Abstract:
Background: Brucellosis is a zoonotic bacterial disease caused by various Brucella species which infect animals and humans. Globally, Brucellosis incidence is estimated at 1.6 -2.1 million new human cases annually. In humans, the disease is acquired through direct contact with infected animals, by eating or drinking contaminated products, inhaling airborne agents or deposition of animal reproductive fluids on skin cuts. Brucellosis has been documented as endemic in Sub-Saharan Africa. From June 2022 to June 2024, surveillance findings in Nakasongola District, Uganda revealed a single health facility with 348(29%) of the 1,211 Brucellosis cases registered in the period from 21 health facilities, an indication of high prevalence in the district. Moreover, challenges exist in implementing the collaborative One Health (OH) approach in Uganda. We therefore investigated the utilization of the OH approach for Brucellosis control among community members in Nakasongola District and also explored the existing barriers to OH.
Methods: We conducted a mixed methods descriptive cross-sectional study guided by the Capability, Opportunity and Motivation for Behaviour Change (COM-B) model. The study took place in Nakasongola District which is a cattle corridor in central Uganda from August to October 2024. We used tablets to administer structured interviews for the quantitative component. For the qualitative component, we conducted 9 Key Informant Interviews among Health facility, district and government institution personnel and through 10 In-depth Interviews and 2 Focus Group Discussions among community members in four parishes of Nakasongola District. The interviews were face to face and audio recorded following informed consent. We transcribed the recorded data verbatim and used thematic analysis to obtain findings for the qualitative results presented.
Results: The study was conducted among 42 participants, 26(62%) males and 16(38%) females. Of the 42, 36(86%) had ever been diagnosed with Brucellosis. The barriers to OH utilization included staff turnover, limited funds for OH implementation, response only during outbreaks by some teams, lack of real time inter-ministry reporting platforms for surveillance updates to be viewed at the same time, thus limiting information flow and lack of standardized the Brucellosis testing thus private and government facilities diagnosing Brucellosis differently. The facilitators for OH included knowledge of OH, work environment and organizational culture favouring OH application and national level support through the provision of policies and capacity building. Barriers to Brucellosis control were cultural practices that favoured consumption of raw unpasteurized milk and community members handling fluids, blood with their bare hands during delivery of animals. The facilitators were health education at the health facilities and the motivation for good health when health information is adhered to.
Conclusions: The national level support and OH knowledge among users facilitated OH implementation in Uganda. Refresher trainings, increased financing and technological advancements in reporting should be promoted. Sensitization sessions among community members should be routinely conducted to curb harmful cultural practices that contribute to Brucellosis infection. One Health is a powerful approach in the control of zoonotic diseases such as Brucellosis. There should be collaborative efforts at national, regional and global levels to finance One Health.
Biography:
Susan Nakubulwa is an Epidemiologist with over 15 years’ research experience and has conducted studies in areas including HIV and TB with great interest in Implementation Science. She holds a Masters degree in Epidemiology from the London School of Hygiene and Tropical Medicine. She is also a Field Epidemiologist who has participated in outbreak investigations for Cholera, Poisonings, COVID-19 surveillance and has investigated Brucellosis with a One Health outlook. She is currently affiliated to Mildmay Research Centre Uganda and is a Site Investigator for an Ebola study investigating Knowledge, Attitudes and social dynamics affecting public health preparedness and response.
