Cystic Echinococcosis at the Human–Animal Interface: Knowledge, Slaughter Practices and Environmental Risk Pathways among Butchers in Eastern Libya

Abstract

Background: Cystic echinococcosis (CE), caused by Echinococcus granulosus sensu lato, persists where dogs, livestock, slaughter practices and contaminated environments remain epidemiologically connected. Butchers occupy a critical interface because the handling and disposal of infected viscera can either interrupt or reinforce the dog–livestock transmission cycle. Evidence on butcher knowledge and routine practices in Libya remains limited. Objectives: To characterise CE awareness, occupational practices and environmental transmission opportunities among butchers in eastern Libya, and to examine whether recognition of zoonotic transmission was associated with safer disposal of abnormal organs. Methods: An anonymous web-based cross-sectional survey was conducted from March to August. The questionnaire link was distributed through an established online page used by a large proportion of butchers in the study area, and participation was based on voluntary completion of the electronic questionnaire. The analytic dataset comprised 320 butchers from Benghazi, Al-Bayda, Al-Abraq, Al-Marj and Tokra. Descriptive proportions were calculated with 95% Wilson confidence intervals for key indicators. For analysis, disposal of abnormal organs with general refuse or by feeding them to animals was classified as high-risk, whereas burial or burning was classified as lower-risk. Associations were assessed using Pearson’s chi-square test and odds ratios where appropriate. Results: Overall, 85.3% (95% CI 81.0–88.8) had heard of CE and 74.7% (69.6–79.1) recognised animal-to-human transmission. Nevertheless, only 14.7% selected the combined dog–sheep option when asked which animals were associated with the disease, indicating incomplete understanding of the canonical transmission cycle. Three-quarters (75.0%) reported having seen hydatid-like cysts in slaughtered animals. High-risk disposal of abnormal organs was reported by 61.6% (56.1–66.7), including disposal with general waste (45.6%) and feeding to animals (15.9%). Stray animals were reported near slaughter sites by 80.6% (75.9–84.6), and 86.6% (82.4–89.9) stated that stray animals fed on slaughter waste at least sometimes. Veterinary supervision was absent or rare for 61.3% of respondents, while only 31.9% (27.0–37.2) had received health education on zoonotic diseases. Correct recognition of zoonotic transmission was not associated with lower-risk offal disposal (61.5% high-risk disposal among those with correct knowledge versus 61.7% among others; OR 0.99, 95% CI 0.59–1.66; p = 0.972). Conclusions: The dominant signal was not simple lack of awareness, but a marked knowledge–practice disconnect embedded within weak waste management, inconsistent veterinary oversight and frequent access of stray animals to slaughter waste. Control in eastern Libya therefore requires a One Health response that combines targeted education with enforceable offal-management procedures, reliable veterinary meat inspection and measures preventing dogs from accessing slaughter waste.