Assessment of socio-behavioural correlates and risk perceptions regarding anthrax disease in tribal communities of Odisha, Eastern India.

BACKGROUND: This study is a baseline survey to assess the knowledge, attitude and practices with regards to the anthrax disease among the communities before demonstrating a One Health approach for elimination of human anthrax in an endemic district of Odisha. A total of 2670 respondents from 112 villages of 14 blocks were interviewed for the study using a structured questionnaire by multi-stage sampling method. Descriptive statistics were reported and logistic regression was performed to estimate the relationship between the variables and knowledge of anthrax. RESULT: Out of 2670 participants in the study, 76.25% were male and about half were illiterate. Most of the respondents (54.19%) were involved in agriculture as an occupation. 71% of the respondents had livestock in their houses and farming was the main purpose for keeping the livestock. Only one-fifth of the respondents (20.26%) knew about anthrax and a majority of them have come across the disease during community outbreaks. Almost 25.9% of livestock owners had knowledge about vaccination against anthrax disease although 83.4% of the livestock owners disposed the animal carcass by burial method. CONCLUSION: The study findings indicated that the community members had poor knowledge of cause, symptoms, transmission and prevention of anthrax disease which may be improved by a One Health approach.

A qualitative exploratory study using One Health approach for developing an intervention package for elimination of human anthrax in an endemic district of Odisha, India.

BACKGROUND & OBJECTIVES: Anthrax is a zoonotic disease of public health concern in India. One of the key predisposing factors is linked to the behaviour of the community. This study was nested within a baseline survey to understand the risk perception, attitude, socio-cultural and behavioural practices among different communities in an anthrax endemic tribal district of Odisha, India. It was aimed to explore the systemic gaps from the officials of different departments while addressing the animal and human anthrax cases and the knowledge, attitude, and behavioural practices among the tribal communities with regards to both animal and human anthrax signs, symptoms, and transmission from animal to human. METHODS: A qualitative exploratory study was carried out in the district of Koraput, Odisha. Insights from eight focus group discussions (FGDs) and 42 in-depth-interviews (IDIs) with the stakeholders from health, veterinary, forest, general administrative departments and community were collected and analyzed thematically. RESULTS: Major themes that emerged were inter-departmental coordination, livestock vaccination, surveillance network, laboratory facilities, prevention and control strategies with regards to the animal and human anthrax cases. The study also emphasized setting up the surveillance system as per the standard guidelines, and strengthening the diagnostic facilities for timely detection of confirmed cases. It also highlighted the current needs and the gaps among inter-sectoral coordination, collaboration, and sensitization among Health, Veterinary, Forest, Education, Nutrition, and Tribal Welfare Departments at various levels to reduce the prevalence and control the outbreaks of anthrax in the district and State. INTERPRETATION & CONCLUSIONS: The coordination gaps, financial burden, insufficient relevant knowledge and information among the concerned stakeholders were the issues found in this study in addition to non-availability of proper diagnostic facility. The coordination among different departments adapting One Health approach may be one of the best possible ways for the elimination of anthrax cases in an endemic region.

One Health intervention for elimination of anthrax in an endemic district of Odisha: A baseline and endline study.

Background: This study was to compare a baseline and endline survey which were conducted to assess the changes in knowledge, attitude and practices about anthrax disease among the communities after One Health intervention for the elimination of human anthrax in an endemic district of Odisha. Methods: A total of 2670 respondents were interviewed during the baseline and 2511 for the endline survey using a structured questionnaire by multi-stage sampling method. Descriptive statistics were used and logistic regression was performed to estimate the relationship between the variables and knowledge of anthrax. Results: Out of the total participants in the study, males were about 76.25% in baseline and 72.08% in endline and about half of the total respondents were illiterate. Majority of the respondents had reported agriculture as their main occupation during both surveys. More than 50% of the respondents had livestock in their houses and farming was the main purpose for keeping them in both surveys. Around 20.26% of respondents knew about anthrax in baseline which raised to 53.64% after One Health intervention. Almost 21.29% of livestock owners had vaccinated their animals against anthrax disease throughout baseline, which increased to 66.5% during the endline survey. Conclusion: This study highlights a significant surge in both knowledge and practices related to anthrax within the community after the implementation of intervention packages based on the One Health approach. The outcome of our study signified the importance of One Health interventions to address the health challenges related to zoonotic diseases in tribal communities. The data could be useful for local Governments to incorporate such an approach in their health policy to eliminate human anthrax.

Investigation of human anthrax outbreak in Koraput district of Odisha, India.

BACKGROUND: Anthrax is a zoonotic infection resulting from the bacteria Bacillus anthracis. Humans contract cutaneous anthrax by coming into contact, and gastrointestinal (GI) anthrax by consumption of infected animals or animal products. An outbreak investigation was conducted to confirm the occurrence of the anthrax outbreak, comprehend its extent, understand the epidemiological characteristics, identify the outbreak's cause, and propose control measures. METHODS: A descriptive epidemiology was carried out for this outbreak investigation. We defined a suspected human cutaneous anthrax case as appearance of skin lesions and symptoms (itching/redness/swelling) and a suspected case of GI anthrax as appearance of diarrhoea/abdominal pain/vomiting in a resident of Koraput district after being associated with slaughtering and/or consumption of carcass during 5th April to 15th May 2023. The etiological hypothesis was formulated using descriptive epidemiological methods. Laboratory confirmation was performed by real-time polymerase chain reaction (RT-PCR). Statistical analyses were conducted using SPSS 25. RESULTS: A total of 47 clinically suspected anthrax cases were identified during the outbreak in five villages of Koraput district in Odisha. The epidemic curve indicated multiple point-source exposures starting from 13th April 2023. About 10 cases were identified by RT-PCR testing as confirmed cases of anthrax. No death was recorded in this outbreak investigation. CONCLUSIONS: Based on a thorough examination of epidemiological survey results and laboratory findings, we conclude that the outbreak was of human cutaneous and GI anthrax. Exposures from handling dead animals were associated with cutaneous anthrax, whereas eating uncooked meat of dead sheep was associated with gastrointestinal anthrax.

The Landscape of Anthrax Prevention and Control: Stakeholders' Perceptive in Odisha, India.

The prevalence and outbreaks of anthrax are interlinked with the animal-environment-human context, which signifies the need for collaborative, trans-disciplinary and multi-sectoral approaches for the prevention and control of anthrax. In India, there are hardly any shreds of evidence on the role of various stakeholders' on anthrax prevention and control. Therefore, this study addressed the experiences of various stakeholders on anthrax prevention and control strategies in Odisha, India. A qualitative explorative study was carried out using 42 in-depth-interviews among the stakeholders from health, veterinary and general administrative departments from the block, district, and state level. Two major themes emerged: (1) Epidemiological investigation of anthrax in Odisha, India, and (2) Biological and social prevention strategies for anthrax in Odisha, India. The study emphasizes setting up the surveillance system as per standard guideline, and strengthening the diagnostic facility at a regional medical college laboratory to avoid delay. Moreover, it emphasizes step-up inter-sectoral co-ordination, collaboration and sensitization among health, veterinary, forestry, education, nutrition and tribal welfare departments at all levels in order to reduce the prevalence and control the outbreaks of anthrax in Odisha state. It also recommends raising community literacy, in particular on safe carcass disposal, changing behavior on dead-livestock consumption, and compliance with livestock vaccinations.