Neglected Zoonoses and the Missing Opportunities for One Health Education: The Case of Cystic Echinococcosis among Surgically Operated Patients in Basrah, Southern Iraq.

Cystic echinococcosis (CE) is recognized as a neglected disease of public health significance throughout the world, particularly in low and middle-income countries. The objectives of this study were to describe the characteristics, attitudes, knowledge, and practices of some Basrah province residents diagnosed with CE. Using a questionnaire survey, we interviewed 50 surgically operated cases of CE from Basrah, south Iraq. The cases comprised of 31 females and 19 males, of which 74% originated from rural areas. The questionnaire contained 30 questions and focused on gathering the demographic characteristics of the patients and capturing their overall knowledge, attitudes, and practices toward CE. Approximately half of the participants reported slaughtering livestock at home for their families' consumption, 78% indicated the presence of a large number of stray dogs roaming freely about their village, 86% reported that they never boiled water before drinking it, and 26% reported not washing vegetables before eating them. Although a large proportion of the participants (72%) had heard of hydatid disease before becoming sick, over half (57%) were not aware of how the disease can be transmitted from animals to humans. This study highlights a gap in One Health education efforts regarding CE in southern Iraq, with a lack of counselling of patients on how to prevent reinfection. An intensive One Health education program should be implemented in Basrah to reduce CE at the human⁻animal interface. Lack of awareness on zoonoses among medical professionals, who are supposed to disseminate advice on preventative measures to their patients, is a challenge to the public health system.

Cystic echinococcosis in marketed offal of sheep in Basrah, Iraq: Abattoir-based survey and a probabilistic model estimation of the direct economic losses due to hydatid cyst.

Cystic echinococcosis (CE) is a highly endemic parasitic zoonosis in Iraq with substantial impacts on livestock productivity and human health. The objectives of this study were to study the abattoir-based occurrence of CE in marketed offal of sheep in Basrah province, Iraq, and to estimate, using a probabilistic modelling approach, the direct economic losses due to hydatid cysts. Based on detailed visual meat inspection, results from an active abattoir survey in this study revealed detection of hydatid cysts in 7.3% (95% CI: 5.4; 9.6) of 631 examined sheep carcasses. Post-mortem lesions of hydatid cyst were concurrently present in livers and lungs of more than half (54.3% (25/46)) of the positive sheep. Direct economic losses due to hydatid cysts in marketed offal were estimated using data from government reports, the one abattoir survey completed in this study, and expert opinions of local veterinarians and butchers. A Monte-Carlo simulation model was developed in a spreadsheet utilizing Latin Hypercube sampling to account for uncertainty in the input parameters. The model estimated that the average annual economic losses associated with hydatid cysts in the liver and lungs of sheep marketed for human consumption in Basrah to be US$72,470 (90% Confidence Interval (CI); ±11,302). The mean proportion of annual losses in meat products value (carcasses and offal) due to hydatid cysts in the liver and lungs of sheep marketed in Basrah province was estimated as 0.42% (90% CI; ±0.21). These estimates suggest that CE is responsible for considerable livestock-associated monetary losses in the south of Iraq. These findings can be used to inform different regional CE control program options in Iraq.

Knowledge, Awareness and Practices Regarding Cystic Echinococcosis among Livestock Farmers in Basrah Province, Iraq.

Cystic echinococcosis (CE) is an endemic neglected parasitic zoonosis in many of the countries of the Middle East. The disease poses a remarkable economic burden for both animals and humans. In this study, we conducted a questionnaire survey among livestock farmers in Basrah province, southern Iraq, in order to evaluate their knowledge and awareness about CE, and to understand some of the risky practices that could contribute to spread and persistence of such disease. Of the interviewed participants (N = 314), 27.4% owned dogs on their farms. Among farmers owning dogs, 76.7% (66/86) never tied up their dogs, and 43% (37/86) indicated feeding uncooked animal viscera to their dogs. The majority (96.5%) of the farmers indicated that they did not de-worm their dogs at all. Only 9.8% (31/314) of the respondents indicated eating raw leafy vegetables without washing. Added to that, 32% of the interviewees indicated that they source water for domestic use from a river; meanwhile 94.3% (296/314) of them do not boil water before using it for domestic purposes. Half of the interviewed livestock farmers in Basrah were not aware about how humans get infected with CE disease, and 41.4% (130/314) did not even realize that CE is a dangerous disease to human health. Almost one in three of the respondents who owned dogs on their farms viewed de-worming of their dogs as a low priority practice. This study highlights the gap in knowledge and awareness about CE among the study population. Risky practices associated with dog keeping management and food and water handling practices were identified. The insight from this research could be used to improve the delivery of a health education message relevant to cystic echinococcosis control at the human-animal interface in Iraq.

A retrospective study of human cystic echinococcosis in Basrah province, Iraq.

Human cystic echinococcosis (CE) is a parasitic zoonosis with serious clinical burden and constitutes a challenge to public health in endemic areas worldwide. We performed a retrospective study to investigate the occurrence of CE in patients at six hospitals in Basrah province, Iraq. In the current study setting, data retrieval and validation of the quality of hospital records was very challenging considering the difficult situation Iraq is unfortunately facing. Hospitalization records were reviewed from January 2005 to December 2015. A total of 748 cases of human with CE were diagnosed and operated in Basrah hospitals, equivalent to an annual clinical incidence of approximately 4.5 cases per 100 000 people. Hospital records show that, cystic echinococcosis affected more females (61.2%) than males (38.8%). Descriptive review of recorded CE cases in the surveyed hospitals revealed that more cases were reported in the age group of 21-30 years than in the other age groups. Based on the reviewed recorded clinical reports, cysts were mainly found in the liver (46.3%) and lungs (28.1%) of the patients. Hospital reports demonstrate that females had more hepatic cysts (63.9%) than males (36.1%). This study found that CE continues to pose a threat to public health in Basrah, and there is a need for more epidemiological investigations of CE in humans in order to determine risk factors and the economic impact of the disease in this province of Iraq.