# Assessment of exposure to zoonoses and perceptions of zoonotic transmission surrounding the Bwindi impenetrable forest, Uganda

## TL;DR

This study explores how communities near Uganda's Bwindi Impenetrable Forest interact with animals and their understanding of zoonotic disease risks, finding low awareness and risky behaviors that could lead to disease outbreaks.

## Contribution

The study provides new insights into community perceptions and practices around zoonotic disease transmission in a high-risk region of Uganda.

## Key findings

- Rural and younger residents, as well as healthcare workers, showed higher awareness of zoonotic disease transmission.
- Consumption of meat from sick or dead animals is common, especially in low socio-economic communities.
- Rural communities demonstrated better understanding of zoonotic disease transmission than urban populations.

## Abstract

Emerging infectious diseases with regional spread and potential to escalate to a global pandemic have increased in the last century. Western Uganda has experienced many emerging infectious disease outbreaks over the last five decades, some with worldwide implications. Outbreaks have originated from wild animal reservoir hosts including Marburg and Sudan virus. The goal of this study was to better understand communities contacts with wild and domestic animals and their knowledge of potential disease risks associated with these interactions around Bwindi Impenetrable National Park (BINP), a known foci for spillover events.

Focus groups (n = 24 groups) with 153 participants were convened and interview guide (See S1 Text) was used to conduct discussions in rural and urban settings surrounding BINP in Southwestern Uganda. Mixed methods were used for data analysis. For qualitative data, thematic analysis was used to identify and organize patterns of meaning related to the study objectives. Inductive coding and deductive analysis using a codebook was used to explore key themes associated with community understanding of zoonotic infections and participation in high-risk activities. For the quantitative analysis, a count data set was generated using the themes, sub-themes, and codes from the codebook. Multivariable logistic regression was used to assess the association of demographic, geographic and occupational factors with zoonotic understanding.

Few participants believed animals could transmit diseases to humans (or vice versa), with rural, younger residents as well as those working in healthcare showing higher awareness. Interviews corroborated this finding noting that even when recognized as potentially unsafe, meat from diseased animals was rarely reported and often consumed or resold.

Misconceptions about zoonotic disease transmission are prevalent in Southwestern Uganda despite high-risk for spillover. Policy makers and government entities should prioritize culturally appropriate community education, contextually relevant mitigation of potential spillover events, and comprehensive research into drivers of high-risk activities.

Emerging and re-emerging infectious zoonotic diseases continue to pose significant threats to human and animal health. In Uganda, there is a growing encroachment into forests resulting in increased contact with wild animals and high-risk for spillover events. Despite the long history of zoonotic outbreaks in Uganda, there is a low awareness of zoonotic diseases. We conducted this study to understand communities’ knowledge of the potential disease risks associated with contact with wild and domestic animals around the Bwindi Impenetrable Forest. Our research highlights economic drivers of unsafe meat consumption along with low awareness of zoonotic spillover risk. We described practices in rural and urban communities in Southwestern Uganda that increase the risk of zoonotic disease outbreaks. We found that a common but risky practice was the consuming of meat from sick or dead animals. This was especially apparent in low socio-economic status communities. Surprisingly, rural communities demonstrated a higher understanding of zoonotic disease transmission compared to urban populations. We noted that there was limited knowledge of the potential for zoonotic disease spread. Our findings emphasized the need for enhanced education efforts regarding zoonotic disease transmission and prevention. We recommend that rural communities, which are engaged in high-risk activities, receive education regarding eliminating practices that increase the risk of zoonotic infection. Additional research is also needed to further elucidate the drivers of misunderstandings about zoonoses and potential impact of educational or other interventions, given complex socio-economic conflicts with meat consumption despite known disease status.