



































Concurrent Brucellosis and Q fever infection: a case control study in Bamyan Province, Afghanistan


 

 

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Concurrent Brucellosis and Q 

Fever Infection: a Case Control 

Study in Bamyan Province, 

Afghanistan 

 

Khwaja Mir Islam Saeed1, 

Jamalludin Ahadi1, Mohammad 

Nadir Sahak2, Ahmad Farid 

Ghiasi2, Rana Jawad Ashgar3 

 
1Afghanistan National Public Health 

Institute, Ministry of Public Health, 
Kabul, Afghanistan; 2World Health 
Organization, Kabul, Afghanistan; 
3National Institute of Health, Islamabad, 
Pakistan 

  

Vol. 2, No. 2 (2013)   |   ISSN 2166-7403 (online)  

DOI 10.5195/cajgh.2013.58 |   http://cajgh.pitt.edu 



 

 

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Abstract 

Background: More than 500,000 people are affected by brucellosis each year while the incidence of Q fever is 

poorly recorded. Consistent outbreaks of brucellosis have been reported in Afghanistan, affecting social and 

economic life. This study aimed to determine the means of propagation of brucellosis and Q-fever and establish 

appropriate control measures for both. 

Methods and Materials: An outbreak of 1,317 cases of brucellosis and Q fever was investigated from May 2011 to 

the end of 2012 in Bamyan province of Afghanistan.  A total of 100 cases were selected by random sampling with 

equal number of neighbor controls. Data were collected through structured questionnaire. 

Results: The average age was 30 years ±14 years. Of those sampled, 62% were female, 38% were male, and resided 

in three districts: Punjab, Yakawlang and Waras. Using multivariate analysis, being a housewife (OR=7.36), being 

within proximity of kitchens to barns (OR= 2.98), drinking un-boiled milk (OR= 5.26), butchering (OR= 3.53) and 

purchasing new animals in the last six months (OR= 3.53) were significantly associated with contraction of 

brucellosis and Q fever. 

Conclusion: Health educators should focus on families dealing with animals, especially on females. Pasturing, 

healthy milking, dunging, and slaughtering practices, along with use of safe dairy products should be the focus of 

preventive measures. 

Keywords:Brucellosis, Q Fever, Afghanistan, Zoonoses 

Concurrent Brucellosis and Q fever 

infection: a case control study in 

Bamyan Province, Afghanistan 

Khwaja Mir Islam Saeed1, Jamalludin 

Ahadi1, Mohammad Nadir Sahak2, 

Ahmad Farid Ghiasi2, Rana Jawad 

Ashgar3 

 
1Ministry of Public Health, Kabul, 
Afghanistan; 2World Health Organization, 
Kabul, Afghanistan; 3National Institute of 
Health, Islamabad, Pakistan 

Research 

Introduction 

Brucellosis is caused by bacteria of the genus 

Brucella; species considered important agents for 

human disease are B. Melitensis, B. Abortus and B.Suis.
1 

It is an old disease with minimal mortality and remains 

the most common zoonotic disease worldwide.
2 

The 

incubation period for brucellosis is variable and difficult 

to ascertain; however, it is usually 5-60 days and 

occasionally several months after exposure.
3
 

The World Health Organization (WHO) 

estimates that 500,000 brucellosis cases occur each year 

worldwide, 45,000 of which occur in the Eastern 

Mediterranean Region. For every case diagnosed, there 

are four cases that go undetected.
4 

Brucellosis is a major 

public and animal health problem in many regions of 

the world, particularly where livestock are a major 

source of food and income. Despite control programs, it 

remains endemic in most developing countries.
5
 The 

WHO considers brucellosis to be a neglected zoonosis 

because, despite its widespread distribution and effects 

on multiple species, it is not prioritized by national and 

international health systems.
6 

Human cases continue to 

occur following traditional use of raw milk products and 

close contact with infected animals.  



 

 

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According to a case-control study in Saudi 

Arabia, the consumption of unpasteurized dairy 

products derived from sheep and goats as well as 

assistance in animal parturition were greatly associated 

with brucellosis.
8
 In a similar study in Yemen, being a 

farmer, shepherd, or microbiologist, and drinking fresh 

milk and buttermilk were significantly associated with 

brucellosis. Socio-economic and educational factors 

were also independent risk factors.
9 

In Iran, the same 

type of study revealed that significant risk factors for 

infection were related to the existence of another case of 

brucellosis in the home and consumption of 

unpasteurized dairy products.
10

 

Investigations carried out in Africa support 

these findings. Risk factors, such as assisting parturition 

during abortion and living in close proximity to other 

households affected with brucellosis, were identified.
11

 

Another study, which was conducted to identify the 

potential risk factors for human brucellosis infection in 

Samarqand, Uzbekistan showed that brucellosis was 

highly associated with contact with aborted animals, 

slaughtering/butchering animals in the household, 

consumption of raw milk, and being in a family that had 

brucellosis sharing the same exposure.
13

 In a study from 

Kyrgyzstan, results of multivariate analysis indicated 

that brucellosis was associated with exposure to aborted 

farm animals in the household and consumption of 

home-made milk products obtained from bazaars or 

neighbors. Knowledge of the mode of brucellosis 

transmission appeared to be protective against disease 

transmission.
14

 

Alongside other endemic communicable 

diseases, Query Fever (Q-Fever) is also common in 

developing countries. Q fever is caused by the bacteria 

Coxiellaburnetii and can affect the lungs, liver, heart, 

and other parts of the body. It is found around the world 

and affects sheep, goats, cattle, dogs, cats, birds, 

rodents, and several other types of animals. Infected 

animals shed these bacteria in birth products, feces, 

milk, and urine. Humans usually contract Q fever by 

breathing in contaminated droplets released by infected 

animals. Drinking raw milk has also caused infection in 

rare cases. People at highest risk for this infection are 

farmers, laboratory workers, sheep and dairy workers, 

and veterinarians.
15 

Initially described in Australia in 

1937, it is prevalent in southern France and Spain and is 

the second most common cause of community-acquired 

pneumonia, causing 5-8% of the endocarditis cases. 

Infected dairy goat farms are believed to be the source 

of the outbreak among humans.
16

 

Few studies have been conducted in 

Afghanistan regarding the prevalence and risk factors of 

communicable diseases. Brucellosis has been counted 

among the endemic diseases in Afghanistan.
17 

In a 

global incidence report, Afghanistan is categorized in 

the group of 2-8/1,000,000;
18

 whereas according to a 

OIE (World Organization for Animal Health) report in 

2005, the incidence of brucellosis was 3.8 per millionin 

country.
19

 Moreover, outbreaks of brucellosis have 

consistently been detected and investigated in Bamyan 

province, especially Punjab district. In August 2007 in 

Punjab district of Bamyan province, 35 cases were 

detected. Five samples were collected, and 3 were 

positive for Brucellosis. In September 2007 in Punjab 

district of Bamyan province, 43 cases were detected, 10 

samples were collected, and 8 samples were positive. In 

June 2008 in Punjab district of Bamyan province, 10 

cases were detected, 4 samples were collected, and all 

were positive for brucellosis.
20

 However, data regarding 

the burden of Q-Fever are not published in Afghanistan, 

but extrapolation of the incidence rate for Q fever is 

estimated at 38 per 1,000,000 nationally.
21

 A report 

from a hospital in the UK shows that some members of 

the army who came back from Afghanistan were 

diagnosed with Q-Fever.
22

 It is confirmed by another 

report from the US army, which found that after the 

deployment of thousands of American troops in 

Afghanistan since 2001, some common and chronic 

infections have persisted, including Q fever, brucellosis, 

and parasitic infections.
23

 



 

 

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The co-infection of both brucellosis and Q-

Fever is poorly recorded in the literature. The aim of 

this study is to investigate the outbreak and determine 

the risk factors associated with brucellosis and Q-Fever 

acquisition in the central province of Bamyan and to 

provide recommendations for control of brucellosis in 

Bamyan Province. 

 

Methods and Materials 

Study area 

On May 29
th

, 2011, the mobile health unit and 

district health officer at Yakawlang District reported the 

suspected outbreak of brucellosis to the provincial 

public health directorate in Bamyan province. The 

outbreak was in the border area between two districts of 

Yakawlang and Punjab, separated by only a hilly 

mountain. The residents of these districts are primarily 

livestock keepers who practice traditional pastoralism 

and follow a semi-nomadic lifestyle. A team consisting 

of an epidemiologist, a medical doctor, a veterinarian, 

and a laboratory technician was dispatched to the area. 

