A quantitative survey on exposures, knowledge, attitudes, and practices (KAP) related to swine influenza among villagers in different regions of Thailand (2025)

Swine influenza is a respiratory disease caused by infection with the influenza A virus (Alphainfluenza virus) that affects pigs [1]. Three subtypes of influenza viruses can infect pigs, namely H1N1, H3N2, and H1N2 [2, 3]. Among the three subtypes, H1N1 and H3N2 are the most common subtypes and can infect humans [3, 4]. Although SIV infection can cause high morbidity in pigs, it typically results in low mortality rates [5]. However, SIV can still lead to economic losses in pig farms. Interspecies transmission of SIVs from pigs to humans has been reported in people with close contact with pigs [6,7,8]. Individuals infected with SIV may experience symptoms such as fever, headache, runny nose, body aches, coughing, and sore throat, similar to the flu [9]. Persons with preexisting medical conditions are more susceptible to infection [9]. In some instances, SIV infection can be misinterpreted as seasonal flu in humans [9].

In Thailand, the pig farming industry has rapidly grown and is becoming a significant business, producing approximately 1million tons of ready-to-eat pork annually [10, 11]. According to data from the Department of Livestock Development (DLD), backyard and small-scale pig farms account for 44% of Thailand’s total pig population [12]. However, backyard and small-scale pig farmers often neglect farm hygiene and animal health, which makes the pigs vulnerable to infectious diseases [13, 14]. Since mid-2009, several outbreaks of pandemic H1N1-2009 in pig farms have been reported in Thailand. Moreover, it was observed that there were reassortant SIVs between pandemic H1N1-2009 and endemic SIVs [15, 16].

In the context of biosecurity for livestock health, an updated study of knowledge, attitudes, and practices (KAP) toward SIV significantly increases public understanding of SIVs, especially for backyard and small-scale pig farmers. A previous study on KAP regarding SIV focused on small-scale pig farmers in Mukdahan province, northeastern Thailand, which showed low biosecurity practices in rural communities, especially in backyard settings [6]. These practices have contributed to the transmission of viruses to other species [6]. In another study in Thailand, a KAP survey on SIV was conducted among people living along the Thailand-Myanmar border in Ratchaburi Province, and KAP regarding SIV among the people in the border areas was very low [4]. They also had constraints related to hygiene and sanitation [4]. In this current study, the analytic cross-sectional study was implemented to determine factors related to KAP scores of SIV among the pig farm owners, pig farmers, and villagers who lived near the pig farms in three provinces: Nakhon Ratchasima (northeastern region), Chiang Mai (northern region), and Nakhon Pathom (central region) of Thailand.

Study design and study sites

This analytic cross-sectional study was a part of a concurrent mixed-method study, which included a qualitative study that was published in 2023 [17]. It was conducted to analyze factors associated with KAP toward SIV among pig farm owners, farm managers, farm workers, and nearby villagers within a radius of 5km from pig farms in three provinces of Thailand, Nakhon Ratchasima (northeastern region), Chiang Mai (northern region), and Nakhon Pathom (central region). The study was carried out from February to December 2022. The study sites were chosen by applying multistage sampling steps. The first stage involved the selection of study provinces, followed by the selection of subdistricts in the second stage, and finally, the selection of villages with documented pig farms, as presented in Table1 of the qualitative study [17].

Sample size estimation, participants, and recruitment procedures

The inclusion criteria for participants were individuals between the ages of 20 and 65 who had lived within five kilometers of the pig farms for at least twelve months prior to data collection and their willingness to participate in the study. We excluded those who could not communicate clearly (e.g., could not understand and speak the Thai language or had mental illness or drunkenness during the data collection activities). The following equation was used to calculate the sample size for this study:

Where p is the proportion of knowledge about SIV, a previous study revealed that approximately 15.8% of participants had knowledge of SIV [18]; therefore, p is 0.158, while z is 1.96 (95% confidence interval), and d (margin of error) is 5%. Thus, the sample size calculation for this study was 204. Following the simple random sampling (SRS) methods of the villager lists from the local health facilities, the potential study participants were contacted by trained researchers for data collection via face-to-face interviews using a structured and standardized questionnaire that included a set of standardized questions per our study objectives, which specified the exact wording and order of the questions for gathering information from the study participants. The participants were interviewed in a not-too-secluded or crowded location.

Study tools

A quantitative questionnaire was designed using a modified outline questionnaire from a previous study on bat contact characteristics [19]. The questionnaire included questions on socio-demographics, KAP toward pig farming practices, SIV and zoonotic diseases, health status, and influenza vaccination histories. It should be noted that the questionnaire included 12 knowledge-, 16 attitude-, and 12 practice-related questions. In addition, it was refined after a pilot study with 30 pig farmers from Nakhon Ratchasima province, who were not the actual study participants. The refined questionnaire was re-briefed to the study team members and field enumerators.

Study procedures

Field enumerators were trained by the principal investigators (PIs) on the study protocol, study objectives, tools, and procedures to obtain informed consent forms. The study team members contacted potential participants using a random list from official household registry records. The potential participants were checked for their availabilities and willingnesses to participate by informing them of the study objectives and procedures for the data collection. Once they agreed to participate in the study, written informed consent forms were obtained prior to the interviews. After the questionnaire interviews, a field supervisor checked the information for validity and precision before analyzing the data using R analysis software.

Study variables and data analysis procedures

Thirty independent variables were included in this study. The questionnaire consisted of variables related to socio-demographics, as well as knowledge, attitudes, and practices (KAP) variables. R statistical analysis software version 4.3.1, R Core Team (2023), was used to analyze the quantitative data. The analytical variables were created after the data was cleaned. The data were analyzed in two steps. First, bivariate analysis was performed, in which the degree of association between each variable was calculated, and each independent variable was determined individually. Pearson chi-square tests or Fisher exact tests, when expected cell counts were 5, were used to determine associations for dichotomous independent variables.

In the second step, a backward stepwise multiple linear regression model was constructed using independent variables with a P-value of < 0.15 from the bivariate analysis. This model applied a cut-off of P < 0.05 for statistical significance. Multiple linear regression was employed to identify factors associated with SIV-related knowledge, attitudes, and practices (KAP). Additionally, a one-way analysis of variance (ANOVA) was conducted to examine differences in SIV-related KAP across provinces [20]. The Kruskal-Wallis’s test and Pearson correlation coefficient (r) were also used to assess the relationship between practices and health status in relation to KAP scores.

In addition, SIV-related knowledge scores were calculated as the total accumulated knowledge score from 12 questions. It scored 1 if answered correctly and 0 if answered incorrectly. Thus, the total accumulated knowledge score ranges from 0 to 12. For SIV-related attitude scores, the overall average attitude score was calculated based on 12 items, with the attitude score given as follows: don’t know/ no answer = 0, strongly disagree = 1, disagree = 2, unsure = 3, agree = 4, and strongly agree = 5. As a result, the calculated average attitude score ranges between 0 and 5. Likewise, for SIV-related practice scores, the overall average practice score was calculated from 16 items, with the practice scores as follows: don’t know/ no answer = 0, never = 1, rarely = 2, occasionally = 3, almost always = 4, and always = 5. As a result, the calculated average attitude score ranges between 0 and 5.

Socio-demographic of pig farmers, pig farm workers, and villagers

In total, 215 participants from three provinces participated in this study, including Pak Chong District in Nakhon Ratchasima (73, 34%), Doi Saket District in Chiang Mai (70, 32.6%), and Mueang District in Nakhon Pathom (72, 33.5%) (Fig.1). There were 100 male (53.5%) and 115 female (46.5%) participants from 18 to 64 years of age, with an average age of 48.8 years. For ethnicity, most participants are Thais (197, 96.1%), followed by Paganyaw (9, 4.2%), Tai Yai or Shan (5, 2.3%), Muser or Lahu (2, 0.9%), Lisu or Lisaw (1, 0.5%), and Karen (1, 0.5%). For education level, 103 (47.9%) participants had primary education or lower (P1-P6), 38 (17.7%) had lower secondary education (M1-M3), 32 (14.9%) had upper secondary education (M4-M6), while 16 (14.9%) individuals had not received any formal education. In addition, 14 (6.5%) participants had a bachelor’s degree, 11 (5.1%) participants had vocational education, and only 1 (0.5%) participant had a postgraduate degree. For monthly income, 125 (58.1%) had a monthly income below 15,000 THB (equivalent to 500.0 USD), while 80 (37.2%), 8 (3.7%), and 2 (0.9%) reported a monthly income of 15,001– 40,000 THB (equivalent to 500.0–1,333.3 USD), 40,001–70,000 THB (equivalent to 1,333.4–2,333.3 USD), and more than 70,000 THB (equivalent to more than 2,333.3 USD), respectively. For occupation, the highest occupation group by numbers was 79 laborers (36.7%), followed by 34 farmers (15.8%), 19 pig farm workers (8.8%), 18 merchants (8.4%), 12 housewives (5.6%), 10 government officers (4.7%), 9 private company employees (4.2%), and 7 pig farm owners (3.3%). In addition, 14 participants (6.5%) reported other occupation types, and 13 (6.0%) indicated they were self-employed. Among the 26 pig farm workers and owners, 18 (69.2%) reported that their farms produced finishing pigs, 11 (42.3%) also produced piglets, and another 11 (42.3%) reported that their farms produced breeding pigs. In terms of the main tasks on the pig farms, out of the total 26 workers reported involving more than one task while working on the farms, which 18 (69.2%) were responsible for cleaning the pigs’ housing, 15 (57.7%) were responsible for feeding the pigs, 14 (53.8%) were responsible for tending the pigs, 7 (26.9%) were responsible for administering vaccine injections and providing supplementation, 5 (19.2%) were responsible for breeding, and 4 (15.4%) were responsible for farrowing assistance (Table1).

Health information of pig farmers, pig farm workers, and villagers

In this study, participants reported receiving the COVID-19 vaccine (211, 98.1%), influenza vaccine (93, 43.3%), tetanus vaccine (12, 5.6%), and an unknown type of vaccination (5, 2.3%). Among 93 influenza-vaccinated individuals, some participants (45, 20.9%) received the influenza vaccine every year, while others (48, 22.3%) received the influenza vaccine but not annually. For recent influenza vaccination, 44 (47.3%) reported receiving the most recent influenza vaccination in 2022, followed by in 2021 (31, 33.3%), in 2020 (8, 8.6%), in 2019 (3, 3.2%), in 2017 (2, 2.2%), and in 2018 (1, 1.1%), and unable to recall or identify the vaccination period (4, 4.3%), respectively. For the influenza vaccination arrangements, individuals reported various locations; for example, 65 (30.2%) participants received the vaccine through a public health agency, 15 (7.0%) sought the vaccine themselves, but the employer covered the cost, and 5 (2.3%) were taken to get vaccinated by the employers. Of some participants, 5 (2.3%) obtained the vaccination through “other” means, and only 3 (1.4%) sought and paid for the vaccination themselves. For the locations of influenza vaccination, 57 (26.5%) participants received the vaccine at a vaccination/public health service unit, 25 (11.6%) were vaccinated at a hospital, 9 (4.2%) were vaccinated at their workplace (employer arranged for public health officers to administer the vaccine) (Supplement Table1). For COVID-19 vaccination, 122 participants (57.8%) were vaccinated in 2022, and 89 participants (42.2%) were vaccinated in 2021. The details of COVID-19 vaccination are shown in supplement Table1.

For health status, 62 (28.8%) participants reported experiencing a high fever with a headache, 55 (25.6%) fever with a cough, 53 (24.7%) fever with body aches, and 44 (20.5%) fever with a sore throat. When experiencing a high fever, 42 participants (19.5%) visited a doctor every time; 50 (23.3%) visited sometimes; and 29 (13.5%) did not seek medical attention. It is to note that individuals were allowed to report multiple symptoms (Supplement Table1).

Swine and other animal exposures

Participants in swine-related occupations reported working with pigs for an average of 121.4 months, or about 10.1 years, ranging between 12 months to 20 years. Participants worked closely with pigs for 6h, ranging from 1 to 9h per day. In the past 12 months, 97 (45.1%) participants had contact with only pigs, while 118 (54.9%) had contact with other domestic animals. Of 118, individual participants were able to report contact with multiple animal species, such as dogs (89, 41.4%), cats (64, 29.8%), chickens (41, 19.1%), “other” animals (18, 8.4%), ducks (4, 1.9%), and wild bird (1, 0.5%). For contact frequency, 38.6% (83) of participants reported having contact with animals every day, 10.7% (23) did sometimes, 5.1% (11) often, and rarely contact (9, 4.2%). It is noted that 92.6% (199) of participants reported that the pigs were not kept with any other animals, while 7.4% (16) reported that the pigs were kept with other animals, such as cats (8, 34.8%), dogs (7, 30.4%), chickens (6, 26.1%), birds (1, 4.3%), “other” animals (1, 4.3%) (Supplement Table2).

Knowledge, attitudes, and practices toward pig farming activities and SIV

SIV-related knowledge, attitude, and practice scores are shown in Table2. The average participant’s score was 6.92 out of 12 for SIV-related knowledge. The lowest score was 2, and the highest was 11. As for SIV-related attitudes, the average score was 3.74 out of 5 points, ranging from 2.31 to 4.63. Meanwhile, the average score for SIV-related practices was 3.63 out of 5, ranking from 0.58 to 5.00.

Knowledge toward SIV

The top five knowledge questions related to SIV that were correctly answered by participants included: (1) frequent cleaning and hand washing with soap can prevent SIV infection (197, 91.6%); (2) humans can become infected with SIV through contact with the body or secretions (e.g., saliva, mucus, and feces) of infected pigs, (167, 77.7%); (3) SIV symptoms in infected humans are high fever, coughing, body aches, breathing difficulties, lung inflammation, and possible fatality, (158, 73.5%); (4) humans can become infected with SIV through contact, (156, 72.6%); and (5) SIV can be transmitted from pigs to other animals, (143, 66.8%) (Supplement Table3).

It is noted that the overall levels of SIV-related knowledge in the three provinces were not statistically different from one another. The median score for all three provinces was 7 out of 12 points, considered a moderate level of knowledge (Table3). The multiple linear regression analysis showed three factors influenced SIV-related knowledge, including: (1) the education level factors (P = 0.04), indicating that the participants with primary school (P1-6) scored 1.23, which was significantly higher than participants with no formal education (P = 0.02). Additionally, participants with upper secondary education (M3-5) scored 1.49, which was significantly higher than those with no formal education (P = 0.01); (2) the participants with monthly income more than 15,000 THB scored 0.62, which was significantly lower than those with a monthly income of 15,000 THB or less (P = 0.02); and (3) responsibility for vaccination/maintenance factor (P = 0.01) indicating that participants whose main responsibility was administrating vaccines had SIV-related knowledge scored of 2.01, which was significantly higher than those who did not have this responsibility (P = 0.01) (Table4).

Attitudes toward SIV

The attitudes toward SIV of the three provinces showed no significant difference (P > 0.05). Chiang Mai had a median score of 3.88, while both Nakhon Pathom and Nakhon Ratchasima had a median scored of 3.69; all were within the “agree” range (Table3). The top five SIV-related attitude statements which the participants “strongly agreed” were: (1) wash hands with soap every time after in contact with pigs (110, 51.2%); (2) regularly clean equipment or areas that come into contact with the bodies or secretions of pigs (103, 41.9%); (3) wear gloves, masks, and boots when contacting or working with pigs (100, 46.5%); (4) pigs with unusual death should not be consumed or sold to others (82, 38.1%); and (5) isolate sick pigs from healthy pigs or other animals (78, 36.3%) (Supplement Table4).

