Health Care

Communication

Biosci. Biotech. Res. Comm. 9(4): 762-768 (2016)

The effect of education on knowledge and attitudes

of people towards Brucellosis in Abdanan city during

2014-15

Foroozan Esmaili

1,2

, Abbas Ghavam

and Abbas Yazdanpanah

Department of Healthcare Management, Fars Science and Research Branch, Islamic Azad University,

Marvdasht Iran

Department of Healthcare Management, Marvdasht Branch, Islamic Azad University, Marvdasht Iran

Assistant Professor, Department of Environmental Science, Institute of Sciences and High Technology and

Environmental Sciences Graduate University of Advanced Technology, Kerman, Iran

Assistant professor, Department of Healthcare Management, Marvdasht Branch, Islamic Azad University,

Marvdasht Iran

ABSTRACT

Brucellosis is one of the most important diseases that are common between human being and animal and it is followed by

socio-economic losses. One of the most important strategies coping with such disease is to train the society about such disease

and to hold educational classes for health personnel and the cooperation between wards and treatments. This study aims to

investigate the effect of educational interventions on knowledge, attitude and performance of public in Abdanan. The study

was conducted in a semi-experimental form in 2014-2015 using an intervention group and a control group. 400 stockbreed-

ers were studied in rural and urban areas of Abdanan and they were placed randomly in intervention and control groups.

Information was gathered by a researcher conducted-questionnaire and educational interventions were conducted within two

months once per two weeks for one hour and half. Data were analyzed by SPSS. The present research indicates that there is a

signi cant difference between mean scores of knowledge, attitude and behaviors control and intervention groups to brucel-

losis and they were obtained before and after intervention. Therefore, educational programs that were conducted in this area

had signi cant effect on promotion of knowledge, performance and attitude of stockbreeders towards brucellosis. Attitude of

people towards the care and prevention from brucellosis has followed by high risk behaviors that increase epidemic disease.

Therefore, it is suggested that authorities focus on attitudes of people towards health issues of stockbreeders.

KEY WORDS: BRUCELLOSIS, KNOWLEDGE, ATTITUDE AND BEHAVIOR, EDUCATIONAL INTERVENTION, HEALTH EDUCATION, ABDANAN

762

ARTICLE INFORMATION:

*Corresponding Author: ghavam39@gmail.com

Received 29

Oct, 2016

Accepted after revision 13

Dec, 2016

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2015: 3.48 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

Esmaili, Ghavam and Yazdanpanah

INTRODUCTION

Among 156 diseases identi ed in human being, 114 dis-

eases are transferred (1.3%) by animals to human beings.

Brucellosis is one of diseases common between human

being and animal and in spite of extensive programs for

 ghting against brucellosis, as a zoonosis or the illness

common between human being and animals the disease

is still addressed in many countries even in developed

countries in the world due to considerable importance

of economy and public health and it is very important

in medical and veterinary sciences (Zeinali et al 2012

and Orouji et al., 2012). While brucellosis is one of the

most prevalent diseases common between human being

and animal, Iran is one of the most infectious countries

throughout the world and Middle East and such disease

is considered as an important zoonosis in Iran and it is

very important regarding its effect on human and ani-

mal health and economy(Esmaieli et al., 2013).

This disease has some complications in animals such

as abortion, preterm delivery, infection inside uterus and

it can be transferred to human being via breath, diges-

tion system, skin scratches, conjunctivitis, intercourse

(rarely) and blood transfusion (Rezaie, 2009) and it make

liver, spleen and bones infectious. The infection resulted

from Brucella abortus is very mild and among four types,

B.canis is the least invasive for human being. B.suis is

very pathogenic and causes severe complications such

as abscesses in deep tissues. Infections resulted from

brucellosis occur always earlier than clinical signs. The

ratio of cases without symptoms of brucellosis to clini-

cal signs may be 8 to 1 or even higher. There is no exact

estimation about prevalence of brucellosis in the world

due to insuf cient information about occurrence of dis-

ease in human and animals in most countries or due to

lack of diagnostic facilities. In addition, brucellosis is

mild in human being in most cases and it is followed by

unusual clinical manifestations that are not diagnosed

correctly (Zeinali et al., 2012).

