Academic Journal of Animal Diseases 11(3): 80-89, 2022

ISSN 2079-200X
© IDOSI Publications, 2022
DOI: 10.5829/idosi.ajad.2022.80.89

Review on Occurrence and Economic Importance of Bovine Tuberculosis in Ethiopia

Yared Tesfay Kahsay

Silte Zone Agriculture Department, SNNPR State, Worabe, Ethiopia

Abstract: Ethiopia is one of the nations that possess the largest livestock population in the African continent
with an estimated 56.7 million cattle, 29.3 million sheep, 29.1 million goats and 9.86million equines, 1.2 million
camels and 56.7 million chickens. The vast majority of the national herd is of indigenous zebu cattle maintained
in rural areas under extensive husbandry systems. In contrast to the huge livestock resource, the livestock
productivity is, however, found to be very low. The major biological and socio-economic factors attributing to
low productivity include low genetic potential and performance, poor nutrition (in quality and quantity terms),
the prevailing of different diseases, traditional way of husbandry systems and inadequate skilled manpower,
among others. Ethiopia is one of the African countries where tuberculosis is wide spread in both humans and
cattle and the endemic nature of tuberculosis in humans and cattle has long been documented. Mycobacterium
bovis is an intracellular, non-motile, facultative, weakly Grampositive acid-fast bacillus that belongs to the
Mycobacterium tuberculosis complex. The pathogen affects all age groups of susceptible hosts of domestic,
wild animals and human. In cattle, Bovine tuberculosis is one of the endemic chronic diseases of cattle that
have long been recorded in Ethiopia. Bovine tuberculosis is widely distributed around the world with significant
economic impact on the livestock production sector. In Ethiopia, cattle breeds, age, sex, body condition score
and herd size, management condition, geographical origin, consumption of raw milk and close contact to
livestock are most commonly identified risk factors for the spread of Mycobaterium bovis. The actual
prevalence rate of bovine tuberculosis (BTB) at a national level is yet unknown. Detection of BTB in Ethiopia
is carried out most commonly on the basis of tuberculin skin testing, abattoir meat inspection and very rarely
on bacteriological techniques. Recently undertaken studies indicated the prevalence rate of BTB with a range
of 3.4% (in smallholder production system) to 50% (in intensive dairy productions) and a range of 3.5% to 5.2%
in slaughter houses in various places of the country. BTB in cattle remains to be a great concern due to the
susceptibility of humans to the disease. Although, the disease represents a potential health hazard to all
susceptible hosts, the economic effects of the disease are not well studied. With the exception of a few attempts
like the condemnation of carcass and organs during meat inspection, culling of infected animals in some
government owned farms and pasteurization of milk, effective disease control strategies do not yet established
in our country.

Key words: Bovine Ethiopia Mycobacterium Occurrence Tuberculosis Risk Factors

INTRODUCTION tuberculosis is widely distributed around the world with

a significant economic impact on the livestock production
A close interaction between animals and humans sector [4-6].
primarily contributes to the transmission of infectious BTB is an infectious disease caused principally by
zoonotic diseases between them [1]. Bovine tuberculosis Mycobacterium (M.) bovis, which is a member of the
is a common zoonotic disease caused by Mycobacterium Mycobacterium tuberculosis complex (MTC). Although
bovis which affects a wide range of animals and humans cattle are susceptible to M. bouis infection and are the
[2, 3]. Cattle-based tuberculosis has become a significant preferred host for M. bouis, the disease has been reported
infectious disease that spread between species. Bovine in many other domesticated animals, wildlife and humans

Corresponding Author: Yared Tesfay Kahsay, Silte Zone Agriculture Department, SNNPR State, Worabe, Ethiopia.

