{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T20:48:04Z","timestamp":1766436484778,"version":"3.48.0"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Soulsby Foundation Fellowship"},{"name":"The University of Melbourne\u00e2\u20ac\u2122s Early Career Research","award":["ECR0662023"],"award-info":[{"award-number":["ECR0662023"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Bovine tuberculosis (bTB) is a chronic disease of cattle and the leading cause of zoonotic tuberculosis. In Bhutan, there is no dedicated program for bTB despite the country being situated in the bTB enzootic region, where a large section of population relies on cattle and raw milk and, dairy products are widely consumed.To contribute to the design of future education, surveillance, mitigation, and control programs, we investigated the knowledge, attitudes, and practices relevant to bTB among dairy farmers. We surveyed 264 farmers in Thimphu, Paro, and Haa Dzongkhags. These farmers contribute to supplying the eight milk outlets in the capital, Thimphu. We found that only 11 farmers (4.2%; confidence interval 95%: 2.1% - 7.3%) were aware that bTB existed, and only five of them (1.9%; CI 95%: 0.6% \u2013 4.3%) were aware that bTB is a zoonosis. Risk perception and practice followed a gradient of variation from Thimphu to Haa, but overall, we found a correlation between bTB risk perception for animals and humans. Farmers and traders, along with the consumption of meat and sick animals, were perceived as occupations and activities involving the highest risk of zoonotic infection. Contact with animals entering the herd and with neighbouring cattle were perceived as the highest risk for animal infection. Most farmers in Haa consume raw milk and dairy products they produced by themselves, whereas farmers in Paro and Thimphu prefer powdered milk. Using generalised low-rank models and k-means clustering, we found that dzongkhag of residence and attitudes toward zoonotic infection prevention explained most variability in the data. The severe knowledge deficits about bTB are particularly concerning given the zoonosis is present in Bhutan, is prevalent in neighbouring countries, and negatively affects cattle health and well-being, diminishing fertility, milk, and overall productivity, ultimately impacting farmers\u2019 livelihoods and undermining Bhutan\u2019s nutritional and economic reliance on this sector. Urgent short and mid-term activities should be prioritised to identify bTB high-risk areas, educate farmers, and mitigate bTB impacts.<\/jats:p>","DOI":"10.1371\/journal.pntd.0013817","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T18:29:03Z","timestamp":1766428143000},"page":"e0013817","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dairy farmers have minimal knowledge of bovine tuberculosis: A cross-sectional study in Bhutan"],"prefix":"10.1371","volume":"19","author":[{"given":"Juan-Pablo","family":"Villanueva-Cabezas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sithar","family":"Dorjee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"McKinley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rinzin","family":"Pem","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5510-2034","authenticated-orcid":true,"given":"Sangay","family":"Rinchen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"journal-title":"Guidelines for the control of Mycobacterium tuberculosis complex in livestock. WOAH","year":"2024","key":"pntd.0013817.ref001"},{"key":"pntd.0013817.ref002","unstructured":"Organisation WOAH. Bovine tuberculosis. https:\/\/www.woah.org\/en\/disease\/bovine-tuberculosis\/. Accessed 2022 July 18."},{"key":"pntd.0013817.ref003","unstructured":"World Health Organization, World Organization for Animal Health, Food and Agriculture Organization of the United Nations, International Union Against Tuberculosis and Lung Disease. Roadmap for Zoonotic Tuberculosis. 2017. www.who.int"},{"volume-title":"Yearbook of Bhutan","year":"2023","author":"Bhutan National Statistics Bureau","key":"pntd.0013817.ref004"},{"issue":"2","key":"pntd.0013817.ref005","doi-asserted-by":"crossref","first-page":"11","DOI":"10.17102\/cnr.2014.02","article-title":"Smallholder Dairy Farming as a Source of Livelihood: A Case Study from Three Agro-Ecological Zones of Bhutan","volume":"1","author":"A Bhujel","year":"2014","journal-title":"BJNRD"},{"key":"pntd.0013817.ref006","article-title":"Smallholder dairy farmers\u2019 group development in Bhutan: strengthening rural communities through group mobilization","volume":"413","author":"T Sonam","year":"2011","journal-title":"Khon Kaen Agr J"},{"issue":"1","key":"pntd.0013817.ref007","doi-asserted-by":"crossref","DOI":"10.1186\/s13570-017-0077-1","article-title":"Assessing livestock herding practices of agro-pastoralists in western Bhutan: Livestock vulnerability to predation and implications for livestock management policy","volume":"7","author":"K Tshering","year":"2017","journal-title":"Pastoralism"},{"issue":"2","key":"pntd.0013817.ref008","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1659\/MRD-JOURNAL-D-13-00021.1","article-title":"The Changing Face of Cattle Raising and Forest Grazing in the Bhutan Himalaya","volume":"34","author":"K Wangchuk","year":"2014","journal-title":"Mountain Research and Development"},{"key":"pntd.0013817.ref009","article-title":"Smallholder dairy farming in Bhutan: Characteristics, constraints, and development opportunities.","volume-title":"Smallholder Dairy in Mixed Farming Systems of the Hindu Kush-Himalayas","author":"Phanchung","year":"2002"},{"issue":"6","key":"pntd.0013817.ref010","doi-asserted-by":"crossref","first-page":"497","DOI":"10.4161\/chan.4.6.12871","article-title":"G protein modulation of CaV2 voltage-gated calcium channels","volume":"4","author":"KPM Currie","year":"2010","journal-title":"Channels (Austin)"},{"key":"pntd.0013817.ref011","first-page":"54","article-title":"Milking management practices by small-scale dairy farmers of Trashiyangtse district in Bhutan","volume":"4","author":"T Dendup","year":"2020","journal-title":"Bhutan Journal of Animal Science"},{"issue":"5","key":"pntd.0013817.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012223","article-title":"Seroprevalence and risk factors associated with bovine tuberculosis in cattle in Eastern Bhutan","volume":"18","author":"K Wangmo","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0013817.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0010428","article-title":"One Health and surveillance of zoonotic tuberculosis in selected low-income, middle-income and high-income countries: A systematic review","volume":"16","author":"R de Macedo Couto","year":"2022","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0013817.ref014","unstructured":"World Health Organization. Global Tuberculosis Report. 2024. https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2024"},{"issue":"6","key":"pntd.0013817.ref015","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1111\/tbed.12915","article-title":"Prevalence of Bovine Tuberculosis in India: A systematic review and meta-analysis","volume":"65","author":"S Srinivasan","year":"2018","journal-title":"Transbound Emerg Dis"},{"key":"pntd.0013817.ref016","doi-asserted-by":"crossref","first-page":"100169","DOI":"10.1016\/j.onehlt.2020.100169","article-title":"Estimates of the global and continental burden of animal tuberculosis in key livestock species worldwide: A meta-analysis study","volume":"10","author":"B Ramos","year":"2020","journal-title":"One Health"},{"key":"pntd.0013817.ref017","doi-asserted-by":"crossref","first-page":"106314","DOI":"10.1016\/j.prevetmed.2024.106314","article-title":"Systematic review of knowledge, attitudes, and practices of dairy farmers and consumers towards bovine tuberculosis in low- and middle-income countries","volume":"232","author":"A Van Der Zwan","year":"2024","journal-title":"Prev Vet Med"},{"key":"pntd.0013817.ref018","article-title":"Animal slaughter and religious nationalism in Bhutan","volume-title":"Asian Ethnology","author":"J Magnusson","year":"2019"},{"issue":"11","key":"pntd.0013817.ref019","article-title":"Bovine tuberculosis prevalence and risk factors in selected districts of Bangladesh","volume":"15","author":"SKS Islam","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pntd.0013817.ref020","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/2041-7136-3-13","article-title":"Transhumant agro-pastoralism in Bhutan: Exploring contemporary practices and socio-cultural traditions","volume":"3","author":"K Namgay","year":"2013","journal-title":"Pastor Res Policy Pract"},{"key":"pntd.0013817.ref021","first-page":"93","article-title":"Foot and Mouth Disease (FMD); Outbreak Containment At Cattle Herd Level In Samdrup Jongkhar District","volume":"2","author":"L Lungten","year":"2018","journal-title":"Bhutan Journal of Animal Science"},{"volume-title":"PVS