Rift Valley Fever (RVF) is a mosquito-borne zoonotic disease that poses significant threats to livestock and human health in Uganda, particularly in ecologically vulnerable districts such as Apac and Lira. Despite its public health importance, limited understanding of community knowledge, attitudes, and practices (KAP) continues to hinder effective prevention and control. This study examined RVF-related KAP in Apac and Lira Districts, Uganda using theory of planned behavior (TPB). Data were collected from six sub-counties using focus group discussions (FGDs), key informant interviews (KIIs), and a structured survey administered to 136 randomly selected livestock-keeping households. Thematic analysis was used to explore patterns across TPB domains (attitudes, subjective norms, and perceived behavioral control), while principal component analysis (PCA) identified latent dimensions underlying RVF risk perception and preventive behavior. High emotional concern was observed, with 58

Introduction Leptospirosis is a major but under-reported zoonotic disease, and epidemiological data from South Sudan remain limited. This study estimated the true prevalence of Leptospira spp. exposure and identified associated risk factors among slaughterhouse workers and slaughtered cattle in Western Bahr El Ghazal.Methods A cross-sectional study was conducted in major slaughterhouses. Serum samples from workers and cattle were tested using the microscopic agglutination test (MAT). Bayesian hierarchical models were used to adjust for diagnostic test imperfections and to estimate true prevalence. Structured questionnaires captured occupational and animal-level risk factors for analysis within the Bayesian framework.Results The estimated true prevalence was 10% in slaughterhouse workers and 85% in slaughtered cattle, indicating a high zoonotic exposure risk. Among workers, flaying, inconsistent use of protective equipment, and handling higher numbers of carcasses per day were significantly associated with seropositivity. In slaughtered cattle, exposure varied by breed, age, and sex. The model further indicated a 78% probability that a randomly selected slaughterhouse was affected and a 65% probability that infection levels among workers remained below 5%.Conclusions This study provides the first Bayesian-based estimates of leptospiral exposure in slaughterhouse settings in Western Bahr El Ghazal. The findings underscore the need to improve occupational safety, strengthen surveillance, and apply One Health approaches to reduce zoonotic transmission. Despite limitations, including lack of environmental data, the Bayesian framework proved effective for generating robust prevalence estimates in a resource-limited setting. Expanded geographic coverage and incorporation of environmental assessments are recommended to inform targeted leptospirosis control strategies.

Uganda has the highest per-capita pork consumption in East Africa, with most pigs raised in free-range smallholder systems. Pork is largely produced and sold in informal markets with limited infrastructure, regulation, and hygiene. By forward-tracing pork from slaughter to retail, this study assessed factors associated with contamination with nontyphoidal Salmonella (NTS) and total bacterial count (TBC), and identified critical control points along the pork value chain. Two pork value chains were evaluated: a Multiple Slaughter unit Value Chain (MSVC), 15 slaughter points supplying 27 retail outlets; and a Single Slaughter unit Value Chain (SSVC), one slaughter point supplying 35 retail outlets. A repeat cross-sectional survey conducted across three regions between December 2021 and December 2022 collected 1,535 samples and hygiene observations. Overall NTS prevalence was 30.5% on carcasses (95% CI: 23.6-38.2), 33.1% in raw pork (95% CI: 26.1-40.6), and 4.0% in cooked pork (95% CI: 1.9-8.4). Mean TBC in the MSVC was 5.70 Log CFU/cm2 on carcasses, 6.00 Log CFU/g in raw pork, and 1.23 Log CFU/g in cooked pork, compared with 5.32, 5.34, and 0.03 Log CFU/g, respectively, in the SSVC. Although raw pork TBC complied with regional limits (<6.0 Log CFU/g), they exceeded international standards (<5.6 Log CFU/g). TBC was significantly higher in the MSVC (p < 0.05), but NTS prevalence did not differ between value chains (p > 0.05). Contaminated meat handlers' hands, rinsing water, floors, and chopping surfaces were identified as key contributors to microbial contamination. These findings highlight substantial contamination along the pork value chain and the need to strengthen hygiene prerequisites and critical control points to improve pork safety.

