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. 2026 Jun 16;12(4):e71038. doi: 10.1002/vms3.71038

Assessing Knowledge, Attitudes and Practices Regarding Brucellosis Among High‐Risk Occupational Groups

Md Abdur Nur Sakib 1, Tajul Islam Mamun 1,2, Sumayae Binta Khaiat 1, Prity Ranjan Talukdar 1, Mahfuzur Rahman 1, Raisa Islam 1, Shabbir Ahmed 1, Fahmida Yesmin Oishee 1, Milton Roy 1,3, Md Mukter Hossain 1,3,✉
PMCID: PMC13270421  PMID: 42299874

ABSTRACT

Background

Brucellosis is a neglected but significant zoonotic disease that poses serious public health and economic challenges, particularly in low‐ and middle‐income countries.

Objectives

This study aimed to assess the knowledge, attitudes and practices (KAP) related to brucellosis among high‐risk occupational groups in Bangladesh, including dairy workers, livestock handlers and butchers.

Methods

A cross‐sectional study was conducted through face‐to‐face interviews using a structured, closed‐ended questionnaire. A total of 435 participants from five districts were randomly selected. The questionnaire covered socio‐demographic characteristics, knowledge of brucellosis, attitudes towards the disease and preventive practices. Descriptive statistics, univariable and multivariable logistic regression and correlation analyses were performed.

Results

Overall, 186 (43%) of participants demonstrated good knowledge about brucellosis. The majority of respondents (96%) exhibited a positive attitude towards the disease, and 59% reported correct practices at their workplaces. Notably, 52.9% of participants were aware of brucellosis transmission routes, and 90.6% reported proper disposal of aborted animal materials. Dairy workers were significantly more knowledgeable (adjusted odds ratio [AOR] = 2.00; 95% confidence interval [CI]: 1.11–3.63; p = 0.021) and demonstrated better practices (AOR = 4.69, CI: 2.30–9.88, p < 0.001) compared to butchers. Participants who had received training were significantly more likely to have good knowledge (AOR: 2.01; 95% CI: 1.12–3.61; p = 0.019) and to practice correct behaviours (AOR: 4.42; 95% CI: 2.11–8.83; p < 0.001) than those without training. A statistically significant, very weak positive correlation was observed between knowledge and practice scores.

Conclusions

This study highlights considerable gaps in knowledge and preventive practices among high‐risk occupational groups in Bangladesh. Targeted educational interventions and comprehensive control programmes are urgently needed, especially for livestock handlers, butchers and individuals with lower educational levels, to reduce the risk of animal‐to‐human transmission and control the spread of brucellosis in the country.

Keywords: attitude, Bangladesh, brucellosis, butchers, dairy workers, knowledge, livestock handlers, practice

Four hundred thirty‐five participants (135 butchers, 133 dairy workers and 147 livestock handlers) took part in this survey from five districts in Bangladesh. The survey was conducted through face‐to‐face interviews generated by KoboToolbox. Following the collection, the data were cleaned and scored by Microsoft Excel. A 65% cut‐off was applied to categorize knowledge, attitude and practice levels. Subsequently, descriptive statistics, univariate and multivariate logistic regression, and correlation analysis were performed to assess associations between socio‐demographic factors and KAP outcomes.

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1. Introduction

Brucellosis is a zoonotic infectious disease caused by the bacteria of the genus Brucella. Among the 12 identified species, four are of particular public health importance due to their ability to infect humans through animal reservoirs: Brucella abortus in cattle, Brucella melitensis in goats and sheep, Brucella suis in pigs and Brucella canis in dogs (Khurana et al. 2021). Brucellosis, formerly known as undulant fever, Mediterranean fever or Malta fever, is a chronic zoonotic disease characterized by intermittent fever and a range of nonspecific clinical symptoms (Qureshi et al. 2024). Human infection primarily occurs through the ingestion of unpasteurized dairy products or undercooked meat derived from infected animals (Khoshnood et al. 2022). Consequently, individuals with occupational exposure to livestock in endemic regions, such as farmers, abattoir workers and dairy workers, are considered to be at elevated risk of brucellosis infection (Doganay and Aygen 2003; Hossain, Islam et al. 2014). Brucellosis presents with a wide spectrum of clinical manifestations in both humans and animals. In humans, the disease is often characterized by nonspecific symptoms, including fever, night sweats, anorexia, headache, back pain, general malaise and arthralgia. In chronic cases, brucellosis can progress to more severe complications such as encephalitis, meningitis, arthritis, sacroiliitis, spondylitis, osteomyelitis and endocarditis (Esmaeilnejad‐Ganji and Esmaeilnejad‐Ganji 2019). In animals, infection with Brucella species adversely affects reproductive health, often resulting in foetal loss, abortions, infertility and other forms of reproductive failure due to its tropism for the reproductive organs and placental tissues (Dadar et al. 2021).

Brucellosis remains a significant global public health concern, with an estimated 500,000 new human cases reported annually worldwide (Mufinda et al. 2017). In the aspect of a worldwide perspective, the overall pooled awareness level of brucellosis was 55.5%, with disaggregated awareness rates of 37.6% for its zoonotic nature, 35.9% for modes of transmission, 41.6% for clinical symptoms in humans and 28.4% for clinical signs in animals since 2019 (Zhang et al. 2019). The global prevalence of human brucellosis is estimated at a pooled rate of 15.49%, with marked regional variations; notably, higher prevalence rates have been observed in Asia (16.65%) and Africa (16.28%) (Dean et al. 2012; Sherasiya 2024). Brucellosis remains endemic across regions of Africa, Central and South America and Asia, with countries in the Middle East exhibiting the highest reported incidence of human infections globally (Musallam et al. 2015). In Asia, efforts to control brucellosis are hindered by the intensification of livestock production, increased animal trade and heightened human–animal interactions, factors that have contributed to the expansion of endemic regions. Although advancements have been made in preventive measures, substantial challenges persist in eradicating brucellosis, particularly in developing countries. Current control efforts in Asia are challenged by the persistently high prevalence of brucellosis and its re‐emergence in regions previously considered to have achieved disease control.

Brucellosis is endemic among both human and animal populations in Bangladesh. The prevalence of human brucellosis in Bangladesh varies among occupations: farmers (2.6%–21.6%), milkers (18.6%), butchers (2.5%) and veterinarians (5.3%–11.1%) since 2011, indicating significant exposure risks for those in direct contact with domestic animals and their products (Islam et al. 2013; Hassan et al. 2014). Recent data from Bangladesh indicate a brucellosis prevalence of 2.62% in milk samples and 2.06% in serum samples, reflecting ongoing circulation of the pathogen within the livestock population (Sarker et al. 2014). Brucellosis exerts a substantial impact on the livestock sector by inducing reproductive disorders such as abortions and infertility, as well as decreased milk yield, collectively resulting in considerable economic losses and limiting trade potential (Hossain, Uddin et al. 2014; Shafy et al. 2017). Dairy workers, livestock handlers and butchers, especially those operating in vulnerable environments, should be educated about the risk of brucellosis transmission from companion animals. This risk is exacerbated by inadequate surveillance systems operating at both local and global levels. To date, there is a lack of substantial research investigating the knowledge, attitudes and practices (KAP) related to brucellosis within Bangladesh.

The primary objective of this study was to identify and address existing knowledge gaps and behavioural patterns related to brucellosis by conducting a KAP survey among high‐risk occupational groups, including dairy workers, livestock handlers and butchers. Additionally, the study sought to examine the socio‐demographic characteristics of these groups to understand how such factors may influence variations in disease risk and transmission dynamics. The present study aimed to assess the knowledge, attitudes and preventive practices related to brucellosis among high‐risk occupational groups in Bangladesh.

2. Materials and Methods

2.1. Study Area

The study was conducted from 22 March to 8 April 2025, throughout five selected districts in Bangladesh: Dhaka, Sylhet, Rangpur, Bogura and Dinajpur (Figure 1). These districts collectively cover an area of 13,658.96 km2, representing approximately 9.25% of the country's total area. The study areas were purposively chosen on the basis of their high density of livestock farming, a strong presence of Brucella, the presence of dairy workers, livestock handlers and butchers, and their representativeness of diverse geographic regions in the study area.

FIGURE 1.

FIGURE 1

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The map offers a visual representation of the study area in Bangladesh, illustrating the surveyed districts using distinct colour codes to differentiate data collection sites created by ArcMap version 10.8.

2.2. Study Design

A cross‐sectional survey was conducted among randomly selected dairy workers, livestock handlers and butchers. The minimum required sample size was estimated at 385, calculated using Cochran's formula with a 95% confidence level, a 5% margin of error and an assumed population proportion of 50% (Mamun et al. 2024). Across the selected districts, at least 10 respondents (dairy workers, livestock handlers and butchers) were interviewed from each sub‐district. Within each sub‐district, households were selected using systematic sampling, and one eligible participant per household was randomly chosen to ensure a representative sample across all regions (Hossain et al. 2025). The survey was carried out offline in selected districts of Bangladesh targeting high‐risk occupational groups. Data were collected through face‐to‐face interviews using a structured questionnaire administered via KoboToolbox. Informed consent was obtained from all participants before the interviews. A pilot study involving 10 participants from the target population was carried out to assess the questionnaire's clarity, acceptability and overall comprehensibility, ensuring its suitability for the main survey. Following the pilot testing, minor revisions were implemented to refine the questionnaire on the basis of participant feedback and observed inconsistencies. Data obtained from the pilot trial were excluded from the final analysis. Considering the sensitive nature of brucellosis, data collection was carried out by trained research assistants under strict confidentiality protocols to ensure the privacy and protection of participant information.

2.3. Questionnaire Design

The questionnaire was developed on the basis of a published literature review (Awwad et al. 2017; Baron‐Epel et al. 2018; Ghugey et al. 2024; Mohamed et al. 2021; Šečić‐Selimović et al. 2024). The questionnaire was composed of 55 well‐structured questions divided into five domains: (i) socio‐demographic information; (ii) information associated with the workplace; (iii) knowledge factors; (iv) attitude factors and (v) practice factors regarding brucellosis. In the socio‐demographic information, we included age, gender, religion, occupation, marital status, education, training in animal handling and disease prevention, and geographical location of participants. The second part consisted of common diseases and the use of common antibiotics in their workplace, as well as knowledge associated with brucellosis. Nine questions were asked to assess the knowledge factor on brucellosis. In the fourth sector, we used a 5‐point Likert scale, 12 questions to evaluate the attitude factor. In the final section, 11 questions were included to assess the preventive practices for brucellosis.