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[7- 9] . Aerosol exposure to M. bouis is believed to be the country to be 54 million, 25.5 million and 24 million,
most frequent mode of transmission in cattle, but infection respectively. And Amhara Regional State owns 13.8
by ingestion has also been reported previously [10]. million cattle, 8.8 million sheep and 5.1 million goats [18].
Human beings can also acquire the infection either by About 98.9% of the total cattle populations in the country
inhalation or ingestion [11, 12]. Thus, BTB is a disease of were local breeds and the remaining were hybrid (0.94%)
major socio-economic importance, with an impact of loss and exotic (0.11 %) breeds. Among a total of 3.4 million
in animal productivity and international trade of animals cattle population aged _'.S.3-10 years, 12.5% were used
and animal products [12]. for milk production [18]. Even though the livelihood of the
Mycobaterium bovis (M. bovis) is an intracellular, people in Ethiopia is extremely dependent on livestock,
non-motile, facultative, weakly Gram-positive acid-fast several constraints including feed shortage, poor genetic
bacillus. The MTBC sub-group also comprises performance and diseases prevalence are limiting the
M. tuberculosis, M. africanum, M. canettii, M. pinnipedii, livestock production and productivity. Prevalence data on
M. microti and M. caprae that are generally regarded BTB infection in Africa is scarce. There is, however,
as host adapted but with the ability to spill over into sufficient evidence to indicate that disease is widely
other species. Mycobaterium bovis is the primary distributed in almost all African countries and even is
cause of bovine tuberculosis (BTB). M. tuberculosis, found at high prevalence in some animal populations [19].
M. africanum, M. caprae and M. canettii are human However, in the tropical countries including Ethiopia, BTB
pathogens. M. caprae which causes infection in goats has been found to affect a higher proportion of exotic
has been initially classified as subspecies of M. bovis breeds than local zebus [20-22]. Thus BTB is still a great
but was recently recognized as a species on its own. concern in many developing countries and Ethiopia is one
M. microti affects rodents and M. pinnipedii have been of those where BTB is considered as prevalent disease in
isolated from seals [13]. Mycobaterium bovis has an cattle populations. Its zoonotic implication has also
exceptionally wide range of mammalian hosts and affects significantly indicated an increasing trend to be of public
all age groups of susceptible hosts of domestic, wild health hazards [21, 23]. So, the objectives of this seminar
animals and humans [13]. Cattle are the most common paper are to review available literatures on the status of
maintenance host for M. bovis infection from which bovine tuberculosis in Ethiopia. Therefore, the objective
transmission can occur to wildlife, or people animals [14]. of this paper was to highlight the occurrence of bovine
The BTB is a chronic contagious debilitating disease tuberculosis in Ethiopia.
of animals associated with progressive
weakness/emaciation and tubercle (granuloma) formation, Etiology: Bovine tuberculosis is a chronic bacterial
mainly confined to respiratory system (primarily in the disease in animals and humans and is a major infectious
lungs) and occasionally in other organs [15]. The disease among cattle, other domesticated animals and
infection to bovine can occur through the colostrum/milk certain wildlife populations in a medium number of
to calves, ingestion of feed contaminated with feces of countries [11, 24]. Although cattle are considered to be
infected animals, aerosol, contact with each other and the main hosts of Mycobacterium bovis (M. bovis),
other wildlife [15]. The causative agent of tuberculosis isolations have been made from many other livestock and
(Mycobacterium) can remain viable in the wildlife species and transmission to humans constitutes
environment/soil for about two years [16]. Various risk a public health problem [19, 25]. Aerosol exposure to M.
factors responsible for the occurrence of disease include bovis is considered to be the most frequent route of
calving site, herd size, the length of time calves kept in infection of cattle, but infection by ingestion of a
groups, the breed, the source of replacement, presence of contaminated material also occurs [26].
wild animals and the region in which they are kept, In addition, a new species, M. bovis sub-species
presence of mixed (dairy and beef) production, age, caprae, previously classified as M. tuberculosis sub-
housing systems [17]. species caprae has been identified as a cause of infection
Ethiopia is ranked top in the list of African countries in humans, goats, cattle, deer and swine [27].
with large livestock populations and it has been Bovine tuberculosis is mainly caused by M. bovis of
contributing considerable portion to the economy of the which cattle are the maintenance hosts. The organism is
country. The 2012/13 livestock survey estimated the total a Gram positive, acid-fast bacterium in the M. tuberculosis
number of cattle, sheep and goat population in the complex of the family Mycobacteriaceae [28].

