Factors associated with severity and anatomical distribution of diabetic foot ulcer in Uganda: a multicenter cross-sectional study.

BACKGROUND: Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda. METHODOLOGY: This was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value < 0.2 at bivariate analysis were considered for multivariate analysis. RESULTS: The right foot was affected in 47.9% (n = 56) of patients, 44.4% (n = 52) had the DFU on the plantar region of the foot and 47.9% (n = 56) had an ulcer of > 5 cm in diameter. The majority (50.4%, n = 59) of patients had one ulcer. 59.8% (n = 69) had severe DFU, 61.5% (n = 72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p = 0.011) and secondary (p < 0.001) school educational levels, moderate (p = 0.003) and severe visual loss (p = 0.011), 2 ulcers on one foot (p = 0.011), and eating vegetables regularly were protective against developing severe DFU (p = 0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p < 0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5-10 cm (p = 0.047) and in those with > 10 cm diameter (p = 0.002), respectively. CONCLUSION: Most DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of > 5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.

The Epidemiology of Zoonotic Brucellosis in Bahr el Ghazal Region of South Sudan.

Background: In this study, we focused on three zoonotic brucellosis risk groups; abattoir workers, febrile cases at Wau hospital and cattle herders, in Bahr el Ghazal region, South Sudan. Competitive c-ELISA was used to detect anti-Brucella antibodies in 725 individuals between December 2015 and May 2016. In addition, questionnaire metadata, focus group discussions and key informant interviews were used to characterize the epidemiology of zoonotic brucellosis in this region. Results: Overall, we estimate 27.2 % (95% CI = 23.9-30.6) brucellosis sero-prevalence; 32.1% (95% CI = 26.2-38.4), 23.0% (95% CI = 19.1-27.4) and 34.6% (95% CI = 24.4-46.3) among abattoir workers, febrile cases, and herders, respectively. Marital status (Single, OR = 0.58, 95%CI: 0.36-0.91, P = 0.02) and ethnicity (Kerash OR = 6.01, 95%CI: 1.97-21.10, P = 0.003 and Balanda, OR = 3.78, 95%CI: 1.42-12.02, P = 0.01) were associated with brucellosis. While gender and ethnicity were important factors for general awareness of zoonotic diseases. Highly ranked occupations at risk included veterinarian, butchers and milk handlers. We also identified covariate patterns for clinical diagnostics and public health interventions. Conclusion: We report the highest sero-prevalence of zoonotic brucellosis in three risk groups in the East African region. All this is not only occurring in a population with limited awareness that brucellosis is a zoonotic disease but also where one in nine health workers tested was sero-positive. We identified social demographic associations with brucellosis, however, the qualitative analysis suggests these are more complex and nuanced. Therefore, future studies could benefit from the use of the mixed methods approach to add extensiveness and depth to our understanding of zoonotic disease drivers, in order to implement mitigating measures such as cattle vaccination.

Sero-prevalence of brucellosis among slaughterhouse workers in Bahr el Ghazal region, South Sudan.

BACKGROUND: Brucellosis is an infectious zoonotic disease and is common especially among pastoral communities in most low and middle-income countries. The aim of this study was to determine sero-prevalence, and risk factors of Brucella infection among Slaughterhouse workers, in Bahr el Ghazal region, South Sudan. METHODS: A cross sectional study was conducted among Slaughterhouse workers in Bahr el Ghazal region, South Sudan from December 2015 to May 2016. A pre-tested questionnaire was used in data collection. Each randomly selected participant was interviewed and a venous blood sample collected. The blood samples were screened for Brucellosis infection using Rose Bengal Plate Test (RBPT) and confirmed using Competitive Enzyme link Immuno Sorbet Assay (c-ELISA). Data was analyzed using Stata version 13 at 95% level of confidence. RESULTS: A total of 234 Slaughterhouse workers were screen for Brucella infection. Overall, a third, 32.1% (75/234) of the participants were sero-positive for brucellosis. The prevalence of brucellosis was higher, 17.1% (40/234) in Wau state compared to other states. There was high prevalence among males, 28.6% (67/234) compared to females 3.4% (8/234). The mean age of study participants was 34.4 ± 9.6 years. A high proportion, 12.8% (30/234) of participants with confirmed brucellosis infection were 31-40 years of age. Brucellosis prevalence was high among butchers, 14.5% (34/234), and meat handlers, 9.0% (21/234). CONCLUSIONS: Brucellosis is common among animal slaughterhouse workers in Bahr el Ghazal region, South Sudan. There is need for public awareness campaigns and educational programs to help sensitize communities on Brucella infection.

