Knowledge, Attitude, and Practices of Population towards Brucellosis in Ethiopia: A Systemic Review and Meta-Analysis

Research Article

Austin J Public Health Epidemiol. 2023; 10(2): 1143.

Knowledge, Attitude, and Practices of Population towards Brucellosis in Ethiopia: A Systemic Review and Meta-Analysis

Kasse GE1*, Alemayehu YD2, Aynew DW3 and Yimam TM4

College of Veterinary Medicine and Animal Sciences, University of Gondar, Ethiopia

*Corresponding author: Gashaw Enbiyale Kasse College of Veterinary Medicine and Animal Sciences, University of Gondar, Ethiopia

Received: December 12, 2022; Accepted: February 06, 2023; Published: February 13, 2023


Background: Brucellosis is one of the zoonotic pathogen in the world which is a challenging issues for health and responsible for enormous economic losses in many developing countries such as/like Ethiopia. Considering the high prevalence and economic importance of brucellosis, the aim of this study was systematically review published data to explore the distributions of the pooled knowledge, the awareness, attitude and practice of level of the disease in Ethiopia.

Methodology: A comprehensive literature search was conducted through search engine includes Web of Science, Google Scholar, Scopus, Scirus, Science Direct, HINARI databases, PubMed and reference lists of previous studies. Published articles were included based on inclusion and exclusion criteria. Overall knowledge, awareness levels, attitude and practices of study participants regarding the mode of brucellosis transmission, zoonotic nature, and symptoms of brucellosis in animals and humans. Results were presented in funnel plot, the forest plot, figures, and tables with a 95% Confidence Interval (CI). To assess heterogeneity we used inconsistency index (I2) test statistics. And also we used random effect model and R studio (4.2.0) statistical software to compute the analysis of the data. The analysis was conducted and reported in accordance with Meta-analyses guidelines and the Preferred Reporting Items for Systematic Review.

Results: After excluded articles which did not fulfill the inclusion criteria, a total of 28 original articles that reporting the brucellosis awareness levels of communities in Ethiopia were included in the analysis. 16.98% of the studies population had overall knowledge of brucellosis, and the pooled awareness levels regarding the zoonotic nature and mode of transmission of brucellosis were 22.75% with 95% CL (0.1337; 0.3373). And also 18.5% of study participants had awareness about clinical sign of signs of human and animal brucellosis. From the study participants, 74.3% of them had poor practice regarding transmission of brucellosis includes consumption of raw milk and meat, unsafely contact their animals. Sub-group analyses showed that there were differences in brucellosis awareness levels among regions. In Oromia region 20.4% of respondents had knowledge with 95% CL (0.0999; 0.2524), I2 = 94.8%, p-value < 0.0001 where as in Amhara region 69.8% of respondents had knowledge about brucellosis. Regarding attitudes in Amhara region the studies participants had lowest attitudes (22%) towards brucellosis as compared with others region.

Conclusion: In general, the result of the present study showed that the population had less clear understanding about brucellosis as it affects their animals, cause abortion and its zoonotic importance. This result implies that it is necessary to create awareness of the zoonotic and its economic effect of brucellosis through a various methods, including the public media, veterinary professionals, community health extension, and local leaders.

Keywords: Knowledge; Attitude; Practices; Brucellosis; Meta-analysis; Ethiopia


The life of human being is closely associated with livestock products in the different livestock production systems particularly in pastoral communities [1]. Because of this interaction the threat of zoonotic diseases for human is high. Brucellosis is one of the most important neglected zoonotic bacterial disease in the world which is caused by Brucella and more than 500,000 human cases occurring globally per year [1,2]. Some important Brucella strains including B. melitensis and B. abortus can affect both livestock and human [3]. World Health Organization (WHO) [4] and World Organization for Animal Health (OIE) [5] reports indicated that brucellosis is rarely prioritized by health systems and is considered a neglected zoonosis. In both agro-pastoral and pastoral livestock production systems, people live closely with livestock making contact with different animal discharge and consumption of raw animal product lead to have a high incidence of brucellosis and thus, are at higher risk of acquiring the infection [4,5]. Brucellosis is the major reproductive problems causes abortions, and infertility in livesock [3,6].