Introduction A range of climate-sensitive diseases are endemic to the Horn of Africa, which is increasingly vulnerable to climate extremes. Global health agencies recognise the need to abandon siloed approaches to climate change and health by integrating health in climate policies, strategies, and guidelines. This structured document review aimed to examine the extent to which health, and specifically infectious diseases, are integrated into climate governance documents in this region, with a focus on Ethiopia, Kenya, Somalia, and Uganda. Methods A desk-based search strategy identified climate governance documents from (1) open-access climate policy databases; (2) targeted websites; (3) citation chaining; and (4) a structured literature search. Data were extracted to summarise document attributes, aims, geographic scope, integration of health topics, and infectious diseases integration, rationale for inclusion, and recommendations. Results Ninety-eight documents were included, from Ethiopia (18.4%), Kenya (63.3%), Somalia (9.2%), Uganda (6.1%), and the broader region (3.0%). Most documents were affiliated with the Government (94.9%) or intergovernmental organisations (5.1%). Dedicated human health and infectious disease sections were identified in 59.2% and 5.1% of documents, respectively. Integrated health topics included infectious diseases (89.7%; predominately malaria, cholera or acute watery diarrhoea, and typhoid fever), nutrition (55.2%), and maternal or child health (39.7%). Conclusions Characterisation of climate governance documents in the Horn of Africa highlighted variable integration of health and infectious diseases. These results support calls for improved coherence between climate and health governance processes and evidence translation at research-policy interfaces. The structured search and review methodology may be adopted in other climate-vulnerable contexts, in collaboration with climate and health stakeholders.

Rift Valley fever (RVF) is a zoonotic viral disease of major veterinary public health and economic importance, transmitted primarily by mosquitoes and associated with significant livestock losses and human infections. Despite its epidemic potential and its demonstrated endemicity in western Uganda, data on its seroprevalence and associated factors from northern Uganda remain limited. This study determined the seroprevalence of RVF and its associated factors in unvaccinated livestock in Apac, Arua, and Lira districts. A cross-sectional study was conducted in selected sub-counties of Apac, Lira, and Arua districts in northern Uganda. Blood samples were collected from 704 randomly selected unvaccinated livestock (cattle, goats, and sheep). Sera were tested for RVF IgG antibodies using a competitive ELISA (IDvet) kit. Data on animal and herd characteristics were collected through interviews of livestock owners using a structured questionnaire. A robust modified Poisson regression analysis was done to estimate prevalence ratios for the factors associated with RVF IgG seropositivity. RVF IgG seroprevalence was 28

Background Leptospirosis is substantially underdiagnosed across sub-Saharan Africa, with its contribution to acute undifferentiated fever (AUF) poorly characterized. We determined the prevalence, risk factors, and clinical profile of leptospirosis among adolescents and adults presenting with AUF at a referral hospital and health centre in Hoima, western Uganda. Methods: In a prospective health facility-based study with convalescent follow-up, blood and urine from AUF patients were tested by LipL32 real-time PCR (qPCR) and microscopic agglutination (MAT). Leptospirosis was confirmed by qPCR positivity, a single test MAT titre of 1:800, or at least a fourfold titre rise or seroconversion in paired sera. Seroconversion was defined as a change from negative or 1:50 to 1:100 (conservative) or 1:200 (lenient). Seroprevalence was defined as a MAT titre of 1:100 or above in any sample. Risk factors were identified by multivariable logistic regression. Results: Among 330 AUF patients, acute leptospirosis prevalence was 27.0% (95% CI 22.3 to 32.1; conservative) and 32.7% (95% CI 27.7 to 38.1; lenient), comparable to malaria at 30.3% (95% CI 25.3 to 35.3), with co-infection in 8.8% (95% CI 5.7 to 11.8). qPCR detected Leptospira DNA in 9.1%, with 63.3% of qPCR-positive cases serologically confirmed and 24.4% of serological cases, qPCR-positive. Seroprevalence was 35.8% (95% CI 30.6 to 41.2); L. interrogans serovar Bataviae was predominant (18.2% of serological cases), reported here for the first time in Uganda. Skinning animals (aOR 5.19, 95% CI 1.40 to 21.16) and mosquito exposure (aOR 2.31, 95% CI 1.17 to 4.70) were the only independent risk factors in multivariable analysis. Discussion: Leptospirosis occurs as frequently as malaria among AUF patients in Hoima and warrants inclusion in Uganda's national febrile illness guidelines. The association of leptospirosis with skinning of animals suggests a potential role of animal exposure in leptospirosis transmission. Poor qPCR-MAT concordance confirms that accurate case ascertainment requires combined molecular and serological diagnostics. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Ugandan IDIREC (approval number: IDI-REC-2023-43), and the Uganda National Council for Science and Technology (approval number: HS3002ES), and the Ethikkommission Nordwest- und Zentralschweiz in Switzerland (approval number: AO 2O23-OOO23). Formal written informed consent was obtained from all participants, with assent from minors aged 12 to 17 years. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors Swiss National Science Foundation, IZSTZ0_190156 Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland

Antimicrobial resistance (AMR) presents a growing threat to global health and food security, accelerated by human behaviours such as suboptimal use patterns. While the negative consequences of AMR will be particularly severe in low- and middle-income countries, relatively little is known about the extent and frequency of behaviours that contribute to AMR in these regions. This mixed-methods study, which included a cross-sectional survey, examines knowledge, attitudes, and practices related to antimicrobial use (AMU) among 417 smallholder dairy farmers in Uganda's Wakiso, Kampala, and Mukono districts. We found that (1) farmers' AMU practices were associated with attitudes toward veterinarians and access barriers, with many relying on private veterinarians due to challenges accessing public animal health services; and; and (2) findings support the concept of a 'knowledge-action gap,' as AMR knowledge and belief items were weakly associated with prudent antimicrobial use and related practices in our exploratory models, These findings highlight the need to rethink the current reliance on conventional knowledge-attitude-practice (KAP) interventions alone. Instead, behaviour-centred approaches informed by theory-driven behaviour change frameworks, along with interdisciplinary collaboration, may offer more profound insight into the multifaceted factors that shape AMR-associated practices and inform more tailored interventions. Finally, given the prominent role of private veterinary service providers as trusted points of contact for farmers, there is a clear need to foster partnerships that formally recognise and engage these actors in stewardship efforts while ensuring alignment with national policy and regulatory oversight.

IntroductionRabies, a neglected tropical disease, causes about 59,000 annual human fatalities globally, the majority of which result from dog bites. Although rabies is preventable by vaccinating dogs and providing post-exposure prophylaxis (PEP) to humans, dog vaccination coverage in Uganda remains low at approximately 10% and not all human dog bite cases receive PEP. This study sought to understand barriers to dog bite case management and dog rabies vaccination.MethodsThis study, conducted between September 2022 and March 2023, involved 10 focus group discussions (FGDs) with dog owners and eight key informant interviews (KIIs) with opinion leaders, veterinary and health professionals. Participants were purposively selected based on their experience with dog vaccination and bite case management. Data was collected from Soroti Municipality (peri-urban) and Kamuda sub-county (rural) using structured interview guides premised on the socio-ecological model. Transcripts were coded and analyzed thematically using NVivo software (version 12.0).ResultsAt the individual level, limited first aid knowledge, few available PEP doses and high PEP costs were major barriers to proper dog bite case management. Community level barriers included poor management of roaming dogs and insufficient knowledge on managing biting dogs. Organizational barriers included frequent PEP stock-outs, improper cold-chain system in health facilities and poor communication between relevant health sectors. Regarding dog rabies vaccination, individual level barriers were, uncertainty about vaccination frequency, high vaccine costs and irresponsible dog ownership. Community level barriers centered on inadequate communication about dog vaccination campaigns and poor communication between the dog owners and veterinary officers, while organizational barriers included inaccurate data on dog population, inadequate staffing and logistical constraints.DiscussionThe study’s findings revealed that effective rabies prevention is constrained by interrelated individual, community and systemic factors. To address these gaps, district health authorities should provide continuous community education on dog bite first aid and timely seeking of care, ensure consistent availability of PEP through improved supply chain management, and implement subsidized or free mass dog vaccination campaigns. In addition, local governments should improve dog registration systems and enforce responsible dog ownership, while strengthening coordination between human and animal health sectors through One Health approaches.

Leptospirosis is a bacterial zoonotic disease that is distributed globally. In livestock, leptospirosis often presents as a subclinical disease that results in significant reproductive and production losses, which could in turn have detrimental economic consequences, particularly in countries like South Sudan that rely on livestock farming for livelihood. Leptospirosis often presents as a subclinical disease in which case the animal may be a maintenance host for a specific serovar. Recent increases in unexplained abortions have prompted us to investigate Leptospira exposure and associated risk factors among cattle in Bor County South Sudan. A cross-sectional study was conducted between 22 nd January to 15 th February 2023. Blood samples were collected from 357 cattle in four of the six cattle camps in the County at that time. Seropositivity was determined by detecting anti- Leptospira antibodies in the serum samples by microscopic agglutination test (MAT) based on a panel of 12 serovars representing 12 serogroups. Data on risk factors were obtained using pre-tested questionnaires administered to the owner or herdsman of each sampled herd. Of the 357 cattle sampled, 66.95% (95% CI = 61.91–71.62) were seropositive (cut-off titer ≥100). Seventy-six of the seropositive cattle (21.65%) had MAT titer ≥800, indicating a probable recent infection at the time of sampling. The most prevalent serogroups were L. borgpetersenii Tarassovi (59.83%) and L . borgpetersenii Ballum (17.38%). In the robust Poisson regression model, only the age of cattle was a significant risk factor to Leptospira seroprevalence. The prevalence in adult cattle was 1.43 times higher than in young ones (95% CI 1.09–1.92; P-value = 0.012). The extremely high seroprevalence indicates that leptospirosis may be endemic in cattle in South Sudan, and potentially one of the etiologies for the recently increasing abortion reports. This may require confirmation of the infection status among the aborting cattle.

Abstract Background Tuberculosis (TB) is a major public health problem in South Sudan. Inadequate knowledge, negative attitudes and perceived stigma may complicate the prevention efforts. This study describes knowledge, attitude, and stigma associated with TB among communities in Wau and Jur River, South Sudan. Methods From March to May 2023, a cross-sectional study was conducted among 352 community members randomly selected from residential blocks. A validated structured questionnaire was used to collect the required data. Descriptive, bivariate and multivariate analyses were performed. Results Out of 352 respondents, 51% (n = 180) were males and 49% (n = 172) were females. Majority 227 (64.5%) had poor knowledge about TB, meanwhile hearing about TB, age and level of education were associated factors. Fear of having TB was the major negative attitude (57.1%; n = 218), and most of the respondents (n = 327; 92.9%) had a perceived stigma towards TB, voicing that they disliked drinking or eating with people with TB and/or felt uncomfortable and kept their distance from people with TB. Conclusions Communities have little knowledge, negative attitude and perceived stigma towards people with TB. Hence, tailored health messages using local languages, training of community volunteers to reach villages without accessibility and communication network are essential to improve TB prevention and control in South Sudan.

Introduction COVID-19 vaccine uptake is low in less wealthy countries like Uganda, where initial campaigns targeted healthcare workers, teachers, and high-risk individuals. However, this led to vaccine wastage. Literature suggests a connection between knowledge, attitudes, and healthcare service uptake, but specific studies on COVID-19 are scarce. This study assessed the knowledge, attitudes, and practices of high-risk groups regarding COVID-19 vaccination in Kampala, Uganda. Methods A cross-sectional study with mixed methods was conducted involving 576 participants in Kampala. Multistage sampling and a digitised questionnaire gathered data, analysed using Stata 14. Descriptive statistics included means, medians, and standard deviations for continuous variables, and frequencies for categorical variables, presented in tables and figures. The modified Poisson regression model established associations between variables, with content analysis for qualitative findings. Results Of the 576 respondents, 53. 1% were male, 48% aged 18-29, and 63. 5% had tertiary education. Approximately 63. 5% had high knowledge of vaccines, with 70. 5% holding positive attitudes. A total of 76. 76.9% had received a COVID-19 vaccine, predominantly AstraZeneca (63. 2%). Over 60. 1% experienced side effects. Significant factors influencing vaccination included sex, attitude, leadership position, and peer influence. Females had a 3% likelihood of being unvaccinated compared to males, while poor attitudes raised the chance of remaining unvaccinated by 12%. Not holding a leadership position was linked to a 20% likelihood of being unvaccinated, and peer influence was connected to lower vaccination likelihood. Conclusion There is a notable gap in knowledge and attitudes towards COVID-19 vaccinations that affects uptake. Key predictors include sex, attitude, leadership position, and peer influence. Targeted community interventions are recommended to address these gaps and counteract negative peer influences that inhibit vaccination.