The multiple linear regression analysis showed three factors influenced SIV-related attitudes as follows: (1) education level factor (P = 0.02), in which participants who had a primary school (P1-P6) demonstrated attitudes towards SIV scored of 0.27, which was significantly greater than those with no formal education (P = 0.02). In addition, participants with an upper secondary education level (M3-M6) scored of 0.42, which was significantly higher than those with no formal education (P < 0.01). In addition, participants with education levels beyond upper secondary education had SIV-related attitude scored of 0.29, which was significantly higher than those without formal education (P = 0.03); (2) occupation type factor (P < 0.01), which participants who were rice/ horticulture farmers or merchants had SIV-related attitude scored of 0.27, which was significantly lower than pig farm owners or workers (P = 0.01). In addition, participants working as hired laborers scored of 0.33, which was significantly lower than pig farm owners or workers (P < 0.01); (3) vaccination history (P = 0.04), which participants who had never received vaccinations had SIV-related attitude scored of 0.24, which was significantly lower than participants who had been vaccinated (P = 0.04) (Table4).

Practices toward SIV

The SIV-related practices in the three provinces were not statistically different (P > 0.08). Chiang Mai had a median scored of 3.71, Nakhon Pathom had a median scored of 3.67, and Nakhon Ratchasima had a median scored of 3.83, all of which were in the “almost always” range (Table3). The top five practices that the participants “always” did were: (1) washing hands with soap after contacting or working with pigs or other animals (154, 71.6%); (2) washing hands with soap every time after contacting pigs or other animals (150, 69.8%); (3) when discovering sick pigs in farm, separate sick pigs from healthy pigs (131, 60.9%); (4) regular cleaning the equipment, pens, and areas that come into contact with pigs’ bodies or secretions (130, 60.5%); and (5) wearing a mask when contact or work with pigs (116, 54.0%) (Supplement Table5).

The multiple linear regression analysis showed that factors influenced SIV-related practices as follows: 1) occupation types (P < 0.01), which participants who worked as rice/horticulture farmers or merchants had SIV-related practice scored of 0.62, which was significantly lower than those who worked as pig farm owners and workers (P < 0.01). The participants who were either unemployed or worked at home had SIV-related practice scored of 0.68, which was significantly lower than pig farm owners and workers (P = 0.01). Government officers or private company employees had SIV-related practice scored of 0.67, which was significantly lower than pig farm owners and workers (P < 0.01) (Table4).

Overall, there was a positive correlation between knowledge and practice, with a significant correlation coefficient (0.211; P < 0.01). On the other hand, a positive correlation between knowledge and attitudes, as well as attitude and practice, was observed, but no significant correlation coefficients (0.047 and 0.052; P > 0.05) (Table5).

Practices toward sick pigs or SIV outbreaks

One hundred thirty-one (60.9%) of all participants always immediately separated the sick pigs from other pigs, followed by almost always separated (30, 14.0%), do not know/ did not answer (26, 12.1%), never separated (17, 7.9%), separated sometimes (10, 4.7%), rarely separated (1, 0.5%), respectively (Supplement Table5). The findings indicated that farm owners and managers at all study locations consistently isolated sick pigs from healthy ones at median score = 5 (3.5, 5) (Table6). In addition, the three study provinces had no statistically significant difference in the practice toward sick pigs or SIV outbreaks (P > 0.05) (Table6).