The more the prevalence of the diseases among ani-

mals, more humans will be contaminated. Such disease

incurs many losses such as heavy costs and disability of

people. In Iran, most patients with brucellosis are farm-

ers and stockbreeders. In order to control disease, it is

important to avoid eating suspicious dairy products and

to use gloves at work place. The generalities of disease

and how to prevent from it should be trained to risky

people and public in local regions. One of the important

ways for controlling the disease is to train health to pub-

lic and how to prevent disease. The human affection to

this disease can be prevented by essential educations to

high risk people (Orouji et al., 2012).

Lack of information has been observed about the

importance and distribution of disease. Costs resulted

from the disease in developing countries are very heavy

due to lack of effective criteria for general health,

national animal health programs and diagnostic equip-

ment and lack of public information about the disease.

Such disease has signs similar to malaria, AIDS and

typhoid in human being resulting in non-precise reports

related to brucellosis (Capasso, 2002). Several factors

can be effective on prevalence of brucellosis in different

species such as geographical and climatic conditions,

species, gender, age and diagnostic tests. However, it is

said that Brucella melitensis was separated from human

blood culture for the  rst time by Dr. Crandall (the head

of Iran Pastor Institute) in 1932 (Esmaieli et al., 2013).

Most problems related to brucellosis in Iran are from

Brucella melitensis that is mainly found in sheep and

goat. Concerning that sheep milk is not used in pasteuri-

zation cycle of the country and its products are produced

traditionally in villages (Esmaieli et al., 2013), many cases

are reported in the country due to long boundaries and

lack of proper control on animal imports, high number

of tribes, traditional farming methods, lack of control on

production and distribution of dairy products and lack

of regular vaccination, test and slaughter of animals. In

spite of measures taken for controlling the disease in

many countries, it seems that brucellosis has not been

decreased in human and animal throughout the world

and such disease has been observed in some of countries

that have not been contaminated. Most researches done

on brucellosis have been in organizational and institu-

tional levels and poverty has been rarely paid attention

whereas the disease in uences as such on farmers of the

region (poverty) and it relates with the increasing num-

ber of brucellosis and its treatment (Anderson & Broch-

Due, 2000).

In the study conducted by (Rezaie, Niknami, Tava-

 an, & Karami, 2013), the effect of an educational

program was investigated on knowledge, attitude and

preventive behaviors of rural women from brucellosis

in Kangavar. Results suggest the signi cant difference

between knowledge, attitude and performance of testing

and control groups. Such difference was signi cant in

pre- and post- tests as well. According to researchers,

the educational program (conducted by the researcher)

was effective on knowledge, attitude and performance

of rural women in Kangavar.

In addition, (Orouji et al., 2012) studied the effect of

health training program (based on Precede model) on

reduction of brucellosis in rural regions of Khomein

city. Results showed that mean scores of prone factors

(knowledge and attitude), reinforcing factors and ena-

bling factors in intervention group (in which 147 were

affected by brucellosis among one hundred thousands)

had statistically signi cant difference compared to con-

trol group (p< 0.05). 43 people were affected by bru-

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS THE EFFECT OF EDUCATION ON KNOWLEDGE AND ATTITUDES OF PEOPLE 763

Esmaili, Ghavam and Yazdanpanah

cellosis (among one hundred thousands) within nine

months in 2008 (P<0.05) and implementation of educa-

tional program based on Precede model can be effective

on reduction of brucellosis.

