https://orcid.org/0000-0001-8725-7180
Figures
Abstract
Background
Zoonotic diseases pose a significant public health threat in low- and middle-income countries (LMICs). This scoping review aimed to map the knowledge, attitudes, and practices (KAP) of abattoir workers and residents living near abattoirs regarding zoonotic diseases in LMICs.
Methodology/principal findings
A comprehensive search was conducted in SCOPUS, PubMed, Web of Science and Google Scholar for articles published between 2010 and 2023. Studies were included if they were conducted in LMICs, published in English, and focused on the KAP of zoonotic diseases among abattoir workers or nearby residents. Data extraction was conducted using a double-blind approach, and discrepancies were resolved by consensus. Of the 4,276 articles screened, 16 met the inclusion criteria. The studies were conducted in nine LMICs, with Nigeria (6; 38%) and Ethiopia (3; 19%) accounting for the highest number. Most studies reported on knowledge (10; 63%) and practices (12; 75%), while 4 (25%) addressed attitudes. Abattoir workers showed varied knowledge of zoonotic diseases, but substantial gaps in preventive practices were observed. Notably, no studies examined the KAP of residents living near abattoirs.
Conclusion/significance
This review underscores the need for targeted interventions to improve KAP among abattoir workers and to expand research to include nearby residents. A conceptual framework was developed to identify factors influencing KAP and guide future research, education, and policy development for zoonotic disease prevention in LMICs.
Author summary
Zoonotic diseases, infectious diseases transmitted between animals and humans, present a significant public health concern causing an estimated 2.5 billion cases and 2.7 million deaths annually. This scoping review analysed 16 studies from nine LMICs to assess the knowledge, attitudes, and practices (KAP) of abattoir workers regarding these diseases. The findings revealed that while workers showed varying levels of knowledge, their preventive practices were often inadequate. Many did not use personal protective equipment and frequently consumed unprocessed animal products such as raw meat and milk. Importantly, no study examined the KAP of residents living near abattoirs, revealing a major research gap. We developed a conceptual framework based on the results to map the individual, cultural, and institutional factors influencing KAP. This framework can guide future studies, interventions, and policy decisions to reduce the risks of zoonotic disease transmission in LMICs.
Citation: Daodu OB, Ogbo PU, Isa AS, Raheem TY, Igbasi UT, Ola OM, et al. (2026) Scoping review of knowledge, attitudes, and practices to zoonotic diseases among abattoir workers and residents in proximity to abattoirs in low-middle income countries. PLoS Negl Trop Dis 20(3): e0013235. https://doi.org/10.1371/journal.pntd.0013235
Editor: Pikka Jokelainen, Statens Serum Institut, DENMARK
Received: June 12, 2025; Accepted: February 26, 2026; Published: March 16, 2026
Copyright: © 2026 Daodu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting information files.
Funding: This work was supported by the Nigerian Institute of Medical Research Foundation [Grant Number NF-GMTP-23-082810]. The funder had no role in study design, data collection, and analysis, decision to publish or preparation of the manuscript. We declare that authors OPO and OOS received salary from Nigerian Institute of Medical Research Foundation.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Zoonotic diseases, those naturally transmitted between vertebrate animals and humans, are responsible for six out of ten infectious diseases and account for an estimated 2.5 billion human cases and approximately 2.7 million deaths annually globally [1]. Beyond this staggering morbidity and mortality, zoonosis pose a continuous threat to global health security and economic stability, with the potential to disrupt supply chains, overwhelm healthcare systems, and inflict substantial economic losses.
Transmission occurs through complex interactions among humans, animals, and the environment [1–3].
Livestock workers, such as abattoir workers, herdsmen, veterinarians, and paraveterinarian professionals, are at particularly high risk for zoonotic infections. These individuals are frequently exposed to animals or animal products and may become infected through direct contact or indirectly via contaminated aerosols, faeces, fomites, raw meat, and unpasteurised milk [4–7]. Abattoirs, although essential for meat processing, can inadvertently serve as hotspots for zoonotic pathogens, posing risks to workers within and nearby communities [3,8].