The sero-prevalence of brucellosis in cattle and their herders in Bahr el Ghazal region, South Sudan.

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.

Prevalence of brucellosis among patients attending Wau Hospital, South Sudan.

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<0.05). The study found a high prevalence of brucellosis among febrile patients attending Wau hospital general outpatient clinic. There is need for co-ordination and collaboration between veterinary and health sectors of government to help prevent and control brucellosis in the region.

Prevalence of adhesin and toxin genes in E. coli strains isolated from diarrheic and non-diarrheic pigs from smallholder herds in northern and eastern Uganda.

BACKGROUND: Enterotoxigenic E. coli (ETEC) significantly contribute to diarrhea in piglets and weaners. The smallholder pig producers in Uganda identified diarrhea as one of the major problems especially in piglets. The aim of this study was to; i) characterize the virulence factors of E. coli strains isolated from diarrheic and non-diarrheic suckling piglets and weaners from smallholder herds in northern and eastern Uganda and ii) identify and describe the post-mortem picture of ETEC infection in severely diarrheic piglets. Rectal swab samples were collected from 83 piglets and weaners in 20 herds and isolated E. coli were characterized by PCR, serotyping and hemolysis. RESULTS: The E. coli strains carried genes for the heat stable toxins STa, STb and EAST1 and adhesins F4 and AIDA-I. The genes for the heat labile toxin LT and adhesins F5, F6, F18 and F41 were not detected in any of the E. coli isolates. Where the serogroup could be identified, E. coli isolates from the same diarrheic pig belonged to the same serogroup. The prevalence of EAST1, STb, Stx2e, STa, AIDA-I, and F4 in the E. coli isolates from suckling piglets and weaners (diarrheic and non-diarrheic combined) was 29, 26.5, 2.4, 1.2, 16, and 8.4 %, respectively. However the prevalence of F4 and AIDA-I in E. coli from diarrheic suckling piglets alone was 22.2 and 20 %, respectively. There was no significant difference in the prevalence of the individual virulence factors in E. coli from the diarrheic and non-diarrheic pigs (p > 0.05). The main ETEC strains isolated from diarrheic and non-diarrheic pigs included F4/STb/EAST1 (7.2 %), F4/STb (1.2 %), AIDA/STb/EAST1 (8 %) and AIDA/STb (8 %). At post-mortem, two diarrheic suckling piglets carrying ETEC showed intact intestinal villi, enterocytes and brush border but with a layer of cells attached to the brush border, suggestive of ETEC infections. CONCLUSION: This study has shown that the F4 fimbriae is the most predominant in E. coli from diarrheic piglets in the study area and therefore an F4-based vaccine should be considered one of the preventive measures for controlling ETEC infections in the piglets in northern and eastern Uganda.

Seroprevalence and risk factors for brucellosis in cattle in selected districts of Jimma zone, Ethiopia.

A cross-sectional study was carried out in Jimma town and Chora Botor district of Jimma zone from February 2014 to May 2014 to determine seroprevalence and risk factors of brucellosis in cattle. A total of 348 blood samples (174 each from zebu and crossbreed) were collected. The sera were separated and screened by Rose Bengal plate test (RBPT), and positive sera were retested by complement fixation test (CFT) for confirmation. The overall seroprevalence of bovine brucellosis was 1.4 and 0.3 % as tested by RBPT and CFT, respectively. The seroprevalence of bovine brucellosis in indigenous and crossbreed cattle was 1.1 and 0.6 % and 1.7 and 0 % using RBPT and CFT, respectively. Retained fetal membrane was the only risk factor found to be significantly associated with seropositivity of brucellosis in this study (p = 0.019). The overall seroprevalence of brucellosis was very low. However, due to the zoonotic and economic importance of the disease, prevention and control measures are required to stop further spread of the disease. To effectively implement this, the One Health (OH) is the most constructive approach we recommend.

Isolation and molecular characterization of Brucella isolates in cattle milk in Uganda.

Brucellosis is endemic in livestock and humans in Uganda and its transmission involves a multitude of risk factors like consumption of milk from infected cattle. To shed new light on the epidemiology of brucellosis in Uganda the present study used phenotypic and molecular approaches to delineate the Brucella species, biovars, and genotypes shed in cattle milk. Brucella abortus without a biovar designation was isolated from eleven out of 207 milk samples from cattle in Uganda. These isolates had a genomic monomorphism at 16 variable number tandem repeat (VNTR) loci and showed in turn high levels of genetic variation when compared with other African strains or other B. abortus biovars from other parts of the world. This study further highlights the usefulness of MLVA as an epidemiological tool for investigation of Brucella infections.

Prevalence of and factors associated with Brucella sero-positivity in cattle in urban and peri-urban Gulu and Soroti towns of Uganda.

Brucellosis is a key zoonosis of major public health, animal welfare and economic significance, and is endemic in livestock in Uganda. A cross-sectional epidemiological study was carried out to estimate the sero-prevalence of brucellosis and identify factors associated with sero-positivity in cattle in urban and peri-urban Gulu and Soroti towns of Northern and Eastern Uganda, respectively. A total of 1007 sera and data on biologically plausible risk factors from 166 herds and their spatial locations, were collected from cattle reared in urban and peri-urban Gulu and Soroti towns of Uganda. The sera were analyzed using indirect ELISA and sero-positive reactors confirmed by competitive ELISA. Multivariable models were used to investigate for risk factors. The overall animal-level and herd-level sero-prevalence was 7.5% (76/1007, 95% Confidence Interval (CI): 6.15-9.4%) and 27.1% (45/166, 95% CI: 20.9-34.3%), respectively. Herd-level sero-prevalence was significantly (P<0.001) higher in Soroti than Gulu. In Gulu town, sero-positivity increased with an increase in herd size (P=0.03) and age (P=0.002), and was higher in cattle brought in from western Uganda (P<0.0001). In Soroti town, introduction of new cattle into a herd was significantly (P=0.027) associated with herd sero-positivity. There was a geographically differential risk (clustering) of Brucella sero- positivity in herds in Soroti, while sero-positivity was homogeneously distributed in Gulu. The data highlight brucellosis occurrence and major risk factors for its transmission in cattle in urban and peri-urban areas.

Salmonella species in piglets and weaners from Uganda: prevalence, antimicrobial resistance and herd-level risk factors.

