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Leptospirosis is a zoonotic bacterial disease reported worldwide. In Uganda, seropositivity has been reported in both humans and domesticated animals, including cattle. However, it remains unknown whether cattle are shedding leptospires and thus acting as potential source for human leptospirosis. We conducted this cross-sectional study in two cattle abattoirs in Kampala, Uganda between June and July 2017. Kidney and urine samples from 500 cattle sourced from across the country were analysed by real-time PCR to establish the prevalence of Leptospira-positive cattle and risk of exposure to abattoir workers. The species of infecting Leptospira was determined by amplification of secY gene and compared to reference sequences published in GenBank. Of 500 cattle tested, 36 (7.2%) had Leptospira DNA in their kidneys (carriers), 29 (5.8%) in their urine (shedders); with an overall prevalence (kidney and/or urine) of 8.8%. Leptospira borgpetersenii was confirmed as the infecting species in three cattle and Leptospira kirschneri in one animal. Male versus female cattle (OR = 3, p-value 0.003), exotic versus local breeds (OR = 21.3, p-value 0.002) or cattle from Western Uganda (OR = 4.4, p-value 0.001) and from regions across the border (OR = 3.3, p-value 0.032) versus from the central region were more likely to be Leptospira-positive. The daily risk of exposure of abattoir workers to ≥1 (kidney and/or urine) positive carcass ranged from 27% (95% credibility interval 18.6-52.3) to 100% (95% CI 91.0-100.0), with halal butchers and pluck inspectors being at highest risk. In conclusion, cattle slaughtered at abattoirs in Uganda carry and shed pathogenic Leptospira species; and this may pose occupation-related risk of exposure among workers in these abattoirs, with workers who handle larger numbers of animals being at higher risk.

Background Brucellosis is a worldwide recognized bacterial zoonotic disease. There is currently no information on bovine brucellosis sero-prevalence in South Sudan regardless of the economic, social and public health impact on populations. Therefore, for the first time in 33 years, we report the sero-prevalence of brucellosis in cattle and their herders. Furthermore, we characterize the drivers associated with the disease at the human-animal interface in Bahr el Ghazal region, South Sudan. Methods A total of 893 and 87 animal and human sera respectively were examined between December 2015 and May 2016. Rose Bengal Plate Test (RBPT) and Competitive Enzyme Linked Immuno Sorbent Assay (c-ELISA) were used in parallel to detect anti-Brucella antibodies. Questionnaires were administered to collect relevant metadata used for the association analysis in R version 3.2.3. Odds Ratio (OR) and Confidence Intervals (CI) were determined. Results Overall bovine brucellosis prevalence was 31% (95%CI = 28.0–34.2), with the highest 63% (95%CI = 53–70) and lowest 10% (95%CI = 4.5–20.1) prevalence estimates in Wau and Gogrial states respectively. The bovine sero-prevalence was approximately equally distributed among the male 30.4% (26.9–34.2) and the females 32.5% (26.8–38.7). Poor body condition (OR = 0.22; 95%CI = 0.07–0.54) and larger herd sizes (OR = 0.05; 95%CI = 0.008–0.173) were protective factors for brucellosis, while the opposite was true for the second (OR = 1.70; 95%CI = 1.08–2.67) and third (OR = 2.5; 95%CI = 1.46–4.47) lactation stage. The overall brucellosis sero-prevalence in herders was estimated at 33.3% (23.9–44.3). Conclusion We report a high prevalence of anti-Brucella antibodies in cattle and their herders in Bahr el Ghazal, indicating an enzootic status in the cattle population being an important source of infection for humans. This represents a genuine public health challenge. Therefore, there is need to raise awareness and build capacity and infrastructure in this fragile state to underwrite future public health strategies for brucellosis., Author summary Enzootic brucellosis is a bacterial infectious disease, which represents millions of dollars in production losses in livestock, as well as Disability- Adjusted Life Years (DALYS) associated with health and treatment in the human populations for Low and Middle Income Countries (LMICs). Despite these unequivocally known challenges, there has not been any reporting on this disease in livestock and humans in the recent past. The limitations the disease puts on livestock health and production, coupled with the zoonotic form, which is primarily driven by risky food consumption habits, and interaction with livestock in an enzootic setting with uncontrolled animal movement, means that this disease is not only of veterinary public health, but of trans-boundary importance as well.