Elizabeth ( 2015) evaluated knowledge, attitude and

performance (KAP-study) of farmers about brucellosis

in small animals in suburbs of the region of Dashnab in

Tajikistan and identi ed possible risky factors. Results

indicated that most farmers of the region (85%) had no

information about brucellosis. Also, it was obvious that

weak information about brucellosis resulted from low

educational levels. Those who consult with their friends

and relatives about treatment of animal disease had

low information about such disease compared to those

who visited the veterinarian. Most of respondents did

not use any protective equipment when caring a cow

that had abortion or when exposing to aborted parts.

She believed that weak knowledge and high risk behav-

iors and tendency to learning encourage the application

of educational programs as a part of control programs,

(James, 2013).

Therefore, concerning abovementioned and high

probability of disease incidence among farmers and

rural people of Abdanan (one of cities of Ilam), the pre-

sent study aims to determine the effect size of preventive

education from brucellosis on knowledge and attitude of

people towards brucellosis in 2013-2014. Another goal

is that departments related to animal affairs, farmers and

the society should be more aware about the importance

of brucellosis. In addition, although there are many

models related to training of diseases, the effect of edu-

cation of knowledge, attitude and performance should

be the base of all models and training brucellosis to this

group is important due to low knowledge.

RESEARCH HYPOTHESES

1. Preventive education from brucellosis is effective

on literacy of people of Abdanan

2. Preventive education from brucellosis is effective

on sensitivity of people to brucellosis

3. Preventive education from brucellosis is effective

on behaviors of people

4. Preventive education from brucellosis is effective

on perception of problems resulted from such dis-

ease.

MATERIAL AND METHODS

This is an applied research based on intervention and

aims to  nd a solution for social and human problems

resulted from brucellosis. In addition, due to high perfor-

mance and simplicity of control of the amount of infor-

mation of people about brucellosis, pretest and posttest

with educational intervention were used. The population

under study is all people resident in villages of Abdanan

city. In present research, in order to reach the samples

in a geographical region and implement the program

there, among 38 residential places with more than 20

households, urban regions of Abanar, Gandab, Anjireh

& Tisheh Kand, Posht Ghaleh, Cham Kaboud (which had

lower population) were chosen by random sampling.

Villages of Posht Ghaleh, Cham Kaboud and Abanar

were chosen as target regions for implementation of

educational programs and Gandab, Anjireh and Tisheh

Kand were chosen as case group. Concerning population

of 48000 persons in the region (28000 rural and 20000

urban people), 400 farmers were selected according to

(N= ).

In order to gather data, library and  eld methods were

used. Therefore, theoretical basic and background were

gathered from library by referring to books, theses, jour-

nals, textbooks, scienti c websites for reaching recent

studies and researches. Quantitative methods have been

used to gather primary data. The main instrument for

gathering quantitative data is a questionnaire consisting

of 25 items in which open and closed questions have

been included. This is a combination of researcher-made

questions and adjusted version of the questionnaire used

by (Lindahl et al., 2015).

The main questionnaire was con rmed by professors

and experts in this  eld and a primary test was imple-

mented to measure transparency and order of questions

and to estimate the time required for answering ques-

tions. The revised version of the questionnaire was used

with focus on knowledge and attitude of individuals in

the present research. In order to obtain the sample size

from the villages under study, the questionnaire was

given to eligible people. 200 questionnaires were given

to the case group and 200 questionnaires were given

to control group. After gathering questionnaires from

intervention and control groups in the  rst stage (pre-

test), educational program was implemented for inter-

vention group in villages under study. This program was

conducted for identi cation and  ght against brucello-

sis with cooperation of staff of veterinary of ces and

health clinic of the region and participation of social

workers of the villages under study.