Non-typhoidal salmonellosis is of concern in humans in sub-Saharan Africa, and this is partly due to the high number of immunocompromised persons. Pork and pork products could be among the sources of these non-typhi Salmonella spp. The aim of this study was to identify Salmonella spp. in piglets and weaners in northern and eastern Uganda, characterize their antimicrobial resistance patterns and determine herd-level risk factors. Fecal samples were collected from 465 piglets and weaners from 93 herds (49 and 44 from northern and eastern Uganda, respectively). In addition, information about the herd management and potential risk factors were collected. The fecal samples were cultured for the identification of Salmonella spp. The Salmonella spp. confirmed by serotyping were further characterized by determination of minimum inhibitory concentration (MIC) to 12 antimicrobials by broth microdilution. At individual level, the total prevalence of Salmonella spp. was 12% (12.2% in northern and 11.9% in eastern Uganda). At herd level, the total prevalence was 39% (43% in northern and 34% in eastern Uganda). From 56 samples with Salmonella spp., 20 serovars were identified including two serovars identified only by their antigenic formulae. The predominant serovars were S. Zanzibar, S. Heidelberg, S. Infantis, S. Typhimurium, S. Stanleyville, S. Aberdeen and S. Kampala. In total, 57% of the 53 Salmonella spp. analyzed, originating from 27% of the herds, were resistant to at least one antimicrobial agent. The majority of drug-resistant isolates (60%) were from northern Uganda. Eight multidrug-resistant (MDR) isolates were from northern Uganda and three MDR isolates were from eastern Uganda. Increased prevalence of Salmonella spp. was associated with feeding the young and adults separately as compared to feeding the young and adults together (p=0.043, OR=4.3; 95% CI 1.1, 17.38). Protective factors were "intensive" method of keeping the pigs versus "tethering and roaming" (p=0.016, OR=0.11; 95% CI 0.02, 0.64), "intensive" method versus "semi-intensive" method (p=0.048, OR=0.12; 95% CI 0.01, 0.96) and cleaning feeders after every two days versus daily (p=0.017, OR=0.18; 95% CI 0.05, 0.72). This study has revealed a high prevalence of infection of piglets and weaners with diverse non-typhi Salmonella serovars and highlights the potential role of pork and pork products as sources of these organisms for humans. In addition, this study has identified protective factors that could be promoted to control Salmonella spp. and in antimicrobial resistance reduction programs in rural pigs from Uganda.

Survey of Brucella infection and malaria among Abattoir workers in Kampala and Mbarara Districts, Uganda.

BACKGROUND: Brucellosis is among the most widespread zoonotic infections estimated at 14% in Uganda. A cross-sectional study was conducted to estimate the sero-prevalence, risk factors of Brucella infection and malaria among abattoir workers. METHODS: A survey was conducted among 232 abattoir workers in main abattoirs of Kampala and Mbarara districts in February 2007. A pre-tested questionnaire captured socio-demographic and occupational data. Brachial vein blood was tested for Brucella using Microplate Agglutination Test (MAT) and Standard Tube Agglutination Test (STAT) with a cut off titre of 1:160, and giemsa stained blood slides for malaria. Data was analyzed in SPSS 17.0. RESULTS: Seven males (3%, n = 232) had malaria and dual brucella and Plasmodium falciparum malaria was found in one person. Brucella sero-positivity was 10% (95% CI 6 - 16; n = 232) with 12% (n = 161) in Kampala and 7% (n = 71) in Mbarara district. Non-use of protective gear Odds ratio (OR 3.3, 95% CI (1.25 - 50) and working in the abattoir beyond 5 years OR 2.4 95% CI (1.4 - 5.6) were associated with increased risk of Brucella infection. Age, sex, religion, keeping animals and consumption of raw milk or products were not significant. CONCLUSIONS: Brucella infection is a real risk among abattoir workers and use of full protective gear reduced risk significantly. Sensitization and public health care programs are needed to control this emerging problem.

Kitchen practices used in handling broiler chickens and survival of Campylobacter spp. on cutting surfaces in Kampala, Uganda.

Cross-contamination during food preparation has been identified as an important factor associated with foodborne illnesses. Handling practices used during preparation of broiler chickens in 31 fast-food restaurants and 86 semisettled street stands (street vendors) were assessed by use of a standard checklist. These establishments used wood, plastic, or metal cutting surfaces during the preparation of broiler chickens. The survival of Campylobacter spp. on kitchen cutting surfaces was determined by inoculating approximately 10(6) CFU of Campylobacter jejuni onto sterile plastic, wooden, and metal cutting boards. The concentrations of the organisms were then assessed in triplicate on each type of cutting board over a 3-h period using standard microbiological methods for thermophilic Campylobacter spp. In 87% of food establishments, the same work area was used for preparation of raw and cooked chicken, and in 68% of these establishments the same cutting boards were used for raw and cooked chicken. None of the establishments applied disinfectants or sanitizers when washing contact surfaces. Campylobacter spp. survived on wooden and plastic but not on metal cutting boards after 3 h of exposure. The handling practices in food preparation areas, therefore, provide an opportunity for cross-contamination of Campylobacter spp. to ready-to-eat foods.