title: Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania.
abstract: BACKGROUND
  Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses.
  
  
  RESULTS
  We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97%) had heard of brucellosis, 26 (42%) leptospirosis, and 20 (32%) Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4), rabies (4), and anthrax (3) in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%), rabies (9, 18%) and anthrax (6, 12%). None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis.
  
  
  CONCLUSIONS
  This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare provider education and improved clinical guidelines for syndrome-based disease management to provoke diagnostic consideration of locally relevant zoonoses in the absence of laboratory confirmation.
authors.affiliation: Duke University Medical Center, Durham, North Carolina, United States of America.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Zhang
authors.affiliation: Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania.|Sokoine University of Agriculture, Morogoro, Tanzania.
authors.forename: Kunda W
authors.initials: KW
authors.lastname: Mnzava
authors.affiliation: Centre for International Health, University of Otago, Dunedin, New Zealand.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Mitchell
authors.affiliation: Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania.|Sokoine University of Agriculture, Morogoro, Tanzania.
authors.forename: Matayo L
authors.initials: ML
authors.lastname: Melubo
authors.affiliation: Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania.|Sokoine University of Agriculture, Morogoro, Tanzania.
authors.forename: Tito J
authors.initials: TJ
authors.lastname: Kibona
authors.affiliation: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cleaveland
authors.affiliation: Sokoine University of Agriculture, Morogoro, Tanzania.
authors.forename: Rudovick R
authors.initials: RR
authors.lastname: Kazwala
authors.affiliation: Duke University Medical Center, Durham, North Carolina, United States of America.|Centre for International Health, University of Otago, Dunedin, New Zealand.|Kilimanjaro Christian Medical Centre, Moshi, Tanzania.|Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.affiliation: School of Geographical and Earth Sciences, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Sharp
authors.affiliation: Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Jo E B
authors.initials: JE
authors.lastname: Halliday
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001291:Attitude of Health Personnel; D001364:Awareness; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011361:Professional Competence; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult; D015047:Zoonoses / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission