title: Knowledge, attitudes and practices with regard to the presence, transmission, impact, and control of cystic echinococcosis in Sidi Kacem Province, Morocco.
abstract: BACKGROUND
  This study is a component of a large research project on five major neglected zoonotic diseases (NZDs) including cystic echinococcosis and was undertaken in the Province of Sidi Kacem over a period of four years (April 2009-March 2013).
  
  
  METHODS
  Questionnaires were administered at community level in a total of 27 communes and visits were made to all of the 10 abattoirs situated in the Province, to collect qualitative data on determinants of transmission for disease in humans and animals. More specifically, community knowledge, attitudes and practices related to cystic echinococcosis were assessed, as well as the extent to which local customs and behaviours may promote transmission. Abattoir infrastructure and practices, and their role in perpetuating disease transmission were also critically evaluated.
  
  
  RESULTS
  The results show that only 50 % of people have heard of the disease, and of those, only 21 % are aware of the dog's role in disease transmission. Sixty-seven per cent of respondents stated that dogs are fed ruminant organs deemed unfit for human consumption. Owned dogs have access to the family home, including the kitchen, in 39 % of households. The extent of this close proximity between humans and animals is even more pertinent when one considers that dogs are omnipresent in the community, with an average of 1.8 dogs owned per household. The unrestricted access of dogs to abattoirs is a huge issue, which further promotes disease transmission.
  
  
  CONCLUSIONS
  This study would suggest that the high prevalence of cystic echinococcosis in humans and animals in Morocco is largely due to three factors: 1) abundance of dogs 2) engagement in risky behaviour of the local population and 3) poor abattoir infrastructure and practices. This has serious implications in terms of the socio-economic impact of the disease, especially for rural poor communities.
authors.affiliation: Department of Pathology and Veterinary Public Health, Institut Agronomique et Vétérinaire Hassan II, BP: 6202, Rabat, Morocco. i.elberbri@gmail.com.
authors.forename: Ikhlass
authors.initials: I
authors.lastname: El Berbri
authors.affiliation: Division of Infection and Pathway Medicine, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom. Marie.Ducrotoy@ed.ac.uk.
authors.forename: Marie J
authors.initials: MJ
authors.lastname: Ducrotoy
authors.affiliation: Department of Parasitology and Medical Mycology, Lyon 1 University, 8 Avenue Rochefeller, 69373, Lyon Cedex 08, France. anne-francoise.petavy@univ-lyon1.fr.
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Petavy
authors.affiliation: Department of Pathology and Veterinary Public Health, Institut Agronomique et Vétérinaire Hassan II, BP: 6202, Rabat, Morocco. o.fassifihri@iav.ac.ma.
authors.forename: Ouaffa
authors.initials: O
authors.lastname: Fassifihri
authors.affiliation: Division of Infection and Pathway Medicine, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom. alex@apconsultants.co.uk.|Avia-GIS, Risschotlei 33, B-2980, Zoersel, Belgium. alex@apconsultants.co.uk.
authors.forename: Alexandra P
authors.initials: AP
authors.lastname: Shaw
authors.affiliation: Department of Pathology and Veterinary Public Health, Institut Agronomique et Vétérinaire Hassan II, BP: 6202, Rabat, Morocco. bouslikhanemed@yahoo.fr.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Bouslikhane
authors.affiliation: ANSES, Laboratoire de la rage et de la faune sauvage de Nancy, Laboratoire national de référence pour Echinococcus spp, 54220, Malzéville cedex, France. Franck.BOUE@anses.fr.
authors.forename: Franck
authors.initials: F
authors.lastname: Boue
authors.affiliation: Division of Infection and Pathway Medicine, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, United Kingdom. Sue.Welburn@ed.ac.uk.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Welburn
authors.affiliation: Department of Pathology and Veterinary Public Health, Institut Agronomique et Vétérinaire Hassan II, BP: 6202, Rabat, Morocco. allaldakkak@gmail.com.
authors.forename: Allal
authors.initials: A
authors.lastname: Dakkak
mesh_terms: D000003:Abattoirs; D000818:Animals; D004285:Dogs; D004443:Echinococcosis / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D004777:Environment; D005843:Geography; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D058751:Livestock; D009018:Morocco / Q000453:epidemiology; D062486:Public Health Surveillance; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015047:Zoonoses / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission