Integrating Ethnography and Structural Equation Modelling to Assess Brucellosis Knowledge, Attitude, and Practices...

Brucellosis is a neglected zoonotic disease endemic in pastoralist communities. It is driven by close human-animal interactions and culturally embedded practices such as consuming raw milk and blood, handling aborted materials, and skins and hides, and limited access to veterinary and healthcare services. Understanding how knowledge, practices, and cultural beliefs intersect structurally is essential for designing context specific One Health interventions for effective disease control.

We employed a mixed-methods approach to explore brucellosis-related knowledge, attitudes, and practices among pastoralist communities in Kajiado and Marsabit counties, in Kenya. Subsequently, we used partial least squares structural equation modeling (PSL-SEM) to estimate the direct and indirect effect of the latent variables (K, A, P) on the brucellosis transmission pathway.

Brucellosis knowledge, attitude, and practices were markedly poor in both counties. Pastoralists in Marsabit demonstrated significantly better knowledge (54% vs 36%, p<0.001), and attitude (45% vs 23%, p<0.001) but worse practice scores (26% vs 52%, p<0.001), compared to Kajiado. Risky practices, such as raw milk consumption and unsafe disposal of animal birthing products, were widespread. PLS-SEM analysis showed a strong indirect effect of knowledge on practices mediated through attitudes: (Knowledge → Attitude: β = 0.921, p<0.001; Attitude → Practice: β = 0.580, p< 0.001), with minimal direct impact (Knowledge → Practice: β = 0.188). Cultural beliefs, such as resistance to boiling milk or using colostrum for healing - persisted regardless of awareness levels.

This study reinforces the observation that knowledge alone is insufficient for behavior change. Cultural norms, traditional knowledge systems, and limited health infrastructure play a critical role in sustaining risk behaviors.

Effective brucellosis control must integrate culturally grounded, community-specific strategies that strengthen attitudes and promote safer practices within a One Health framework.