Rift Valley Fever: A survey of knowledge, attitudes, and practice of slaughterhouse workers and community members in Kabale District, Uganda

<div><p>Background</p><p>Rift Valley Fever virus (RVF) is a zoonotic virus in the <i>Phenuiviridae</i> family. RVF outbreaks can cause significant morbidity and mortality in humans and animals. Following the diagnosis of two RVF cases in March 2016 in southern Kabale district, Uganda, we conducted a knowledge, attitudes and practice (KAP) survey to identify knowledge gaps and at-risk behaviors related to RVF.</p><p>Methodology/Principal findings</p><p>A multidisciplinary team interviewed 657 community members, including abattoir workers, in and around Kabale District, Uganda. Most participants (90%) had knowledge of RVF and most (77%) cited radio as their primary information source. Greater proportions of farmers (68%), herdsmen (79%) and butchers (88%) thought they were at risk of contracting RVF compared to persons in other occupations (60%, p<0.01). Participants most frequently identified bleeding as a symptom of RVF. Less than half of all participants reported fever, vomiting, and diarrhea as common RVF symptoms in either humans or animals. The level of knowledge about human RVF symptoms did not vary by occupation; however more farmers and butchers (36% and 51%, respectively) had knowledge of RVF symptoms in animals compared to those in other occupations (30%, p<0.01). The use of personal protective equipment (PPE) when handling animals varied by occupation, with 77% of butchers using some PPE and 12% of farmers using PPE. Although most butchers said that they used PPE, most used gumboots (73%) and aprons (60%) and less than 20% of butchers used gloves or eye protection when slaughtering.</p><p>Conclusions</p><p>Overall, knowledge, attitudes and practice regarding RVF in Kabale District Uganda could be improved through educational efforts targeting specific populations.</p></div

Use of personal protective equipment (PPE) in persons with animal contact by occupation.

<p>Use of personal protective equipment (PPE) in persons with animal contact by occupation.</p

Types of contact with animals and animal products.

<p>Types of contact with animals and animal products.</p

Use of personal protective equipment in persons with animal contact by gender.

<p>Use of personal protective equipment in persons with animal contact by gender.</p

Participant knowledge of RVF symptoms by occupation.

<p>Participant knowledge of RVF symptoms by occupation.</p

Participant demographics.

<p>Participant demographics.</p

Participant knowledge of RVF symptoms by gender.

<p>Participant knowledge of RVF symptoms by gender.</p

Map of study region.

<p>Purple squares represent the site of a probable or confirmed case in the outbreak; and the yellow indicates parishes sampled in Kabale District as part of the KAP assessment. The red triangles represent the villages that were sampled. The Green circles represent sites where mosquitoes were sampled for a separate RVF study. <i>This figure was created specifically for this manuscript in ArcGIS using open source data from ESRI and DIVA-GIS for the background layers</i>, <i>and GPS points collected in the field</i>.</p

Prevalence and risk factors of Rift Valley fever in humans and animals from Kabale district in Southwestern Uganda, 2016

<div><p>Background</p><p>Rift Valley fever (RVF) is a zoonotic disease caused by Rift Valley fever virus (RVFV) found in Africa and the Middle East. Outbreaks can cause extensive morbidity and mortality in humans and livestock. Following the diagnosis of two acute human RVF cases in Kabale district, Uganda, we conducted a serosurvey to estimate RVFV seroprevalence in humans and livestock and to identify associated risk factors.</p><p>Methods</p><p>Humans and animals at abattoirs and villages in Kabale district were sampled. Persons were interviewed about RVFV exposure risk factors. Human blood was tested for anti-RVFV IgM and IgG, and animal blood for anti-RVFV IgG.</p><p>Principal findings</p><p>655 human and 1051 animal blood samples were collected. Anti-RVFV IgG was detected in 78 (12%) human samples; 3 human samples (0.5%) had detectable IgM only, and 7 (1%) had both IgM and IgG. Of the 10 IgM-positive persons, 2 samples were positive for RVFV by PCR, confirming recent infection. Odds of RVFV seropositivity were greater in participants who were butchers (odds ratio [OR] 5.1; 95% confidence interval [95% CI]: 1.7–15.1) and those who reported handling raw meat (OR 3.4; 95% CI 1.2–9.8). No persons under age 20 were RVFV seropositive. The overall animal seropositivity was 13%, with 27% of cattle, 7% of goats, and 4% of sheep seropositive.</p><p>In a multivariate logistic regression, cattle species (OR 9.1; 95% CI 4.1–20.5), adult age (OR 3.0; 95% CI 1.6–5.6), and female sex (OR 2.1; 95%CI 1.0–4.3) were significantly associated with animal seropositivity. Individual human seropositivity was significantly associated with animal seropositivity by subcounty after adjusting for sex, age, and occupation (p < 0.05).</p><p>Conclusions</p><p>Although no RVF cases had been detected in Uganda from 1968 to March 2016, our study suggests that RVFV has been circulating undetected in both humans and animals living in and around Kabale district. RVFV seropositivity in humans was associated with occupation, suggesting that the primary mode of RVFV transmission to humans in Kabale district could be through contact with animal blood or body fluids.</p></div

Map of Kabale district showing percent RVFV seropositivity for animal samples by sub-county with less seropositivity in lighter colors and increasing seropositivity in darker color.

<p>(ESRI—<a href="http://opendata.arcgis.com/about" target="_blank">http://opendata.arcgis.com/about</a>, DIVA-GIS—<a href="http://www.diva-gis.org/" target="_blank">http://www.diva-gis.org/</a>).</p