Prevalence, risk factors and socio -economic effects of human and bovine brucellosis in post conflict northern Uganda

Abstract

Brucellosis is a zoonotic disease with worldwide impact on both animal production and public health. Human brucellosis is closely associated with the disease occurrence in animals, and it is endemic in many developing countries, including Uganda. Effective brucellosis control is significantly impacted by the knowledge, attitudes and practices of key stakeholders, including the community, policy makers medical and veterinary workers. This underscores the importance of having data on the magnitude and risk factors, as well as information on the social and economic impact of the disease, which in turn requires an efficient indicative method. In view of this, a cross-sectional study was conducted from March 2014 to February 2015 covering seventeen selected health facilities in four purposively chosen districts of Apac, Gulu, Lira and Pader in post-conflict northern Uganda. The overall objective of this study was to establish the state of occurrence and the social economic dynamics of brucellosis in post-conflict-northern Uganda. The specific objectives were firstly to determine the knowledge, attitudes, and practices of the community, medical and veterinary workers regarding brucellosis in post-conflict northern Uganda. Secondly to estimate the seroprevalence of brucellosis in prolonged fever patients and to identify modifiable risk factors for the infection in humans. Thirdly to estimate the seroprevalence and risk factors for bovine brucellosis in cattle kept in households where individual diagnosed with the disease live. Fourthly to examine the social and economic significance of brucellosis in post-conflict northern Uganda. Fifthly to evaluate the diagnostic accuracy of the commonly used serological tests against Polymerase Chain Reaction as a reference test. A total of 251 community members, 59 medical and 29 veterinary workers participated in the study. A pretested structured questionnaire was used to collect data on knowledge, attitude, practices, risk factors, social and economic effects of Brucellosis. Human and bovine sera from 251 subjects and 311 cows respectively was analyzed for brucellosis using indirect Enzyme Linked Immunosorbent Assay. Data was analyzed using SPSS (SPSS Inc. Chicago, USA Version 16.0). Categorical variables were presented as proportions. The effect of sociodemographic data was assessed using Chi-square test and Odds Ratio at 95% confidence level. The burden of Brucellosis on people’s health was determined by calculating disability-adjusted life years (DALYs). To evaluate the accuracy of serological tests, Epitools online statistical software (https://epitools.ausvet.com.au/) was employed to analyze diagnostic parameters including Sensitivity, Specificity, (McNemer X2, Kappa and Accuracy of the study serological tests against Polymerase Chain Reaction as a reference test for diagnosing human brucellosis. Regarding Brucellosis control and eradication most study participants had positive attitude but low levels of knowledge and inadequate practices. Education level was associated with knowledge and practices among community participants. Seroprevalence of human brucellosis was estimated at 18.7% (n=251). Rearing livestock (p < 0.005) and consumption of unpasteurised milk (p= 0.023) were factors associated with human brucellosis. Animal level bovine brucellosis was estimated at 19.3% (n=311) and the DALY calculations estimated a loss of 0.65 years of full healthy life years. An individual infected with brucellosis was likely to spend $68.56 USD to treat the disease and an estimate of $244.40 USD was lost annually per household with a brucellosis seropositive herd (due to milk reduction and infertility). There was no significant difference between Brucellosis seroprevalence results estimated by the modified Rose Bengal Plate Test (McNemer X2, p= 0.343) and Polymerase Chain Reaction a reference test. High education level increases knowledge and improves practices regarding brucellosis prevention and control. The positive attitude provides an opportunity to stimulate formulation of effective policies for implementing low-cost methods to enhance drives for controlling animal bovine brucellosis with a resultant impact of reducing human brucellosis. The social and economic effects of brucellosis is significant and calls for collaborative efforts between relevant sectors, to monitor and mitigate the impacts of the disease.