Non-typhoidal Salmonella (NTS) are foodborne pathogens of global public health significance. The aim of this study was to subtype a collection of 85 NTS originating from poultry farms in Uganda, and to evaluate a subgroup of phenotypically resistant isolates for common antimicrobial resistance genes and associated integrons. All isolates were subtyped by pulsed-field gel electrophoresis (PFGE). Phenotypically resistant isolates (n = 54) were screened by PCR for the most relevant AMR genes corresponding to their phenotypic resistance pattern, and all 54 isolates were screened by PCR for the presence of integron class 1 and 2 encoding genes. These genes are known to commonly encode resistance to ampicillin, tetracycline, ciprofloxacin, trimethoprim, sulfonamide and chloramphenicol. PFGE revealed 15 pulsotypes representing 11 serotypes from 75 isolates, as 10 were non-typable. Thirty one (57.4%) of the 54 resistant isolates carried at least one of the seven genes (blaTEM-1, cmlA, tetA, qnrS, sul1, dhfrI, dhfrVII) identified by PCR and six (11%) carried class 1 integrons. This study has shown that a diversity of NTS-clones are present in Ugandan poultry farm settings, while at the same time similar NTS-clones occur in different farms and areas. The presence of resistance genes to important antimicrobials used in human and veterinary medicine has been demonstrated, hence the need to strengthen strategies to combat antimicrobial resistance at all levels.

Seroprevalence of Leptospira spp. in cattle is unknown in Uganda. The aim of this study was to estimate the seroprevalence of L. interrogans Icterohaemorrhagiae, Pomona, L. kirschneri Butembo, Grippotyphosa, L. borgpetersenii Nigeria, Hardjo, Wolfii, and Kenya and an overall seroprevalence in cattle from Kole and Mbale districts. Two hundred-seventy five bovine sera from 130 small holder farms from Kole (n = 159) and Mbale (n = 116), collected between January and July 2015, were tested for antibodies against eight Leptospira strains by Microscopic Agglutination Test. A titer of ≥100 was considered seropositive, indicating past exposure. Overall, the seroprevalence was 19.27% (95% CI 14.9–24.5%). Pomona seroprevalence was highest with 9.45% (6.4–13.7%), followed by Kenya 5.09% (2.9–8.6%), Nigeria 4.00% (2.1–7.2%), Wolfii 3.27% (1.6–6.3%), Butembo 1.86% (0.7–4.4%), Hardjo 1.45% (0.5–3.9%), and Icterohaemorragiae and Grippotyphosa with less than 1% positive. Seroprevalence did not differ between districts and gender (p ≥ 0.05). Seven animals had titers ≥400. Cross-reactions or exposure to ≥1 serovar was measured in 43% of serum samples. Seroprevalence of 19% implies exposure of cattle to leptospires.

Background Uganda has reported five (5) Ebola virus disease outbreaks and three (3) Marburg virus disease outbreaks from 2000 to 2016. Peoples’ knowledge and attitude towards Ebola and Marburg virus disease impact on control and prevention measures especially during outbreaks. We describe knowledge and attitude towards Ebola and Marburg virus outbreaks in two affected communities in Uganda to inform future outbreak responses and help in the design of health education and communication messages. Methods The study was a community survey done in Luweero, Ibanda and Kamwenge districts that have experienced outbreaks of Ebola and Marburg virus diseases. Quantitative data were collected using a structured questionnaire and triangulated with qualitative participatory epidemiology techniques to gain a communities’ knowledge and attitude towards Ebola and Marburg virus disease. Results Out of 740 respondents, 48.5% (359/740) were categorized as being knowledgeable about Ebola and Marburg virus diseases, whereas 60.5% (448/740) were having a positive attitude towards control and prevention of Ebola and Marburg virus diseases. The mean knowledge and attitude percentage scores were 54.3 (SD = 23.5, 95%CI = 52.6–56.0) and 69.9 (SD = 16.9, 95%CI = 68.9–71.1) respectively. People educated beyond primary school were more likely to be knowledgeable about Ebola and Marburg virus disease than those who did not attain any formal education (OR = 3.6, 95%CI = 2.1–6.1). Qualitative data revealed that communities describe Ebola and Marburg virus diseases as very severe diseases with no cure and they believe the diseases spread so fast. Respondents reported fear and stigma suffered by survivors, their families and the broader community due to these diseases. Conclusion Communities in Uganda affected by filovirus outbreaks have moderate knowledge about these diseases and have a positive attitude towards practices to prevent and control Ebola and Marburg viral diseases. The public health sector should enhance this community knowledge gap to empower them more by supplying educational materials for epidemic preparedness in future using appropriate communication channels as proposed by the communities., Author summary Ebola Virus Disease (EVD) and Marburg Virus Disease (MVD) are caused by a family of viruses known as Filoviruses. When they occur, they cause high lethality among infected people, which causes panic to the population, as well as interfering with the health care delivery system, especially in developing countries. Usually, at the beginning of these infections, the affected communities tend to think that witchcraft or some bad luck has befallen their community. Because of limited knowledge about these diseases, it becomes hard for local authorities to institute control and prevention measures. We administered a questionnaire to individual participants and held focus group discussions to help us tease out the communities’ understanding of these diseases. We found that people have moderate knowledge about EVD and MVD, and a positive attitude towards the prevention and control measures instituted by health authorities in Uganda. However, they still reported stigma subjected to the survivors of these diseases and affected families at large. EVD still causes much fear which drives some of the irrational actions by communities during outbreaks. Communities highlighted early sensitization as a means of controlling outbreaks. We recommend the findings in this paper to public health authorities in epidemic-prone countries like Uganda to aid in control and epidemic preparedness of filovirus outbreaks.