Laboratory Mission Report Bhutan","year":"2016","author":"N Bloch","key":"pntd.0013817.ref022"},{"volume-title":"Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys","year":"2008","author":"World Health Organization","key":"pntd.0013817.ref023"},{"issue":"1","key":"pntd.0013817.ref024","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5588\/pha.12.0085","article-title":"The burden and treatment outcomes of extra-pulmonary tuberculosis in Bhutan","volume":"3","author":"T Jamtsho","year":"2013","journal-title":"Public Health Action"},{"volume-title":"Livestock Census 2021","year":"2021","author":"Bhutan National Statistics Bureau","key":"pntd.0013817.ref025"},{"key":"pntd.0013817.ref026","doi-asserted-by":"crossref","first-page":"539573","DOI":"10.3389\/fvets.2020.539573","article-title":"Sample Size Estimation in Veterinary Epidemiologic Research","volume":"7","author":"MA Stevenson","year":"2021","journal-title":"Frontiers in Veterinary Science"},{"key":"pntd.0013817.ref027","unstructured":"REDCap. https:\/\/clinicalresearch.mdhs.unimelb.edu.au\/about-us\/health-informatics\/redcap. Accessed 2024 November 26."},{"volume-title":"R: A Language and Environment for Statistical Computing","year":"2023","author":"R Core Team","key":"pntd.0013817.ref028"},{"issue":"1","key":"pntd.0013817.ref029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1561\/2200000055","article-title":"Generalized Low Rank Models","volume":"9","author":"M Udell","year":"2016","journal-title":"FNT in Machine Learning"},{"volume-title":"h2o: R interface for the \u201cH2O\u201d scalable machine learning platform","year":"2024","author":"T Fryda","key":"pntd.0013817.ref030"},{"issue":"6","key":"pntd.0013817.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1145\/3459665","article-title":"k-Nearest Neighbour Classifiers - A Tutorial","volume":"54","author":"P Cunningham","year":"2021","journal-title":"ACM Comput Surv"},{"volume-title":"Hands-On Machine Learning with R","year":"2020","author":"B Boehmke","key":"pntd.0013817.ref032"},{"key":"pntd.0013817.ref033","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.prevetmed.2016.09.005","article-title":"Methods and processes of developing the strengthening the reporting of observational studies in epidemiology - veterinary (STROBE-Vet) statement","volume":"134","author":"JM Sargeant","year":"2016","journal-title":"Prev Vet Med"},{"volume-title":"Bhutan Annual Health Bulletin","year":"2023","author":"Bhutan Ministry of Health","key":"pntd.0013817.ref034"},{"issue":"6","key":"pntd.0013817.ref035","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1136\/vr.j568","article-title":"Geography matters: farmer perceptions of a voluntary TB risk-based trading system","volume":"180","author":"D Maye","year":"2017","journal-title":"Vet Rec"},{"issue":"6","key":"pntd.0013817.ref036","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.1111\/tbed.13782","article-title":"One Health needs a vision beyond zoonoses","volume":"67","author":"JP Villanueva-Cabezas","year":"2020","journal-title":"Transbound Emerg Dis"},{"issue":"2","key":"pntd.0013817.ref037","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3329\/bjvm.v6i2.2332","article-title":"Prevalence of bovine tuberculosis and its effects on milk production in Red Chittagong cattle","volume":"6","author":"M Rahman","year":"1970","journal-title":"Bangl J Vet Med"},{"key":"pntd.0013817.ref038","doi-asserted-by":"crossref","first-page":"100156","DOI":"10.1016\/j.onehlt.2020.100156","article-title":"Risk factors of tuberculosis in human and its association with cattle TB in Nepal: A one health approach","volume":"10","author":"TR Gompo","year":"2020","journal-title":"One Health"},{"key":"pntd.0013817.ref039","doi-asserted-by":"crossref","unstructured":"Azami Y, Zinsstag J. Economics of Bovine Tuberculosis: A One Health Issue. https:\/\/cabidigitallibrary.org. 2018.","DOI":"10.1079\/9781786391520.0031"},{"key":"pntd.0013817.ref040","doi-asserted-by":"crossref","first-page":"1014666","DOI":"10.1155\/2023\/1014666","article-title":"Tuberculosis Knowledge, Attitudes, and Practice in Middle- and Low-Income Countries: A Systematic Review","volume":"2023","author":"OM Craciun","year":"2023","journal-title":"J Trop Med"},{"key":"pntd.0013817.ref041","unstructured":"Juffs H, Deeth H. Scientific Evaluation of Pasteurisation for Pathogen Reduction in Milk and Milk Products. 