Zoonotic diseases pose a growing threat to global health, with an increasing frequency of outbreaks. Filoviruses, including the Ebola virus, have caused widespread and fatal epidemics, particularly in sub-Saharan Africa, such as Uganda. The persistence of the virus in the environment, often linked to poor hygiene and sanitation, serves as a potential source of infection. A stochastic model examining the bat-human-environment interface was developed to assess its role in disease extinction or persistence. Through branching process analysis, bats and humans were shown to significantly influence outbreak persistence. Numerical simulations of these models revealed a high likelihood of sustained Ebola virus outbreaks, findings that are also applicable to Marburg virus outbreaks. Results reveal that infected hosts are the primary drivers of epidemics. A single infected bat (P₀ = 0.00001) or human (P₀ = 0.00944) is highly likely to trigger a major outbreak. Conversely, the environment alone is an inefficient initiator, with a high probability of extinction (P₀ = 0.90362) when it is the sole source of contamination. While managing environmental contamination is essential, it alone cannot control transmission without addressing infected hosts. These findings demonstrate a critical duality: while filovirus persistence is dependent on infected hosts, it is most effectively controlled by managing environmental transmission pathways. These results stress the importance of addressing both host populations and environmental contamination in designing effective public health interventions to manage filovirus outbreaks. These findings underscore the need for a One Health approach that integrates human, animal, and environmental health.

BackgroundTaenia solium (T. solium), a neglected zoonotic tapeworm transmitted between humans and pigs, is a leading cause of acquired epilepsy in endemic areas where it is propagated by poor sanitation and pig husbandry practices. The World Health Organisation (WHO) NTD roadmap 2021-2030, recommended that targeted control interventions need to be initiated, and intensified in T. solium hyperendemic areas. Geospatial risk maps have identified Northern Uganda as a potential hyperendemic area. This study aimed to validate these findings and provide contextual evidence to support design and implementation of targeted interventions to control the parasite.MethodsA cross-sectional study was conducted in 2023 in four districts of northern Uganda. Blood samples were collected for serological analysis from 1049 pigs drawn from 714 households. Self-reported and observational data, and environmental variables from secondary sources were also collected. A subset of the seropositive pigs was dissected to confirm the presence of the parasite. The crude prevalence was adjusted for the test's sensitivity (Se = 0.867) and specificity (Sp = 0.947). Risk factors for seropositivity were evaluated using generalized mixed-effects models run in both R and Stata statistical software.ResultsThe prevalence of porcine cysticercosis in this area was 17.4% (15.1- 19.7; 95% CI). Pig level predictors of infection were pigs that were eight months or older (odds ratio (OR)=1.88; p = 0.001), and non-local breeds of the pig (OR=1.7; p = 0.01). Household-level risk factors included the use of borehole water, (OR=6.39; P = 0.001), free-roaming pigs (OR=1.92; p = 0.023), whilst the presence of a toilet in the compound was protective (OR=0.64, p = 0.05).ConclusionOur findings confirm that the study area is hyperendemic for T. solium infections, as the geospatial risk maps predicted. To achieve the targets laid out in the 2021-2030 WHO roadmap for control of NTDs, this region requires intensified targeted control interventions, preferably targeting both human and porcine hosts using the One Health approach.

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.