Table 1: population of villages selected in the research

Name of village Population based on census

Abanar 1309

Gandab 1027

Anjireh & Tisheh Kand 1091

Posht Ghaleh 1443

Cham Kaboud 1290

764 THE EFFECT OF EDUCATION ON KNOWLEDGE AND ATTITUDES OF PEOPLE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Esmaili, Ghavam and Yazdanpanah

Social workers participated in the program because

they had stronger relationship with residents. Educa-

tional sessions were held as lecture and group discus-

sion by the group who  ghts against epidemic diseases

and social workers of health clinics within 2 months for

60-90 minutes. Educational content includes importance

of familiarity with brucellosis, the ways of transfer and

prevention, socio-economic losses and complications of

brucellosis in human being and wrong beliefs in disease

transfer, familiarity with unhealthy removal of placenta

and animal excreta and presenting educational materials

for studying at home. Enabling factors included taking

permission for killing infectious animals from veteri-

nary organization and paying compensation to farmers,

using veterinarians for training and awarding loan by

agricultural Jihad department for converting traditional

farms into industrial one and helping improvement of

traditional farms. Encouraging staff of health centers,

local in uential people (members of council, governor

of a rural district and other in uential people), friends,

informed relatives were considered as reinforcing fac-

tors. In addition, such educations were taught to one of

family members of individuals under study to increase

effectiveness of the program on target groups.

After four months, the questionnaire was given to

both groups and  nal data were compared and analyzed.

Firstly, data were entered SPSS and statistical tests such

as independent T test, variance analysis with repetition

Table 2: comparing demographic variables in intervention and control groups

Variable Intervention group Control group Signi cance level

Number Percent Number Percent

Gender Man 121 60.5% 148 69% 0.596

Woman 79 39.5% 62 31%

Age 20-30 46 23% 52 26% 0.769

30-40 61 30.5% 68 34%

40-50 72 36% 64 32%

Over 50 21 10.5% 16 8%

Education Illiterate 32 16% 35 17.5% 0.759

Primary 77 38.5% 81 40.5%

Elementary 31 15.5% 35 17.5%

Diploma 42 21% 26 13%

University 18 9% 23 11.5%

Table 3: comparing means of knowledge, attitude, reinforcing factors and enabling factors

Variable Mean and standard deviation

of intervention group

Mean and standard deviation

of intervention group

P value

Knowledge Before intervention 42/1±9/2 42/3±10/5 0/978

Immediately after

intervention

79/0±5/0 -

After two months 83/5±10/0 52/0±15/7 p<0/001

*p<0/001 *p<0/001

Attitude Before intervention 61/4±11/2 61/3±11/4

Immediately after

intervention

After two months 69/6±7 57/7±10/8 p<0/001

*p<0/001 *p= 0/517 0/538

Performance Before intervention 54/7±9/3 56/8±9/7 0/704

Immediately after

intervention

83/8±8/0 -

After two months 85/0±6/1 57/2±10 p<0/001

*p<0/001 *p= 0/586

* Independent t test, *ANOVA test

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS THE EFFECT OF EDUCATION ON KNOWLEDGE AND ATTITUDES OF PEOPLE 765

Esmaili, Ghavam and Yazdanpanah

of observations, Mann-Whitney test, Chi square and

Wilcoxon test were used to compare knowledge and

performance of both groups before and after interven-

tion. Signi cance level has been considered as 5% in all

tests.

DATA ANALYSIS

In this section, obtained data were summarized and clas-

si ed using statistical indices in order to describe fea-

tures of the sample. Then, descriptive statistic such as

mean, standard deviation related to research variables

were used and hypotheses were either rejected or con-

 rmed using indices of inferential statistic.

ANALYSIS OF DESCRIPTIVE STATISTIC

Inferential statistic

After description of variables and responses obtained

from statistical population, hypotheses and the statisti-

cal tests used in this research were addressed in order to

study hypotheses statistically via analysis of contexts.