The following article, Madut, N.A., Nasinyama, G.W., Muma, J.B., Sube, K.L.L., Ocan, M., Muwonge, A., ... Kankya, C. (2018). Prevalence of brucellosis among patients attending Wau Hospital, South Sudan. PLoS ONE, 13, (6), can be accessed at https://doi.org/10.1371/journal.pone.0199315. Brucellosis is a zoonotic disease of public health importance; its prevalence varies globally. In low-income countries, brucellosis is an endemic and neglected disease affecting both animals and humans. This study was intended to establish brucellosis sero-prevalence among patients attending Wau hospital, South Sudan. Across sectional study, was done among randomly selected patients attending Wau hospital. Data was collected using questionnaires and laboratory investigations. Rose Bengal plate Test (RBPT), Serum agglutination test (SAT) and Competitive Enzyme Linked Immuno Sorbent Assay (c-ELISA) was used in the analysis of blood samples serially starting with RBPT which is more sensitive and least specific then SAT. c-ELISA test which is most specific and less sensitive compared to RBPT and SAT was then used to confirm presence of Brucella antibodies in the samples. A total of 416 participants out of 1664 were enrolled to this study. The majority of participants were between 7-to-76 years of age with mean age of 30.72 (SD+/- 12.83). The sero-positivity of patient’s blood samples for brucellosis using c-ELISA was 23.3% (97/416) among patients presenting to Wau hospital. Socio-demographic characteristics, occupation, clinical signs of disease and types of animals reared by animal owners showed no significant correlation with occurrence of sero-positivity among patient’s blood samples for brucellosis. While ethnicity (Nilotic), knowledge of zoonotic disease, and consumption of animal urine were statistically significant (p

Background: Brucellosis is the most common zoonotic infections in pastoral settings. Lack of knowledge about the disease may cause devastating out come to the patients, thus sustained it in such communities. This study assessed knowledge and practices among high-risk groups in Bahr el Ghazal region, South Sudan. Methods: Across sectional survey involving abattoir workers, febrile patients at Wau referral hospital and cattle herders from cattle camps from four states namely, Wau, Tonj, Gogrial and Aweil. By using open-ended questionnaire and key informant guideline, for triangulations by for interviews, focus group discussions and key informant interview. Data collected include knowledge on causes, symptoms, transmission, treatment, prevention and risk factors of brucellosis. Using SPSS version 24 for analysis, X2 and Multivariable logistic regression analysis was performed. Results: In this study, 234, 416 and 87 abattoir workers, febrile patients and herders. Brucellosis prevalence is fair among abattoir workers and the febrile patients, all workers Knows Brucellosis and Tuberculosis more than other diseases. Brucellosis among febrile patients, female more than male’s respondents 23.7% (50/416), 22.9% (47/234/416) respectively, the prevalence is very high among age group 16 to 35. The disease was very high among non-educated people 25.4% (35/416). Nilotic group have high prevalence 21.8% (39/416), according to C-ELISA. In the cattle camps brucellosis prevalence among males was high than females 44.0% and 29.0% respectively. The prevalence was high among age groups 16- 35 years and 36-60years, 32.7% and 38.1 respectively, according to C- ELISA. The distribution of awareness of zoonotic diseases and brucellosis among abattoir workers, knowing zoonotic diseases 33.3% (30/90), knowing brucellosis 27.8% (25/90), knowing transmission of brucellosis 11.11% (10/25), however, knowledge of causes, signs of brucellosis in animals and signs human mode of transmission and treatment of brucellosis is very low. Conclusions: Brucellosis prevalence is fair among abattoir workers, febrile patients and high in the cattle camps. All workers Knows Brucellosis and Tuberculosis more than other diseases.in the community the prevalence look equally between gender, knowledge about the diseases causes, signs in human and animal also mode of transmission and treatment was very low between the three groups. Community sensitization and awareness about zoonotic diseases is needed

Questionnaire used for study data collection. (DOCX 33Â kb)

Background Non-typhoidal Salmonella (NTS) are among the leading global foodborne pathogens and a significant public health threat. Their occurrence in animal reservoirs and their susceptibilities to commonly used antimicrobials are poorly understood in developing countries. The aim of this study was to estimate the prevalence, determine antimicrobial susceptibility and identify risk factors associated with NTS presence in laying hen farms in Uganda through a cross-sectional study. Results Pooled faecal samples were collected from 237 laying hen farms and these were analysed for NTS following standard laboratory procedures. In total, 49 farms (20.7%; 95% Confidence interval (CI): 15.6–25.6%) were positive for NTS presence. Altogether, ten Salmonella serotypes were identified among the confirmed 78 isolates, and the predominant serotypes were Salmonella Newport (30.8%), S. Hadar (14.1%), S. Aberdeen (12.8%), S. Heidelberg (12.8%), and S. Bolton (12.8%). Phenotypic antimicrobial resistance was detected in 45(57.7%) of the isolates and the highest resistance was against ciprofloxacin (50.0%) followed by sulphonamides (26.9%) and sulphamethoxazole/trimethoprim (7.7%). Resistance was significantly associated with sampled districts (p = 0.034). Resistance to three or more drugs, multi-drug resistance (MDR) was detected in 12 (15.4%) of the isolates, 9 (75%) of these were from Wakiso district. A multivariable logistic model identified large farm size (OR = 7.0; 95% CI: 2.5–19.8) and the presence of other animal species on the farm (OR = 5.9; 95% CI: 2.1–16.1) as risk factors for NTS prevalence on farms. Having a separate house for birds newly brought to the farms was found to be protective (OR = 0,4; 95% CI: 0.2–0.8). Conclusion This study has highlighted a high prevalence and diversity of NTS species in laying hen farms in Uganda and identified associated risk factors. In addition, it has demonstrated high levels of antimicrobial resistance in isolates of NTS. This could be because of overuse or misuse of antimicrobials in poultry production. Also importantly, the insights provided in this study justifies a strong case for strengthening One Health practices and this will contribute to the development of NTS control strategies at local, national and international levels. Electronic supplementary material The online version of this article (10.1186/s12917-017-1291-1) contains supplementary material, which is available to authorized users.

Background Members of the Mycobacterium avium complex (MAC) cause disease in both human and animals. Their ubiquitous nature makes them both successful microbes and difficult to source track. The precise characterization of MAC species is a fundamental step in epidemiological studies and evaluating of possible reservoirs. This study aimed at identifying and characterizing Mycobacterium avium subsp. hominissuis isolated from human, slaughter cattle and pigs in various parts of the Uganda cattle corridor (UCC) at two temporal points using variable number of tandem repeat (VNTR) analysis. Methods A total of 46 M. avium isolates; 31 from 997 pigs, 12 from 43 humans biopsies and three from 61 cattle lesions were identified to subspecies level using IS 1245 and IS 901 PCR, thereafter characterized using VNTR. Twelve loci from two previously described VNTR methods were used and molecular results were analyzed and interpreted using Bionumerics 6.1. Principal findings 37 of the isolates were identified as M. avium subsp. hominissuis and four as M. avium subsp. avium , while five could not be differentiated, possibly due to mixed infection. There was distinct clustering that coincides with the temporal and spatial differences of the isolates. The isolates from humans and cattle in the North Eastern parts of the UCC shared identical VNTR genotypes. The panel of loci gave an overall discriminatory power of 0.88. Some loci were absent in several isolates, probably reflecting differences in isolates from Uganda/Africa compared to isolates previously analyzed by these methods in Europe and Asia. Conclusions The findings indicate a molecular difference between M. avium subsp. hominissuis isolates from pigs in Mubende and cattle and human in the rest of the UCC. Although human and cattle shared VNTR genotypes in the North Eastern parts of the UCC, it is most likely a reflection of a shared environmental source.

In the originally published article, the name of the fifth author was incorrectly presented as Godfroid Jacques. The correct name is Jacques Godfroid.

Background: The importance of civil society organisations in health care delivery systems cannot be under-rated in sub-SaharanAfricaand other developing nations worldwide. Civil society organisations play a central role in service delivery and development of democracy. However, little is known about the roles and achievements of Civil Society Organisations (CSOs) in healthcare. The study aimed at exploring the role of civil society organisations in health care delivery system particularly in children immunization. Methods: A questionnaire survey involving 282 households was conducted. Data were analysed using descriptive statistics followed by multivariable logistic regression. Results: Ninety seven percent (97%) confirmed that CSOs/NGOs healthcare facilities played a major role in healthcare service delivery. 84% travelled long distances to access the healthcare services including child immunisation services. Travelling long distances (>2 km) to access for health care services including immunization compared to short distance (enguli) compared to not having a food store (enguli) (OR = 2.3, P = 0.002), having separate animal houses compared to not having livestock houses (OR = 0.09, P = 0.0001), and owning a bicycle compared to not having a bicycle (OR = 2.2, P = 0.005) are important determinants for the number of clients at CSO health centers. Further, possessing and using a cellphone compared to no cellphone (OR = 3.7, P = 0.001), Possessing and watching a television compared to not having a television (OR = 2.4, P = 0.002), educated compared to not acquiring any formal education (OR = 0.084, P = 0.0001), and female compared to male respondent (OR = 0.49, P = 0.0045) are other most important factors likely to determine the numbers of clients at the CSO healthcare. Conclusion: Geographies of CSO and community socioeconomics strongly determine the operations and the roles played by the CSO healthcare services in Uganda. Further studies to assess the role of CSO health service providers in other healthcare services need to be done.

