Neglected tropical diseases are known to be highly stigmatized conditions. This study investigates tungiasis-related stigma and control practices in the impoverished Napak District in rural northeastern Uganda, where tungiasis is hyperendemic and effective treatment is unavailable. We conducted a questionnaire survey with the main household caretakers (n = 1329) in 17 villages and examined them for tungiasis. The prevalence of tungiasis among our respondents was 61.0%. Questionnaire responses showed that tungiasis was perceived as a potentially serious and debilitating condition and that tungiasis-related stigma and embarrassment were common. Among the respondents, 42.0% expressed judging attitudes, associating tungiasis with laziness, carelessness, and dirtiness, and 36.3% showed compassionate attitudes towards people with tungiasis. Questionnaire responses further indicated that people made an effort to keep their feet and house floors clean (important tungiasis prevention measures), but lack of water was a common problem in the area. The most frequent local treatment practices were hazardous manual extraction of sand fleas with sharp instruments and application of various and sometimes toxic substances. Reliable access to safe and effective treatment and water are therefore key to reducing the need for dangerous treatment attempts and breaking the vicious cycle of tungiasis stigma in this setting marked by poverty.

Background/Objectives: Antimicrobial Resistance (AMR) is a pressing global animal and public health challenge. There is limited data on AMR prevalence, trends, and drivers in bacterial pathogens from animal sources in Uganda. Thus, this study investigated the occurrence and factors associated with multidrug resistance (MDR) in bacterial isolates recovered from clinical samples of animals submitted to the national veterinary diagnostic laboratory in Uganda. Methods: A retrospective study analyzed antibiogram data of bacteria from animal samples submitted to the Central Diagnostic Laboratory, Makerere University in Uganda between 2014 and 2020. The cleaned dataset comprised 590 cases with antibiogram data. Statistical analyses were conducted using R software version 4.5.2. Results: Gram-negative bacteria were predominant (74.4%) among the samples from clinical cases. The overall MDR proportion in the general bacteria population was 41.7% over the seven-year period. Among the clinically relevant bacteria, MDR was highest in Escherichia coli (57.2%), followed by Staphylococcus aureus (35.8%) and Salmonella (15.5%). Univariable screening of predictors hypothesized that MDR was influenced by year of case submission, animal host type, and bacterial group (p < 0.05). Multivariable logistic regression showed that isolates submitted in 2019 (vs. 2015) had significantly higher odds of MDR (aOR = 4.21; 95% CI: 1.62–13.14), indicating a marked temporal increase in resistance. Gram-negative bacteria (vs. Gram-positives) were also more likely to exhibit MDR (aOR = 1.62; 95% CI: 1.07–2.48). Conclusions: The high occurrence of MDR in bacterial pathogens from animal clinical submissions revealed the need for improved antimicrobial stewardship and integrated AMR surveillance in Uganda, particularly within the central region from which most diagnostic samples originated.

Background: Tungiasis is a neglected tropical skin disease caused by adult female fleas which burrow into the skin of people and animals, causing considerable pain and itching. The distribution of the disease is heterogeneous, with Napak district, Karamoja sub-region of northeastern Uganda having the highest disease burden recorded globally. We aimed to determine the factors associated with this high prevalence to inform future intervention strategies. Methods: We conducted a cross-sectional study to identify factors associated with infection of individual children and adults, and a nested case–control study to identify factors for whole households (families). Infected children were identified through mass-screening of children aged 8–14 years between January and March 2022 in 25 villages. Of the 1619 children screened, 210 infected and 358 uninfected children were randomly selected, and their households were enrolled into the study. Observations were made of the homesteads, and structured interviews were conducted with the caregivers. All adults and children in the households were examined. Mixed effect logistic regression analysis was used to identify factors associated with infection of individuals or households. Results: We found children who lived in high-density settlements (manyattas) had more than three times the odds of being infected than those in more open, low-density settlements (adjusted odds ratio aOR 3.51, 95% CI 1.57–7.83, p = 0.002). To our knowledge, this is the first study to show an association of household infection (at least one case) with having a child with a disability (aOR 5.38, 95% CI 1.92–15.03, p = 0.001) and a caregiver who did not show affection to their child (aOR 1.79, 95% CI 1.02–3.13, p = 0.041). For individual adults, those who reported drinking alcohol had four times the odds of infection than those who did not (aOR 4.74, 95% CI 1.93–11.68, p = 0.001). Frequency of washing feet, soap use and house cleanliness were also associated with household infection. Conclusion: Control programs should be developed together with the caregivers to enable them to reduce alcohol use, improve their childcare, hygiene and sanitation practices.