Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania

Abstract

Background: Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses.

Methodology/results: We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97%) had heard of brucellosis, 26 (42%) leptospirosis, and 20 (32%) Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4), rabies (4), and anthrax (3) in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%), rabies (9, 18%) and anthrax (6, 12%). None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis.

Conclusions: This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare provider education and improved clinical guidelines for syndrome-based disease management to provoke diagnostic consideration of locally relevant zoonoses in the absence of laboratory confirmation.

Fig 1. Diseases transmitted from livestock to humans named by animal (n = 10) and human (n = 48) healthcare providers in Moshi, Tanzania, 2014–2015.

Named diseases reported by ten or more respondents are included. Bars show proportion of respondents from each sector (out of those responding “Yes” to the question “Do you know of any diseases that people can catch from livestock?”) who reported each disease.

Fig 2. Bacterial zoonoses awareness among healthcare providers in Moshi, Tanzania, 2014–2015.

Proportion of animal (n = 10) and human (n = 52) healthcare providers who reported having heard of specific zoonoses (* indicates a significant difference between the proportion of respondents in the two sectors p< 0.05).

Fig 3. Zoonoses cases reported by healthcare providers in Moshi, Tanzania, 2014–2015.

Proportion of animal (n = 10) and human (n = 52) healthcare providers who reported having seen or advised on specific zoonotic diseases during the past 12 months. Respondents were prompted to respond for each named disease. Shading indicates the proportion of all responses that were volunteered before prompting on each specific disease.

Fig 4. Symptoms and signs of human brucellosis (n = 44), leptospirosis (n = 7), and Q fever (n = 6) reported by healthcare providers in Moshi, Tanzania, 2014–2015.

Stars indicate signs and symptoms included in CDC case definitions for each disease. For each disease, all healthcare providers were first asked if they could provide information about the signs and symptoms of the disease in humans. Respondents included representatives of both sectors as follows: 8 animal and 36 human sector respondents for brucellosis, 3 animal and 4 human sector respondents for leptospirosis, one animal and 5 human sector respondents for Q fever.

Fig 5. Knowledge and awareness of brucellosis among healthcare providers in Moshi, Tanzania.

Proportion of animal (n = 10) and human (n = 52) healthcare providers who reported ‘Yes’ in response to the questions: ‘Have you heard of a disease called brucellosis?’; ‘Can you tell me about the clinical signs and symptoms that are commonly seen with brucellosis in animals/humans?’; ‘Do you advise clients/patients to get a test or can you provide any tests that can be used to diagnose brucellosis in animals/humans?’; and ‘Do you recommend any treatments that can be used to treat brucellosis in animals/humans?’ Figure depicts responses regarding animal brucellosis from animal healthcare providers and responses regarding human brucellosis from human healthcare providers.