Abattoir waste, such as animal remains and effluent, can contaminate local water sources, soil, and air, contributing to disease outbreaks [9]. Contaminated water can spread pathogens through drinking or crop irrigation [9,10]. Moreover, abattoirs attract disease vectors such as flies, ticks, and rodents, facilitating the transmission of pathogens to nearby communities [11]. These risks can be exacerbated by inadequate waste management, poor sanitation, and limited regulatory oversight, particularly in low-resource settings [12]. Consequently, abattoirs in LMICs can act as critical bridging points where animal pathogens amplify and spill over into the wider human population, making them a frontline for pandemic prevention.
The global emergence and resurgence of zoonotic diseases such as COVID-19, mpox, ebola, and lassa fever underscore the urgent need for early preparedness and prevention [13]. Critical components of preparedness include raising awareness and promoting safe practices among high-risk populations [13]. In this context, understanding the knowledge, attitudes, and practices (KAP) of abattoir workers and residents living in proximity to abattoirs is essential, particularly in low- and middle-income countries (LMICs) where both human and animal health systems are often under-resourced [14,15].
This scoping review, therefore, aims to map the existing literature on the KAP related to zoonotic infections among abattoir workers and residents living near abattoirs in LMICs. It also seeks to identify key research gaps and inform strategic interventions to mitigate the risk of zoonotic disease transmission.
Based on the findings of this review, a conceptual framework was developed to illustrate the key factors influencing KAP related to zoonotic disease prevention, which may guide future research, interventions, and policy in LMIC contexts.
Methods
Protocol registration
This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews [16]. The protocol was registered with OSF available at https://osf.io/kb34f. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) [17].
Research questions
- What is the knowledge of abattoir workers and nearby residents in LMICs regarding zoonotic diseases?
- What are abattoir workers’ and residents’ prevailing attitudes toward zoonotic diseases?
- What preventive practices are currently adopted by abattoir workers and residents near abattoirs to mitigate zoonotic diseases?
- What gaps exist in the knowledge, attitudes, and preventive practices related to zoonotic diseases among these populations?
Search strategy
An initial limited search was conducted in PROSPERO, PubMed and Google Scholar on October 11, 2023 to identify relevant keywords and index terms. These were used to develop comprehensive search strategies for SCOPUS, PubMed, Web of Science and Google Scholar, targeting studies published between 2010 and 2023. The search was carried out from October 13 – 18, 2023.
The list of LMICs used was based on the Wellcome Trust’s Classification [18]. The search strategy combined Medical Subject Headings (MeSH) and free text terms including ‘zoonotic diseases’, ‘slaughterhouse’, ‘abattoir workers’, ‘knowledge’, ‘attitudes’, ‘practices’ and ‘proximity’ (this and its synonyms did not return any results). These terms were adapted for each database and the detailed strings are provided in supporting information. We defined residents near abattoirs based on geographical proximity or distance, as our hypothesis concerns environmental exposure (air, water, noise, pathogens etc.) within the radius of 600 metres as many regulations require abattoirs to be located at least 300 metres away from residential areas to minimise health and environmental hazards.
Inclusion and exclusion criteria
Studies were included if they were primary research studies (cross-sectional, cohort, or case-control designs), conducted in LMICs, focused on the KAP of abattoir workers and/or residents living near abattoirs regarding zoonotic diseases, and published in English.
Studies were excluded if they were systematic reviews, commentaries, editorials, conference abstracts, or research protocols, not available in full-text, not focused on KAP or zoonotic diseases, and not conducted in an LMIC.
Selection of sources of evidence
All identified references were imported into Rayyan 2022 software, where duplicates were automatically and manually removed. To ensure consistency, all authors jointly screened the title and abstract of the first 40 articles, achieving 85% agreement.
Subsequently, two reviewers (SAI and OBD) independently screened titles and abstracts based on predefined eligibility criteria. Two reviewers (UTI and PUO) conducted full-text screening independently, with discrepancies resolved through discussion or by a third reviewer (OBD) when needed.
Data charting process
Data extraction was carried out by two reviewers (TYR and UTI) using a pre-tested Microsoft Excel data extraction tool developed through team consensus. The tool was piloted with two articles and refined accordingly. Discrepancies during data extraction were resolved through consensus.
The following data items were extracted: first author and year of publication, country of study, study design and sample size, type of zoonotic disease(s) studied, findings on KAP, and gaps in reported KAP components.
Synthesis of results
Results were synthesised descriptively and narratively. Extracted data were summarised narratively, thematically, and organised according to the KAP domains. Quantitative data (e.g., frequency of personal protective equipment (PPE) use, proportion with correct knowledge) were reported in frequencies, proportions, and tabulated results where appropriate consistent with the methodology of scoping review. We also analysed the gap to identify under-researched KAP domains and geographic regions.
Critical appraisal of included studies
In line with JBI guidance for scoping reviews, no formal critical appraisal or risk of bias assessment was conducted. This review aimed to map the existing evidence, rather than to evaluate methodological quality.
Limitations of the method
Potential limitations of this review include the exclusion of non-English language studies, which may have introduced language bias; the exclusion of grey literature may limit the evidence base’s comprehensiveness; and the focus on published peer-reviewed articles may have excluded relevant programmatic or field-level reports.
Results
Study selection
A total of 4,404 records were identified through the systematic search. After removing 128 duplicates, 4,276 titles and abstracts were screened. Of these, 4,254 records were excluded based on the eligibility criteria. The full texts of 22 articles were retrieved and assessed, including 16 studies that met the predefined criteria [19–34]. The study selection process is illustrated in Fig 1.
Six articles were excluded at the full-text review stage due to either an ineligible study design (n = 2) or outcomes not aligned with the review objectives (n = 4). Notably, no study examined the knowledge, attitudes, and practices related to zoonotic diseases among residents living near abattoirs.
Article characteristics
The 16 included articles were published in 11 different journals over 12 years from 2011 to 2023. Fig 2 shows the number of articles published biennially. The most publications occurred in 2018–2019 (31%), and no article was published in 2014–2015 (Fig 2).
This figure details the frequency of publications on our research topic in a two-year range.
All included studies employed cross-sectional designs, with sample sizes ranging from 107 to 738 participants per study. Collectively, the studies involved a total of 4,178 abattoir workers, comprising 3,260 males and 918 females. The studies were conducted across eight low- and middle-income countries: five in Africa (Nigeria, Ethiopia, South Sudan, Kenya, and Cameroon), one in South America (Jamaica), and two in Asia (Myanmar and Iran). Nigeria accounted for the highest number of studies, contributing six articles (38%) to the review.
As shown in Table 1, six specific zoonotic diseases were investigated: leptospirosis (n = 1), zoonotic tuberculosis (n = 1), bovine tuberculosis (bTB) (n = 4), Crimean-Congo haemorrhagic fever (n = 1), brucellosis (n = 4), and Toxoplasma gondii infection (n = 1). One study addressed multiple zoonotic diseases (n = 1), while three did not specify the exact zoonotic disease investigated (n = 3).
Knowledge
Out of the 16 included studies, 10 articles [19,21,22,25,27–29,32–34] reported on respondents’ knowledge of zoonotic diseases. Six studies specifically examined knowledge related to modes of transmission [19,21,22,27,30,33], one study focused on hygiene practices [32], and four studies assessed general awareness and recognition of zoonotic diseases [22,25,28,34].
Knowledge regarding disease transmission varied significantly across studies, with reported awareness levels ranging from 31% to 93%, depending on the specific transmission route assessed. For instance, 83% of respondents knew leptospirosis could be transmitted from animals to humans [19]. In contrast, only 31% of respondents in other studies recognised the zoonotic transmission potential of bovine tuberculosis (bTB) or zoonotic diseases in general [21,22]. Two studies reported that 31% of the participants knew that bTB or pathogens could spread from animal to humans [21,22] while 51% of participants knew that certain food-producing animals could carry meat-borne pathogens [33]. In another study, 93% of respondents correctly identified the consumption of raw meat as a transmission route for bTB [27], while 45.6% were aware that using contaminated water during carcass processing could result in human infection [33]. Furthermore, 39.1% recognised the increased risk of zoonotic transmission due to the non-use of PPE [33].
Regarding hygiene knowledge, one study found that 73.7% of abattoir workers lacked awareness of standard hygiene practices [32]. Regarding general disease recognition, many respondents could identify zoonotic diseases when clinical signs were described in detail. However, they often failed to recognise these diseases by name, were unaware of the associated risks, or lacked basic knowledge of them [22,25,28].
Attitudes
Three studies [19,28,31] explored the attitudes of abattoir workers toward zoonotic diseases. While respondents generally acknowledged that zoonotic transmission from animals to humans was possible, this awareness did not consistently translate into appropriate attitudes toward hygiene, ergonomics, or the use of sanitizers [31,32].
In one study, participants identified food sellers, butchers, and herders as high-risk groups due to their frequent contact with raw animal products, reflecting an understanding of occupational exposure risks [28]. Another study highlighted that while workers recognised the importance of using PPE and handwashing after handling animal body fluids, this recognition was not always reflected in their routine practices [19]. Some of the findings suggest a disconnect between knowledge and behaviour (practice), with attitudes shaped by occupational norms, perceived invulnerability, or limited enforcement of safety standards [29,31].
Practices
Approximately 75% of the studies reviewed reported adequate and inadequate practices within abattoirs [21–23,25,27,29,31–34]. One of the most consistent issues across studies was the limited and inconsistent use of PPE during animal handling and slaughter. A study linked poor PPE use to factors such as long-term abattoir experience, lack of knowledge, and habitual consumption of raw animal products [25]. However, one study notably reported consistent PPE use among workers [20].
Frequent direct contact with animal organs and the consumption of raw animal products such as liver and unpasteurised milk were common practices noted to significantly increase the risk of zoonotic disease transmission [25,32,34]. Although some positive hygiene practices were observed, such as regular handwashing in certain settings [34], unsafe behaviours persisted. Preventive behaviours also appeared to correlate with age and years of experience, where more experienced workers reported greater use of hygiene measures. Additionally, several studies observed inappropriate practices like reusing water to wash multiple carcasses [33], dressing carcasses on bare floors, and improper disposal of waste materials such as eviscerated foetuses [26].
Inspection practices were inconsistent across settings. While one study reported low rates of both pre- and post-slaughter inspection [31], another highlighted a combination of appropriate inspection procedures but poor waste management [20,26], reflecting variability in adherence to slaughterhouse operation and food safety standards in different settings.
Table 2 shows the overview of knowledge, attitudes and practices reported by respondents in the included articles.
Discussion
This scoping review identified significant gaps in the KAP of abattoir workers concerning zoonotic diseases in LMICs. Importantly, no studies assessed KAP among residents living near abattoirs, indicating a substantial evidence gap in this vulnerable group. Also, only three included studies assessed attitudes as other studies did not set out with attitude assessment as an objective. Attitudes are often the least studied component of many KAP assessments because attitudes are ubiquitous, abstract, and subjective. Attitudes have affective, cognitive and behavioural components and expressing an attitude involves making a judgement about an attitude object. This complexity makes attitudes harder to define and quantify than knowledge or practices [36,37]. Knowledge and practices can be assessed using straightforward, factual or observational questions, and identified knowledge gaps and unsafe practices are easier to translate into interventions such as training, regulations, and provision of PPE. However, attitude assessments typically require longer questionnaires, Likert scale items, or qualitative methods, increasing costs and field time [37].
Among abattoir workers, knowledge about zoonotic disease transmission varied widely by disease type and geographic context. Although a general awareness of zoonotic transmission was reported in several studies, this awareness rarely translated into consistent protective behaviour. Unsafe practices, such as non-use of personal protective equipment (PPE), consumption of raw meat or milk, poor hand hygiene, and improper carcass and waste handling, were common despite some knowledge of the risks involved.
These findings suggest that awareness alone cannot change behaviour and that knowledge does not necessarily drive practices. This disconnect between knowledge and action underscores the need for targeted, context-sensitive interventions beyond awareness campaigns to address structural and behavioural barriers to safe practices.
Factors influencing KAP
Multiple factors were identified as shaping KAP among abattoir workers. Occupational experience emerged as a double-edged sword—workers with more years in the abattoir were often more likely to use protective measures, yet their prolonged exposure also increased their risk of infection, particularly for diseases like bovine tuberculosis [30]. In some cases, more experienced workers had developed habitual practices, both protective and risky, shaped by long-term workplace norms.
Access to health information and training was another key determinant. Workers with limited exposure to health education programmes or zoonotic disease training were more likely to engage in unsafe practices [19,35]. However, even among those who had received some training, behaviour change was often incomplete, suggesting that knowledge transfer alone is insufficient without reinforcement and supportive environments.
Cultural and social norms were also suggested to have played a critical role as observed in the primary studies. Deeply ingrained behaviours, such as eating raw meat, drinking unpasteurised milk, or even sleeping in animal sheds, were considered traditional practices, not risky behaviours [29]. These findings highlight the importance of culturally sensitive interventions that engage communities to reframe traditional norms in the context of public health.
Institutional and structural barriers
Beyond individual behaviours, systemic and infrastructural deficiencies within abattoir settings further limit the ability of workers to adhere to safe practices. Many reviewed studies reported inadequate access to PPE, poor sanitation infrastructure, and the absence of formal hygiene protocols [14,26,29,32]. In environments where PPE is unavailable or unaffordable, expecting consistent use is unrealistic.
Meat inspection practices, pre- and post-slaughter, were inconsistently implemented, leaving gaps in detecting diseased animals before human exposure [31]. Additionally, improper disposal of waste and carcasses due to weak regulatory enforcement created environmental hazards and increased the potential for zoonotic spillover events. These structural issues call for institutional reforms and policy enforcement mechanisms that make safe practices the norm, not the exception.
Conceptual framework
We developed a conceptual framework based on the review findings (See Fig 3) to illustrate the complex interplay between individual-level factors (knowledge, attitudes, experiences), cultural influences, and institutional enablers or constraints. This framework offers a multi-level perspective on how zoonotic disease prevention behaviour is shaped in abattoir contexts.
The conceptual framework shows the interplay between individual-level factors (knowledge, attitudes and practices), cultural influences, and institutional enablers or constraints. The framework offers a multi-level perspective on how zoonotic disease prevention behaviours is shaped in abattoir contexts. It also shows how knowledge, attitudes and practices relate to one another depicted as ‘inclusive’, ‘translate’ or ‘does not translate’.
The framework can guide future research on zoonotic disease prevention, designing multi-pronged interventions that align with real-world constraints and informing policymakers and programme designers on areas where targeted investments (e.g., infrastructure, training, behavioural change communication) are most likely to yield impact.
Public health and policy implications
Abattoir workers are frontline actors in the food safety chain. Their actions directly influence the risk of zoonotic transmission, not just to themselves but to consumers and the broader community. Yet, this review underscores that current practices are suboptimal, with potentially serious public health implications.