2.4. Response to the KAP Assessment

Each correct response to knowledge‐ and practice‐based questions was awarded a score of 1, whereas incorrect or uncertain responses received a score of 0. Attitude‐based questions were measured using a 5‐point Likert scale: strongly agree (5), agree (4), neutral (3), disagree (2), and strongly disagree (1) (Sakib et al. 2025). The total KAP scores ranged from 0 to 9 for knowledge, 0 to 60 for attitude and 0 to 11 for practice, with practice scores calculated by summing the individual responses. The data were subsequently dichotomized into binary outcomes according to the proportion of correct responses. A 65% cut‐off point was used to classify the level of KAP (Mamun et al. 2024). Scores equal to or above the cut‐off point were categorized as good knowledge, positive attitude and correct practices, whereas scores below 65% indicated poor knowledge, negative attitudes and incorrect practices. The estimation of overall KAP levels was conducted on the basis of previously established methods (Mamun et al. 2024).

2.5. Statistical Analysis

At the end of data collection, the complete questionnaire was manually reviewed to verify the accurate completion of variables and data quality, before being cleaned and scored using Microsoft Excel (Microsoft 365 version). Statistical analysis was then performed using R programming (version 4.4.2). Reproducible descriptive tables, univariable and multivariable logistic regression tables were created using the gtsummary‐R package for reproducible research (Sjoberg et al. 2021). The internal consistency and reliability of the data were assessed using Cronbach's alpha coefficient, ensuring the robustness of the instrument within the context of the research framework. The survey instrument achieved an overall Cronbach's alpha of 0.75, indicating a satisfactory level of internal consistency and reliability. Cronbach's alpha value greater than 0.60 is generally considered indicative of acceptable reliability, whereas values above 0.80 reflect a high degree of internal consistency and excellent reliability (Ursachi et al. 2015).

Descriptive statistics, including frequencies and percentages, were employed to summarize categorical variables. Univariable and multivariable analyses were conducted to assess the associations between socio‐demographic variables (independent factors) and KAP outcomes (dependent factors), using a significance level of p < 0.05. Univariable logistic regression analysis was employed to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for various socio‐demographic variables. To achieve comprehensive adjustment, all socio‐demographic factors were incorporated into the multivariable logistic regression model, irrespective of their significance in the univariable analysis. A multivariable logistic regression model was used to estimate adjusted odds ratios (AORs) along with their corresponding 95% CIs. Statistical significance was defined as a p value less than 0.05, and results were reported as AORs accompanied by 95% CIs. Furthermore, Spearman's rank correlation coefficient was utilized to assess the relationships among KAP.

2.6. Visualization and Geo‐Spatial Mapping

The statistical package ‘ggplot2’ in R programming was used to visualize all plots. The study area was illustrated using geo‐spatial mapping conducted in ArcMap version 10.8 (ESRI, Redlands, CA, USA). The base‐layer shapefile was obtained from the Global Administrative Areas database (https://gadm.org/).

3. Results

3.1. Socio‐Demographic Characteristics of Participants

A total of 435 respondents participated in the study, comprising 82% males and 18% females. Most of the respondents (48.5%) in this study were 41 years old or older. Nearly all of the participants (88%) were married. The study included heights; 35.6% of participants were butchers. Approximately, 23% of the participants had received training in animal handling and disease prevention, whereas 24% were residents of the Sylhet district. The respondents’ socio‐demographic characteristics are shown in Table 1.

TABLE 1.

Socio‐demographic characteristics of participants (n = 435).

Variables Frequency (%)
Age of participants
Less than 20 years 8 (1.8)
20–30 years 98 (22.5)
30–40 years 118 (27.2)
41 or more years 211 (48.5)
Gender of the participants
Female 79 (18)
Male 356 (82)
Marital status
Married 384 (88)
Unmarried 51 (12)
Occupation
Butchers 155 (35.6)
Dairy workers 133 (30.6)
Livestock handlers 147 (33.8)
Education
No schooling 85 (19.6)
Primary education 175 (40.2)
Secondary education 115 (26.4)
Higher secondary education 34 (7.8)
Graduate/Professional degree 26 (6)
Training in animal handling or disease prevention
No 335 (77)
Yes 100 (23)
Geographical location
Bogura 63 (14)
Dhaka 65 (15)
Dinajpur 103 (24)
Rangpur 100 (23)
Sylhet 104 (24)
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3.2. Prevalence of Common Livestock Diseases and Associated Antimicrobial Use in Farm

The study findings indicated that a mere fraction (22.8%) identified lumpy skin disease (LSD) as the predominant health challenge encountered in their workplace. In comparison, 19.1% reported facing other infectious diseases (Figure 2). Among the antibiotics reported for use in farming, 18.9% of respondents indicated the use of streptomycin on their farms, and 14.9% reported amoxicillin, whereas only 1.4% reported using sulphadimidine (Figure 3).

FIGURE 2.

FIGURE 2

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Common prevalent livestock diseases on the farms. LSD, lumpy skin disease.

FIGURE 3.

FIGURE 3

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The most frequently used antibiotics in farming.

