Smallholder Cattle Farmers’ Knowledge, Attitudes, and Practices Regarding Foot-and-mouth Disease and Lumpy Skin Disease in Bali Province, Indonesia

1. Introduction
Foot-and-mouth disease (FMD) and Lumpy skin disease (LSD) are major viral transboundary diseases of livestock, primarily affecting cattle. Both are characterized by high morbidity, low mortality, and rapid transmission, leading the World Organization for Animal Health (WOAH, formerly OIE) to classify them as notifiable diseases due to their severe economic consequences [1, 2].
FMD is endemic in most of the Southeast Asia countries. Indonesia, after successfully eradicating the disease and being declared FMD-free in 1986, experienced a re-emergence in May 2022, with outbreaks reported in Aceh and East Java Province. The disease subsequently spread to other regions, including Bali Province, with 556 positive cases in 2022 [3, 4]. Meanwhile, LSD, first identified in Zambia in 1929, reached Southeast Asia by 2020. In Indonesia, the disease was detected in Riau Province in early 2022 and has since spread [5, 6]. Meanwhile, Bali Province is officially still LSD-free. However, the area is considered at high risk due to its proximity to affected neighboring regions, such as East Java Province, which has reported five cases [7].
Effective control and eradication of these diseases rely on strategies such as early detection, movement controls, public awareness, and vaccination, all of which are underpinned by farmers’ knowledge [8]. Understanding the knowledge, attitudes, and practices (KAP) of cattle farmers is therefore essential for designing and implementing effective, locally relevant prevention and control measures [9]. However, there is a scarcity of comprehensive KAP data regarding FMD and LSD in Indonesia, particularly in Bali.
This study was conducted to assess the KAP of smallholder cattle farmers in Bali concerning FMD and LSD and to identify the factors associated with their KAP. The findings are intended to provide evidence-based recommendations for local animal health authorities to strengthen FMD and LSD management strategies.

2. Materials and Methods

2.1. Study location and population
The study was conducted in Bali, a province renowned as a centre for the development of Bali cattle (Bos javanicus domesticus), an important native breed and national genetic resource [10]. Cattle farming in Bali is dominated by smallholder operations, characterized by traditional, non-intensive management systems where cattle graze during the day and are confined at night [11]. These farmers are crucial stakeholders in the conservation of Bali cattle and the local agricultural economy.

2.2. Study design and sampling
A cross-sectional study was conducted among smallholder cattle farmers across eight regencies of Bali Province. A minimum sample size of 102 was calculated using Cochran’s formula [12], and an additional 10% was included to account for potential non-responses, resulting in a final sample of 112 participants. A convenience sampling method was used to select participants from lists provided by local agricultural departments due to the accessibility of these individuals. Denpasar, being an urban centre with minimal smallholder farming, was excluded.

2.3. Data collection
Data were collected through in-person interviews using a pre-tested, structured questionnaire. The questionnaire comprised 59 questions covering: (a) socio-demographic characteristics, (b) knowledge of FMD and LSD (18 questions), (c) attitudes towards FMD and LSD (16 questions), and (d) preventive and control practices (17 questions). The questionnaire was developed based on relevant literature and validated by veterinary experts. A pre-test was conducted with 10% of the target sample size to ensure clarity and comprehension.

2.4. Data analysis
Data were entered into Microsoft Excel 2019 and analysed using SPSS statistics for windows, version 22.0. Descriptive statistics (frequencies, percentages) were used to summarize the data. 
To assess KAP levels, a scoring system was employed. For each correct or positive response to a KAP question, a score of one (1) was assigned; an incorrect, negative, or “don’t know” response received a score of zero (0). The total score for each component (knowledge, attitude, practice) for each disease was calculated. The median score was used as a cut-off point. Respondents with a score above the median were categorized as having ‘adequate’ knowledge, a ‘positive’ attitude, or ‘proper’ practices. Those with scores at or below the median were categorized as ‘inadequate,’ ‘negative,’ or ‘improper,’ respectively.
To identify factors associated with KAP outcomes, a logistic regression analysis was performed. First, a bivariate analysis (chi-square test) was conducted. Variables with a P≤0.25 in the bivariate analysis were then included in a multivariate logistic regression model to identify significant associated factors. The final model retained variables with a P<0.05, and results are presented as odds ratios (OR) with 95% confidence intervals (CI).

