Knowledge, perceptions, and practices on zoonotic tuberculosis among pastoral communities in selected districts of Afar Region, Ethiopia

Zoonotic tuberculosis (zTB) remains a significant public health concern in pastoral communities in the Afar region, Ethiopia, yet evidence on community knowledge, attitudes, and practices (KAP) regarding zTB are poorly documented. This study aimed to assess KAP of pastoral and agropastoral populations towards zTB in selected districts of the Afar region, Ethiopia. A quantitative cross-sectional study was conducted from March to June 2025 among 284 respondents in pastoral communities in selected districts of the Afar region, Ethiopia. Data on knowledge, perceptions, and practices were collected using Kobo Tool digital platform and analyzed with SPSS version 23. Among the 284 respondents, most were male (65.8%), married (96.1%), aged 31–40 years (54.2%), unable to read (81.7%), and engaged in pastoralism (79.2%). While awareness of human TB (hTB) was high (90.8%), only about half of respondents (51.8%) knew about animal TB (aTB), and fewer than one-third recognized its zoonotic transmission (26.1%). Few respondents identified raw milk (10.9%) or raw meat (6.7%) as transmission routes. Attitudinal gaps were marked: over half were neutral about isolating sick animals (52.8%), most were undecided regarding traditional versus modern medicine (81.7%), and one-quarter (25.7%) strongly disagreed that raw milk could transmit TB. High-risk behaviors were common, including frequent raw milk consumption (82.4%) and cohabitation with livestock (33.8%). Respondents who were unable to read and male gender emerged as strong predictors of poor knowledge (p = 0.001) and practices (p < 0.0001), respectively, whereas respondents aged 18–30 (p = 0.001), 31–40 (p = 0.001), and 41–50 years (p = 0.002) demonstrated better preventive practices compared to those aged ≥ 51 years. Despite high awareness of hTB, understanding of aTB and its zoonotic transmission was lower, and risky practices were common. Targeted interventions and culturally appropriate education for older adults and individuals unable to read are recommended to improve awareness and promote behavioral change.