Results of normalization test of dependent variables

Firstly, data normalization should be determined in

order to use a statistical technique because parametric

tests can be used for testing hypotheses if data distribu-

tion is normal and non-parametric tests will be used in

case of abnormal data. In this stage, the testing results

were addressed for each dependent and independent

variables and based on results; the test was selected for

research hypothesis. Before using covariance analysis,

its defaults were studied. As seen in results of Shapiro-

Wilk test in table 3, distribution of scores has been nor-

mal. Therefore data normalization is con rmed. Also,

the equality of variances was studied by Levin test and

showed that variance equality is con rmed for posttest

scores of knowledge and performance except or attitude

(p<0.05). Concerning the results and equality of sam-

ple size in both groups, covariance analysis is used as a

parametric test.

RESULTS OF COVARIANCE ANALYSIS

As seen in results, there is a signi cant difference

between mean scores of knowledge, attitude and perfor-

mance in both groups. The high effect size shows that

the scores are mostly different in educational interven-

tion. Statistical power of 1 shows that the probability of

the second type error has been zero and results can be

generalized.

DISCUSSION

The aim of this study was to empower villagers in pre-

venting from Malt fever. The statistical  ndings of this

study showed that  st hypothesis: instruction in the

ground of preventing from Malt fever illness impacts

on the literacy level of Abdanan inhabitants in this

ground. The results of covariance analysis showed that

the average knowledge scores in posttest was signi -

cantly higher than control group score and regarding

its high impact rate (72%), it could be concluded that

training intervention could signi cantly promote people

knowledge level. These results are consistent with  nd-

ings of (Orouji et al., 2012) and (Khanian , Hashemian,

& Shakeri, 2013).

Table 4: results of Shapiro-Wilk test for normal distribution of scores

Variable statistic Freedom degree Signi cance level

Knowledge Experimental 0.978 400 0.001

control 400 0.001

Attitude Experimental 400 0.538

control 0.517 400 0.441

Performance Experimental 0.001 400 0.704

control 0.585 400 0.145

Table 5: results of covariance analysis of scores of knowledge, attitude and performance

Stage Sum squares Freedom

degree

Mean

squares

F Signi cance

level

Effect

size

Statistical

power

Knowledge 1406.742 1 1406.742 55.505 0.000 0.731 1

Attitude 852.823 1 852.823 34.023 0.000 0.618 1

Performance 967.166 1 967.166 31.268 0.000 0.598 1

766 THE EFFECT OF EDUCATION ON KNOWLEDGE AND ATTITUDES OF PEOPLE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

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Second hypothesis: instruction in the ground of pre-

venting from Malt fever impacts on people sensitivity

to Malt fever illness. Examining the second hypothesis

shows that though instruction of preventing from and

 ghting with malt fever has changed people sensitivity

and attitude towards this illness (0.001), but these atti-

tude has not been statistically signi cant among con-

trol group and this means that this study participants

more emphasize the illness after training. These results

are consistent with  ndings of (Orouji et al., 2012) and

(Khanian et al., 2013).

This illness could be transferred through direct con-

tact with herd or bestial products or excreta. This study

showed that herd excreta, sucking and direct contact with

placenta and germ are important risk factors for catch-

ing the illness. Also, shambling herds at home is one of

methods that this region people usually use as strategy

of supplying family and neighbors meat. This too could

be an important risk factor. The cases mentioned at the

time of attending herd like cleaning the pound, fertiliz-

ing agriculture products with bestial dung, sucking milk,

holding herds, helping in herd litter and butchering at

home are signi cant. These  ndings are consistent with

the results reported by (Mostafa & Hassan 2010), (Regassa

et al., 2009) and (Zeinali et al., 2012) which showed that

those stockbreeders who are in direct contact with bestial

excreta and products like unclean milk, meat, wool and

skin may be infected to Malt fever illness.

Third hypothesis: instruction in the ground of pre-

venting from Malt fever illness is effective in perceiv-

ing problems due to this illness in Abdanan city people.

Signi cant change in people attitude towards this ill-

ness (signi cance level= 0.538) showed that this level of

training has been successful for changing the attitude of

people towards the illness signi cance, but lack of sig-

ni cant increase in washing hands after milking could

still be considered due to two factors of non-perception

of illness risk and contamination of herd breast that this

conclusion makes necessary more measurements for

changing attitude.