3. Results

3.1. Demographic profile of respondents
The majority of respondents were male (57.1%), over 40 years of age (53.6%), and had attained less than an undergraduate level of education (53.6%). Farming experience was evenly split, with 50% having over 10 years of experience. The primary motivation for raising cattle was investment purposes (67.9%) (Table 1).

3.2. Knowledge of FMD and LSD
There was a stark contrast in knowledge between the two diseases. All farmers (100%) had heard of FMD, knew it was an infectious disease affecting cattle, were aware of its clinical signs, and understood that it caused major economic losses. However, knowledge gaps were evident, with only 12.5% knowing it could spread via processed animal products and only 5.4% aware that FMD could be fatal. Crucially, only 1.8% of farmers knew about the importance of quarantining new animals.
In contrast, knowledge of LSD was significantly lower. Only 30.4% of respondents had heard of LSD and were aware of its clinical signs, transmission, and potential for causing death and economic impact. Encouragingly, all farmers (100%) recognized that farm biosecurity was an important preventive measure for animal diseases in general.

3.3. Attitudes toward FMD and LSD
Attitudes towards FMD were overwhelmingly positive. All farmers (100%) considered it a serious threat, believed vaccination was an effective control measure, and supported government control policies and movement restrictions.
For LSD, attitudes were also generally positive despite lower knowledge levels. A high proportion of farmers (100%) believed LSD could threaten their farm’s sustainability, supported reporting suspected cases, and agreed on the importance of vaccination and biosecurity. However, only 30.4% considered it a serious personal threat to their animals at present, and only 8% were confident in their ability to recognize its symptoms.

3.4. Practices for disease control
Regarding FMD, all farmers (100%) reported regularly checking their cattle for clinical signs and had vaccinated their animals. However, biosecurity practices were lacking. Only 30.4% had fences to prevent other animals from entering their farms, and only 43.8% restricted visitor access or regularly used disinfectants. Critically, none of the farmers reported suspected cases to authorities, preferring to manage them independently or with traditional remedies.
Practices related to LSD were less developed. No cattle had been vaccinated against LSD, consistent with Bali’s LSD-free status. Biosecurity practices were similar to those for FMD, with only 30.4% of farmers quarantining new animals. No farmers had attended training on LSD.

3.5. Overall KAP scores and associated factors
Based on the median score cut-off, all farmers (100%) had adequate knowledge of FMD, while 75.9% had positive attitudes and 83.0% had proper practices. For LSD, only 41.1% had adequate knowledge. However, 98.2% demonstrated a positive attitude, and 66.1% had proper practices (Figure 1).

The multivariate analysis identified several factors associated with KAP outcomes (Table 2). For FMD, older age (>40 years) and higher education (undergraduate or higher) were associated with adequate knowledge and positive attitudes. For LSD, having an investment-driven farming purpose was associated with adequate knowledge and positive attitudes. Female gender of farmers was associated with proper preventive practices for both FMD and LSD.