There is an urgent need to implement mandatory health and safety training, enforce standard operating procedures (SOPs) for abattoir hygiene, and ensure routine availability of PPE. Additionally, governments should invest in pre- and post-slaughter meat inspections and explore behavioural nudges and incentive-based compliance strategies.
One promising approach is periodic health screening for zoonotic infections among abattoir workers. For example, a study in Ghana reported that within six months, two previously negative workers tested positive for Crimean-Congo haemorrhagic fever, underscoring the value of biannual surveillance as both a prevention and monitoring tool [38].
Strengths and limitations
This scoping review used a rigorous, transparent methodology, including protocol registration, comprehensive database searching, and independent, consensus-based screening and data extraction. These strengths enhance the reliability of our findings.
However, several limitations must be acknowledged. First, excluding non-English studies and grey literature may have led to omitting relevant research. Second, the included studies represent only nine of the 136 LMICs, limiting generalisability. Third, the cross-sectional design of all included studies restricts causal inference regarding KAP determinants. Fourthly, considering we conducted a scoping review, we did not carry out a formal quality of appraisal of included studies. This may restrict the interpretability of our findings.
Recommendations
Future research should explore the KAP of residents living near abattoirs, a group currently overlooked. Studies should assess the effectiveness of culturally appropriate interventions that address individual behaviours such as not washing hands after processing raw meat, and consumption of raw meat; and systemic barriers such as open-air dump method of abattoir wastes. Applying implementation science frameworks can improve the adoption of safe practices. Finally, longitudinal and mixed-methods studies are needed to better understand behaviour change and its drivers in LMIC contexts.
Conclusion
The review showed that gaps existed in literature on studies on KAP related to zoonotic infections among abattoir workers and residents living near slaughterhouses in LMICs. This underscores the need for targeted interventions to improve KAP among abattoir workers and to expand research to include nearby residents in order to mitigate the risk of zoonotic disease transmission. Based on the findings of this review, a conceptual framework was developed to illustrate the key factors influencing KAP related to zoonotic disease prevention, which may guide future research, interventions, and policy in LMICs contexts. The conceptual framework developed from this review offers a useful foundation for guiding future studies on KAP related to zoonotic infections in LMICs. The review also highlights the urgent need for multi-faceted interventions based on the identified knowledge gaps, modify risk-related attitudes, and reinforce the need for safe practices through institutional support and culturally sensitive health education.
Given the limited geographic coverage of existing research and the clear influence of cultural norms on abattoir practices, there is a strong need for studies across more diverse settings. This will ensure that interventions are contextually relevant and effective. The framework can also inform policy recommendations and guide the development of targeted health programmes aimed at preventing zoonotic infections among abattoir workers.
Supporting information
S1 Appendix. This list has the words that were abbreviated in some parts of the manuscript.
https://doi.org/10.1371/journal.pntd.0013235.s001
(DOCX)
S1 Text. Search strategy for PubMed.
The search strategy presents the search terms and strings used to search PubMed. The strategy was adapted to suit other databases.
https://doi.org/10.1371/journal.pntd.0013235.s002
(DOCX)
S1 Table. Study characteristics.
The table of study characteristics presents the information extracted from the 16 included articles.
https://doi.org/10.1371/journal.pntd.0013235.s003
(DOCX)
S2 Table. This table shows all studies found from the databases.
It captures the reason for the exclusion of six studies.
https://doi.org/10.1371/journal.pntd.0013235.s004
(DOCX)
S1 Data. Data used to build Fig 2: The file shows the data used to build Fig 2. It contains the number of years (classified in two years period) and the number of publications during that period.
https://doi.org/10.1371/journal.pntd.0013235.s005
(XLSX)
Acknowledgments
We acknowledge the Nigerian Institute of Medical Research (NIMR) Foundation for the training we received in learning how to do research. We also gratefully acknowledge Professor Morenike Folayan-Ukpong for her invaluable contribution to the development of this scoping review manuscript. Her expertise and mentorship were instrumental to the successful completion of this review.
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