 

Cases definitions and blood sampling 

Operational case definition was developed 

prior to data collection. Those who had recurrent or 

continuous fever, joint pain/swelling, and general body 

malaise or backache in the area  were considered to be 

suspected cases while those who exhibited the above 

symptoms and  had contact with animals were thought 

as probable cases. Finally, those suspected and/or 

probable cases that were verified by laboratory testing 

(Rose Bengal Test) were considered to be confirmed 

cases. Initially in June 2011, a total of 147 subjects were 

line listed; blood was sampled and tested for brucellosis 

from 39 suspected cases at the district level. Twenty-

eight samples were shared with the Food and 

Agriculture Organization supported laboratory at the 

Ministry of Agriculture, Irrigation and Livestock 

(MAIL) to test for brucellosis and Q-fever. 

 

Study design 

As part of the outbreak investigation, a case 

control study was conducted to identify the associated 

factors for brucellosis and Q-Fever in order to formulate 

health education and preventive measures. Cases were 

defined as those showing at least two of the following 

clinical features: recurrent or continuous fever, 

sweating, joint pain, joint swelling, general body 

malaise, or backache. A total of 100 cases were 

identified. For every case, a control was selected 

randomly, irrespective of exposure from neighbors. 

Cases were given appropriate treatment and referred to 

hospital if necessary. Health education sessions were 

conducted during investigation and cases were managed 

clinically at the district hospital. 

 

Data collection and analysis 

A questionnaire asking for demographics and 

risk factors was developed by research team and used to 

collect data from both cases and controls. Data 

collection was completed in July 2011 and was entered 

in Epi Info 3.5.3. After cleaning, the data was analyzed 

using IBM Statistical Package for the Social Sciences 

(SPSS) statistical software version 20.
24

 Data were 

analyzed by time, person and place along with clinical 

information. Logistic regression analysis was used to 

analyze the data at univariate and multivariable levels. 

 

Results 

Descriptive Analysis: 

All age groups within the population were 

affected by the infection; however, those who were 15 

to 30 years of age were most commonly affected 

compared to the other age groups. Of 39 blood samples 



 

 

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collected initially and tested using the Rose Bengal test 

at the local level, 59% (n=23) of the samples from 

Punjab District Hospital and 16 samples from 

Yakawlang district hospital tested positive for 

brucellosis. 

Of the 28 samples, which were tested in the 

Ministry of Agriculture laboratory using the Rose 

Bengal Test, all were positive for brucellosis. After 

conduction of a laboratory tests for Q-Fever in MAIL, it 

was found that 96.4% (n=27) samples were also positive 

for Q-Fever on PCR. A wide range of clinical signs and 

symptoms including fever (100%), general body pain 

(96%), back pain (93%), joint pain (92%), chills (78%), 

sweating (86%), anorexia (95%), and tremor (66%) 

were common among cases. The majority had contact 

with animals and/or their products. The team was of the 

opinion that this was potentially the beginning of a more 

extensive outbreak. This was confirmed after the first 

round of investigation by a case-control study 

conducted from July to September 2011. Line listing 

continued until the December 31, 2012. 1,317 total 

cases were line listed until November 31, 2012. The 

updated epidemic curve, which includes the cases for 

2010 to 2012, is reflected in Figure 1. The first peak is 

due to the outbreak while the second peak might be due 

to delivery of medical supplies for treatment of disease 

in the province. 

 

Figure 1: Epidemic curve of brucellosis and Q fever 

outbreak in Bamyan province 

 

The ages of cases during the outbreak varied 

from one year to 75 years, with an average age of 30 

years. 62% were female and 38% (498) were male. The 

mean age of the cases was 29.5 years ± 14 SD and the 

mean age of the controls was 25.7 ± 16.6 years. 

However, this difference in age was not statistically 

significant. Education status of both cases and controls 

was low, with 69% being illiterate and 49% housewives. 

Out of the study participants, 83% did not have 

knowledge about brucellosis and Q fever, while 96% 

owned animals at their home. 57% had sick animals 

within a one-year period. Almost 80% had less than 5 

cows. 82% had less than 30 sheep and less than 8 goats 

at their stables. More than 90% of them had contact 

with animals, including feeding, watering, pasturing, 

milking, dunging, slaughtering, and butchering. More 

than 90% used at least one of the following animal 

products: butter, cream, milk, yogurt, or other local 

products. Approximately 93% did not wash their hands 

with soap after handling animals. Table 1 describes the 

distribution of demographic and socio-economic 

variables as a whole among study participants. 