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Taxonomically, Mycobacteria are classified under the for other cattle. Cattle in the early stages of the disease,
order Actinomycetales, which includes among others the before any lesions are visible, may also excrete viable
genera Mycobacterium, Rhodocccus and Nocardia. mycobacteria in nasal and tracheal mucus [31]. Inhalation
Mycobacteria are aerobic, non-motile, non-spore forming, is the almost invariable portal of entry in housed cattle
straight or slightly curved roads 1.5 to 4 micro meter long and even in those at pasture it is considered to be the
and 0.3 to 0.5 micro meter wide [29]. Their cell wall principal mode of transmission [36-54].
contains a high content of lipids which once stained with
carbol fuchsin, cannot be decolorized by acid alcohol: Diagnosis, Clinical Symptoms and Treatment: Bovine
thus the name ‘acid fast bacteria’ [29]. Therefore, the tuberculosis cannot be diagnosed simply because of its
criterion of inclusion in to this genus is: acid fastness, clinical symptoms and the symptoms of the disease are
presence of mycolic acids containing between 60 and 90 similar with some other livestock diseases. Treatment of
carbon atoms and a G+C mole between 61% - 71% [30]. BTB is not effective and the drug used is furthermore
excreted with the milk and after termination of the
Occurrence: All species, including humans and age treatment the disease may recur.
groups are susceptible to M. bovis, with cattle, goats and
pigs most susceptible and sheep and horses showing a Diagnosis: The diagnosis of bovine tuberculosis is not
high natural resistance [31]. In developed countries that that easy and simple because of its clinical findings.
have had rigorous tuberculosis (TB) control programs in For eradication of BTB on a herd bay her basis, the
place for many years, tuberculosis in animals is now a tuberculin test is applied [31]. The inspection of the
rarity, with occasional severe outbreaks occurring in a carcass of slaughtered animal as an identification
small group of herds. The presence of the disease is technique will give enough indications to ensure the
usually signaled by detection in carcasses at abattoirs diagnosis. Besides, it is easy to demonstrate the
[32]. characteristic acid-fast, slender rods in their typical
position microscopically with Ziehl-Neelson staining in
Risk Factors: The major risk factors affecting the impression smears from caseous tubercles of affected
occurrence of BTB are environmental, host and pathogen organs or lymph nodes [27]. The fastidious cultural
risk factors. Housing predisposes to the disease, as does isolation and identification of the pathogen or the
high stocking intensity and a medium number of animals transmission of tissue from affected organs to guinea-pigs
on a farm so the disease is more common and serious will only be required in exceptional case [27].
where these forms of husbandry are practiced [33]. The
closer the animals are in contact, the greater is the chance Clinical Symptoms: Although signs referable to
that the disease will be transmitted [29]. In spite of the low localization in a particular organ usually attract attention
overall incidence in countries where cattle are at pasture to the possible occurrence of tuberculosis, some general
all the year round, individual herds with 60-70% morbidity signs are also evident [31]. Some cows with extensive
may be encountered [34]. miliary tubercular lesions are clinically normal but in most
Zebu (Bos indicus) type of cattle is thought to be cases progressive emaciation associated with other signs
much more resistant to tuberculosis than European cattle occur and should arouse suspicion of tuberculosis [31].
[35]. The effect of the disease on these cattle are much A capricious appetite and fluctuating temperature are also
less severe but under intensive feedlot conditions, a commonly associated with the disease [37]. The hair coat
morbidity rate of 60% and a depression of weight gain can may be rough or sleek. Affected animals tend to become
be experienced in tuberculous Zebu cattle [32]. The more docile and sluggish but the eyes remain bright and
causative organism is moderately resistant to heat, alert. These general signs often become more pronounced
desiccation and many disinfectants. It is readily destroyed after calving [32].
by direct sunlight unless it is in a moist environment. In
warm, moist, protected positions, it may remain viable for Treatment: The risk of shedding organisms, hazards to
weeks [36]. humans and potential for drug resistance make treatment
controversial [31] and, in some countries, it may be illegal.
Source of Infection and Transmission: As to source of Antimicrobial treatment has been attempted in some
infection, infected cattle are the main source of infection species of animals, but the treatment must be long term