3.3. Distribution of KAP Regarding Brucellosis

Regarding the knowledge about brucellosis, 43% of the respondents exhibited a satisfactory level of knowledge (Table 2). Although 78.9% of respondents reported having heard of brucellosis in animals, over half demonstrated insufficient knowledge regarding the specific animal species most affected by the disease. Notably, a high percentage of participants (69.2) were aware that brucellosis causes abortion. Half of the participants (50.1%) were aware of the brucellosis transmission. An overview of respondents’ knowledge of brucellosis is summarized in Figure 4.

TABLE 2.

Overall knowledge, attitudes and practices (KAP) outcome related to brucellosis (n = 435).

Knowledge outcome Frequency (%)
Good 186 (43)
Poor 249 (57)
Attitude outcome
Positive 417 (96)
Negative 18 (4)
Practice outcome
Correct 255 (59)
Incorrect 180 (41)
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FIGURE 4.

FIGURE 4

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Distribution of knowledge on brucellosis among high‐risk occupational groups (N = 435).

Regarding the attitudes related to brucellosis, most dairy workers/butchers/livestock handlers (96%) had positive attitudes towards it (Table 2). A majority (53.3%) of the respondents agreed that brucellosis is a serious problem among livestock in their workplace, and less than half of the respondents (28.7%) strongly agreed that good hygiene practice in animal sheds reduces the risk of brucellosis. An overview of respondents’ attitudes towards brucellosis is summarized in Figure 5.

FIGURE 5.

FIGURE 5

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Distribution of attitudes on brucellosis among high‐risk occupational groups (N = 435).

In terms of practice related to brucellosis, overall, 59% of respondents exhibited correct practice (Table 2). A large number of participants (57%) did not wear gloves and protective clothing. A significant portion of participants (80.2%) practice handwashing and other hygiene measures during handling animals and animal products. Among all the responses, 91% of participants properly dispose of animal waste and carcasses, and 90.6% dispose of aborted material properly. Regarding practices associated with routine tests on the farm, more than half (59.8%) of respondents displayed correct practices, whereas less than half (40.2%) of respondents demonstrated incorrect practices based on routine tests on their farm. An overview of respondents’ practice of brucellosis is summarized in Figure 6.

FIGURE 6.

FIGURE 6

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Distribution of practices on brucellosis among high‐risk occupational groups (N = 435).

3.4. Association Between Demographic Factors and the Level of Participants’ KAP

A multivariable analysis revealed that age, gender, occupation, education, training and location of participants were significant factors affecting their knowledge. Participants aged between 30 and 40 years had significantly better knowledge compared to those under 20 years (AOR: 8.57; 95% CI: 1.29–78.6; p = 0.035). Male participants demonstrated significantly 0.29 times lower odds of having adequate knowledge compared to females (AOR: 0.29; 95% CI: 0.14–0.58; p < 0.001). Among the occupations, participants who work in dairy farms had a significantly higher level of knowledge (AOR: 2.00; 95% CI: 1.11–3.63; p = 0.021) than livestock handlers (AOR: 1.04; 95% CI: 0.55–1.98; p = 0.9), compared to butchers. Respondents who had completed secondary education were significantly more likely to possess a higher level of knowledge regarding brucellosis compared to those with no formal education (AOR: 2.16; 95% CI: 1.04–4.57; p = 0.041). Respondents from Dinajpur (AOR: 6.42; p < 0.001), Rangpur (AOR: 2.53; p = 0.034) and Sylhet (AOR: 3.10; p = 0.007) districts had significantly higher knowledge of brucellosis compared to participants from Bogura district. Furthermore, respondents who received training on animal handling or disease prevention had significantly better knowledge (AOR: 2.01; 95% CI: 1.12–3.61; p = 0.019) compared to individuals with no training (Table 3).

TABLE 3.

Univariable and multivariable analyses show the association of socio‐demographic factors with the knowledge level, n = 435.