 

Table 1: Frequency distribution of the socio-

demographic characteristics of study participants in 

Bamyan Province- Afghanistan in July 2011 (N=200) 

 

Univariate Analysis: 

There was a significant difference among age 

groups. Those aged less than 15 years were used as a 

reference group. It seems that the higher age groups 

were at higher risk than the lowest age group. Similarly, 

there was a significant difference between cases and 

controls by sex, with an odds ratio of 2.40 and 95 % 

confidence interval of 1.37 to 4.44. Level of education 

(as a proxy for socio economic status) showed 

significant differences between illiteracy and secondary 

education (OR=2.27 and 95% CI=1.13 – 4.58). This 

difference was not significant between primary and 

secondary education. There was no significant 

difference between employees of the government and 

students or between those owning a small business and 

farmers. However, those working as housewives were 

significantly different from others with an odds ratio of 

8.32 and 95% CI of 3.40 to 20.43. There was no 

association with having or not having knowledge of 

diseases among cases and controls. Table 2 shows the 



 

 

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association of socio-demographic factors with 

brucellosis and Q fever. 

 

Table 2: Statistical analysis of the risk factors (Socio-

economic) associated with Brucellosis and Q fever in 

Bamyan Province in July 2011 

 

We found a significant difference among cases 

and controls with respect to having sick animals at 

home in the last six months with an odds ratio of 3.89 

and 95 % CI of 2.14 to 7.05. Likewise, there was a 

significant association between those who had more 

than 5 cows and more than 30 sheep with an odd ratios 

of 3.03 (95% CI = 1.55 – 7.07) and 2.86 (95% CI = 1.40 

– 5.90) respectively. There was no association between 

the number of goats between cases and controls. There 

were significant differences among cases and controls 

with respect to pasturing (OR= 2.63 and 95% CI = 1.35 

– 5.10), milking (OR= 3.04 and 95% CI = 1.71 – 5.42), 

dunging (OR= 3.81 and 95% CI = 2.10 – 6.96), 

butchering (OR= 3.03 and 95% CI = 1.70 – 5.40), and 

assisting deliveries in animals (OR= 3.80 and 95% CI = 

2.11 – 6.85). Approximately all cases and control were 

using different dairy products and it was not possible to 

test the difference among groups. Cases were 3.82 (95% 

CI = 2.12 – 6.90) times more likely to be exposed to 

aborted materials as compared to controls. There was a 

significant difference in the frequency of boiling milk 

between cases and controls. The odds ratio of drinking 

milk without boiling was 7.04 (95% CI = 3.43 – 14.46) 

times higher among cases as compared to controls. 

Cases had 2.12 (95% CI = 1.19 – 3.77) and 2.27 (95% 

CI = 1.10 – 4.65) times more odds of exposure in 

slaughtering animals or living in close proximity with 

animals at home as compared to control groups. The 

cases had 4.55 (95% CI = 2.15 – 9.61) times more odds 

of living within 10 meters of their animals as compared 

to controls. Table 3 shows detailed information 

regarding the association of these risk factors to 

contraction of Brucellosis and Q fever. 

 

Table 3: Statistical analysis of behavioral risk factors 

associated with Brucellosis and Q fever in Bamyan 

Province in July 2011 

 

Multivariate Analysis: 

Multiple logistic regression analyses method 

was used to adjust for confounding. We used the 

biological as well as statistical significance (p ≤ 0.25) as 

criteria for inclusion in our model. Table 4 shows 

multivariate analysis results with adjusted OR and 95 % 

Confidence Intervals (CI). 

 

Table 4: Multivariate analysis of risk factors associated 

with Brucellosis and Q fever in Bamyan Province 

 

According to multivariate analysis, housewives 

are 7.36 (95% CI = 3.05 – 17.78) times as likely to be 

infected compared to students and government 

employees. Infected individualswere 3 times (95% CI = 

1.21 – 7.35) as likelyof living in close proximity to 

animals (>10 meter) as compared to those controls. In 

addition, we found significant association with drinking 

un-boiled milk (OR= 5.26, 95% CI = 2.30 – 12.02), 

being a butcher (OR = 3.53, 95% CI = 1.56 – 8.10), and 

purchasing new animals in the last six months (OR= 

3.53, 95% CI = 1.42 – 8.53) with infection of 

brucellosis and Q fever. 

 

Discussion 

Concurrent infection of Brucellosis-Q fever has 

been detected in an outbreak in which all cases have 

been in contact with animals and their products. 

