Shamilah Namusisi

In 2014, Uganda was identified as a high-risk country for Ebola Virus Disease (EVD), with a series of outbreaks recorded since 2000. In 2007, the second outbreak in Bundibugyo district resulted in 149 reported cases and 37 confirmed Ebola deaths. Through the outbreak response, a new strain of the Ebola virus ( Bundibugyo ebolavirus) was discovered. Although much is known about the nature of Ebola, including disease signs and symptoms, transmission and management, there is limited understanding of the short and long-term sociocultural impacts of the disease in communities. The study team conducted a focused ethnography in Bundibugyo District 10 years after the 2007 outbreak. Data collection included a review of archival data, participant observation, field notes and 19 in-depth interviews with survivors and affected families. Results underscored short and long term social, cultural and economic disruptions caused by the outbreak. We interpreted findings through an Eco-health framework with an emphasis on ways that underlying stigma accentuated detrimental long-term effects of the outbreak. Affected women, particularly widows, experienced social exclusion, and economic strain, and acknowledged loss of opportunity for a better life for their orphaned children. Deepening fear of the possible recurrence of Ebola resulted in ethnic tension driven by speculations on the 2007 outbreak source. Survivors reported varying persistent health effects including impaired vision and general body weakness. Community members reported positive changes in health seeking behaviors. Health care workers described high levels of alert for early clinical signs of Ebola, a critical factor for early outbreak detection at the community level. Our findings can inform future research, Ebola response, and recovery interventions, particularly those targeting community re-integration and mitigation of the fear and stigma associated with survivorship.

More than 70% of new, emerging, and reemerging infectious diseases are from animal origin. Human interaction with bats has been associated as a driver for various fetal zoonoses, including numerous viral diseases of bat-origin. A lot of serological evidence has been gathered around human-bat interaction, yet very little is known regarding the underlying risk factors at community level. This study was aimed at understanding the human-bat interactions and associated factors among communities in Bundibugyo District in Uganda. A cross-sectional study was conducted using both qualitative and quantitative data collection methods in Harugale, Burondo and Ntandi Subcounties in Bundibugyo District between November 2022 and March 2023. A total of 344 participants were interviewed using a structured questionnaire. Key Informant Interviews (KIIs) were also conducted among purposively selected individuals who have vast knowledge on human-bat interaction. Proportional piling and FGDs were conducted among groups of men, women, and youths to get their insights into human-bat interaction. The study revealed that 54.1% of the respondents were males, 42.1% were aged above 40 years. Households headed by males (APR = 1.31, 95% CI:1.07-1.62, Batwa communities (APR = 3.03, 95% CI:1.87-3.94), residing in urban areas (APR = 1.72, 95 CI%:1.35-2.20), trading of food and animal products (APR = 0.6, 95 CI%:0.36-0.99), no occupation (APR = 0.27, 95 CI%:0.12-0.57) and residing in incomplete houses (APR = 1.57, 95 CI%:1.25-1.98) were significantly associated with exposure of humans to bats. There was high exposure of humans to bats in Ntandi compared to Burondo and Harugale. Women groups highlighted use of bat repellants and killing of bats using sticks as the measures to reduce human bat interaction during the focus group discussions (FGDs). Generally, there is high exposure to bats among human communities in Bundibugyo district which increases the risk of zoonotic disease transmission at human-bat interface. Findings from this study aim to enable the one health interventions to reduce bat-human interaction potential risks in both urban and rural areas and support design of feasible interventions for Bundibugyo district and Uganda at large.

Background More than 70% of new, emerging, and reemerging infectious diseases are from animal origin. Human interaction with bats has been associated as a driver for various fetal zoonoses, including numerous viral diseases of bat-origin. A lot of serological evidence has been gathered around human-bat interaction, yet very little is known regarding the underlying risk factors at community level. This study was aimed at understanding the human-bat interactions and associated factors among communities in Bundibugyo District in Uganda. Methods A cross-sectional study was conducted using both qualitative and quantitative data collection methods in Harugale, Burondo and Ntandi Subcounties in Bundibugyo District between November 2022 and March 2023. A total of 344 participants were interviewed using a semi structured questionnaire installed on the Kobo Collect Software. Key Informant interviews were also conducted among purposively selected individuals who have vast knowledge on human-bat interaction. Proportional piling and focus group discussions were conducted among groups of men, women, and youths to get their insights into human-bat interaction. Quantitative data was cleaned using Microsoft Excel and exported to Stata 15 for analysis. Qualitative data was analyzed using Atlas. ti (version 8.0). Our study was limited by response and recall bias during data collection. Results The study revealed that 54.1% of the respondents were males, 42.1% were aged above 40 years. Households headed by males (APR=1.31, 95% CI:1.07-1.62, Batwa communities (APR=3.03, 95% CI:1.87-3.94), residing in urban areas (APR=1.72, 95 CI%:1.35-2.20), trading of food and animal products (APR=0.6, 95 CI%:0.36-0.99), no occupation (APR=0.27, 95 CI%:0.12-0.57) and residing in incomplete houses (APR=1.57, 95 CI%:1.25-1.98) were significantly associated with exposure of humans to bats. There was high exposure of humans to bats in Ntandi compared to Burondo and Harugale. Women groups highlighted use of bat repellants and killing of bats using sticks as the measures to reduce human bat interaction during the Focus Group Discussions. Conclusion Generally, there is high exposure to bats among human communities in Bundibugyo district which increases the risk of zoonotic disease transmission at human-bat interface. Findings from this study aim to enable the one health interventions to reduce bat-human interaction potential risks in both urban and rural areas and support design of feasible interventions for Bundibugyo district and Uganda at large.

In 2014, Uganda was identified as a high-risk country for Ebola Virus Disease (EVD), with a series of outbreaks recorded since 2000. In 2007, the second outbreak in Bundibugyo district resulted in 149 reported cases and 37 confirmed Ebola deaths. Through the outbreak response, a new strain of the Ebola virus ( Bundibugyo ebolavirus) was discovered. Although much is known about the nature of Ebola, including disease signs and symptoms, transmission and management, there is limited understanding of the short and long-term sociocultural impacts of the disease in communities. The study team conducted a focused ethnography in Bundibugyo District 10 years after the 2007 outbreak. Data collection included a review of archival data, participant observation, field notes and 19 in-depth interviews with survivors and affected families. Results underscored time-limited social, cultural and economic disruptions caused by the outbreak. We interpreted findings through an Eco-health framework with an emphasis on ways that underlying stigma accentuated detrimental long-term effects of the outbreak. Affected women, particularly widows, experienced social exclusion, and economic strain, and acknowledged loss of opportunity for a better life for their orphaned children. Deepening fear of the possible recurrence of Ebola resulted in ethnic tension driven by speculations on the 2007 outbreak source. Survivors reported varying persistent health effects including impaired vision and general body weakness. Community members reported positive changes in health seeking behaviors. Health care workers described high levels of alert for early clinical signs of Ebola, a critical factor for early outbreak detection at the community level. Our findings can inform future Ebola response and recovery interventions, particularly those targeting community re-integration and a mitigation of the fear and stigma associated with survivorship.

In biodiversity hotspots, there is often tension between human needs and conservation, exacerbated when protected areas prevent access to natural resources. Forest-dependent people may compensate for exclusion by managing unprotected forests or cultivating planted woodlots. Outside Bwindi Impenetrable National Park in Uganda, household wood product needs are high and population growth puts pressure on the environment. We investigated the role of privately and collectively managed woodlots in provisioning wood products and supporting local livelihoods. We found that households relied heavily on woodlots for daily needs and as resources during time of need. We also found that locally relevant social institutions, called stretcher groups, played a role in the management of woodlots, providing shared community resources. Privately and collectively owned woodlots support local livelihoods and wood product needs in the region. Long-term management of forests in Uganda should consider the value of woodlots and the mechanisms required to support them.

Zoonotic diseases pose a significant health challenge at the human–wildlife interface, especially in Sub-Saharan Africa where ecosystem services contribute significantly to local livelihoods and individual well-being. In Uganda, the fragmented forests of Hoima district, form part of a “biodiversity and emerging infectious disease hotspot” composed of communities with high dependency on these wildlife protected areas, unaware of the associated health risks. We conducted a cross-sectional mixed methods study from March to May 2017 and interviewed 370 respondents, using a semi-structured questionnaire from eight villages neighbouring forest fragments in Hoima District, Uganda. Additionally, a total of ten (10) focus group discussions (FGDs) consisting of 6–10 men or women were conducted to further explore the drivers of hunting and perception of zoonotic disease risks at community level. Qualitative and quantitative data were analysed using content analysis and STATA version 12 respectively. We found twenty-nine percent (29.0%, CI: 24.4–33.9) of respondents were engaged in hunting of wildlife such as chimpanzee (Pan troglodytes) and 45.8% (CI: 40.6–51.0), cane rats (Thryonomyidae spp). Acquisition of animal protein was among the main reasons why communities hunt (55.3%, CI: 50.1–60.4), followed by “cultural” and “medicinal” uses of wildlife and or its parts (22.7%, CI: 18.6–27.4). Results further revealed that hunting and bushmeat consumption is persistent for other perceived reasons like; bushmeat strengthens the body, helps mothers recover faster after delivery, boosts one’s immunity and hunting is exercise for the body. However, respondents reported falling sick after consumption of bushmeat at least once (7.9%, CI: 5.3–11.1), with 5.3% (CI: 2.60–9.60) reporting similar symptoms among some family members. Generally, few respondents (37.0%, CI: 32.1–42.2) were aware of diseases transmissible from wildlife to humans, although 88.7% (CI: 85.0–92.0) had heard of Ebola or Marburg without context. Hunting non-human primate poses a health risk compared to edible rats (cane rats) and wild ruminants (cOR = 0.4, 95% CI = 0.1–0.9) and (cOR = 0.7, 95% CI = 0.2–2.1) respectively. Study suggests some of the pathways for zoonotic disease spillover to humans exist at interface areas driven by livelihoods, nutrition and cultural needs. This study offers opportunities for a comprehensive risk communication and health education strategy for communities living at the interface of wildlife and human interactions.