Bovine Tuberculosis (bTB), caused by Mycobacterium bovis, is a neglected zoonotic disease primarily associated with cattle. The incidence of bTB is highest in low-income settings with high cattle density and unpasteurised dairy consumption. Smallholder dairy farming has been steadily growing in low- and middle-income countries (LMICs) with limited professional support for adequate bTB surveillance and risk mitigation. Several studies have explored the knowledge, attitudes, and practices (KAP) of stakeholders of the milk value chain towards bTB in LMICs, but this evidence has not been collated and synthesised. We conducted a systematic review to determine what is known, believed, and done in relation to bTB among dairy producers and consumers in LMICs. We performed a systematic search of studies in OVID Medline, Scopus and CABI on 11 September 2023. KAP data were summarised using narrative synthesis and forest plots. We retrieved 2763 articles, retaining 52 for the review. Only studies from Africa (n=38) and Asia (n=13) met the eligibility criteria. Most populations reported awareness of human tuberculosis and knew it could be treated, but there was limited awareness of bTB and its zoonotic potential. Knowledge of bTB transmission routes and bTB mitigation varied and risky practices were also variable across populations. Inconsistencies in study design and survey tools suggest some results may have mid- to high risk of bias. Awareness of bTB is surprisingly low among African and Asian populations with high bTB exposure risk, possibly due to the long-standing divide between animal and human health messages that has obscured the One Health implications of bTB. Addressing bTB in LMICs requires a structural One Health approach and standard KAP survey tools to adequately explore the socio-cultural, political, and economic processes and drivers favouring bTB spread and persistence.

The authors have declared no competing interest.

JP Villanueva-Cabezas received support from The University of Melbourne through an Early Career Research Grant (ECR0662023).

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