According to the findings of our study using univariate 



 

 

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analysis, gender and age group is significantly 

associated with brucellosis and Q fever infections. We 

expected that males, due to their professions, should 

have been affected more often by brucellosis than 

females.
25

 This has been supported by a sero-prevalence 

study of human brucellosis in Turkey in which a 

statistically significant correlation found between 

seropositivity and age, sex, and consuming fresh cheese 

and cream made from un-boiled milk.
12

 In addition, 

illiteracy was another significant risk factor for infection 

at this level. This may be due to less concern with being 

healthy or lower awareness of preventive and control 

measures. Housewives in Afghanistan are busy with the 

management of animal products, and this maybe the 

reason for the significance of the relationship between 

this occupation and infection.  

More important is contact with aborted 

materials, which is thought to be the source of infection. 

The study showed significant association with assisting 

deliveries and brucellosis infection. The finding that 

contact with livestock during parturition is a strong risk 

factor for brucellosis is consistent with results from 

other studies, which demonstrate an increased risk in 

association with assisted parturition.
26

 Protective 

measures such as using gloves, gowns and masks should 

be used while touching these materials, and the product 

should be discharged safely. Hands should be washed 

with soap after handling animals. Before purchasing 

animals, buyers should ensure that the animals are 

healthy. The stables of animals should be away from 

residential areas or at least substantial distance from 

rooms and kitchens. 

However, using multivariate analysis, being a 

housewife, having a kitchen in close proximity to 

animals, drinking and using un-boiled milk, 

involvement in butchering activities, and purchasing 

new animals in last six months were significantly 

related to infection. It seems that housewives are in 

more contact with animals and animal products 

compared to other groups. This should be a focus for 

health education activities. In addition, the boiling of 

milk before using or drinking should be promoted, if not 

enforced. The butchers and slaughterers should have 

more information on disease to avoid unprotected 

contacts with animals. The new animals’ movement and 

marketing should be managed by veterinary services in 

the province as well as the country in general. 

The approach to control, prevention, or 

eradication of brucellosis in a country or region will 

depend on many factors, such as the level of infection in 

the herds or flocks, type of husbandry, economic 

resources, public health impacts, and potential 

international trade implication.
7 

The implementation of 

control measures, including sustained enhanced 

surveillance and required case management activities, is 

expected to pose a challenge to the national public 

health system. There is a need to expand and enhance 

the surveillance system and strengthen collaborations 

and coordination with veterinary services. Effective 

control of brucellosis requires a long-term commitment 

from many governmental agencies and assistance from 

international animal and human health organizations. 

An educational program is needed for high risk groups 

for zoonosis about the prevention of infection. 

 

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http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00313
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00313
http://www.oie.int/
file:///C:/Users/freesek/AppData/Local/Microsoft/Windows/Temporary%20Internet%20Files/Content.IE5/0H07AQ0P/www.wrongdiagnosis.com


 

 

SAEED 

 

 

This work is licensed under a Creative Commons Attribution 3.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2013.58 | http://cajgh.pitt.edu 

 

 

Table 1: Frequency distribution of the socio-demographic characteristics of study 

participants in Bamyan Province- Afghanistan in July 2011 (N=200) 

 

SociodemographicVariables N (%) 

Age (years)  

<15 53 (26.5) 

15-30 72 (36.0) 

30-45 46 (23.0) 

>45 29 (14.5) 

Sex  

Male 77 (38.5) 

Female 123 (61.5) 

Education Status  

Illiterate 138 (69.0) 

Primary Education 18 (09.0) 

Secondary Education 44 (22.0) 

Occupation  

Government employee & student 36 (28.0) 

Small Business holder 25 (12.5) 

Farmers 41 (20.5) 

Housewife 98 (49.0) 

Knowledge of Brucellosis and Q fever  

Yes 34 (17.0) 

No 166 (83.0) 

Residence (Districts)  

Panjab 150 (75.0) 

Waras 50 (25.0) 

  



 

 

SAEED  

 

This work is licensed under a Creative Commons Attribution 3.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2013.58 | http://cajgh.pitt.edu 

 

 

Table 2: Statistical analysis of the risk factors (Socio-economic) associated with Brucellosis 

and Q fever in Bamyan Province in July 2011 

 