BackgroundGender mainstreaming in zoonotic disease prevention and control is paramount to produce sustainable solutions as well as keeping communities at the human-animal-environment interface safe and healthy. It is important to note that zoonoses register high mortality rates globally once they occur and they are highly transmissible. Hence this study aimed to explore the gender perspectives on zoonotic disease epidemiology using a (strength, weakness, opportunities and threats) SWOT analysis in Bundibugyo district, Uganda.MethodsThis study employed a descriptive participatory approach, utilizing data gathered sequentially from 12 Key informant interviews, 4 In-depth interviews and 4 Focus group discussions methods in Bundibugyo district. Interviews used interdisciplinary groups systematically using a SWOT analysis. The research methodology employed an interpretative phenomenological analysis (IPA) approach allowing participants to articulate their perspectives in their own words. Data analysis was done using both inductive and deductive thematically using NVIVO 12 pro, facilitating the development of codes, sub-themes, and themes.ResultsThe results of this study prioritized key zoonotic diseases within the district that affect community health. The key themes from these results a) Threats increasing risk of zoonotic spillover, b) Community weaknesses increasing zoonotic diseases occurrence, c) Community strength for zoonotic disease management, prevention and control, d) Opportunities for communities in management of zoonotic diseases. The study emphasizes that political instability, land migration, food insecurity, cultural hunting practices, and climate change act to increase the risk of zoonotic diseases. Complications arise from the mis-identification of diseases due to similar symptoms, and a lack of community education about these diseases. The risk of exposure is influenced by gender roles, with men, who generally interact more with animals, at higher risk. Conversely, women, due to their roles in caring for the sick and involvement in child immunization, are at risk but also play a crucial role in disease control. Despite these challenges, there are opportunities for disease management and prevention such as leveraging experienced health workers for disease identification and education, utilizing local communication channels, engaging opinion leaders for effective risk communication, and providing regular training for health workers could address these issues. However, limited funding hinders the execution of recommended strategies such as regular surveillance, tracing of suspected cases, and health register reviews.ConclusionThis study emphasizes the necessity of gender-sensitive approaches in understanding and mitigating zoonotic diseases, advocating for strategies that recognize socio-cultural factors, promote health education, and tailor interventions to provide comprehensive care and protection for all, irrespective of gender.

Increasing protein demand in low- and middle-income countries may accelerate livestock intensification, antibiotic overuse and antimicrobial resistance (AMR) risk. Here, we examined Uganda's growing pig sector, tracking 70 farmers and their pigs in semi-intensive and free-range systems for a year. We investigated AMR and AMR gene abundance of 668 Escherichia coli, Klebsiella and DNA isolated from 877 faecal samples using diffusion disc-method and qPCR, respectively. Pigs in semi-intensive systems were 2.2 times more likely to exhibit AMR and had higher ermB levels. AMR in free-range farmers was twice that of pigs but still 1.4 times less likely than in semi-intensive systems. AMR prevalence increased by 0.76% per month. Potential transmission events were more likely on semi-intensive farms (OR = 3.16, 95% CI: 2.1-4.3, P < 0.001), especially when farmers had higher tetQ levels than pigs; the reverse was true for ermB. Intensified urban pig production may elevate AMR risks, underscoring the need for targeted interventions.

Rabies remains endemic in Uganda and is a priority zoonotic disease due to its significant public health burden. Although Uganda has committed to eliminating dog-mediated human rabies deaths by 2030, operational and financial challenges persist. A key gap is the lack of a focused research agenda and insufficient funding for its implementation, highlighting the need to map existing research to guide future priorities. This scoping review, thus, aimed at describing and mapping the existing research on rabies in Uganda by identifying, categorizing, and summarizing existing research, while highlighting research gaps to guide future studies and support evidence-based interventions for rabies control and elimination. The scoping review followed PRISMA-ScR guidelines and was registered with the Open Science Framework. A systematic search of PubMed, Web of Science, and Embase databases yielded 110 studies after deduplication. Following screening, 26 original studies regarding rabies research that were based in Uganda were included in the review. Most of these studies were descriptive cross-sectional in design (n = 15), including knowledge, attitudes, and practices (KAP) studies (n = 5), and surveys and interviews (n = 10). Most studies focused on human populations (n = 21). Six studies adopted a One Health approach integrating human and animal health sectors. Only two studies employed laboratory methods for molecular characterisation of circulating rabies virus strains, and one study used interventional design to assess vaccination coverage. Notably, no studies implemented consistent and integrated rabies surveillance systems or included economic evaluations of rabies control programs. Our scoping review highlights critical gaps in rabies research in Uganda, particularly the need for intervention-based and longitudinal studies that operationalize the One Health framework. Key areas of research needs include dog vaccination coverage, integrated surveillance systems, diagnostics, and economic evaluations to assess the impact of rabies control and prevention programs. Addressing these gaps is essential for understanding rabies transmission dynamics and strengthening control strategies. Scoping review registration: https://osf.io/wu5pj.