Knowledge level Univariable analysis Multivariable analysis
Variables Poor N = 249 Good N = 186 OR 95% CI p value AOR 95% CI p value
Age of participants
Less than 20 years 6 (2.4%) 2 (1.1%) Ref. Ref. Ref. Ref.
20–30 years 51 (20.5%) 47 (25.3%) 2.76 0.60, 19.5 0.2 4.22 0.71, 35.5 0.13
30–40 years 56 (22.0%) 62 (33.3%) 3.32 0.73, 23.3 0.2 8.57 1.29, 78.6 0.035
41 or more years 136 (54.6%) 75 (40.3%) 1.65 0.37, 11.5 0.5 4.90 0.75, 44.3 0.11
Gender of the participants
Female 23 (9.2%) 56 (30.1%) Ref. Ref. Ref. Ref.
Male 226 (90.8%) 130 (69.1%) 0.24 0.14, 0.40 <0.001 0.29 0.14, 0.58 <0.001
Marital status
Married 224 (90.0%) 160 (86%) Ref. Ref. Ref. Ref.
Unmarried 25 (10.0%) 26 (14.0%) 1.46 0.81, 2.62 0.2 1.92 0.82, 4.52 0.13
Occupation
Butchers 112 (45.0%) 43 (23.1%) Ref. Ref. Ref. Ref.
Dairy workers 63 (25.3%) 70 (37.6%) 2.89 1.78, 4.75 <0.001 2.00 1.11, 3.63 0.021
Livestock handlers 74 (29.7%) 73 (39.3%) 2.57 1.60, 4.17 <0.001 1.04 0.55, 1.98 0.9
Education
No schooling 64 (25.7%) 21 (11.3%) Ref. Ref. Ref. Ref.
Primary education 108 (43.4%) 67 (36.0%) 1.89 1.07, 3.43 0.031 1.15 0.59, 2.24 0.7
Secondary education 55 (22.1%) 60 (32.3%) 3.32 1.82, 6.24 <0.001 2.16 1.04, 4.57 0.041
Higher secondary education 13 (5.2%) 21 (11.3%) 4.92 2.14, 11.8 <0.001 2.64 0.93, 7.63 0.069
Graduate/Professional degree 9 (3.6%) 17 (9.1%) 5.76 2.29, 15.4 <0.001 2.30 0.71, 7.72 0.2
Training in animal handling or disease prevention
No 210 (84.3%) 125 (67.2%) Ref. Ref. Ref. Ref.
Yes 39 (15.7%) 61 (32.8%) 2.63 1.67, 4.18 <0.001 2.01 1.12, 3.61 0.019
Geographical location
Bogura 50 (20%) 13 (7.0%) Ref. Ref. Ref. Ref.
Dhaka 51 (20.5%) 14 (7.5%) 1.06 0.45, 2.49 >0.9 1.70 0.67, 4.39 0.3
Dinajpur 42 (16.9%) 61 (32.8%) 5.59 2.77, 11.9 <0.001 6.41 2.78, 15.5 <0.001
Rangpur 41 (16.5%) 59 (31.7%) 5.53 2.73, 11.8 <0.001 2.53 1.09, 6.10 0.034
Sylhet 65 (26.1%) 39 (21.0%) 2.31 1.14, 4.92 0.024 3.10 1.39, 7.25 0.007
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Note: Statistically significant p value in bold.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; OR, odds ratio.

Binary logistic regression analysis was performed to identify factors associated with participants’ attitude levels (Table 4). The multivariable analyses demonstrated that age, gender, marital status, occupation, level of education, geographical location and training did not show a statistically significant association. Compared to butchers, dairy workers demonstrated a more positive attitude (AOR: 1.33; 95% CI: 0.23–8.81; p = 0.8).

TABLE 4.

Univariable and multivariable analyses show the association of socio‐demographic factors with the attitude level, n = 435.

Attitude level Univariable analysis Multivariable analysis
Variables Negative N = 18 Positive N = 417 OR 95% CI p value AOR 95% CI p value
Age of participants
Less than 20 years 1 (5.5%) 7 (1.7%) Ref. Ref. Ref. Ref.
20–30 years 8 (44.4%) 90 (21.6%) 1.61 0.08, 10.8 0.7 3.39 0.11, 64.2 0.4
30–40 years 4 (22.4%) 114 (27.3%) 4.07 0.19, 32.6 0.2 12.3 0.30, 36.5 0.15
41 or more years 5 (27.7%) 206 (49.4%) 5.89 0.29, 43.7 0.13 14.1 0.38, 35.3 0.11
Gender of the participants
Female 4 (22.2%) 75 (18.0%) Ref. Ref. Ref. Ref.
Male 14 (77.8%) 342 (82.0%) 1.30 0.36, 3.75 0.6 0.41 0.09, 1.53 0.2
Marital status
Married 15 (83.3%) 369 (88.5%) Ref. Ref. Ref. Ref.
Unmarried 3 (16.7%) 48 (11.5%) 0.65 0.21, 2.88 0.5 2.15 0.39, 17.4 0.4
Occupation
Butchers 4 (22.2%) 151 (36.2%) Ref. Ref. Ref. Ref.
Dairy workers 3 (16.7%) 130 (31.2%) 1.15 0.25, 5.92 0.9 1.33 0.23, 8.81 0.8
Livestock handlers 11 (61.1%) 136 (32.6%) 0.33 0.09, 0.98 0.061 0.32 0.06, 1.38 0.14
Education
No schooling 2 (11.0%) 83 (20.0%) Ref. Ref. Ref. Ref.
Primary education 7 (38.9%) 168 (40.2%) 0.58 0.08, 2.46 0.5 1.06 0.14, 5.38 >0.9
Secondary education 3 (16.7%) 112 (26.8%) 0.90 0.12, 5.54 >0.9 2.50 0.26, 21.8 0.4
Higher secondary education 5 (27.8%) 29 (7.0%) 0.14 0.02, 0.69 0.023 0.26 0.03, 1.80 0.2
Graduate/Professional degree 1 (5.6%) 25 (6.0%) 0.60 0.06, 13.3 0.7 0.82 0.05, 23.4 0.9
Training in animal handling or disease prevention
No 13 (72.0%) 322 (77.0%) Ref. Ref. Ref. Ref.
Yes 5 (28.0%) 95 (23.0%) 0.77 0.28, 2.44 0.6 1.27 0.34, 5.37 0.7
Geographical location
Bogura 2 (11.0%) 61 (14.6%) Ref. Ref. Ref. Ref.
Dhaka 1 (5.6%) 64 (15.3%) 2.10 0.20, 45.8 0.5 1.38 0.10, 34.4 0.8
Dinajpur 8 (44.5%) 95 (22.8%) 0.39 0.06, 1.62 0.2 0.42 0.05, 2.35 0.4
Rangpur 6 (33.3%) 94 (22.6%) 0.51 0.07, 2.31 0.4 0.40 0.05, 2.48 0.4
Sylhet 1 (5.6%) 103 (24.7%) 3.38 0.32, 73.6 0.3 2.38 0.19, 57.1 0.5
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Note: Statistically significant p value in bold.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; OR, odds ratio.

A binary logistic regression model was employed to examine the predictive effect of socio‐demographic variables on participants’ level of practice. Table 5 presents a detailed summary of the results from the binary logistic regression analysis, highlighting key factors influencing specific practices related to brucellosis among the participants. Dairy workers were more likely to follow correct practice compared to butchers (AOR = 4.69, CI: 2.30–9.88, p < 0.001). Respondents who had completed secondary education (AOR: 3.03; 95% CI: 1.32–7.16; p = 0.010) and a professional degree (AOR: 6.39; 95% CI: 1.31–49.0; p = 0.037) were significantly more likely to correct practice regarding brucellosis compared to those with no formal education. Participants who had received training were more likely to adhere to correct practices compared to those without any training (AOR: 4.42; 95% CI: 2.11–8.83; p < 0.001). Furthermore, individuals in Sylhet exhibited significantly higher odds of correct practices (AOR = 8.39, p < 0.001) regarding brucellosis compared to individuals in the Bogura region.

TABLE 5.

Univariable and multivariable analyses show the association of socio‐demographic factors with the practice level, n = 435.

Practice level Univariable analysis Multivariable analysis
Variables Incorrect N = 180 Correct N = 255 OR 95% CI p value AOR 95% CI p value
Age of participants
Less than 20 years 5 (2.8%) 3 (1.2%) Ref. Ref. Ref. Ref.
20–30 years 32 (17.7%) 66 (25.9%) 3.44 0.79, 17.6 0.10 4.50 0.67, 34.2 0.13
30–40 years 55 (30.6%) 63 (24.7%) 1.91 0.45, 9.65 0.4 1.62 0.21, 13.8 0.6
41 or more years 88 (48.9%) 123 (48.2%) 2.33 0.56, 11.6 0.3 1.83 0.24, 15.1 0.6
Gender of the participants
Female 32 (17.8%) 47 (18.4%) Ref. Ref. Ref. Ref.
Male 148 (82.2%) 208 (81.6%) 0.96 0.58, 1.57 0.9 0.57 0.27, 1.19 0.14
Marital status
Married 163 (90.6%) 221 (86.7%) Ref. Ref. Ref. Ref.
Unmarried 17 (9.4%) 34 (13.3%) 1.48 0.81, 2.79 0.2 0.95 0.33, 2.88 >0.9
Occupation
Butchers 94 (52.2%) 61 (24.0%) Ref. Ref. Ref. Ref.
Dairy workers 24 (13.3%) 109 (42.7%) 7.00 4.11, 12.3 <0.001 4.69 2.30, 9.88 <0.001
Livestock handlers 62 (34.5%) 85 (33.3%) 2.11 1.34, 3.36 0.001 0.97 0.49, 1.91 >0.9
Education
No schooling 52 (28.9%) 33 (13%) Ref. Ref. Ref. Ref.
Primary education 79 (43.9%) 96 (37.6%) 1.91 1.13, 3.27 0.016 1.43 0.70, 2.93 0.3
Secondary education 36 (20.0%) 79 (31.0%) 3.46 1.93, 6.28 <0.001 3.03 1.32, 7.16 0.010
Higher secondary education 11 (6.1%) 23 (9.0%) 3.29 1.45, 7.87 0.005 2.70 0.87, 8.68 0.089
Graduate/Professional degree 2 (1.1%) 24 (9.4%) 18.9 5.15, 123 <0.001 6.39 1.31, 49.0 0.037
Training in animal handling or disease prevention
No 156 (86.7%) 179 (70%) Ref. Ref. Ref. Ref.
Yes 24 (13.3%) 76 (30.0%) 2.76 1.68, 4.66 <0.001 4.24 2.11, 8.83 <0.001
Geographical location
Bogura 24 (13.3%) 39 (15.3%) Ref. Ref. Ref. Ref.
Dhaka 56 (31.1%) 9 (3.5%) 0.10 0.04, 0.23 <0.001 0.08 0.03, 0.21 <0.001
Dinajpur 48 (26.7%) 55 (21.6%) 0.71 0.37, 1.33 0.3 0.78 0.33, 1.81 0.6
Rangpur 41 (22.8%) 59 (23.1%) 0.89 0.46, 1.68 0.7 0.25 0.09, 0.62 0.004
Sylhet 11 (6.1%) 93 (36.5%) 5.20 2.37, 12.0 <0.001 8.39 3.37, 22.0 <0.001
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Note: Statistically significant p value in bold.

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; OR, odds ratio.

3.5. Knowledge About the Common Signs and Symptoms of Human Brucellosis

The survey revealed that the majority of respondents were knowledgeable about the common signs and symptoms of brucellosis (Table 6), whereas approximately 25% of participants lacked this awareness. A summary of participants’ knowledge regarding these common signs and symptoms is presented in Table 6.

