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Original Research (Original Article) 


Mohammed Abdulrahman Mohammed Sahhari et al, 2019;3(7):577–580.

International Journal of Medicine in Developing Countries

Primary health care physicians’ knowledge and practice on brucellosis; its prevention, diagnosis, and treatment

Mohammed Abdulrahman Mohammed Sahhari1*, Yahya Salman Hassan Suhluli1, Fahad Khairy Jerb1

Correspondence to: Mohammed Abdulrahman Mohammed Sahhari

*Jazan University, Jazan, Saudi Arabia.

Email: mohammed-sahhari [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 16 January 2019 | Accepted: 30 January 2019


ABSTRACT

Background:

Brucellosis is the most common global bacterial zoonotic disease. Although more than half a million cases are reported annually, many experts believe that the number of reported cases is only a small fraction of the real number due to misdiagnosis and underreporting. This study aimed to understand the level of knowledge and practice related to brucellosis; its prevention, diagnosis, and treatment among primary health care physicians in Saudi Arabia.


Methodology:

A cross-sectional survey about brucellosis was administrated including physicians working in primary health care centers (N = 300). We assessed knowledge and practice regarding preventive and clinical part of brucellosis by analyzing the participants’ answers.


Results:

The level of knowledge about brucellosis was good among participating physicians, except for general practitioner group as their knowledge was slightly less than participating physicians. Also, the participant’s level of knowledge was significantly associated with their years of experience. Regarding physicians’ practice on brucellosis, the mean score was moderate and was not significantly associated with their sociodemographic characters.


Conclusion:

The majority of primary health care physicians are well-informed about brucellosis; its prevention, diagnosis, and treatment. However, successful prevention of brucellosis requires more training for physicians as general practitioners and younger physicians still need to be updated about brucellosis starting from the disease known to its treatment measures.


Keywords:

Primary health care physicians, knowledge, practice brucellosis, prevention, diagnosis, treatment.


Introduction

Brucellosis is the most common global bacterial zoonotic disease [1]. Although more than half a million cases are reported annually, many experts believe that the number of reported cases is only a small fraction of the real number due to misdiagnosis and underreporting [2]. Brucellosis is caused by infection with a Gram-negative bacillus of the genus Brucella [3]. This bacterial pathogen is considered by US Centers for Disease Control and Prevention (CDC) as a category (B) pathogen that has potential to be used as a bioterrorism weapon with a capability of airborne transmission [4]. The genus Brucella includes three important species; Brucella melitensis which predominantly infects sheep and goats, Brucella abortus which affects cattle, and Brucella. suis, which affects swine [3,5,6]. Camels are not the primary hosts of Brucella but they are susceptible to both B. abortus and B. melitensis [7]. Camel brucellosis was firstly reported in 1931. Since then, the disease has been reported from all camel-keeping countries such as Saudi Arabia [8,9]. A more recent study reported camel brucellosis in Riyadh Region, Saudi Arabia by detecting Brucella antibody in clinically normal camels with twice prevalence of infection in housed than in free-ranged camels [10]. Brucellosis is generally transmitted to humans through ingestion of unpasteurized dairy products or contaminated undercooked meat derived from infected animals. Also, direct contact with infected animals tissues as blood, urine, placentas, or aborted fetuses results in a human infection [11]. However, brucellosis becomes one of the occupational diseases in countries where milk pasteurization is a common practice; it remains an important zoonotic disease in areas where Brucella is endemic in sheep and goats, such as the Mediterranean basin, Southwest Asia, and parts of Latin America [1214]. Brucellosis is a major public health problem in endemic countries due to its extensive economic burden. Brucellosis has hazard effects on both animal related industries (reduced milk production, increased abortion, and delayed conception) and public health (cost of treatment and loss of productivity) [1517]. Saudi Arabia is one of the highly endemic countries for brucellosis, with more than 8,000 cases reported annually. The highest incidence of brucellosis cases was observed in Al-Qassim region which is a highly enzootic region. In this region, 4,283 cases of human brucellosis were notified between 2010 and 2014, with a decrease in the annual incidence from 84.5 to 48.7 per 100,000 populations [18,19]. Although there is a decrease in annual incidence, the disease still constitutes a major health threat in Saudi Arabia as it hosts thousands of travelers and imports high numbers of livestock [18]. The clinical presentation of brucellosis is non-specific, including fever, nausea, anorexia, headache, sweating, and prostration. These symptoms may be associated with gastrointestinal, musculoskeletal, hepato-biliary, and vascular complications. Fever is the most common manifestation, followed by arthritis, sweating, and constitutional symptoms. It may present as acute or chronic form, with variable incubation period from days to several years [11,20,21]. Brucellosis is often misdiagnosed as other febrile syndromes such as malaria and typhoid fever resulting in mistreatments and underreporting [22]. The definitive diagnosis of brucellosis represents various difficulties due to the chronic or asymptomatic nature of the disease, different incubation period, and often lacks laboratory confirmation [23]. The laboratory diagnosis of brucellosis requires the isolation of the organism from the patient, which is restricted by the fact that Brucella is a slow-growing intracellular pathogen and the successful culture of which from blood decreases as the disease progresses [24]. However, serology in the form of various agglutination tests and enzyme-linked immune sorbent assay (ELISA) is extremely useful as the sensitivity and specificity of both approaches are above 85% [25]. Believing that Saudi Arabia still has an endemic for brucellosis and misdiagnosis is the common problem faced, this study is carried out to assess the level of knowledge and practice related to brucellosis treatment among primary health care physicians.