4. Discussion
This study provides the first comprehensive assessment of smallholder cattle farmer KAP regarding FMD and LSD in Bali, Indonesia. The findings revealed a high level of awareness and positive engagement concerning FMD, which is likely a direct result of intensive government communication, education, and vaccination campaigns following the 2022 outbreak [13]. The high scores for FMD-related KAP align with studies in other FMD-endemic regions, such as Ethiopia (90%) and Thailand (66.06%) [14, 15].
However, a critical gap was identified in biosecurity knowledge and application. The low rates of quarantining new animals (1.8%) and implementing basic biosecurity measures (e.g. disinfection, fencing) are alarming. This represents a significant vulnerability for the introduction and spread of not only FMD and LSD but other infectious diseases as well. This discrepancy, where farmers have relatively high disease-specific knowledge but poor general biosecurity practices, has also been observed in Cambodia and Bangladesh (P>0.05) [16, 17]. It suggests that while emergency disease campaigns are effective at raising awareness about a specific threat, they may fail to instil foundational principles of farm biosecurity.
In stark contrast, knowledge about LSD was poor. This is understandable given Bali’s current LSD-free status and the national focus on the FMD emergency. This lack of awareness, combined with poor biosecurity practices, places Bali’s cattle population at high risk should the disease be introduced from neighboring islands. This study serves as an early warning and a baseline for future interventions. To our knowledge, following the initial study in Thailand [18], this is one of the first KAP studies on LSD in Southeast Asia since the disease’s emergence in the region, and it provides crucial preliminary data.
The factors associated with KAP provide valuable insights for targeting interventions. The association of higher education and age with better FMD knowledge and attitudes is consistent with findings from other studies in Sri Lanka [19]. The finding that female farmers were more likely to adopt proper preventive practices is significant and suggests that women play a crucial role in daily animal care and on-farm biosecurity in Bali Province, consistent with a similar study in South Sulawesi [20]. Future extension programs should ensure they are inclusive and specifically target female farmers. The link between an investment motive and better LSD-related KAP was observed, suggesting that farmers who view their cattle as a business are more proactive in seeking information about emerging economic threats.
This study has several limitations. The use of convenience sampling may limit the generalizability of the findings to all smallholder cattle farmers in Bali. Furthermore, self-reported data on practices may be subject to social desirability bias. Despite these limitations, the study offers valuable insights into the current KAP landscape and provides a strong evidence base for policy.

5. Conclusion
In conclusion, smallholder cattle farmers in Bali demonstrate adequate knowledge, positive attitudes, and proper practices for managing FMD, though significant gaps in biosecurity remain. Conversely, while attitudes towards LSD prevention are positive, knowledge of the disease is critically low, posing a significant risk to the island. Key factors influencing KAP include age, education, farming purpose, and gender.
Based on these findings, we strongly recommend that animal health authorities design and implement targeted educational campaigns to cattle farmers that focus on strengthening foundational biosecurity principles (e.g. quarantine, disinfection, visitor control) applicable to all infectious diseases; urgently increasing awareness and knowledge of LSD, including its clinical signs, transmission, and economic impact, and tailoring educational materials to different demographic groups in Bali Province, with a special focus on engaging female farmers who are key to implementing on-farm practices. By addressing these gaps, the Bali government can build a more resilient and prepared farming community capable of effectively mitigating the threats of both FMD and LSD.

Acknowledgements
The authors express their sincere gratitude to the staff of animal health departments in all regencies of Bali Province for their invaluable assistance during data collection. We also thank the local veterinarians and smallholder cattle farmers who generously gave their time to participate in this study.

Compliance with ethical guidelines
This study was approve by the Research Ethics Committee of Udayana University, Denpasar City, Indonesia (Code: B/UN14.2.9/PT.01.03/2025). 

Data availability 
The data that support the findings of this study are available upon request from the corresponding author.

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
Conceptualization, study design, and writing the original draft: I Gede Hendra Prasetya Wicaksana and I Made Kardena; Data acquisition: I Gede Hendra Prasetya Wicaksana, I Made Kardena, and I Wayan Suardana; Data analysis and interpretation: Tri Komala Sari, Ida Bagus Kade Suardana, and Tjok Gede Oka Pemayunhs; Statistical analysis, administrative, technical, and material support, review and editing: I Made Kardena, I Wayan Suardana, Tri Komala Sari, Ida Bagus Kade Suardana, Tjok Gede Oka Pemayunhs; Supervision: I Wayan Suardana, Tri Komala Sari, Ida Bagus Kade Suardana, and Tjok Gede Oka Pemayunhs.

Conflict of interest
The authors declared no conflict of interest.

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