A systematic review and meta-analysis of knowledge, attitudes, and practices toward anthrax prevention and control in Ethiopia: Implication for a one health policy

BACKGROUND: Anthrax is one of the tropical diseases that are often overlooked... Anthrax's burden extends beyond its effects on health; it also has an economic cost. Implementing One Health policies requires knowledge, attitude, and practice (KAP) about anthrax prevention and control. However, there is no nationally aggregated evidence in Ethiopia. Therefore, this review was done to generate evidence and offer suggestions for incorporating KAP findings into One Health strategy to prevent and control anthrax in Ethiopia. METHODS: The protocol was registered in a PROSPERO with a reference CRD420251141478 and Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines were adhered. The electronic databases: Pub-Med, Scopus, Web of Science, CAB abstracts, AGRICOLA, and Google-Scholar were searched to retrieve the included studies using key search terms with database specific search strings. Studies that reported KAP outcomes in Ethiopian and were published only in English language irrespective of publication time were included in this review. The random-effects model was used to pool effect sizes using STATA 17 software. Subgroup and meta-regression analyses were performed to explore potential sources of heterogeneity, while sensitivity analysis was performed to assess the robustness of the pooled estimates. Forest plots were used to display the results. RESULTS: This study included 17 articles with 8,369 participants that met the inclusion criteria. Our synthesis found that consuming raw meat, backyard slaughtering, improperly disposing of carcasses, and sharing a home with animals are common risk factors for anthrax infection in Ethiopia. The pooled knowledge, attitude, and practice levels of anthrax prevention and control were 51.25% (95% CI: 43.93, 58.58; I2 = 98.01%), 59.26% (95% CI: 50.43%, 68.08%; I2 = 98.33%), and 50.62% (95% CI: 42.95, 58.29; I2 = 97.93%), respectively. CONCLUSIONS: Half of the communities in Ethiopia remain with suboptimal knowledge, attitudes, and practices for anthrax prevention and control. This could lead to ineffective outbreak management, delayed reporting, and continuous transmission of anthrax to humans and animals, particularly in endemic areas. As a result, from a One Health perspective, an integrated multisectoral intervention is urgently required to promote collaboration among the human, animal, and environmental health sectors.