Table 1. Socio-demographics characteristics of the participants.

Variables N (%)
Age (years)
Mean ± SD

37.1 ± 5.8
Gender
Male
Female

200 (66.7%)
100 (33.3%)
Nationality
Saudi
Non-Saudi

160 (53.3%)
140 (46.7%)
Job position
Resident
GP
Senior practitioner
Consultant

170 (56.7%)
40 (13.3%)
50 (16.7%)
40 (13.3%)
Years of experience
Mean ± SD

7.3 ± 4.2

Materials and Methods

It is a cross-sectional analytic study including 300 primary health care physicians in Jizan, Saudi Arabia. A validated structured self-administered questionnaire was applied for data collection. This survey consists of three main parts: sociodemographic data which included questions to assess knowledge and attitude regarding brucellosis and questions to evaluate the practice regarding this disease. Individual verbal consent for data collection was obtained from each participant. Participants were well informed about the purpose and procedures of the study and informed consents were received. The ethical committee of Jazan University approved the consent procedure. The collected data were coded, tabulated, and statistically analyzed to come up with descriptive statistics for respondents’ knowledge and practice relation to brucellosis and the associations with respondents’ sociodemographic characteristics. Description of qualitative variables was in form of number and percentage. Unpaired t-test was used to compare two independent groups with quantitative variables. Person correlation coefficient rank test was used to rank different variables against each other positively or inversely. Physician’s knowledge and practice were scored from 0 to 10. A knowledge mean score of 6.7 ± 1.2 was considered Good, and practice mean score of 5.4 ± 1.4 was deemed to be moderate. A p-value of <0.05 was considered to be significant.


Results

The socio-demographic characteristics of the respondents are presented in Table 1. The mean of their age was 37.1 ± 5.8 years and the mean years of experience were 7.3 ± 4.2. About two-thirds of participants were male (66.7%) and more than half of them were Saudi nationals (53.3%). The participants were at different job position ranging from resident to consultant with 53.3% of them being resident physicians.

Table 2. Knowledge and practice about brucellosis according to physicians’ characteristics.

Variables Knowledge Mean ± SD Practice Mean ± SD
Gender
Male
Female
p-value

6.1 ± 2.2
5.9 ± 1.3
0.07

5.5 ± 1.3
5.7 ± 1.4
0.2
Nationality
Saudi
Non-Saudi
p-value

5.9 ± 1.8
6.2 ± 1.3
0.1

5 ± 0.7
5.2 ± 0.9
0.1
Job position
Resident
GP
Senior practitioner
Consultant
p-value

6.7 ± 1.5
6.6 ± 1.4
6.9 ± 1.7
7.4 ± 2.1
0.001

±
±
±
±
0.08

Table 3. Correlation of level of knowledge and practice with physicians’ age and years of experience.

Variables Knowledge Mean ± SD Practice Mean ± SD
Age (years)
r
p-value

0.4
0.07

0.3
0.1
Years of experience
r
p-value

0.5
0.001

0.3
0.07

Table 2 presents the distributions for knowledge and practice regarding brucellosis according to physicians’ baseline characteristics. There was no significant difference in the level of knowledge between physicians according to gender and nationality. Regarding job position, there was a significant positive difference in the level of knowledge between different groups with the highest level noticed among consultant physicians and the lowest level was found in the general practitioner group. On the other hand, there was no significant difference in the mean level of practice among different physician groups. According to Table 3, a significant positive correlation was noticed between the mean level of knowledge and the mean of physicians’ years of experience.


Discussion

Brucellosis is one of the major clinical conditions that affect people’s health and causes economic loss for the country. One crucial step in disease prevention is the ability of primary health care physicians to diagnose or detect all suspected cases of brucellosis [18]. This study was carried out to assess the primary health care physicians’ knowledge and practice on brucellosis. To our knowledge, this is the first study to assess physicians’ knowledge about brucellosis conducted in the Saudi population. According to the results in Table 2, most of participating physicians had good knowledge about brucellosis, except for general practitioners as their knowledge was slightly below than the “good level.” John et al. [26] detected insufficient knowledge regarding the causes, clinical features, and diagnosis of common zoonoses as brucellosis among medical practitioners in Tanzania. Kassraian et al. [27] reported that physicians’ knowledge of four prevalent diseases including brucellosis was not at an acceptable level. The physician knowledge about brucellosis was found associated with the number of years of their experiences and the highest knowledge score was seen among consultant physicians. Although, knowledge score was higher among male physicians than female ones and non-Saudi physicians than Saudi ones, these differences were not significant. Regarding the practice of primary health care physicians on brucellosis, the mean level was moderate and was not associated with different sociodemographic characteristics of participating physicians. The result of this study is in agreement with the study findings from Jokhdar [28], who recommended that alertness of medical staff in Saudi Arabia is needed to recognize and diagnose brucellosis. As to an unaware physician, the diagnosis of brucellosis can be problematic. The physicians must keep in mind the possibility of occupational or environmental exposure in cases of fever. Also, the history of travel to endemic countries along with animal contact and food habits could be helpful to raise suspicion of brucellosis and usually critical to making the clinical diagnosis. Laboratory testing is necessary for diagnosis. So that alertness of clinician and close collaboration with microbiologist are essential to diagnose and treat this human infection in Saudi Arabia correctly.


Conclusion

According to this study, it is evident that the majority of primary health care physicians are well-informed about brucellosis; it’s prevention, diagnosis, and treatment. Moreover, successful prevention of brucellosis requires more training, especially for general practitioners to diagnose and treat brucellosis in the most efficient way.


List of abbreviations

CDC Center for Disease Control and Prevention
ELISA Enzyme-linked immune sorbent assay

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was conducted after the verbal approval of the concerned authority at Jazan University.


Author details

Mohammed Abdulrahman Mohammed Sahhari1, Yahya Salman Hassan Suhluli1, Fahad Khairy Jerb1

  1. Jazan University, Jazan, Saudi Arabia

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How to Cite this Article
Pubmed Style

Sahhari MAM, Suhluli YSH, Jerb FK. Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment. IJMDC. 2019; 3(7): 577-580. doi:10.24911/IJMDC.51-1547676939


Web Style

Sahhari MAM, Suhluli YSH, Jerb FK. Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment. http://www.ijmdc.com/?mno=26610 [Access: August 20, 2019]. doi:10.24911/IJMDC.51-1547676939


AMA (American Medical Association) Style

Sahhari MAM, Suhluli YSH, Jerb FK. Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment. IJMDC. 2019; 3(7): 577-580. doi:10.24911/IJMDC.51-1547676939



Vancouver/ICMJE Style

Sahhari MAM, Suhluli YSH, Jerb FK. Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment. IJMDC. (2019), [cited August 20, 2019]; 3(7): 577-580. doi:10.24911/IJMDC.51-1547676939



Harvard Style

Sahhari, M. A. M., Suhluli, . Y. S. H. & Jerb, . F. K. (2019) Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment. IJMDC, 3 (7), 577-580. doi:10.24911/IJMDC.51-1547676939



Turabian Style

Sahhari, Mohammed Abdulrahman Mohammed, Yahya Salman Hassan Suhluli, and Fahad Khairy Jerb. 2019. Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment. International Journal of Medicine in Developing Countries, 3 (7), 577-580. doi:10.24911/IJMDC.51-1547676939



Chicago Style

Sahhari, Mohammed Abdulrahman Mohammed, Yahya Salman Hassan Suhluli, and Fahad Khairy Jerb. "Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment." International Journal of Medicine in Developing Countries 3 (2019), 577-580. doi:10.24911/IJMDC.51-1547676939



MLA (The Modern Language Association) Style

Sahhari, Mohammed Abdulrahman Mohammed, Yahya Salman Hassan Suhluli, and Fahad Khairy Jerb. "Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment." International Journal of Medicine in Developing Countries 3.7 (2019), 577-580. Print. doi:10.24911/IJMDC.51-1547676939



APA (American Psychological Association) Style

Sahhari, M. A. M., Suhluli, . Y. S. H. & Jerb, . F. K. (2019) Primary health care physicians' knowledge and practice on brucellosis; its prevention, diagnosis, and treatment. International Journal of Medicine in Developing Countries, 3 (7), 577-580. doi:10.24911/IJMDC.51-1547676939