Owing to frequent reports of suspected outbreaks and the presence of reservoir hosts and vectors (warthogs, bushpigs and O. moubata ticks), African swine fever (ASF) is believed to be an endemic disease in Uganda. There have, however, been very few studies carried out to confirm its existence in Uganda. This study was carried out to describe the prevalence of ASF based on pathologic lesions and analysis of serum samples from slaughtered pigs during a suspected outbreak in the Mubende district of Uganda. The study was based on visits to 22 slaughterhouses where individual pigs were randomly selected for a detailed ante-mortem and post-mortem inspections. Sera were also collected for laboratory analysis. A total of 997 pigs (53.7% male and 46.3% female) were examined for lesions suggestive of ASF and sero-positivity of sera for ASF antibodies. The sera were tested using enzyme-linked immunosorbent assay (ELISA) and positive samples were further confirmed with an immunoblot assay. The results showed that 3.8% (38/997) of the pigs examined had clinical signs and post-mortem lesions suggestive of ASF. Two of 997 (0.2%) sera analysed were positive for ASF antibodies. Of the sub-counties investigated, Bagezza (12%) and Kiyuni (11%) had the highest prevalence of lesions suggestive of ASF based on ante- and post-mortem examination results, while Mubende town council (1.7%) had the lowest. This study found a low number of pigs (3.8%) with lesions suggestive of ASF at slaughter and an even lower number of pigs (0.2%) that were seropositive at slaughter, however a significantly higher number of pigs were slaughtered during the outbreak as a strategy for farmers to avoid losses associated with mortality.

To date, the public health relevance of mycobacterial infections in pigs is not well investigated despite high risk of infection. Recently, there has been a documented increase in opportunistic infections and risk of acquiring opportunistic mycobacterial infections in HIV/AIDS patients in Mubende district; unfortunately, there has been no published information on the epidemiology of mycobacterial infections in this area. This study was carried out between September 2008 and February 2009. Investigations were done to assess the prevalence and associated risk factors of mycobacterial infections in slaughtered pigs in Mubende district of Uganda. A total of 997 pigs (53.7% male and 46.3% female) from 31 different slaughterhouses were examined for the presence of lesions compatible with TB and mycobacterial infections. Pathologic tissue specimens were collected for culturing and isolation of mycobacteria. A cross-sectional technique was used based on convenient visits to slaughterhouses but random selection of individual slaughtered pigs for a detailed post-mortem inspection on a daily basis. The results reflected a 9.3% and 3.1% (95% CI) prevalence of Mycobacterium species based on necropsy examinations and culture isolation, respectively. The highest prevalence of mycobacterial infection was recorded in Buwekula County (the mixed agro-zone) whilst the lowest was in Kassanda County (pastoral zone). A multivariable logistical regression analysis identified age (P ≤ 0.001) and sex (P ≤ 0.05) as risk factors for mycobacterial infections in pigs. Post-estimation statistics of the regression model evaluation and validation fit it well into the data (HL, χ 2 = 5.9; P = 0.69 for necropsy, HL χ 2 = 2.9; P = 0.94 for culturing). This study documented a high prevalence of mycobacterial infections in slaughter pigs in Mubende district. The fact that pigs and human often share common housing and environment poses a high risk of zoonotic transmission. This then warrants further molecular investigation to identify the specific Mycobacterium species and their public health importance in this area.

Multiple strain tuberculosis (TB) infections are now an acceptable facet of tuberculosis epidemiology. Identification of patients infected with more than one strain gives an insight in disease dynamics at individual and population level. This study therefore aimed at identifying multiple strain infections among TB infected patients. Furthermore, to determine factors associated with multiple strain infections in Mubende district of Uganda. A total of 72 Mycobacterium tuberculosis isolates from patients at Mubende regional referral hospital were characterized using 15 loci MIRU-VNTR, Spoligotyping and deletion analysis. Genotypic and epidemiological data were analyzed using MIRU-VNTR plus , Bionumerics software version 6.1 and an exact logistic regression model respectively. Eight (11.1%) of the 72 patients had mixed TB infections. Five were exclusively pulmonary mixed infections while three had both pulmonary and extra-pulmonary infections (Compartmentalized TB infections). Unlike previous studies that have linked this phenomenon to Beijing strains, multiple strains in this study belonged to T2-Uganda, X2 and T1 lineages. Two of the pulmonary mixed infections were resistant to rifampicin or isoniazid. All except one were HIV positive, newly diagnosed cases and urban residents of Mubende district. The study revealed that one in nine urban dwelling, HIV/TB co-infected patient were infected with more than one M. tuberculosis strains. The molecular findings give indications of a vital component of the disease dynamics that is most likely under looked at clinical level.

