 0.001 0.022 with the practice score of the participants. Low levels of disease
Kapurthala −0.067 0.051 0.003
awareness were observed in some of the districts (Tables 4 and 5) as
Hoshiarpur −0.041 0.232 0.001
Rupnagar −0.017 0.617 0.00
compared to others indicating a need to direct education programs in
SBS Nagar 0.037 0.284 0.00 such areas.
SAS Nagar −0.10 0.003 0.009
Mansa −0.049 0.150 0.001 3.5. Multivariable analyses
Moga −0.021 0.538 0.00
Ludhiana 0.274 < 0.001 0.074
Fazilka 0.221 < 0.001 0.048 The results of multivariable analysis are presented in Table 5. The
Ferozepur −0.062 0.070 0.003 level of education, being a cattle farmer and whether the farmer came
Faridkot 0.072 0.036 0.004 for a basic livestock training or was covered under survey were the
Barnala −0.024 0.476 0.00
significant parameters found associated with the zoonoses knowledge.
Sangrur 0.070 0.041 0.004
Patiala −0.061 0.073 0.003 In addition, being a resident of district Gurdaspur, SBS Nagar,
Fatehgarh Sahib 0.005 0.893 0.00 Ludhiana, Fazilka, Faridkot and Bathinda was found to be positively
Bathinda 0.005 0.874 0.00 associated with zoonotic disease knowledge among the participants
Primary occupation (Table 5).
Referent: any other occupation
Crop farming −0.015 0.657 0.001 4. Discussion
Livestock farming 0.118 0.001 0.013

Secondary occupation We assessed knowledge, attitude, practices and level of under-

Referent: any other occupation
standing of the livestock farmers relating to zoonotic diseases in Punjab
Crop farming 0.061 0.072 0.003
Livestock farming 0.121 < 0.001 0.014 state of India. Results of the study indicated that most of the farmers are
not aware of the transmission, prevention and control of zoonosis such
Level of education
Referent: Post-graduate as toxoplasmosis, taeniosis/cysticercosis, hydatidosis and ringworm in
Illiterate −0.217 < 0.001 0.046 Punjab state of India. Previous studies also indicate low to medium
Matric −0.251 < 0.001 0.062 knowledge of farmers relating to zoonotic diseases in Punjab, India
12th 0.243 < 0.001 0.058 (Hundal et al., 2016). Similarly, Babu et al. (2015) found that
Graduate 0.158 < 0.001 0.024

Years since rearing Table 5

Less than 5 years 0.160 < 0.001 0.025
Multivariable linear regression analysis, demonstrating the influence of ex-
5–10 years 0.122 < 0.001 0.014
planatory variables on the outcome variables.
11–15 years 0.066 0.054 0.003
16–20 years 0.067 0.051 0.003 Variable St. β P-value Adjusted R2
Dependent variable: Practice score
Dependent variable: Knowledge score 0.333
Knowledge score −0.024 0.476 0.001
Covered under survey or came for training −0.211 0.001
Attitude score 0.112 0.001 0.011
Owns cattle −0.172 0.001
District
Referent: Mukatsar
brucellosis to be transmitted by buffalo as compared to 16% who Gurdaspur 0.195 < 0.001
identified cow as responsible for transmitting brucellosis. For tox- SBS Nagar 0.180 < 0.001
oplasmosis, 16% identified cat as a reservoir host. More than 25% of the Ludhiana 0.227 < 0.001
Fazilka 0.150 0.002
farmers had a lack of knowledge and believed cancer to be transmitted
Faridkot 0.170 0.001
by different livestock species. Bathinda 0.104 0.034
Level of education
3.3. Attitude and practices of participants on zoonotic diseases Referent: Post-graduate
Illiterate −0.224 < 0.001
Matric −0.280 < 0.001
For practices, 359 (42%) farmers believed that an animal died due 12th −0.170 0.08
to disease should be buried and disinfectants such as lime should be