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and clinical improvement can occur without the livestock productivity is, however, found to be
bacteriological cure. In many cases, the pathogens will very low. The major biological and socio-economical
not be eliminated from the organisms [31]. factors attributing to the low productivity includes the
The tuberculous process will only be encapsulated low genetic potential and performance, poor nutrition
and the chronic stage of the disease stabilized. Thus, (in quality and quantity terms), the prevailing of different
treated animals will remain carriers and excrete the diseases, traditional way of husbandry systems and
pathogen. Furthermore, the drug is excreted with the milk inadequate skilled manpower among others [18].
and after termination of treatment the disease may recur Ethiopia is one of the African countries where BTB
[31]. Because of the progress being made in the treatment is considered as protruding disease in animals [49].
of human tuberculosis with some drugs, the treatment of Bovine tuberculosis is considered as one of the major
animals with tuberculosis has undergone some livestock diseases that results in high morbidity and
examination and claims have been made for the efficiency mortality [49]. However, still there is lack of knowledge
of long-term oral medication with both as treatment and as about the actual prevalence and distribution of the
prophylaxis [31]. disease at a national level. Despite this, the economic
impacts and zoonotic importance of the BTB infection are
Public Health Significance: Bovine tuberculosis is a either notwell studied or documented[49].
chronic bacterial disease of cattle that occasionally affects Among the recently undertaken studies, the
other species of mammals []. This disease is a significant prevalence rate of BTB ranges from 3.4% in a small holder
public health hazard that can spread to humans, typically production system to 50% in intensive dairy productions
by the inhalation of aerosols or the ingestion of has been reported in various places of the country [21, 33,
unpasteurized milk. In developed countries, eradication 50, 51]. Exotic breeds were found to be more susceptible
programs have reduced or eliminated tuberculosis in cattle than cross and local breeds to M. bovis with manifestation
and human disease is now rare; however, reservoirs in of high incidence and prevalence rates in Ethiopia [21-23].
wildlife can make complete eradication difficult [26]. A herd prevalence rate of 42.6% to 48.6% was found to be
The current increasing incidence of tuberculosis in higher than the prevalence rate of individual animals
humans, particularly in immune-compromised humans, has (7.9% to 18.7%), that may indicate that the herd size can
given a renewed interest in the zoonotic importance of favour the transmission of BTB in intensive dairy farms in
M. bovis, especially in developing countries [43] and the particular [52].
ease and frequency of the spread of tuberculosis from
animals to humans in an uncontrolled environment makes Animal Production Systems and Bovine Tuberculosis:
this an important zoonosis. M. bovis can be responsible The livestock production systems in the country basically
for 5 to 10% of human tuberculosis with higher rates in falls into three categories according to the mode of animal
children in some areas [43]. husbandry and/or the production system, as well as the
use of livestock products. These production systems
Control and Eradication: Control in a herd rests on the include [53, 54].
removal of the infected animals, preventing the spread of
infection and avoidance of further introduction of the Integrated Extensive And/or Pastoral Production System:
disease [31]. Eradication of bovine tuberculosis has From the very few undertaken studies, in an integrated
been virtually achieved in many developed countries. extensive production system in the highlands, the
The methods used have depended on a number of factors prevalence rates of BTB ranging from 3.4% Regassa [23]
but ultimately the test and slaughter policy has been the to 22.6% Tadele [55] have been reported.
only one by which effective eradication had been Among these few conducted studies the prevalence
achieved [43-49]. rates of BTB of 5.1% Teshome [56], 4.2% Gemta [57] and
16.2% Regassa [23], have been reported.
Bovine Tuberculosis in Ethiopia: Ethiopia is one among Unlike other production systems, better prevalence
the nations that possesses the largest livestock studies have been undertaken and frequently incidences
population in the African continent with an estimated and higher prevalence rates of BTB have been observed.
56.7 million cattle, 29.3 million sheep, 29.1 million goats Based on the undertaken tuberculin skin tests, in
and 9.86million equines, 1.2 million camels and 56.7 million different intensive dairy farms, a prevalence rate of 24.3%
chicken [18]. In contrast to the huge livestock resource, to 65.8% [22] and 18.7% [52] have been reported.