TABLE 6.

Knowledge about the common signs and symptoms of human brucellosis among participants (n = 435).

Characteristics Frequency (%)
Fever 173 (39.8)
Headache 3 (0.7)
Joint and muscle pain 52 (12.0)
Flu‐like illness 41 (9.4)
Fatigue 26 (6.0)
Chills 25 (5.7)
Sweating 5 (1.1)
Don't know 110 (25.3)
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3.6. Correlation Among KAP

Spearman's rank‐order analysis indicated a weak to moderate positive association. There were statistically significant differences throughout; a weak positive association was observed in both knowledge and attitude (ρ = 0.133, p = 0.005) and knowledge and practice (ρ = 0.198, p < 0.001). A significant but very weak positive correlation was observed between attitude and practice (Table 7).

TABLE 7.

Spearman's rank correlation among respondents of knowledge, attitude and practice.

Association Correlation (ρ) p value
Knowledge and attitude 0.133 0.005
Knowledge and practice 0.198 0.000
Attitude and practice 0.107 0.026
Open in a new tab

Note: Statistically significant p value in bold.

4. Discussion

The present study investigates the existing KAP among the high‐risk occupational group and clarifies the gap between participants’ KAP. The study examines various socio‐demographic factors to assess their influence on disease risk, transmission dynamics, awareness of disease transmission and associated behavioural patterns.

The study determined a brucellosis awareness level of 43% among the respondents. The observed knowledge levels among participants may be attributed to limited formal education, which likely restricts access to accurate health information regarding brucellosis. This finding aligns with similar patterns of low awareness reported in a study conducted in Namibia (Madzingira et al. 2023). These findings highlight a significant knowledge deficit, underscoring the need for targeted awareness campaigns and structured educational interventions to enhance understanding and awareness of the disease among at‐risk populations. In agreement with studies conducted in Tajikistan (Lindahl et al. 2015) and Ecuador (Pérez Ruano 2017), our results showed low awareness of the disease among lower education levels. This finding underscores the importance of directing public health education and risk communication efforts towards specific demographic groups to enhance awareness levels. Notably, male participants demonstrated significantly higher knowledge levels compared to females, indicating gender as a potential predictor of brucellosis‐related knowledge. This observation is consistent with findings from previous studies (Al‐Homayani et al. 2023). Several factors may contribute to this gender‐based disparity in knowledge. Males are more commonly engaged in livestock management activities and tend to have greater access to veterinary services and training programmes, which likely enhances their exposure to relevant information sources (Babo et al. 2022). This study revealed that there was a significant occupational group gap in brucellosis knowledge, where dairy workers are more aware compared to the other groups, because our findings demonstrated that comparatively more dairy workers received training in animal handling and disease prevention. This difference may be attributed to a more structured work environment, greater access to formal training opportunities and frequent interactions with veterinary professionals, all of which facilitate improved knowledge acquisition and awareness. Dairy workers are more likely to receive comprehensive guidelines on hygiene and safety practices due to their direct involvement in milk production and responsibilities related to animal health and welfare (Rahman et al. 2022). Concerning health information, butchers and livestock handlers often have limited access to educational resources, which may hinder their disease awareness. Additionally, underlying vulnerability factors, such as socio‐economic constraints, further contribute to this gap. These findings highlight the urgent need for targeted training programmes to enhance awareness and promote effective disease prevention practices within these groups (Alghafeer et al. 2024; Swai and Schoonman 2009). Most respondents (78.9%) had heard of the disease brucellosis. These findings indicate that brucellosis is relatively well‐known in Bangladesh; however, individuals engaged in animal‐related occupations were significantly more likely to be aware of the disease. Similar results were reported by a previous study, where 74.17% of participants had heard about animal brucellosis (Tahir et al. 2022) as well as similar results have been shown in Egypt (Holt et al. 2011), where the majority of the farmers were aware of brucellosis. This finding has been attributed by the authors to the endemic presence of brucellosis in the study region, which may have influenced participants’ awareness and perception of the disease. We found that 69.5% of respondents are aware that brucellosis causes abortion in animals, but research conducted in Pakistan, including in the Kasur district, has revealed that farmers have a considerably lower knowledge level of about 38% (Hussain et al. 2021). Our study found that more than half (53.3%) of the respondents were aware of the zoonotic transmission of brucellosis, which is consistent with previous investigations (Xu et al. 2025). This level of awareness is comparable to findings reported in a previous study conducted in the Benadir Region of Somalia (Mohamed et al. 2021). Regarding attitude, the current study found that the attitude level regarding brucellosis is 96% among the respondents, which is slightly below the study conducted in Belagavi Taluka (Hiremath et al. 2023). Despite participants demonstrating a generally positive attitude towards brucellosis prevention, their overall knowledge regarding the disease was found to be limited. This finding underscores the significance of the disease while indicating that participants’ understanding of its transmission, clinical manifestations and preventive measures remains insufficient. The observed discrepancy between knowledge and attitude suggests that a positive attitude alone does not necessarily translate into informed or appropriate behaviours. These findings emphasize the critical need for comprehensive health education programmes to bridge this gap effectively. A similar observation has been reported in other studies conducted in Saudi Arabia (Alghafeer et al. 2024) and Tanzania (Swai and Schoonman 2009). Concerning practices, our study revealed that 59% of participants engaged in appropriate preventive behaviours, a parallel practice level found in the previous study (Alghafeer et al. 2024). Although participants exhibited a highly positive attitude, their level of knowledge remained low, accompanied by only a moderate adoption of appropriate preventive practices. This notable gap indicates that although participants possess a general awareness of the disease, their insufficient knowledge impedes timely action and the effective implementation of preventive practices. However, 29.9% of respondents who consumed unpasteurized dairy products, which is almost similar to the previous study (Xu et al. 2025). Although a majority of participants (59%) reported adherence to appropriate practices, a substantial proportion (41%) continued to engage in behaviours that may increase the risk of brucellosis transmission and hinder disease control efforts. However, the study highlighted a significant need for improved knowledge and practices, particularly among those with less education and experience in handling livestock. The data show a gap between knowledge and attitude, where most people have a positive attitude but do not have enough knowledge. Practice outcomes are moderately good but still need improvement. These findings suggest that educational interventions, particularly those leveraging the existing positive attitudes, may effectively enhance both knowledge and preventive practices related to brucellosis.