2007. http:\/\/www.foodstandards.gov.au"},{"issue":"3","key":"pntd.0013817.ref042","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/0950-3293(94)90034-5","article-title":"Public perceptions of food-related hazards: Individual and social dimensions","volume":"5","author":"P Sparks","year":"1994","journal-title":"Food Quality and Preference"},{"issue":"1","key":"pntd.0013817.ref043","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1186\/s12889-020-08877-1","article-title":"\u201cWe never boil our milk, it will cause sore udders and mastitis in our cows\u201d- consumption practices, knowledge and milk safety awareness in Senegal","volume":"20","author":"B Chengat Prakashbabu","year":"2020","journal-title":"BMC Public Health"},{"issue":"4","key":"pntd.0013817.ref044","doi-asserted-by":"crossref","DOI":"10.1093\/jambio\/lxad080","article-title":"A systematic literature review of milk consumption and associated bacterial zoonoses in East Africa","volume":"134","author":"JP Mpatswenumugabo","year":"2023","journal-title":"J Appl Microbiol"},{"issue":"1","key":"pntd.0013817.ref045","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/s12889-022-12665-4","article-title":"Milk and meat consumption patterns and the potential risk of zoonotic disease transmission among urban and peri-urban dairy farmers in Ethiopia","volume":"22","author":"TT Deneke","year":"2022","journal-title":"BMC Public Health"},{"key":"pntd.0013817.ref046","article-title":"Advances in dairy research caught in the middle: Reasons for hindered growth among dairy groups of Haa district in western Bhutan","author":"K Wangchuk","year":"2019","journal-title":"Adv Dairy Res"},{"issue":"1","key":"pntd.0013817.ref047","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1017\/S1930297500000346","article-title":"Gender Differences in Risk Assessment: Why do Women Take Fewer Risks than Men?","volume":"1","author":"CR Harris","year":"2006","journal-title":"Judgm decis mak"},{"issue":"2","key":"pntd.0013817.ref048","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/0272-4332.212113","article-title":"Socioeconomic determinants of health- and food safety-related risk perceptions","volume":"21","author":"DM Dosman","year":"2001","journal-title":"Risk Anal"},{"key":"pntd.0013817.ref049","article-title":"South Asian dairy smallholders: A scoping review of practices and zoonoses","author":"E Schembri","year":"2023","journal-title":"Asian Pacific Journal of Tropical Medicine"},{"key":"pntd.0013817.ref050","doi-asserted-by":"crossref","first-page":"106714","DOI":"10.1016\/j.prevetmed.2025.106714","article-title":"Dairy consumers\u2019 knowledge, attitudes, and practices towards zoonotic bovine tuberculosis in a country without veterinary and public health interventions: A cross-sectional study in Bhutan","volume":"246","author":"S Rinchen","year":"2026","journal-title":"Prev Vet Med"},{"key":"pntd.0013817.ref051","volume-title":"Veterinary Epidemiologic Research","author":"I Dohoo","year":"2010","edition":"2"},{"volume-title":"Expansion of milk value chain in Punakha District of Bhutan Expansion of milk value chain in Punakha District of Bhutan Partial Fulfilment of the Requirements for the Degree of Master Agricultural Production Chain Management, Specialisation in Livestock Chains","year":"2019","author":"P Ugyen","key":"pntd.0013817.ref052"},{"key":"pntd.0013817.ref053","article-title":"A case study of Pungdzong dairy farmer\u2019s group: Analysis of milk value chain","author":"P Ugyen","year":"2020","journal-title":"BJAS"},{"key":"pntd.0013817.ref054","article-title":"Analysis of diary value chain: The case study of Guma Gewog","author":"S Uroan","year":"2021","journal-title":"Int J Innov Sci Res Technol"},{"volume-title":"Standard Treatment Guidelines","year":"2017","key":"pntd.0013817.ref055"},{"volume-title":"National Strategic Plan to End TB","year":"2017","author":"National Tuberculosis Control Programme","key":"pntd.0013817.ref056"}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013817","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T18:29:32Z","timestamp":1766428172000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0013817"}},"subtitle":[],"editor":[{"given":"Sitara Swarna Rao","family":"Ajjampur","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,22]]},"references-count":56,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0013817","relation":{},"ISSN":["1935-2735"],"issn-type":[{"type":"electronic","value":"1935-2735"}],"subject":[],"published":{"date-parts":[[2025,12,22]]}}}