Variable Cases Controls OR 95 % CI 

Age         

<15 16 37 1 Reference 

15 - <30 42 30 3.23 1.52 – 6.85 

30 - <45 27 19 3.28 1.43 – 7.53 

≥45 15 14 2.47 0.97 – 6.31 

Sex         

Male 51 49 1 Reference 

Female 49 51 2.4 1.37 – 4.44 

Education Status         

Illiterate 78 60 2.27 1.13 – 4.58 

Primary Education 12 12 0.87 0.27 –2.78 

Secondary Education 10 28 1 Reference 

Occupation         

Housewife 69 29 8.32 3.40 – 20.43 

Farmer 17 24 2.48 0.91 – 6.75 

Small Business 6 19 1.1 0.33 – 3.69 

Student 8 28 1 Reference 

Knowledge of Diseases         

Yes 16 18 1 Reference 

No 84 82 0.86 0.41 – 1.81 
 

 

  



 

 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

This work is licensed under a Creative Commons Attribution 3.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2013.58 | http://cajgh.pitt.edu 

 

 

Table 3: Statistical analysis of behavioral risk factors associated with Brucellosis and Q 

fever in Bamyan Province in July 2011 

 

Variables  Cases Controls OR 95 % CI 

Having a sick animal in the last 6 months 

No 27 59 1.00 Reference 

Yes 73 41 3.89 2.14-7.05 

Types and number of animals 

Cattle Group 

≤ 4 71 89 1.00 Reference 

> 4 29 11 3.03 1.55-7.07 

Sheep Group 

≤ 30 70 87 1.00 Reference 

> 30 30 13 2.86 1.40-5.90 

Goat Group 

≤ 8 79 58 1.00 Reference 

> 8 21 14 1.63 0.77-3.40 

Type of activities in animal husbandry 

Pasturing 

No 23 65 1.00 Reference 

Yes 17 35 2.63 1.35-5.10 

Milking 

No 67 40 1.00 Reference 

Yes 33 60 3.04 1.71-5342 

Dunging 

No 75 44 1.00 Reference 

Yes 25 56 3.81 2.10-6.96 

Butchering 

No 61 34 1.00 Reference 

Yes 39 66 3.03 1.70-5.40 

Assisting Delivery 

No 70 38 1.00 Reference 



 

 

SAEED  

 

This work is licensed under a Creative Commons Attribution 3.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2013.58 | http://cajgh.pitt.edu 

 

 

 

 

  

Yes 30 62 3.63 2.02-6.52 

Contact with Aborted Products 

No 29 61 1.00 Reference 

Yes 71 39 3.82 2.12-6.90 

Boiling of milk before drinking 

Yes 51 88 1.00 Reference 

No 49 12 7.04 3.43-14.46 

Slaughtering Animals 

No 32 50 1.00 Reference 

Yes 68 50 2.12 1.19-3.77 

Living in close proximity to animals 

No 9 32 1.00 Reference 

Yes 91 68 2.27 1.10-4.65 

Distance from kitchen >10 meters 

Yes 11 36 1.00 Reference 

No 89 64 4.55 2.15-9.61 

Purchasing new animals in last 6 months 

No 70 88 1.00 Reference 

Yes 30 12 3.14 1.50-6.58 



 

 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

This work is licensed under a Creative Commons Attribution 3.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2013.58 | http://cajgh.pitt.edu 

 

 

Table 4: Multivariate analysis of risk factors associated with Brucellosis and Q fever in 

Bamyan Province 

Variables Adjusted OR 95% CI P-value 

Working status/Job category 

Housewives 7.36 3.05-71.78 >0.001 

Farmers 1.19 0.42-3.34 0.738 

Students/govt. employees 1.00 Reference - 

Distance from kitchen 

<10 meters 2.95 1.21-7.35 >0.05 

>10 meters 1.00 Reference - 

Drinking milk after boiling 

No 5.26 2.30-12.02 >0.001 

Yes 1.00 Reference - 

Involvement in butchering activities 

Yes 3.53 1.56-8.10 >0.05 

No 1.00 Reference - 

Purchasing new animals in the last 6 months 

Yes 3.53 1.42-8.53 >0.05 

No 1.00 Reference - 

 

  



 

 

SAEED  

 

This work is licensed under a Creative Commons Attribution 3.0 United States License. 

 

This journal is published by theUniversity Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2013.58 | http://cajgh.pitt.edu 

 

 

Figure 1: Epidemic curve of brucellosis and Q fever outbreak in Bamyan province 

 

 

 

 

 

0 

20 

40 

60 

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120 

140 

N
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Time in Months from 2010 to 2012 

Epi Curve of Brucellosis  and Q-Fever 2010-2012 


