A Descriptive Study Of Zoonotic Disease Risk At The Human-Wildlife Interface In A Biodiversity Hot Spot In South Western Uganda

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 this 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.Author summaryZoonotic diseases are increasingly becoming an emerging public health threat, partially due to the risk of spillover events at the human-wildlife interface. This cross -sectional study was carried out among high-risk communities around forest fragments of Hoima District, Uganda, to describe activities that could lead to disease spillover in humans in order to inform public health practitioners of the potential risks at community level for preparedness and response efforts. The study also sought to gain an understanding of the community's perception of the risk of zoonotic diseases, what activities could expose them to zoonoses, and whether the healthcare services are adequate to identify such diseases at community level. We found that most people were not aware of zoonotic diseases transmissible from wildlife to humans and this can partly be explained attributed by lack of information filtering through to the grass root. It is important to note however, that the interaction between wildlife and humans, largely driven by communities' struggle to survive and meet their livelihood needs making it difficult to predict under what circumstances disease could emerge in the community. We need to remind ourselves that all major outbreaks have started at community level and well as the health experts are fast to diagnose the disease in question, some communities are hearing these diseases for the very first time. Quite often these outbreaks are putting the available alternative livelihood in question and demanding for quick unstainable changes that communities are quick to abandon once the outbreaks are over. We recommend that this is the time to invest in health education and create awareness about zoonotic diseases among communities at the human-wildlife interface. Health promotion and or livelihood-based intervention programs should use existing evidence and case studies implemented in collaboration with government agencies and partners.