Fourth hypothesis: instruction in the ground of pre-

venting from malt fever impacts on people behavior.

About boiling milk before consumption and sale, we

should say that most of the time (usually and always,

95%) people boil this milk before consumption but if

they intend to sell the milk in high volume, they assign

this act to buyer (usually factories of dairy products or

ice cream shops). However, studied people use an unsuit-

able method for boiling the milk so that they usually

appropriate a time much less that the time required for

pasteurization and only after boiling the milk and com-

ing up of the dish content due to milk frothing turn the

 ame out. In case of herds becoming sick, stockbreeders

perform in several ways.

If the illness cases are limited (especially in small

herds) and their symptoms are known, they, themselves,

measure for treating the herd illness or purchasing

drug from veterinary drugstore. But, if no recovery is

observed in herds or some cases of other herds infection

to that illness is observed, they take herds to veterinar-

ian or if possible wait for veterinarian periodical visits.

But, in heavy herds like cow, since the possibility of loss

is much more,  rst the veterinarian is informed and in

case of failure do some measurements like selling herds

or butchering (risky measurements).

In these cases, even if illness factor is something else,

health department should show sensitivity to it since it

is possible that at this time malt fever to be in its latency

period. About disinfecting the place of keeping herds,

it should be said that though more than 70% of people

sterilize the location but sterilization time spaces, the

rate of using materials and method of performing it are

not so effective, yet stockbreeders regarding the number

of kept herds cleaned the excreta of their herds keeping

location. This issue requires more attention.

Finally, we can conclude that this illness is a threat for

general health and social and economic welfare and life

of animals either domestic or wild. The most important

factors which were identi ed in this study were factors

of attitude and performance of people about illness and

health issues. In this study, most of the studied society

kept their herd in their homes or in the nearest distance

from their home and this means that most people in this

study and their families are exposed to various illnesses

common between human and herd including malt fever.

Sometimes people are not aware of malt fever problems

which require that how much people consider themselves

exposed to the risk of catching this illness which was

assessed in this research. The assessment results showed

that awareness of both groups of test and control before

training intervention in this regard was in a low level

that this issue encounters  ghting with the illness with

problem. After training intervention, the studied soci-

ety’s awareness considerably increased. But in control

group in which no training intervention has been done,

no signi cant difference was observed in answers aver-

age. One of reasons and achievements of the present

study is that such a study has not yet been performed in

the region and so some  rsthand information are pro-

vided for authorities and stakeholders of  ghting with

malt fever to be able to have a better performance in

illness control in the studied region and healthier and

safer products to be produced for presentation.

One of important issues in preventing from or  ght-

ing with such illness is people attitude towards that ill-

ness, i.e. if people’s attitude towards that health problem

or illness is negative and people see themselves exposed

to risk, naturally battle with the issue will be easier.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS THE EFFECT OF EDUCATION ON KNOWLEDGE AND ATTITUDES OF PEOPLE 767

Esmaili, Ghavam and Yazdanpanah

Before training, most people believed in illness trans-

fer through consuming not boiled and non-pasteurized

dairy products and less believed in other transfer ways

such as breathing dust and direct contact with animal

contaminated tissues. The results of this study about

attitude towards illness show that intervention group

means after training have had a signi cant difference

with control group. This indicates that training program

has had a positive impact in promoting studied people

attitude level by considering cultural features and rela-

tions between trainer and trainees. Also, it should be

said that in the present study, pursuing and encouraging

and behavioral motivating was performed by health-

care personnel and agriculture jihad propagators which

creates a positive impact in increasing awareness and

improving people’s attitude towards malt fever along-

side the training program.

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768 THE EFFECT OF EDUCATION ON KNOWLEDGE AND ATTITUDES OF PEOPLE BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS