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Epidemiology Of Bovine Tuberculosis And Its Public Health Significance In Peshawar

By: Irfan Khatak (2011-VA-562) | Dr. Muhammad Hassan Mushtaq.
Contributor(s): Prof. Dr. Umer Sadique | Prof. Dr. Mansur-ud-Din Ahmad | Prof. Dr. Muhammad Sarwar Khan.
Material type: materialTypeLabelBookPublisher: 2016Description: 153p.Subject(s): Epidemiology and Public Health | Phd ThesisDDC classification: 2540-T Dissertation note: A cross-sectional study was carried out to determine the prevalence of bovine tuberculosis (bTB) and associated risk factors in cattle and buffalo in Peshawar, Pakistan. Cattle and buffalo, randomly selected from all four towns of District Peshawar were screened for bovine tuberculosis using comparative cervical intradermal tuberculin test (CCIT). For obtaining data on risk factors, socio-demographic condition, animal characteristics and management, interviewer administered pretested questionnaire to animal owners. Multivariable logistic regression models were used to measure association between risk factors and comparative cervical intradermal tuberculin reactors. A total of 556 cattle and buffalo were screened for bovine tuberculosis. Out of 556 animals screened, 5.75% (3.9-8.0%) were found positive. The prevalence was higher in old animals (P= 0.001) as compared to younger animals. Prevalence also varied with source of animal (either raised on farm or purchased), stay of animals at night (indoor or outdoor) and herd size. Farmer’s knowledge about transmission of TB from animals to human as well as signs and symptoms of TB was extremely low. Only 3.6% farmers correctly stated the combination of three major symptoms of TB. Results of the study call for immediate intervention to control bTB in animals as well as its transmission to human population. Furthermore, it is suggested to emphasize on local epidemiology of bTB and husbandry practices of cattle and buffalo during the control program. To assess the presence of Mycobacterium bovis (M. bovis) in milk sold at retail shops and find the knowledge, attitude and practice (KAP) about tuberculosis (TB) in the high risk M. bovis contaminated milk consumers, milk samples were obtained from 92 milk shops and analysed for presence of M. bovis. Data on socio-demographic characteristics and KAP about TB was Summary 152 obtained from 800 M. bovis contaminated milk consumers. Mycobacterium bovis was detected in 8.7% (8/92) milk samples. Although 97.4% of the participants had heard of TB but only 39.6% knew that cough lasts for more than 3 weeks was one symptom. Only 79.2% have awareness that TB can be prevented and the most frequently stated (48.4%) method of TB prevention was good nutrition. Participants believed that TB can be cured by prayers/ eating well (41.8%) and also by herbal cures/ consulting Hakeem (35.7%). Mean knowledge score for the participants was 12.1± 2.47 out of maximum 22. Mean knowledge score varied significantly with ethnicity, level of education and residential status (Urban vs rural). Overall knowledge about TB was low. Therefore community’s health education focused on increasing knowledge of TB must be initiated. This part of study was conducted to determine the occurrence of active pulmonary tuberculosis due to M. bovis in abattoir workers, butchers, livestock farmers and veterinarians and to document the Knowledge and practices of these professional regarding bTB. The cross sectional study included 141 abattoir workers, 317 butchers, 50 livestock farmers, 5 veterinary doctors and 3 veterinary assistants. Sputum samples were collected from those respondents who had chronic cough that last for more than 2 weeks. Four out of 16 suspected abattoir workers and 1 out of 50 livestock farmers were found positive for M. bovis by Polymerase chain reaction analysis. Duration of work as abattoir worker was found significantly associated (p<0.05) with occurrence of zoonotic TB. The knowledge of abattoir workers, butchers, livestock farmers and veterinary assistants regarding transmission of bTB from animal to human and symptoms of TB in human was very low. Most of these professional did not use protective material/ techniques and are considered at high risk of acquiring zoonotic tuberculosis. This study declares zoonotic tuberculosis a critical public health issue especially for professionally exposed groups in Summary 153 Peshawar, Pakistan and warrant immediate intervention for control of bovine and zoonotic tuberculosis. The last part of study aims to determine the proportion of zoonotic TB cases out of overall human TB patients and school children, drug resistance of M. bovis isolates and knowledge, attitude and practices about TB. Total 300 human TB patients and 100 school children were included in the study. Sputum samples were processed by PCR for presence of Mycobacterium tuberculosis and M. bovis. Sputum samples from TB patients were cultured and M. bovis isolates were subjected to drug susceptibility testing. Data on knowledge, attitude and practices were obtained from TB patients by administering pre-tested questionnaire. Among TB patietns 4% (12/300) were infected with M. bovis. None of the school children was positive for M. bovis. Residence, occupation, presence of animals at home and sleeping in shed at night was found significantly associated with occurrence of zoonotic TB. Except one all M. bovis isolates were resistant to Pyrazinamide. Among other drugs resistance to streptomycin and isoniazid was high. Low level of knowledge and practices were observed. The study concluded that considering zoonotic aspect of TB during diagnosis and treatment of TB is necessary and recommends national survey for true estimation of burden of zoonotic TB in Pakistan.
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A cross-sectional study was carried out to determine the prevalence of bovine tuberculosis (bTB)
and associated risk factors in cattle and buffalo in Peshawar, Pakistan. Cattle and buffalo,
randomly selected from all four towns of District Peshawar were screened for bovine
tuberculosis using comparative cervical intradermal tuberculin test (CCIT). For obtaining data on
risk factors, socio-demographic condition, animal characteristics and management, interviewer
administered pretested questionnaire to animal owners. Multivariable logistic regression models
were used to measure association between risk factors and comparative cervical intradermal
tuberculin reactors. A total of 556 cattle and buffalo were screened for bovine tuberculosis. Out
of 556 animals screened, 5.75% (3.9-8.0%) were found positive. The prevalence was higher in
old animals (P= 0.001) as compared to younger animals. Prevalence also varied with source of
animal (either raised on farm or purchased), stay of animals at night (indoor or outdoor) and herd
size. Farmer’s knowledge about transmission of TB from animals to human as well as signs and
symptoms of TB was extremely low. Only 3.6% farmers correctly stated the combination of
three major symptoms of TB. Results of the study call for immediate intervention to control bTB
in animals as well as its transmission to human population. Furthermore, it is suggested to
emphasize on local epidemiology of bTB and husbandry practices of cattle and buffalo during
the control program.
To assess the presence of Mycobacterium bovis (M. bovis) in milk sold at retail shops and find
the knowledge, attitude and practice (KAP) about tuberculosis (TB) in the high risk M. bovis
contaminated milk consumers, milk samples were obtained from 92 milk shops and analysed for
presence of M. bovis. Data on socio-demographic characteristics and KAP about TB was
Summary
152
obtained from 800 M. bovis contaminated milk consumers. Mycobacterium bovis was detected in
8.7% (8/92) milk samples. Although 97.4% of the participants had heard of TB but only 39.6%
knew that cough lasts for more than 3 weeks was one symptom. Only 79.2% have awareness that
TB can be prevented and the most frequently stated (48.4%) method of TB prevention was good
nutrition. Participants believed that TB can be cured by prayers/ eating well (41.8%) and also by
herbal cures/ consulting Hakeem (35.7%). Mean knowledge score for the participants was 12.1±
2.47 out of maximum 22. Mean knowledge score varied significantly with ethnicity, level of
education and residential status (Urban vs rural). Overall knowledge about TB was low.
Therefore community’s health education focused on increasing knowledge of TB must be
initiated.
This part of study was conducted to determine the occurrence of active pulmonary tuberculosis
due to M. bovis in abattoir workers, butchers, livestock farmers and veterinarians and to
document the Knowledge and practices of these professional regarding bTB. The cross sectional
study included 141 abattoir workers, 317 butchers, 50 livestock farmers, 5 veterinary doctors and
3 veterinary assistants. Sputum samples were collected from those respondents who had chronic
cough that last for more than 2 weeks. Four out of 16 suspected abattoir workers and 1 out of 50
livestock farmers were found positive for M. bovis by Polymerase chain reaction analysis.
Duration of work as abattoir worker was found significantly associated (p<0.05) with occurrence
of zoonotic TB. The knowledge of abattoir workers, butchers, livestock farmers and veterinary
assistants regarding transmission of bTB from animal to human and symptoms of TB in human
was very low. Most of these professional did not use protective material/ techniques and are
considered at high risk of acquiring zoonotic tuberculosis. This study declares zoonotic
tuberculosis a critical public health issue especially for professionally exposed groups in
Summary
153
Peshawar, Pakistan and warrant immediate intervention for control of bovine and zoonotic
tuberculosis.
The last part of study aims to determine the proportion of zoonotic TB cases out of overall
human TB patients and school children, drug resistance of M. bovis isolates and knowledge,
attitude and practices about TB. Total 300 human TB patients and 100 school children were
included in the study. Sputum samples were processed by PCR for presence of Mycobacterium
tuberculosis and M. bovis. Sputum samples from TB patients were cultured and M. bovis isolates
were subjected to drug susceptibility testing. Data on knowledge, attitude and practices were
obtained from TB patients by administering pre-tested questionnaire. Among TB patietns 4%
(12/300) were infected with M. bovis. None of the school children was positive for M. bovis.
Residence, occupation, presence of animals at home and sleeping in shed at night was found
significantly associated with occurrence of zoonotic TB. Except one all M. bovis isolates were
resistant to Pyrazinamide. Among other drugs resistance to streptomycin and isoniazid was high.
Low level of knowledge and practices were observed. The study concluded that considering
zoonotic aspect of TB during diagnosis and treatment of TB is necessary and recommends
national survey for true estimation of burden of zoonotic TB in Pakistan.

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