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Epidemiological Characteristics of Human Brucellosis in Shahin Dezh, Western Azerbaijan, Iran, 2008-2012

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Epidemiological Characteristics of Human Brucellosis in Shahin Dezh, Western Azerbaijan, Iran, 2008-2012 See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/272400990 Epidemiological Characteristics of Human Brucellosis in Shahin Dezh, Western Azerbaijan, Iran, 2008-2012 Article · January 2015 DOI: 10.5812/archcid.22279 CITATIONS READS 5 102 6 authors, including: Farzad Maleki Hosein Rafiemanesh Tehran University of Medical Sciences Shahid Beheshti University of Medical Sciences 11 PUBLICATIONS 26 CITATIONS 38 PUBLICATIONS 464 CITATIONS SEE PROFILE SEE PROFILE Abbas Abbasi-Ghahramanloo Ahmad Kousha Iran University of Medical Sciences Tabriz University of Medical Sciences 34 PUBLICATIONS 152 CITATIONS 34 PUBLICATIONS 240 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: a project on nurse's self care in tehran View project Systematic reviews- Cancer group View project All content following this page was uploaded by Farzad Maleki on 18 August 2017. The user has requested enhancement of the downloaded file. Arch Clin Infect Dis. 2015 January; 10(1): e22279. DOI: 10.5812/archcid.22279 Research Article Published online 2015 January 24. Epidemiological Characteristics of Human Brucellosis in Shahin Dezh, Western Azerbaijan, Iran, 2008-2012 1 1 1 2 Farzad Maleki ; Hossein RafieManesh ; Abbas Abbasi Ghahramanloo ; Naser Ghadimi ; 3 4,1,* Ahmad Kousha ; Saeid Safiri 1Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran 2Shahin Dezh Health Center, UrmiaUniversity of Medical Sciences, Urmia, IR Iran 3Department of Health Educations and Promotion, Tabriz University of Medical Sciences, Tabriz, IR Iran 4Road Traffic Injury Research Center, Department of Statistics & Epidemiology, Tabriz University of Medical Sciences, Tabriz, IR Iran *Corresponding author: Saeid Safiri, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98- 9141005277, E-mail: [email protected] Received: ; Revised: ; Accepted: July 24, 2014 December 30, 2014 January 13, 2015 Background: Brucellosis is still one of the most challenging issues for health and the economy in many developing countries such as Iran. Objectives: This study investigated the epidemiological features of brucellosis in Shahin Dezh, Western Azerbaijan province, North West of Iran. Materials and Methods: This study had across-sectional design and data was collected from private and public sectors over a five-year period (2008-2012). All cases were studied between years 2008 and 2012 in Shahin Dezh. Results: In total, 492 cases of brucellosis were reported. The prevalence of brucellosis decreased from 152 cases/100000 inhabitants in 2008 to 97 cases/100000 inhabitants at the beginning of 2012. About 52.3% of subjects were male, and most cases of brucellosis were aged 25-30 years. Eighty-one percent of subjects lived in rural areas. There was a statistically significant difference regarding contact with livestock between rural and urban areas (91.7% vs. 68.8%) (P value <0.001).Raw milk was the most commonly consumed dairy product; consumed by 37% of cases. Finally, during winter and spring a high prevalence rate of brucellosis was reported. Conclusions: Comprehensive health-related interventions need to empower communities at risk, especially young men and young and adult women in the Shahin Dezh County. Health education is needed to raise awareness of people in the studied area. Keywords:Brucellosis; Epidemiology; Iran 1. Background lence calculated by studies from Iran is23.86 cases per 100000 individuals per year (7, 8). Prevalence rate of bru- Brucellosis is one of the most common zoonotic in- cellosis in various parts of Iran varies from 0.73 to 141.60 fectious diseases (1), which is transmitted to humans per 100000 (7, 9, 10). Western Azerbaijan province,with a through consumption of unpasteurized dairy products prevalencerate of 71.4 per 100000 individuals, has been or through direct contact with infected animals, pla- one of the most importantendemic areas of brucellosis centas or aborted fetuses. This bacterial disease causes in north of Iran (11). Despite the importance of the men- a severely debilitating and disabling illness, with fever, tioned disease in this province, studies about its trend sweating, fatigue, weight loss, headache, and joint pain and correlations are rare. persisting for weeks to months (2). The importance of Brucellosis is not only due to its 2. Objectives physical complications, it is also considered to be one This study aimed to determine the epidemiological fea- of the biggest challenges for economic development in tures of brucellosis in one of the most important coun- many countries such as Iran (3) due to patients being un- ties of the Western Azerbaijan province, Shahin Dezh, able