Introduction:The zero by 30 initiative aims to eliminate dog-mediated human rabies by 2030, for which dog vaccination is a crucial pillar. This study piloted four different dog vaccination campaign strategies in Kyegegwa, a rural district in Uganda, where rabies is endemic, and compared the vaccination coverages achieved by the strategies. Methods:Four vaccination strategies were rolled out, each in three parishes from different sub-counties: (i) static point vaccination (SP), (ii) school-based (SB, i.e., information campaigns were mainly conducted at schools and vaccination was done at the school during weekends), (iii) integrated dog with livestock vaccination (D-L), and (iv) integrated dog vaccination with human health services (D-H, One Health approach). Vaccination coverage was estimated using transect and household survey data, analyzed with a Bayesian model that estimated, besides the vaccination coverage, the dog population size and the proportion of ownerless dogs for each dog population. Results:The mean vaccination coverage achieved among the owned dog population across the three parishes for each respective strategy was 29.5% for SP strategy (the model converged in one parish only), 53.9% (range 27.4-79.5%) for SB, 66.2% (range 53.5 and 86.0%) for the D-L, and 74.5% (range 63.7 and 88.4%) for D-H. The mean proportion of ownerless dogs in the villages investigated was estimated at 0.1% for the parishes with SP strategy, 7.0% (range 0.1-20.8%) for SB strategy, 29.7% (range 0.5-88.1%) for D-L, and 7.9% (range 0.3-17.7%) for D-H strategy villages. Discussion:The strategy integrating dog vaccination with human health services outperformed the other strategies by achieving the highest mean vaccination coverage and reaching a constantly high coverage of above 60% for all the three parishes of that strategy. This demonstrates the potential of the human-animal integrated D-H vaccination strategy as an effective approach for rabies control. Sensitization strategies for dog owners also depended in the vaccination strategy performed, i.e., spread of information through health centers for the D-H strategy, which is part of the success of this strategy. The study needs to be taken as a pilot, because of limitations such as different settings between the sub-counties. Further testing across diverse settings can help assess integrated dog vaccination strategies' consistency and scalability, providing valuable insights for developing a One Health model to strengthen future rabies elimination efforts.

IntroductionRabies, a neglected viral zoonotic disease endemic in Uganda, is one of the country’s top seven priority zoonotic diseases. In the period 2021 to 2024, it caused 190 human deaths. Rabies requires an integrated participatory One Health approach for its control. This approach may help reduce the estimated 59,000 annual global human rabies deaths. Over 99% of these deaths are due to bites from infected dogs. Access to the highly effective post exposure prophylaxis (PEP), mass dog vaccinations and rabies surveillance are prioritised in Uganda’s National Rabies Elimination Strategy that is aligned to the global target of eliminating dog-mediated rabies by 2030. Surveillance, required to guide and evaluate rabies control, is currently weak in Uganda, resulting in few cases being recorded. This leads to a “cycle of neglect” of the disease. Medical and animal health professionals require comprehensive surveillance data to inform post-bite responses. An integrated bite case management (IBCM) system presents the opportunity for information about the bite victim and biting animal to be obtained timely to support judicious and economical use of PEP in humans and management of the biting animal. IBCM has not yet been tested in Uganda where PEP is scarce.MethodsA collaborative change research approach was therefore applied to progressively develop key elements of an IBCM form over three successive multidisciplinary and multi-sectoral stakeholder meetings, which noted that to attain effective joint surveillance, both animal- and human-related information should be obtained from an animal bite incident.Results and DiscussionStakeholders identified elements that were grouped under five categories: details of the human bite victim, details of the bite incident, details of biting animal, follow-up of the biting animal and laboratory diagnosis. Four existing rabies surveillance tools in the country were assessed against these categories. The process revealed gaps in the tools currently in use by government ministries hence exposing the silo system in rabies surveillance. This paper highlights the rich content of an IBCM form designed through a stakeholder participatory process, and its advantages over existing tools regarding data collected. It is hoped that its implementation will significantly strengthen joint human and dog rabies surveillance in Uganda.