In addition, the results showed that the farm owners/ managers had always (65, 30.2%) moved those pigs dying abnormally or had any SIV outbreak events to other areas, followed by never moved (62, 28.8%), almost always moved (37, 17.2%), do not know/ did not answer (34, 15.8%), moved sometimes (9, 3.7%), rarely moved (8, 3.7%), respectively (Supplement Table5). When we compared this practice between the study locations, we found that the three provinces had statistically significant differences in this practice (P < 0.05). Chiang Mai province has a median = 1 (0,3), indicating that rarely moved those pigs died abnormally or when they encountered any SIV outbreak in other areas. Meanwhile, the Nakhon Pathom and Nakhon Ratchasima provinces had medians = 4 (1,5), indicating that they always moved those pigs dying abnormally or had any SIV outbreak events to other areas (Table6).

Heath status related to the KAP scores

This study used self-reported symptoms, including fever and other relevant symptoms, that might be useful to indicate or serve as proxy indicators of potential infections resulting from contact with pigs. The findings showed that the study participants in the three provinces who reported only having high fever without other symptoms had no statistically significant difference (Table7). However, those who reported having high fevers with a cough had low association levels of the knowledge and practice scores at statistically significant differences, with correlation coefficient (r) levels at 0.14 and 0.17, respectively (Table7).

The participants in Nakhon Ratchasima who reported having high fever with a cough and who had high fever with sore throat had low associations with attitude scores at statistically significant differences, with correlation coefficient (r) levels at 0.26 and 0.34, respectively (Table7). Meanwhile, the participants in Chiang Mai who reported having high fever with and without other symptoms had no association with the KAP scores (Table7). In addition, those who reported having high fever with or without other symptoms in Nakhon Prathum had associations with attitude and practice scores at statistically significant differences, with correlation coefficient (r) levels at 0.33 and 0.35, respectively (Table7).

This analytical cross-sectional study was implemented to determine factors associated with KAP toward SIV among pig farm owners, pig farm workers, and nearby villagers in three provinces across three regions of Thailand. The results of this study revealed that the overall knowledge level regarding influenza prevention was moderate among the rural population. While most participants were aware of standard preventive measures, such as hand hygiene and covering the mouth when coughing or sneezing, there were gaps in knowledge regarding using face masks and the importance of vaccination. In this study, the attitudes towards influenza prevention were generally appropriate, with a willingness to adopt preventive behaviors. In addition, our study also revealed that farm owners/ managers at all study locations regularly separated sick pigs from healthy pigs. Chiang Mai’s farm owners or managers rarely transferred those pigs when they died abnormally or when there was an SIV outbreak in other areas. However, the study revealed inconsistent practices, particularly regarding vaccination coverage in the study locations.

Similarly, a previous study [21] on the knowledge and practices related to pandemic influenza A (H1N1) among Myanmar migrant workers in Thailand aimed to assess the awareness and preventive measures revealed that most migrant workers had a limited understanding of the influenza virus and its transmission. Although a significant proportion of participants were aware of preventive measures such as hand hygiene and wearing masks, there was a lack of proper implementation [21]. The study emphasized the need for targeted health education interventions and improved access to healthcare services for migrant workers [21].

The current results of the top five knowledge questions related to SIV showed that participants had varying levels of understanding of different aspects of SIV. Overall, most participants had a relatively good understanding of some key aspects of SIVs. For instance, a significant number of participants recognized that frequent cleaning and hand washing with soap could help prevent SIV infection. Additionally, a substantial proportion of participants correctly identified that humans could become infected with SIVs through contact with the body or secretions of infected pigs. This study also highlighted areas where knowledge gaps existed. For example, fewer participants correctly answered questions related to the symptoms of SIV in infected humans and the potential transmission of SIVs from pigs to other animals. Our findings suggest a need for targeted educational initiatives to improve awareness and understanding in these specific areas, including those with no and low educational attainment levels.