Background The burden of human leptospirosis in Uganda is unknown. We estimated the seroprevalence of Leptospira antibodies, probable acute/recent leptospirosis, and risk factors for seropositivity in humans in rural Western Uganda. Methodology and Principal Findings 359 non-pregnant adults visiting the Kikuube and Kigorobya Health Centers were sequentially recruited during March and April 2014. A health history survey and serum were collected from consented participants. Overall, 69% reported having fever in the past year, with 49% reporting malaria, 14% malaria relapse, 6% typhoid fever, 3% brucellosis, and 0% leptospirosis. We tested sera by microscopic agglutination test (MAT) against eight Leptospira serovars representing seven serogroups. Leptospira seroprevalence was 35% (126/359; 95%CI 30.2–40.3%) defined as MAT titer ≥ 1:100 for any serovar. The highest prevalence was against L. borgpetersenii Nigeria (serogroup Pyrogenes) at 19.8% (71/359; 95%CI 15.9–24.4%). The prevalence of probable recent leptospirosis (MAT titer ≥1:800) was 1.9% (95%CI 0.9–4.2%) and uniquely related to serovar Nigeria (serogroup Pyrogenes). Probable recent leptospirosis was associated with having self-reported malaria within the past year (p = 0.048). Higher risk activities included skinning cattle (n = 6) with 12.3 higher odds (95%CI 1.4–108.6; p = 0.024) of Leptospira seropositivity compared with those who had not. Participants living in close proximity to monkeys (n = 229) had 1.92 higher odds (95%CI 1.2–3.1; p = 0.009) of seropositivity compared with participants without monkeys nearby. Conclusions/Significance The 35% prevalence of Leptospira antibodies suggests that exposure to leptospirosis is common in rural Uganda, in particular the Nigeria serovar (Pyrogenes serogroup). Leptospirosis should be a diagnostic consideration in febrile illness and “smear-negative malaria” in rural East Africa., Author Summary Leptospirosis is an emerging zoonotic disease caused by bacteria of the genus Leptospira. Despite its relatively common frequency, mild/moderate leptospirosis often goes unrecognized, due to its usually non-specific symptoms of fever, vomiting, and malaise. Knowledge of leptospirosis in Uganda is limited, and the disease may often be misdiagnosed as malaria. This study sought to define the percentage of healthcare seeking Ugandans in rural Western Uganda who have antibodies to Leptospira in their blood, suggesting prior exposure. We found 35% of study participants had antibodies to at least one Leptospira serovar, predominantly L. borgpetersenii sv Nigeria representing the Pyrogenes serogroup (20% of all participants). Individuals with increased odds of having antibodies to leptospires included participants who skinned cattle and those who reported monkeys near their home. Individuals who self-reported recent diagnosis of malaria were more likely to have leptospirosis antibodies. Antibodies to leptospirosis are not lifelong, typically lasting a few years. The high 35% seroprevalence suggests there is ongoing exposure. Further studies are needed to understand the burden of leptospirosis in rural Africa, the risk factors associated with exposure, and the public health opportunities to mitigate leptospirosis.

Adrian Muwonge1, Ashemeire Patience4, Clovice Kankya2, Demelash Biffa5, Eystein Skjerve1 and James Oloya3 1Department of Food Safety and Infection Biology, Norwegian School of Veterinary Science 2Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Makerere University 3Department of Epidemiology and Biostatistics/ Population Health, college of Public health, 132 Coverdell centre, University of Georgia Athens, 4Faculty of Community Psychology, Makerere University, 5Schools of Veterinary Medicine, Hawassa University, 1Norway 2,4Uganda 3USA 5Ethiopia

Background Two types of lechwe antelopes exclusively exist in their natural ecosystems in Zambia; the Black lechwe (Kobus leche smithemani) and the Kafue lechwe (Kobus leche kafuensis). Despite inhabiting similar ecosystems, tuberculosis has been reported in Kafue lechwe without its documentation in Black lechwe antelopes. However, the past few decades have seen a drastic decline in both lechwe populations. Whereas studies have postulated that infectious diseases such as tuberculosis are having a negative impact on the Kafue lechwe population, no information is available on Black lechwe antelopes. Thus this study was conducted to investigate tuberculosis in Black lechwe antelopes of the Bangweulu swamps in comparison with the Kafue lechwe antelopes of Lochinvar. Findings A total of 44 lechwe antelopes (Black (n = 30): Kafue (n = 14) were sampled from Bangweulu and Lochinvar respectively. A positive case was defined with findings of gross lesions with Ziehl Nielsen and culture confirmation. Out of the 14 animals examined in Lochinvar, 21.4% [95% CI: 15.4, 44.4%] had necropsy lesions consistent with tuberculosis. The corresponding samples from 30 Black lechwe of Bangweulu yielded negative results on all the three tests. Conclusions Current findings from this study intimate the possible absence of tuberculosis in Black lechwe antelopes whilst confirming the presence of tuberculosis in Kafue lechwe of the Kafue basin. The absence of tuberculosis in the Black lechwe suggests that the observed population decline may not be caused by tuberculosis. However, without detailed molecular epidemiological studies it is not possible to determine the association of M. bovis infection in sympatric animal populations. The possible role of transmission of tuberculosis between wildlife and cattle is discussed herein. Findings