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Table 1: Prevalence of bovine tuberculosis detected by tuberculin skin taste whole carcass is condemned, while condemnation of
by traditionally managed extensive production system
organs is undertaken if localised tuberculous lesions are
No of cattle
observed in parenchymatous organs and their associated
------------------------------------------
Area of study Tested Positive % Reference
lymph nodes [60].
Assella 281 25 8.9 [56]
Debre-birhan 76 11 14.5 [55] Detectionof Tuberculous Lesions at Slaughter Houses:
Kombolcha 53 12 22.6 [55] Detection of tuberculous lesions in slaughterhouses takes
Dessie 34 4 11.8 [55] place by observation of the visible tuberculous lesions in
West-wellega 353 12 3.4 [23]
infected cattle; however, the level of the quality of such
North shewa 1041 169 16.2 [23]
practices mayvary from place to place and/or abattoir to
Total 1838 233 12.9
abattoir in the country. The very few studies in Ethiopia
Small holder production system
have indicated that not all cattle infected with M. bovis
Table 2: Prevalence of bovine tuberculosis in small holder dairy farms based have visible tuberculous lesions at slaughter [39, 51].
on tuberculin test. This may limit the sensitivity of this detection technique
No of cattle at abattoirs, although detection of tuberculous lesions
--------------------------------------------- through abattoir inspection is so far the common
Area Tested Positive % Reference
procedure in Ethiopia. Among the undertaken abattoir
Holleta 381 25 6.4 [56]
studies, prevalence rates of7.96% Regassa [23], 5.2%
Selale 1528 18 5.1 [56]
Wolayta-sodo 416 59 14.2 [23]
Ameni et al. [47], 4.5% Teklu et al. [39] and 3.5%
Fiche 235 31 4.2 [57] Shitaye et al. [52], have been reported in different
Wuchale-jida 263 60 7.9 [47] abattoirs in the country (Table 4). The infection rate in
Assella 514 18 3.5 [58] cattle has been found to differ greatly from place to place,
Addis Ababa 473 61 12.9 [49] especially in slaughterhouses recorded as having a low
Total 4818 332 6.9
prevalence of the infection. This difference is most
Intensive Production System
probably linked to the type of the production system [52].
Table 3: Prevalence of bovine tuberculosis detected by tuberculin skin test
in intensive dairy farms Economic Importance of Bovine Tuberculosis: Animal
No of cattle tuberculosis is a disease of high economic relevance
------------------------------------------ within the context of livestock farming as it directly affects
Area of study Tested Positive % Reference animal productivity. The disease considerably reduces
Addis Ababa 2098 392 18.7 [52] milk and meat production of infected animal and affect
Ambo 133 37 27.8 [22]
animal reproduction as well as it reduce pulling power in
Asella 281 23 8.2 [49]
Debre-Birhan 51 3 5.9 [55]
traditional farming system [15]. Tuberculosis has also an
Debre-Zeit 788 234 29.7 [21] economical and financial burden to society human health
Debre-Zeit 281 185 65.8 [22] costs. The disease become is an obstacle to socio-
Dessie 121 89 73.6 [47] economic development; 75% of people affected by TB are
Holleta 70 17 24.3 [47] within the economically productive age group of 15-54
Kombolcha 197 96 48.7 [55]
years. This may have a negative influence on the national
Mojo 493 338 68.6 [56]
Repi 481 310 64.4 [59]
economy [62].
Sebeta 37 4 10.8 [22] Recently, Zinsstag et al. [63], reviewed the economic
Sellale 44 3 6.8 [22] effects of BTB on cattle productivity, the burden of
Ziway 205 56 27.3 [47] disease in different settings and at different stages of
public health development and the trans-sectoral (Public
Meat Inspection at Slaughterhouses: In Ethiopia the health, Agricultural, Environment) economic analysis of
routine abattoir inspection involves visual examination BTB control. However, in Ethiopia, the economic impact
and palpation of intact organs like the liver and kidney as of BTB on cattle productivity, BTB control programmes
well as palpation and incision of the head, lung and other and other related economic effects of the disease are not
lymph nodes [60]. During observation of the miliary yet well documented or studied. Few abattoir meat
tuberculous lesions in various parts of the carcass inspection surveillances have shown the condemnation
(lung, intestine, liver and multiple lymph nodes), the rate of the total or partial carcass and organs.

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Tables 4: Prevalence of bovine tuberculosis detected by abattoir meat (such as sharing shelter) which intensifies the
inspection in cattle. transmission and spread of BTB. Kiros [21], demonstrated
City abattoirs Examined Positive % Reference that out of 7, 138 human patients with tuberculosis, 38.4%
Addis Ababa 984 34 3.46 [52]
were found with extra-pulmonary tuberculosis and the
Debre-Zeit 3934 7 0.18 [60]
proportion of patients with extra-pulmonary tuberculosis
Dire-Dawa 7453 4 0.05 [60]
was significant in patients who have close contact with
Gonder 12525 3 0.02 [60]
Hossana 751 34 4.53 [39] cattle and in those who frequently used to drink raw milk
Kombolcha 57965 265 0.46 [50] in particular.
Makele 39875 730 1.83 [60] Regassa [23], demonstrated the association of
Nazareth 1125 58 5.16 [61] M. tuberculosis and M. bovis in causing tuberculosis
Wolaita-Sodo 402 32 7.96 [23] between humans and cattle. The cattle owned by
Wondo-Genet 38303 207 0.54 [60] tuberculous patients had a higher prevalence (24.3%)
Total 246611 1517 0.62 than cattle owned by non-tuberculous owners with 8.6%.
The author also noted that 73.8% and 16.7% of 42 human
Lately Gezahegne [64], demonstrated that from isolates were identified as M. tuberculosis and M. bovis
1.2 million slaughtered cattle in eight export abattoirs had and from cattle isolates 18.1% and 45.5% of 11 were found
an estimated cost of more than 600, 000 ETB during a to be M. tuberculosis and M. bovis species, respectively.
respective time, resulted due to condemned carcasses and This showed that the role of M. bovis in causing human
organs. Asseged et al. [51], demonstrated that, based on tuberculosis seemed to be significantly important. On the
the ten years retrospective analysis of the detection of other hand, in Ethiopia, consuming raw meat is a welcome
BTB lesions in the Addis Ababa abattoir, there was a tradition, thus meat may also remain to be another area of
cause of 0.024% for whole carcass condemnation. concern or threat to be a source of BTB infection [23].
Recently, Shitaye et al. [52], indicated that, in both Addis
Ababa and Debre-Zeit abattoirs tuberculous lesions that, CONCLUSION AND RECOMMENDATIONS
causes condemnation of carcasses and/or organs have
also been found to be highly significant economically. Bovine tuberculosis is a chronic bacterial disease of
animals and humans characterized by the formation of
Zoonotic Importance of Bovine Tuberculosis in Ethiopia: granulomatous lesion in different organs. The causative
In Sub- Saharan Africa, nearly 2 million tuberculosis cases agent of this disease is M.bovis and is a significant
in humans occur each year; yet it is unknown what role zoonotic disease. Wherever milk and dairy products are
BTB plays in the rising epidemic of tuberculosis fostered consumed without heat treatment, the disease is an
by HIV/AIDS [43]. A varying portion of pulmonary important zoonosis. In Ethiopia, the endemic nature of
tuberculosis cases are considered to occur, however, infection due to M. bovis has long been confirmed. Even
almost all cases of the non-pulmonary type of though the disease is endemic in Ethiopia, there is great
tuberculosis in humans has been caused due to BTB [65]. gap in information on the prevalence of the disease at the
BTB in the human population mainly takes place through national level. The prevalence rate of tuberculosis in
drinking raw milk and occur in the extra-pulmonary form in livestock varies among different production system and
the cervical lymphadenitis form in particular [65]. is much higher on intensive dairy farms.
The proportion of which BTB contributes to the total Based on these conclusions, the following
of tuberculosis cases in humans depends on the recommendations are forwarded:
prevalence of the disease in cattle, socioeconomic
conditions, consumer habits, practiced food hygiene and Identification of animals: Before embarking on any
medical prophylaxis measures. In countries where BTB in control program it is essential that all dairy farms
cattle is still highly prevalent, pasteurization is not widely (because of high prevalence) should be registered
practiced and/or milk hygiene is insufficient, usually and that all dairy cattle older than six months of age
estimated to be about 10% to 15% of human tuberculosis are identified with permanent marks, at least tagged
is considered to be caused by BTB [66]. with ear tags. At present, tagging is practiced in
In rural areas of Ethiopia, most people drink raw milk intensive dairy farms, but it does not yet cover all
and do have extremely close attachment with cattle dairy farms, smallholders in particular.

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Improvement of management and hygienic practices: a negative result in two successive tests could be
In most parts of Ethiopia, animals are kept near declared provisionally free from BTB. If this strategy
dwellings and maintained under very poor is started, it should then be strengthened with a
management and hygienic status, thus increasing the frequent follow up to make sure that these farms are
risk of acquiring infection for animals and humans as not re-infected.
well. Therefore, creating awareness among the
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