Human brucellosis is characterized by muscular pain, lumbar pain, weight loss, fatigue, fever, sweating, joint pain, headache, and arthritis [7,8]. Humans become infected through ingestion of raw milk or milk products, handling of infected animals, contact with animal discharges such as vaginal fluids, placenta especially during parturition [9]. Veterinary health workers, farmers, pastoral communities, abattoir workers and laboratory personnel are highly exposed for brucellosis and are considered the highest occupational risk- groups [10-12]. Generally, due to prevalence of the disease in animals and poor hygiene practices of humans that expose to infected animals or their products can significantly increase the risk of the occurrence of the disease in humans. As its clinical manifestation resembles other febrile illnesses such as tularaemia, malaria, typhoid fever and tuberculosis, and lacking resources and laboratory diagnostics, the disease is difficult to accurately diagnose based solely on clinical sign [13-15]. The prevalence of brucellosis in Ethiopia is ranging between 1.3% and 22.8% with depending on husbandry systems and livestock species [2,16]. Dairy cattle owners, consumers, institutions promoting dairy industry, public health professionals, veterinarians and policy makers require baseline information about the health of dairy cattle, the public health implication and the safety of dairy products. Control and eradication of brucellosis cannot be achieved through test-and-slaughter, vaccination and treatment only; the cooperation of relevant occupational groups is an important component in achieving this goal [17]. Knowledge and attitude are promotes people to take protective measures at work and actively participate in disease control programs, thus greatly assisting the development of brucellosis control strategies. So far, in Ethiopia, different studies have been done on the prevalence, knowledge, attitude, and practice about brucellosis among the public. However, the findings of these different studies show that there is a high variability in the level of the knowledge, attitude, and practice across the regions of the country and unclear. The aim of this systemic and meta-analysis was to explore the knowledge, attitude and practice of peoples towards brucellosis in Ethiopia.

Materials and Methods

Data Bases, Literature Search and Selection

Typically, the published papers were reported based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline [18]. The published papers and abstracts were identified by a computerized literature search of electronic databases include PubMed (, Science Direct (, Scirus (, ISI Web of Knowledge (, Google Scholar ( and HINARI databases. The search was performed from May to July 2022. The search queries were set based on Medical Subject Headlines (MESH) and Boolean logic. Relevant MeSH terms and keywords were used to retrieve all relevant articles from the databases listed above. The keywords and MeSH terms used were “brucellosis AND knowledge OR awareness AND perception OR KAP) OR attitude AND Ethiopia:” [Publication Date]). (“Knowledge” [Mesh] OR “Knowledge, Attitudes, Practice” [Mesh])OR(“Attitude”[Mesh] OR “Attitude” [Mesh] OR“ Attitude to brucellosis ”[Mesh ] )) OR “Awareness” [Mesh]) AND (“Ethiopia”[Mesh].To identify additional relevant citations search was conducted on the previous studies of reference lists as well as “cited by” and “related information” tools in PubMed and Google scholars were searched. Only those articles which fulfill the selection criteria and written by English language were used to analyses the information.

Inclusion and Exclusion Criteria

Studies were chosen for this systemic review and meta-analysis based on inclusion criteria includes randomized subjects in all studies, trial procedures, provide complete data, the study design, method of assessing the outcome, and handling of protocol deviations whereas, secondary reports, no original research, comments, editorials and reviews were directly excluded. Research conducted on knowledge, attitude and practices towards brucellosis in Ethiopia and full-length published articles in the English language were included in the analysis. The papers that were conducted to assess only the prevalence of brucellosis in Ethiopia not included. The studies were included cross-sectional observational studies and conducted in Ethiopia only.