Background: The importance of non-tuberculous mycobacteria (NTM) infections in humans and animals in subSaharan Africa at the human-environment-livestock-wildlife interface has recently received increased attention. NTM are environmental opportunistic pathogens of humans and animals. Recent studies in pastoral ecosystems of Uganda detected NTM in humans with cervical lymphadenitis and cattle with lesions compatible with bovine tuberculosis. However, little is known about the source of these mycobacteria in Uganda. The aim of this study was to isolate and identify NTM in the environment of pastoral communities in Uganda, as well as assess the potential risk factors and the public health significance of NTM in these ecosystems. Method: A total of 310 samples (soil, water and faecal from cattle and pigs) were examined for mycobacteria. Isolates were identified by the INNO-Lipa test and by 16S rDNA sequencing. Additionally, a questionnaire survey involving 231 pastoralists was conducted during sample collection. Data were analysed using descriptive statistics followed by a multivariable logistic regression analysis. Results: Forty-eight isolates of NTM were detected; 25.3% of soil samples, 11.8% of water and 9.1% from animal faecal samples contained mycobacteria. Soils around water sources were the most contaminated with NTM (29.8%). Of these samples, M. fortuitum-peregrinum complex, M. avium complex, M. gordonae, and M. nonchromogenicum were the most frequently detected mycobacteria. Drinking untreated compared to treated water (OR = 33), use of valley dam versus stream water for drinking and other domestic use (OR = 20), sharing of water sources with wild primates compared to antelopes (OR = 4.6), sharing of water sources with domestic animals (OR = 5.3), and close contact with cattle or other domestic animals (OR = 13.8) were the most plausible risk factors for humans to come in contact with NTM in the environment. Conclusions: The study detected a wide range of potentially pathogenic NTM from the environment around the pastoral communities in Uganda. Drinking untreated water and living in close contact with cattle or other domestic animals may be risk factors associated with the possibility of humans and animals acquiring NTM infections from these ecosystems. Background Although members of the Mycobacterium tuberculosis complex (MTC) are responsible for the majority of mycobacterial infections worldwide, environmental opportunistic infections due to non-tuberculous

Background Nontuberculous mycobacteria (NTM) are emerging opportunistic pathogens whose role in human and animal disease is increasingly being recognized. Major concerns are their role as opportunistic pathogens in HIV/AIDS infections. The role of open natural water sources as source and livestock/wildlife as reservoirs of infections to man are well documented. This presents a health challenge to the pastoral systems in Africa that rely mostly on open natural water sources to meet livestock and human needs. Recent study in the pastoral areas of Uganda showed infections with same genotypes of NTM in pastoralists and their livestock. The aim of this study was to determine the environmental, animal husbandry and socio-demographic factors associated with occurrence and the pastoral community knowledge of mycobacterial infections at the human-environment-livestock/wildlife interface (HELI) areas in pastoral ecosystems of Uganda. Methods Two hundred and fifty three (253) individuals were subjected to a questionnaire survey across the study districts of Nakasongola and Mubende. Data were analyzed using descriptive statistics and multivariable logistic regression analysis. Results Humans sharing of the water sources with wild animals from the forest compared to savannah ecosystem (OR = 3.3), the tribe of herding pastoral community (OR = 7.9), number of rooms present in household (3-5 vs. 1-2 rooms) (OR = 3.3) were the socio-demographic factors that influenced the level of knowledge on mycobacterial infections among the pastoral communities. Tribe (OR = 6.4), use of spring vs. stream water for domestic use (OR = 4.5), presence of sediments in household water receptacle (OR = 2.32), non separation of water containers for drinking and domestic use (OR = 2.46), sharing of drinking water sources with wild animals (OR = 2.1), duration of involvement of >5 yrs in cattle keeping (OR = 3.7) and distance of household to animal night shelters (>20 meters) (OR = 3.8) were significant socio-demographic factors associated with the risk of occurrence of mycobacterioses among the pastoral communities in Uganda. Conclusion The socio-demographic, environmental and household related factors influence the risk of occurrence as well as pastoralists' knowledge of mycobacterial infections in the pastoral households at the human-environment-livestock/wildlife pastoral interface areas of Uganda.

