Highly infectious emerging zoonotic diseases such as Ebola are a major cause of morbidity and mortality in Africa [25] as shown by the recent outbreaks in West and Central Africa [7, 26]. The past six Ebola outbreaks in Uganda accentuate the country’s vulnerability to further outbreaks, especially due to spill-over from the Democratic Republic of Congo, a neighbouring country prone to frequent Ebola outbreaks [27, 28]. Also, Uganda’s location in an area with great biodiversity, together with a fast-rising population density that comingle closely with animals are high risk factors for Ebola and other emerging zoonotic diseases [27, 29].
Our focus on the Ebola outbreak with respect to the pig value chain, was prompted by Uganda’s fast growing pig sector, that continues to register increasing pork consumption rates (average of 3.4 kg/person per year), the highest in East Africa [30]. Primarily, the national Ebola control programs are designed to protect the human health and remotely consider enterprises that support farmers’ livelihoods. However, the neglect of the community’s survival and sustenance options, especially the pig value chain could lead to adversative effects on livelihoods. With the recent zoonotic disease prioritization [31] and having the multi-sectoral-multi-agency One health strategic plan in place [32], Uganda has the opportunity to embrace a One Health approach while handling Ebola and other priority zoonotic diseases for the benefit of the community. Effective post-Ebola intervention plans in Uganda and elsewhere, must encompass the primary sources of livelihoods for such agro-pastoral communities in order to mitigate the negative impacts of the disease. For instance, farmers could be provided with breeding pigs, access to credit, and training for the small holder pig enterprises. This is in concurrence with strategies put in place in West Africa in lieu of efforts to stimulate social and economic recovery of vulnerable communities affected by Ebola [33]. Ebola control programs cognisant of the inter-sectoral collaboration that would assure sustainable pig production, supply and marketing for the small holder pig farmers in Uganda.
With regards to knowledge, a majority of the respondents were able to recall previous Ebola outbreaks in Luwero that occurred more than two years ago. This was contrary to common health care events, often not recalled accurately within a few months of occurrence [34]. Most likely, the impact of Ebola outbreaks associated with economic turbulence and social stigma in communities appear to last longer. Indeed, people tend to remember disastrous events associated with excessive changes in routine life, even after several years of the incident [35]. One such event was the introduction of ‘safe burial’ practices for Ebola victims [36]. Whereas this was needed to prevent disease spread, the communities misconstrued the practice as being disgraceful and demeaning to the dead. This is because the bereaved family members were denied a chance to pay their last respect to their dead, (pray, wash, dress, perfume the corpses) and mark the graves of the deceased [36]. In effect, this caused psycho-social trauma among relatives and community members that might have led to long-term memories which lasted for several years, even after the Ebola outbreak.
The fact that respondents were able to identify the major signs and symptoms of Ebola such as fever, vomiting, bleeding and diarrhoea was not unexpected. These were frequently shared on the information education and communication materials that were available in the community health centres and public spaces in Luwero [37]. Communities that are able to identify the main signs of Ebola can ably avoid the infections when such cases occur. However, other important signs which are frequently associated with common ailments such as malaria could not be identified, suggesting that the community could mistakenly handle Ebola patients with minimal or no precautionary measures. This is particularly possible if Ebola presents with nonspecific symptoms that can easily be mistaken for other endemic diseases like malaria, typhoid fever, yellow fever or, even measles or meningococcemia in children [38]. Efforts should be put in place to educate the public to consider patients with such signs as suspected cases, especially when there is an Ebola outbreak in the community.
Besides, the health centres, a significant proportion of patients suspected to have Ebola could be treated by traditional healers or witchdoctors. A number of communities in Uganda and elsewhere in Africa still associate Ebola outbreaks with witchcraft [20]. Traditional healers have evolved with communities in Africa, and continue to offer first line of health care services in Uganda for unknown ailments believed to be associated with witchcraft to appease the spirits [20, 39]. Nonetheless, escalation of Ebola infections in West Africa and DRC was linked to traditional healers due to inability to adhere to preventative measures [40]. Training traditional healers on the basic preventive measure for Ebola and closely monitoring their operations would minimize spread of the disease in the community.
This study observed mixed perceptions on the transmission of Ebola with a majority linking transmission with eating of bats, monkey and bush meat. This was in conformity with the study conducted by [5, 41, 42], who noted that consumption of bush meat could contribute to infection. Conversely, the respondents did not consider eating of game meat as a high risk factor, probably because in earlier outbreaks that occurred in Kibaale district [43] and also in Luwero district [20] the victims could not be linked to eating of wild animals such as monkeys before falling ill. Meanwhile, as eating of bats or other wild animals could not be regarded as a high risk for acquiring Ebola, hunting and eating of game meat continues unabated, exposing the vulnerable communities to future Ebola infections. Besides hunting game meat for authentic values, most communities depend on wild game as source food and income security. Efforts to provide alternative livelihoods and food security could protect vulnerable communities from Ebola.
Our findings showed that the unit cost of pork was significantly reduced during Ebola outbreak. Also, the average number of kilograms of pork sold as well as the final income significantly reduced during the outbreak. This was in conformity with the assertions that beyond the public health impacts, emerging global infectious cause wider socioeconomic consequences often disregarded in impact assessments [44]. This could be attributed to the human health sector-based Ebola preparedness and prevention practices and the public behaviour of stigmatizing the pigs as the source of Ebola that led to avoidance of eating pork. Evidently, zoonotic infectious disease outbreaks have been associated with substantial economic impacts due to disruption of the livestock markets (44). In consequence, the reduced sales and incomes negatively impacted the household incomes. In accord with prior reports from West Africa, household and community incomes dropped significantly during the Ebola outbreak [45] leading to increased food insecurity and household vulnerability.
A plausible explanation for the reduced sales of pigs/pork was due to the misconception that pigs were the source of Ebola, creating fear of contracting the disease and avoiding eating of pork by the consumers. It was not clear why the community associated pigs with the Ebola. However, the two Ebola outbreaks in Luwero were apparently preceded by African swine fever (ASF) epidemics with wide spread mortalities of pigs in the community. Besides, pigs with ASF show signs of haemorrhages on the skin and in internal organs, labored breathing with frothy nasal discharges mixed with blood, and death of most affected animals within 2-5days [46]. Farmers have frequently observed reddening of the ears, clinical signs consistent with of ASF [47, 48]; but more less the same sign (bleeding) is observed in human cases with Ebola. As a result, the ASF in pigs and Ebola in humans are erroneously believed to be caused by the same agent that originates from pigs. To clear this misconception, a deliberate social-anthropological understanding of the agro-pastoral communities with regard to such diseases should be given priority attention to minimize losses to the pig industry in future.