19
B.B. Singh et al.
respondents had little knowledge of zoonoses except rabies in Andhra
Pradesh, India.
People primarily involved in livestock farming had better knowl-
edge on zoonotic diseases as compared to others. This might be due to
the fact that they are more likely to be in contact with veterinary
personnel or other sources of information associated with livestock
farming. Similarly, Swai et al. (2010) found higher knowledge on
zoonotic diseases in smallholder dairy as compared to traditional live-
stock keepers in Tanzania. The zoonotic disease knowledge was nega-
tively associated with increase in the age of participants. This might be
due to improvement of education system in the Punjab state of India.
Livestock farmers belonging to bigger households had poor knowledge
as compared to others. This might be due to the fact that large house-
holds have limited resources resulting in lower level of education in
such families. On the other hand, non-significant associations between
age, level of education, herd size have also been reported (Hundal et al.,
2016). The farmers coming for training scored better than those re-
cruited in villages. This might be due to the fact that they were more
progressive or aware than others.
The attitude and practices of livestock farmers present several po-
tential risks. For example, consumption of raw milk from infected an-
imals is a potential risk for transmission of brucellosis and tuberculosis.
Similarly, walking barefoot in the field or garden could serve as a po-
tential risk for cutaneous larvae migrans. Non-disposal of infected
carcasses could serve as an important source for diseases such as tu-
berculosis, brucellosis and many other zoonotic infections.
Globally, research indicates that livestock farmers have a poor
knowledge relating to zoonotic pathogens. Lindahl et al. (2015) found
that 85% of the respondents in Tajikistan were not aware of brucellosis
and respondents with low knowledge are at high risk of being infected.
In Turkey, only 2% of livestock farmers had sufficient knowledge re-
lating to zoonotic diseases (Cakmur et al., 2015). Although all the li-
vestock keepers were aware of brucellosis in Jordan, most of them were
not known to transmission routes of the disease (Musallam et al., 2015).
Similarly, moderate overall knowledge of brucellosis among the parti-
cipants from Uganda has been reported (Kansiime et al., 2014). In
Zimbabwe, Chikerema et al. (2013) found awareness level of rabies,
anthrax and brucellosis among farmers to be 9%, 72%, and 21%, re-
spectively. For leptospirosis, significantly lower prevention practice
scores have been reported among agricultural workers in Philippines
(Arbiol et al., 2016). Cediel et al. (2012) found that immigrants from
Asia had high frequency of risky behaviours and low knowledge re-
lating to zoonotic diseases.
The study has many limitations. Farmer’s KAPs related to many
other zoonotic diseases such as leptospirosis could not be ascertained.
The number of villages per district varies from 124 to 1532 in Punjab
state of India (ESOP, 2011). This might have led to overrepresentation
of the selected villages from smaller districts. The participants might
have gained some knowledge about zoonotic diseases after reading the
questionnaire and this could have biased their response.
The present analysis found the level of education of the livestock
farmers to be significantly associated with their zoonoses knowledge.
Previous studies indicate that health education intervention sig-
nificantly improved the knowledge and attitudes towards Taenia solium
control among pig farmers in Tanzania (Ngowi et al., 2011).
We recommend an on-going occupational health and food safety
educational program for the farming community in Punjab state of
India. Veterinarians, public health and agriculture development officers
could substantially contribute to update farmer’s knowledge on im-
portant zoonotic diseases. Additionally, mass media communications
such as radio and television talks, and newspaper articles on the pre-
vention and control of zoonotic diseases could also improve livestock
farmer’s knowledge and practices relating to zoonotic diseases. The
persons with low levels of education and involved in livestock rearing
should receive additional zoonotic disease education training programs.
20
Acta Tropica 189 (2019) 15–21
Competing interests
None declared.
Acknowledgements
The authors wish to thank the Department of Science and
Technology, Government of India for financially supporting this study
under the research project “Community awareness project for preven-
tion and control of zoonoses” in Punjab, India. The authors also wish to
thank S. Manjit Singh, School of Public Health and Zoonoses for his
valuable help in the conduct of this study.
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