The epidemiology and impact of cystic echinococcosis in humans and domesticated animals in Basrah Province, Iraq

Cystic Echinococcosis (CE) is a zoonotic disease caused by the larval stages of Echinococcus spp.. The disease results in significant public health effects to the community and economic burden for livestock owners. Although CE is endemic in Iraq, few studies have been undertaken in Basrah Province on the disease’s epidemiology in humans and other animals. This study was designed to address these deficiencies. Medical records from five public hospitals for the period 2005 to 2015 were examined for records of CE. Data on 748 surgical cases of CE were retrieved representing an annual incidence of 4.5 cases per 100,000 people. More females were affected (61.2%) than males (38.8%). Cysts were detected most frequently in the liver (46.3%) and lungs (28.1%) of the patients. A questionnaire was administered to 50 CE patients who had undergone surgery to describe the characteristics of the patients and their knowledge, attitudes and practices about the disease. The majority of patients were found to adopt poor hygienic practices and had a low level of understanding of how the disease was transmitted. Most specialist medical staff did not inform patients on how to prevent reinfection and the study highlighted the need for improved health education for CE in southern Iraq. 314 livestock farmers were administered a questionnaire to determine their knowledge, attitudes and practices relating to CE in their livestock. Only 86 (27%) farmers owned a dog. 9.8% of respondents ate raw leafy vegetables without prior washing and most (94.3%) did not boil water before using it for domestic purposes. Approximately half of the farmers had a low level of knowledge about CE, especially how it is transmitted and 41.4% did not realize that CE is a potentially dangerous disease to human health. Eggs of Echinococcus were detected in the faecal samples of 10.1% (95% CI 7.1, 13.9) of 335 free-roaming and owned domesticated dogs sampled. A questionnaire was administered to 86 dog-owners to investigate the influence of socio-demographic factors and management and husbandry practices on the knowledge of CE. A multivariable logistic regression model indicated that owners who fed offal had less knowledge about CE (OR=0.17, 95% CI 0.05, 0.53), while keeping a dog tied up was associated with good knowledge (OR=7.0, 95% CI 2.07, 23.78). Dog owners who had a secondary or higher level of education also had better knowledge (OR=5.35, 95% CI 1.65, 17.31) than those with a lower level of formal education. 7.3% (95% CI: 5.4, 9.6) of 631 sheep examined at an abattoir in Basrah contained hydatid cysts. Cysts were detected most frequently in both the livers and lungs of affected sheep (54.3%). The average annual economic loss arising from total or partial condemnation of affected liver and lungs of sheep in Basrah was estimated at US$72,470 (90% CI; ±11,302) or US$ 8.79 per affected sheep. It is concluded that a public health education campaign and a control programme involving worming domesticated dogs and controlling the population of free-roaming dogs should be developed and implemented in Basrah to reduce the impact of CE