Background Tuberculosis (TB) remains a global public health problem whose effects have major impact in developing countries like Uganda. This study aimed at investigating genotypic characteristics and drug resistance profiles of Mycobacterium tuberculosis isolated from suspected TB patients. Furthermore, risk factors and economic burdens that could affect the current control strategies were studied. Methods TB suspected patients were examined in a cross-sectional study at the Mubende regional referral hospital between February and July 2011. A questionnaire was administered to each patient to obtain information associated with TB prevalence. Isolates of M. tuberculosis recovered during sampling were examined for drug resistance to first line anti-TB drugs using the BACTEC-MGIT960TMsystem. All isolates were further characterized using deletion analysis, spoligotyping and MIRU-VNTR analysis. Data were analyzed using different software; MIRU-VNTR plus, SITVITWEB, BioNumerics and multivariable regression models. Results M. tuberculosis was isolated from 74 out of 344 patients, 48 of these were co-infected with HIV. Results from the questionnaire showed that previously treated TB, co-infection with HIV, cigarette smoking, and overcrowding were risk factors associated with TB, while high medical related transport bills were identified as an economic burden. Out of the 67 isolates that gave interpretable results, 23 different spoligopatterns were detected, nine of which were novel patterns. T2 with the sub types Uganda-I and Uganda-II was the most predominant lineage detected. Antibiotic resistance was detected in 19% and multidrug resistance was detected in 3% of the isolates. Conclusion The study detected M. tuberculosis from 21% of examined TB patients, 62% of whom were also HIV positive. There is a heterogeneous pool of genotypes that circulate in this area, with the T2 lineage being the most predominant. High medical related transport bills and drug resistance could undermine the usefulness of the current TB strategic interventions.

Background The importance of infections caused by non-tuberculous mycobacteria (NTM) in animals and humans has gained considerable recognition during the past few years. In the developed world, where pig production is extensively practiced, studies on mycobacterial infections and related control strategies have received increasing attention. The infections are reported to be caused by a wide spectrum of NTM. Unfortunately, these infections have been less recognized in sub-Saharan Africa owing to lack of awareness and systematic studies. In this study we aimed at isolating and identifying species of mycobacteria involved in causing infections in slaughter pigs in Mubende district of Uganda. Furthermore we wanted to identify factors associated with infection prevalence in the study area. Methods A total of 363 lymph nodes were collected and cultured for the presence of mycobacteria. Isolates were identified by 16S rDNA gene sequencing. A questionnaire survey was administered to identify production related factors associated with infection prevalence. Data were assembled and analysed using descriptive statistics and mixed effects logistic regression analysis. Results Mycobacteria were detected in 39 % (143/363) of the examined lymph nodes, 63 % (59/93) of lymph nodes with gross lesions typical of mycobacteriosis and 31% (84/270) of lymph nodes with no visible lesions. Nineteen per cent of the isolated mycobacteria were identified as Mycobacterium (M) avium, of these 78% and 22% were M. avium sub sp. Hominissuis and avium respectively. Other mycobacterial species included M. senuense (16%), M. terrae (7%) and M. asiaticum (6%). This study found free range systems (OR = 3.0; P = 0.034) and use of water from valley dams (OR = 2.0; P = 0.049) as factors associated with high prevalence of mycobacteria in slaughter pigs. Conclusions This study demonstrated a high prevalence of NTM infections among slaughter pigs in Mubende district of Uganda. M. avium was the most prevalent of all NTM isolated and identified. Free range system of pig management and valley dam water were the most significant factors associated with NTM prevalence in Mubende district. These findings could be of a major public health concern given that it is in a predominantly pork consuming population with 18% HIV/AIDS prevalence. Therefore, stringent post-mortem inspection at the slaughter houses is of paramount importance to reduce human exposure.

Background Awareness of bovine tuberculosis (BTB) by cattle owners is of extreme importance to policy makers when considering mitigation. However, to our knowledge, little is known on cattle owners' awareness of BTB in Zambia. Similarly, such knowledge is uncommon within and outside Africa. The current study investigates the epidemiological characteristics of BTB in Zambian cattle in relation to awareness by cattle owners in high and low cattle BTB prevalence settings. A cross sectional study was designed and data was gathered based on 106 cattle owners and cattle herds; subjected to an interviewer-administered questionnaire and comparative intradermal tuberculin test using a cut-off for positivity of 4 mm, respectively. Results Reported levels of cattle and wildlife contact by respondents was at 40%, 58.2% and 1.8%, were relatively proportional to herd level prevalence of cattle BTB at 64.8%, 58.1% and 5.9% in Blue lagoon, Lochinvar and Kazungula respectively. Although 42/106 (39.6%) of cattle owners had heard of BTB, only 3 (7%) had an idea on how the disease was spread. Cattle contact with wildlife was associated with high levels of awareness by cattle owners (χ2 = 43.5, df = 2, P < 0.001). Awareness of BTB in low prevalence settings was lower compared to high prevalence settings. Conclusions Our study has revealed low levels of awareness among cattle owners on BTB. These results could be useful for policy makers when planning mitigation measures to consider awareness levels by cattle owners for effective implementation. Such information is useful for determining sensitisation programs for cattle owners before mitigation. These results further provide useful insights that disease control is a multi-factorial process with cattle owners as an integral part that can support policy implementation.