to perform their normal daily activities (2) and loss- during a five-year period. es in animal production (4).Brucellosis is widespread in the world, and it isprevalent in countries of the Mediter- 3. Materials and Methods ranean basin, the near east, South America, and possibly Sub-Saharan Africa (3). The World Health Organization (WHO) has estimated that 500000 cases are reported 3.1. Study Design worldwide annually, while this value is one-fifth of all This study had a cross-sectional design and was con- cases (5, 6). ducted on all patients (n= 492) with brucellosis, during a Brucellosis is an endemic disease in Iran, and its preva- five-year period from 2008 to 2012. Copyright © 2015, Infectious Diseases and Tropical Medicine Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Maleki F et al. 3.2. Setting and Participants tion was not significantly different between urban and rural areas (P value= 0.426) Figure 2. This study was done in the Shahin Dezh County. Shahin The findings showed that housewives and students Dezh County is a county in the West Azerbaijan Province of were more profoundly affected in both urban and rural Iran. The capital of the county is Shahin Dezh. At the 2006 groups (40.9% and 20.4% in rural; 39.1% and 13.8% in urban, census, the county's population was 89356with20911 fam- respectively). Meanwhile, the most common occupations ilies (Azerbaijani Turks being the majority). The county is among cases from urban areas were labor (9.7%), rancher subdivided into two districts; the Central District and Ke- (6.5%), and self-employment (6.5%). Among rural cases, shavarz District. The county has three cities: Shahin Dezh, ranchers (12.5%), and farmers (9.8%) were more affected Mahmudabad and Keshavarz. after housewives and students (Table 1). Based on the national surveillance of brucellosis, the in- There was a statistically significant difference regarding clusion criteria were as follows, suspected clinical symp- contact with livestock between cases from rural and urban toms, Wright test titer of >1/80, positive Coombs–Wright's areas (91.7% vs. 68.8%) (P value <0.001). Ninety-one percent test or titer of 2-mercaptoethanol (ME) test > 1/40, and of housewives in rural areas had contact with livestock, having records at one of the health centers during the and this rate was 57.9% in urban areas. Direct contact with past five years as a new case, relapse or failure case. Data livestock was higher in rural students than urban students collection was done using a standard questionnaire in (90.9% vs. 63.2%). Also among workers, direct contact with current use by the health surveillance system. These data livestock was more common in rural compared to urban ar- included demographic and epidemiological informa- eas (94.7% vs. 77.8%) (Table 2). Diary consumption was com- tion, which were collected from all of the state-related mon in both rural (98%) and urban subjects (97.8%), and health centers and private clinics and laboratories with- there was no statistically significant difference between ar- in the Shahin Dezh County over a five-year period (2008- eas (P value=0.929). The findings of this study showed that, 2012). It is important to note that, during the entire re- the prevalence rate in winter and spring was higher, and in search, confidentiality was established and names of the fall it decreased to minimum levels (Figure 3). subjects were not declared. 30 3.3. Sampling, Sample Size and Statistical Analysis 250 All of the identified subjects (n= 492) who had referred to the Shahin Dezh health center were included in the 200 study using the health center’s records. For analyzing the 150 data Stata version 11 was used. In the descriptive statistics, means (± SD) and frequencies were used for quantitative 100 and qualitative variables, respectively. It is important to mention that, because the expected frequency in cells 50 was not enough, multiple Fisher's exact test was used for 0 analyzing the qualitative variables. 2008 2009 2010 2011 2012 4. Results Urban population Rular population Total population Figure 1. In total, 492 affected cases with brucellosis symptoms Brucellosis Trend of Prevalence Rates per 100000 Individuals in Western Azerbaijan Province; Urban, Rural and Total Populations (2008- whose disease had been confirmed by diagnostic tests 2012) were included in this study. Six and five individuals were failure and recurrent cases, respectively. According to the 16 authors’ estimations, the prevalence of brucellosis de- 14 creased from 152 cases/100000 inhabitants in 2008 to 97 12 cases/100000 inhabitants at the beginning of 2012. Mean- 10 while, the average prevalence of brucellosis was 102.86 / Cass 8 100000 over the five-year period of the study in this prov- Total % of Male ince; 37.58 /100000 in the urban population and 172.83 6 Female /100000 in the rural population (Figure 1).
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