This study also revealed several factors influencing SIV-related KAP. Our findings indicated that individuals with higher education levels and exposure to healthcare professionals and pig farms tended to possess more knowledge, have more appropriate attitudes, and engage in practices that mitigates the spread of SIV. These were expected because those with a high level of education, exposure to health personnel, and pig farms had greater access to health information, particularly about zoonotic and pig-borne diseases, than the general population living near the farms. This could imply that better knowledge could lead to more positive attitudes and appropriate practices. In contrast, individuals who were not exposed to health personnel or did not work in pig farms, such as villagers living nearby pig farms, might be at risk for contracting SIV and other zoonotic disease infections due to their limited KAP. These findings aligned with a previous study that showed that students had higher KAP scores after being educated on preventing influenza [22]. Likewise, a KAP study on SIV in Malaysia showed that most students had high KAP achievements regarding preventing SIV [23]. On the other hand, another KAP study in Pakistan showed that protective measures against influenza H1N1 virus among medical and dental students remained low [24]. Surprisingly, in this study, those with a higher income (≥ 15,000 THB per month) had less SIV-related knowledge than those with a lower income (< 15,000 THB per month). This could be because those with higher incomes had less contact with pigs, did not work in pig farms, or worked in other occupations, so they had less chance to be educated about SIV and zoonotic diseases.

In conclusion, individuals with higher education who were in contact with healthcare professionals and pig farms could be more likely to gain more knowledge, adopted more appropriate attitudes, and engaged in more suitable practices toward SIVs. The villagers living near pig farms should be educated on SIVs to improve their knowledge, attitudes, practices, and health literacy. This will help reduce the risk of contracting SIV and other zoonotic diseases. In this regard, a communication strategy and an intervention plan for villagers living close to pig farms should be developed in collaboration with the local health authorities.

Study limitations

This study encountered limitations, including the fact that we had to conduct the study for nearly a year due to the COVID-19 pandemic in study locations. Recall biases could be one of the limitations; however, the study team members were trained to interview and track information from the study participants, especially to gather information about vaccination information and experiences.

Recommendations

This study could provide valuable insights into the general understanding of influenza-related knowledge, including knowledge levels, behaviors, attitudes, and preventive practices, which can contribute and apply to a broader context of SIV-related KAP. Moreover, the findings highlighted the need for targeted health education programs to improve knowledge and promote consistent adherence to preventive practices, including increased vaccination rates, among the rural population in Thailand [25].

Authors and Affiliations

1. Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals, Chulalongkorn University, Bangkok, Thailand

   Kanokwan Suwannarong,Kannika Thammasutti&Alongkorn Amonsin

2. SUPA71 Co., Ltd, Bangkok, Thailand

   Thanomsin Ponlap

3. School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand

   Phitsanuruk Kanthawee

4. Nakhon Sawan Campus, Mahidol University, Nakhon Sawan, Thailand

   Chutarat Saengkul

5. Sirindhorn College of Public Health Trang, Trang, Thailand

   Paisit Boonyakawee

6. Doi Saket District Health Office, Chiang Mai Provincial Health Office, Chiang Mai Province, Thailand

   Rungsimun Pothita

7. Nakhon Pathom Provincial Health Office, Nakhon Pathom Province, Thailand

   Darunee Phosri,Supaporn Anuragudom&Suthutta Changtes

8. Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand

   Alongkorn Amonsin

Contributions

KS, KT, TP, PK, CS, PB, DP, SA, RP, and SC performed data collection in the field, questionnaire interviews, and data analysis. KS, KT, TP, and PK performed data analysis and drafted manuscript and data analysis. AA and KS designed the study, drafted, revised, and approved the manuscript. All authors reviewed the manuscript.

Corresponding author

Correspondence to Alongkorn Amonsin.

Ethics approval and consent to participate

The study was reviewed and approved by the Research Ethics Review Committee for Research Involving Human Research Participants, Group 1, Chulalongkorn University (Ref No. 197.2/2564; COA No. 190/2022). Local authorities and health offices collaborated and coordinated during the implementation of the study. Prior to the start of data collection, written informed consents were obtained. The participants were assured that their information would be kept confidential and that their identifications would be coded and not disclosed to individuals outside the study team. This study complied with the Declaration of Helsinki and was performed according to the ethics committee’s approval from the Chulalongkorn University.

Consent for publication

Not applicable.

Clinical trial number

Not applicable.

Competing interests

The authors declare no competing interests.

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