Collectively, the evidence demonstrates that improving KAP related to brucellosis requires a multi‐layered One Health approach. Community engagement, locally adapted educational materials, enhanced surveillance, livestock vaccination, biosecurity measures and supportive policies that promote safe handling of animals and animal products. Without such integrated efforts, behavioural gaps and occupational risks are likely to persist, particularly in regions where traditional livestock management practices and environmental conditions favour the transmission of zoonotic diseases.

5. Conclusion

In conclusion, the findings of this study highlight the urgent necessity for targeted public health interventions focused on improving awareness and promoting preventive practices against brucellosis among high‐risk occupational groups in Bangladesh. The findings reveal significant gender‐based disparities in knowledge, as well as variations across different occupational groups, underscoring the positive impact of training and awareness programmes in enhancing knowledge and promoting preventive practices. To fill the gaps of knowledge, raising awareness, publicity and workshops or training can help the farmers, farm owners, butchers and handlers. These data are necessary to overcome the problems of brucellosis. KAP studies can measure effectiveness and contribute to public and animal health. Given the high zoonotic potential of brucellosis, its widespread occurrence among livestock and ongoing ecological and occupational risk factors, these findings underscore the urgent need for targeted and sustained interventions. Public health policies should focus on strengthening surveillance systems, enhancing syndromic reporting and implementing continuous awareness campaigns, particularly in high‐risk communities. This is the very first KAP study about Brucella in Bangladesh. So, further research is needed into the prevalence of the causal agent in people and animals to play a vital role in evaluating the efficacy of approaches, as well as developing policies based on evidence to enhance animals’ well‐being in Bangladesh.

6. Limitations

This study has several limitations. First, the cross‐sectional design captures participants’ KAP at a single point in time; therefore, causal relationships between demographic factors and KAP outcomes cannot be established. Second, the survey was conducted in only five purposively selected districts, and although these sites represented different geographic regions and high‐risk occupational settings, the findings may not be fully generalizable to all high‐risk populations across Bangladesh. Third, data were collected using a structured, closed‐ended questionnaire through interviews, which may have introduced social desirability bias or recall bias, particularly for practice‐related questions. Fourth, the study assessed KAP using a limited number of survey items, and some important contextual factors, such as detailed animal husbandry practices (feeding systems), animal movement, supply‐chain/marketing practices and time taken to market animal products, were not evaluated. These factors may influence exposure pathways and spread disease and should be integrated into future One Health studies. Finally, although participants reported other common livestock health problems, the primary focus of this study was brucellosis. Therefore, results related to other diseases were not explored in depth, and future studies may consider evaluating brucellosis alongside other priority livestock diseases in integrated awareness programmes to improve cost‐effectiveness and public health impact.

Author Contributions

Md. Abdur Nur Sakib: writing – review and editing, writing – original draft, visualization, methodology, formal analysis, conceptualization, data curation, investigation. Tajul Islam Mamun: writing – review and editing, writing – original draft, conceptualization. Sumayae Binta Khaiat: data curation, writing – original draft, writing – review and editing. Prity Ranjan Talukdar: data curation, writing – original draft, writing – review and editing. Mahfuzur Rahman: data curation, formal analysis, writing – original draft. Raisa Islam: data curation, writing – original draft, writing – review and editing. Shabbir Ahmed: data curation, writing – original draft, writing – review and editing. Fahmida Yesmin Oishee: data curation, writing – original draft, writing – review and editing. Milton Roy: formal analysis, writing – original draft, writing – review and editing. Md. Mukter Hossain: conceptualization, methodology, formal analysis, investigation, supervision, writing – original draft, writing – review and editing.

Funding

The authors have nothing to report.

Ethics Statement

This study was carried out in compliance with the ethical guidelines of Animal Experimentation and Ethics Committee (AEEC) at Sylhet Agricultural University, Bangladesh (approval no. ARP2025016).

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgements

The authors gratefully acknowledge the support of the relevant authorities in facilitating data collection and extend their sincere appreciation to the study participants for their voluntary participation in the survey.

Data Availability Statement

All data generated and analysed in this study are included in the main manuscript.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

All data generated and analysed in this study are included in the main manuscript.

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