Henry Mulondo, F. Monge, D. Mugabi, G. Asiimwe, C. Odong, H. Kazoora T. Odoch, L. Mayega, M. Kirumira, I. Nabukenya Makerere University

Outline Background Study objectives Methodology Results Discussion Conclusion and Recommendations Public health actions taken Acknowledgement

Background Brucellosis: zoonosis; affects animals and humans Cause: bacteria of genus Brucella; has different species B. abortus, B.melitensis, B. ovis, B. suis and B. canis B. melitensis and B.suis from goats and pigs most virulent Endemic in many countries especially those in Africa Transmission: - Contact with body fluids, aborted fetuses, fetal membranes - Consumption of raw/poorly prepared animal products, - Inhalation of contaminated aerosols - Self inoculation.

Background cont’d Worldwide, over 500,000 new cases are registered annually Africa prevalence is 5-55% in humans and 8-46% in animals. Uganda: 18-24% in humans,15.8% in cattle and 26% in goats April 2012, an abattoir worker diagnosed with brucellosis study was conducted May – July 2012

Study objectives Determine sero-prevalence of brucellosis - slaughtered beef animals - abattoir workers Identify risks associated with brucellosis transmission to abattoir workers

Methodology Study design: cross sectional study Study setting: Masaka Municipal abattoir - Abattoir lies in Katwe-Butego division - Slaughters beef animals per week and has 30 workers Study populations: - Beef animals Slaughtered from May-July Workers in Masaka municipal abattoir Sampling technique: - Abattoir workers self selected - beef animals selected by simple random method Sample size: 24 abattoir workers and 236 beef animals Inclusion criteria: - workers ≥18 years who verbally consented - beef animals slaughtered (May-July 2012)

Methodology cont’d Map of Masaka

Methodology cont’d Blood samples from workers collected from brachial vein by nurse Cattle samples collected from jugular vein by Principal investigator Qualitative data was collected on; - socio-demographic characteristics of worker, breeds, sex mostly slaughtered - pregnancy status of females, protective gear use and duties done - Mini survey conducted, 24 abattoir workers interviewed - KI conducted with 4 Veterinary staff using KI guide Testing serum samples: -Human samples; St. Agnes Lab using BMAT Cattle samples; microbiology lab (COVAB)using Rose Bengal’s test Data entered, cleaned and analyzed using Epinfo version 3.5.1

Results Dependent variables Analysis of blood samples showed that - abattoir workers: 6(25%) were Brucellosis +ve - titer values

Result cont’d Results from the survey with abattoir workers Independent variables Table 1. Socio demographic characteristics of workers in Masaka municipal abattoir n=24 Variable Response Masaka municipal abattoir (n=24,%) Age (years) (8.3) (41.7) >30 12(50.0) Religion Catholic 11(45.8) Muslims 7(29.2) Protestants 6(25.0) Marital Single 6(25.0) Status Maried 18(75.0) Level of Primary 14(58.3) Education Secondary 4(16.7) Tertiary 1(4.2) university 5(20.8) work < 5 2(16.7) Experience (yrs) 5-108(33.3) > 10 12(50.0)

Results cont’d Breeds slaughtered: 21(87.5%) ankole, 2(8.3%) borans and 1(4.2%) sahiwal Majority 224(95%) were females Of the 224 females, 170(76%) were pregnant Protective gear use: 23(95.8%) had partial set of protective gears (gumboots and overalls) Only 1 (4.2%) had a full set (gumboots, overalls, gloves, face and nose masks)

Results cont’d Table 2. Bivariate analysis to determine the association between duties done with Brucella infection, n= 24 ( fishers’ exact test used ) Variable Response Total ill p-value Response Slaughter cattle Yes No Meat inspection Yes No Cleaning abattoir Yes No Handling of offals, Yes *** Fetuses, and fetal No Remains Carrying carcasses Yes No Moving on track Yes with beef cattle No *** statistically significant factor

Results cont’d Table 2 shows the association between use of personal protective gears with Brucellosis infection (fishers exact test used) Variable Response Total ill p-value Response Personal Full gear Protective gear Partial gear 23 06

Results cont’d Results from KI All respondents (100%) reported that beef animals were from - Ssembabule, Lyaantode, Rakai and Gomba markets More cows slaughtered than bulls because they were the most screened of the 4 KI conducted, 75%(3) said majority of the cows were pregnant they look healthy, heavy and fetch more money 50%(2) reported that the “high infection rate among offal, fetus and fetal remain handlers was due to high bacterial load on fetus and fetal remain” All KI suggested that to prevent brucellosis in animals and humans - Sensitization of animal and meat handlers - Mass vaccination of healthy animals - Regular screening of animal and meat handlers

Discussion Sero-prevalence was high in beef cattle because; - animals were from pastoral communities that don’t vaccinate against brucellosis - Farmers culled and sold animals due to infertility Sero-prevalence was high among abattoir workers handling offals fetuses and fetal remains due to - Erythritol produced by the placenta - the sugar stimulates multiplication of brucella organisms in reproductive systems of pregnant female animals to very high levels predisposing handlers to the infection Most slaughtered animals were pregnant - pregnant animals look healthy, heavy and fetch more money Bivariate analysis of risk factors identified - handling offals, fetuses and fetal remains as a risk

Conclusions and Recommendations Conclusions: Sero-prevalence of brucellosis in slaughtered beef cattle and abattoir workers was high Handling offals, fetuses and fetal remains was a risk Recommendations: Brucellosis prevention in humans depends on its control in animals Routine mass vaccination of livestock animals should be done Sensitization of animal and meat handlers including consumer about brucellosis Regular screening of abattoir workers

Public health actions taken Findings were disseminated to participants and district stake holders Infected workers were encouraged to seek treatment

Acknowledgement AFENET RESPOND MAAIF Masaka District Local Government (MDLG) COVAB St Agnes Laboratory, Nyendo Masaka

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