Selection of the Identified Publications

All the retrieved studies were imported and duplicates were removed by using the software of EndNote version 8. The two investigators (GEK and YD) independently selected the research titles and abstracts which were followed by a full-text review to determine the eligibility of each study. If there was any disagreement between the two investigators the gap was solved by consensus with the presence of the third investigator (DW). The screening and selection of studies were promoted by the creation of appropriately labeled sub-groups in EndNote.

Data Extraction

The selected articles were coded and the data were extracted from selected articles using a format prepared in Microsoft Excel. The format consist of the following basic information: author name, study period, publication year, geographic region, study design, study population, sampling method, number of participants (sampling size), sample type, gender distribution and the number of participants for the assessment of brucellosis awareness, knowledge, and acceptance, or the rate percentage proportions for these studied factors. The number of studied cases (n) and sample size (N) were the two necessary parameters for the calculation of the pooled level of awareness, knowledge, and practices of brucellosis in the meta-analysis. In particular, the number of participants who answered positively (n) was obtained directly from these studies or by multiplying the sample sizes (N) with the proportions (%) associated with the investigated items reported in the studies.

Quality Control

The quality of each search study was evaluated by using different criteria based on Joanna Briggs Institute (JBI) [19]. Quality appraisal criteria adapted for studies including appropriateness of the research design to address the target population, quality of paper, completeness of the information, adequate sample size and appropriateness of methods for isolation of the bacteria and appropriate statistical analysis [20]. The eligibility of selected research articles was also assessed and approved by experts in the discipline.

Publication Bias and Heterogeneity

Part of the strategy in conducting a meta-analysis is to identify factors that may be significant determinants of sub-population analysis or covariates that may be appropriate to explore in all studies. Variation among different trials is usually assessed using Cochran’s Q statistic, a chi-squared (Χ2) test of heterogeneity with k-1 degrees of freedom. Variability in the participants, interventions, and outcomes studied has been described. Meta-analysis was conducted sufficiently homogeneous studies in terms of subjects involved, interventions, and outcomes. To check publication bias we used funnel plot and asymmetry detected using Egger’s linear regression test, and Begg’s rank correlation test [21]. Heterogeneity of results among trials was quantified using the inconsistency index I 2, which describes the percentage of total variation across studies [22]. Therefore, the value of I2, 25%, 50%, and 75% represented low, moderate, and high heterogeneity, respectively. Negative values of I 2 are put equal to zero, consequently I 2 lies between 0 and 100%. In the same way, a p-value less than 0.05 were used to declare heterogeneity. A random effect model was used to reduce the heterogeneity of studies [23].

Data Analyses

The data were compiled in Microsoft Excel 2016 spreadsheet and summarized by descriptive statistics. A random-effect model was used to estimate the overall status of knowledge, attitude, and practice with the 95% Confidence Interval (CI). All statistical analysis was done by using R statistical software (Version 4.2.0). The presence of publication bias was assessed by funnel plot; in addition the Begg and Egger’s weighted regression method was used to detect evidence of publication bias. Hence, a p-value of < 0.05 was considered as indicating the presence of significant publication bias. All available data were pooled in the present meta-analysis [24]. The sub-groups and categories considered included region, study population, education, and occupation. The data were described using forest plots, figures, and tables. Statistical heterogeneity was evaluated by Cochran’s chi-square (Q-test) and the inconsistency index (I2). A funnel plot was constructed to visually examine the publication bias [21].


Characteristics of the Included Studies

The selection process of different studies for this systematic review was presented through a flow diagram shown in (Figure 1). Of 3886 identified studies, 3086 articles were removed due to duplication then after 725 articles were excluded upon reviewing the titles, abstracts and full articles because they were irrelevant (were not focusing on KAP of brucellosis) or were done outside Ethiopia and review, sero-prevalence and meta-analysis articles. 75 studies were screened and from these screened studies 60 studies were assessed for eligibility, of these 60 studies, 32 articles were excluded because they were not meeting the inclusion criteria. Finally, 28 studies meeting the inclusion criteria were included in the qualitative synthesis and quantitative synthesis (meta-analysis) as presented (Table 1).