Knowledge and risky behaviors of Kabul city butchers regarding Crimean-Congo hemorrhagic fever

Abstract

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne zoonotic disease with high morbidity and case fatality rates (CFR) in humans, especially among the high-risk groups, including butchers. Therefore, a cross-sectional study was conducted in Kabul City to determine the knowledge gaps and risky behaviors of Kabul City’s butchers about CCHF. Data were collected from 123 butchers by structured interview using a pre-designed questionnaire. The finding of the present study revealed that of the total CCHF cases in the butchers, their family members, and co-workers, 37.9% died. Nearly half of the butchers (45.0%) experienced splashing of animal blood on their faces, while 70.1% of them had cut their hands with a knife during their occupation life. In addition, 27.0% of the respondents held the knife in their mouth while dressing the animal carcasses, and 27.3% of the butchers consumed raw liver. Hand washing and PPE application were practiced by 94.3% and 22.8% of the respondents, respectively. About 92% of the respondents had heard about CCHF, and 67.4% of the participants had good knowledge about CCHF. The knowledge level of the respondents (poor or good) was statistically related to their age, history of blood splash in the face and eyes of the butchers, holding work knives in the mouth, blowing the skin of animals, hand washing with soap and water, and slaughter places ( p < 0.05). A medium correlation between education and total knowledge of the butchers was observed (r = 0.3; p < 0.05). It is necessary to change such high-risk behaviors by continually coordinating awareness campaigns through mass media, workshops, and informative leaflet distribution to improve knowledge. CCHF is a multifaceted zoonotic disease where tick bites, direct contact with the tissue, secretions, and body fluids of the infected animals and humans, and consumption of raw milk, meat, and liver of infected animals are the main transmission methods of the disease to humans. Although livestock including cattle, sheep, goats, camels, and ostrich are the main reservoirs of the virus, they are infected in subclinical form, and humans are the only hosts where fatal clinical disease develops. Since the CCHF virus circulates in nature between tick-vertebrates-ticks, the only method that can effectively control and prevent the disease in humans is by using a targeted One Health approach between the human, veterinary, and environmental health sectors. Meanwhile, it has been proven that public awareness campaigns through the use of mass media, community leaders, and integrated workshops are the most effective tools to prevent the transmission of the CCHF virus from infected animals and ticks to humans.