Zoonotic tuberculosis in India: knowledge, attitudes, practices, and associated risk factors among livestock handlers in Haryana, northern India

Objective Bovine tuberculosis (bTB) is an under-recognised zoonotic threat in India, given the high burden of human TB, high livestock density, and widespread unpasteurised milk consumption. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) regarding bTB among livestock handlers in the northern region (Haryana) India. To the best of our knowledge, this is one of the first studies in the region specifically to evaluate KAP related to zoonotic TB and its findings provide critical evidence to support zoonotic tuberculosis (zTB) surveillance and control strategies, with potential for broader application in other regions of the country. Methods A cross-sectional study was conducted among 646 livestock handlers across using a structured questionnaire assessing demographic characteristics along with knowledge, attitudes, and practices regarding bTB. Associations between demographic variables and KAP scores were examined using chi-square tests. Results Participants were predominantly rural, middle-aged men engaged in livestock handling, with intermediate levels of education; 99.2% owned buffaloes or cattle for milk production. Raw milk consumption was widespread, with 42.5% consuming both raw and boiled milk and 16.1% consuming raw milk only, posing significant exposure to bTB transmission risk. Overall (39.2%)of respondents had heard of bovine TB, based on composite knowledge score (mean 6.35 ± 3.56) = 50% have good knowledge and 50% have poor knowledge. Suggesting that current knowledge levels are insufficient to drive meaningful behavioural changes such as avoiding raw milk, isolating infected animals, and seeking medical care. Only 31.1% of participants supported the isolation of suspected animals, revealing a major gap in farm-level biosecurity. Age was the strongest correlate of knowledge level ( χ 2 = 19.497, p < 0.001) and educational status ( χ 2 = 19.465, p = 0.003). Educational status also showed a highly significant relationship with attitude scores ( χ 2 = 36.011, p < 0.001), highlighting education as a key determinant of KAP. Conclusion Overall KAP regarding bTB remains moderate among livestock handlers in Northern region (Haryana) India. Achieving the WHO goal of ending TB requires strengthened awareness through education and training, alongside integrated human–animal surveillance for bTB under a One Health approach, particularly in developing countries.