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1.
Ir Vet J ; 76(1): 27, 2023 Sep 30.
Article in English | MEDLINE | ID: mdl-37777782

ABSTRACT

BACKGROUND: This novel study forms part of a larger research programme seeking an improved understanding of aspects of the owned dog population in Ireland. Dog welfare organisations (DWOs) in Ireland are recognised as an instrumental pillar of the animal welfare sector with some receiving substantial public funding. We conducted a survey of DWOs in Ireland (n = 39) to gain a better understanding of their role and function, including their policies and procedures and the rehoming of dogs to other regions. In addition, we wanted to get a better understanding of the challenges experienced by DWOs in fulfilling their role and their perspectives on potential solutions to these challenges. The survey questions consisted of closed and open-ended items. Closed items were analysed quantitively; open-ended items were analysed thematically. RESULTS: Most DWOs (> 80%) had written protocols for important welfare actions including rehoming procedures, assessment of owner suitability and euthanasia. DWOs sent dogs to Northern Ireland (13%), Great Britain (38.5%) and to other countries outside the United Kingdom (36%, including Germany, Sweden, Italy, the Netherlands and Czechia). Reported challenges included a general lack of funding, limited public awareness of the importance of dog welfare and insufficient capacity to handle dog numbers. To address these challenges, the DWOs highlighted the potential contribution of subsidised programmes and access to resources to educate potential owners. In a further qualitative evaluation to capture perceptions of appropriate solutions by DWOs, several themes emerged, relating to legislation, education, an overwhelmed workforce, and funding. CONCLUSIONS: This study provides important insights into the roles and functions of DWOs and challenges they experience in Ireland. It is hoped that the findings from this research will inform future research investigating potential solutions to these challenges as well as the development of policy in Ireland.

2.
Animals (Basel) ; 12(23)2022 Nov 25.
Article in English | MEDLINE | ID: mdl-36496810

ABSTRACT

This novel qualitative study identifies challenges and opportunities to improve dog welfare in Ireland, as perceived by dog welfare organisations (DWOs), a previously underutilised stakeholder. This study sought the views of this predominantly voluntary sector of the next steps for policy and action in dog welfare, in light of the effects of the "puppy pandemic", increased costs and COVID-19 restrictions. An integrated online focus group and interview design involving DWOs was analysed using inductive thematic analysis. Thematic analysis identified 2 key themes: (1) Key challenges and solutions in general dog welfare and (2) Challenges and opportunities in the welfare organisation sector. DWOs perceived poor public awareness of appropriate dog-husbandry, inadequate legislation enforcement, negative impact of puppy farms, and increased financial and volunteer burden. DWOs helped construct a best practice rehoming pathway, identified how overall standards could be improved and recommendations to enhance dog welfare. The DWOs perceived an increased numbers of households acquiring dogs, difficulties in rehoming, and financial challenges as threatening their viability as organisations and Irish dog welfare. Greater enforcement of legislation, greater communication between organisations and the government, and more media awareness were seen as helpful by the DWOs to improve dog welfare standards and their organisations.

3.
Ir Vet J ; 75(1): 16, 2022 Jul 14.
Article in English | MEDLINE | ID: mdl-35836251

ABSTRACT

BACKGROUND: Reliable information about national pet dog populations is an important contributor to informed decision-making, both by governments and national dog welfare organisations. In some countries, there is an improved understanding of aspects of the national pet dog population, but as yet limited published information is available in Ireland. The current study reviews the utility of existing data to inform our understanding of recent changes to the pet dog population in Ireland, including both biological and organisational processes. RESULTS: Based on national data on dog licencing and microchipping registration, pet dog numbers have remained relatively stable in recent years (ie prior to the COVID-19 pandemic). Since 2015, there has been a substantial decrease in the number of dogs managed through dog control centres. Although the completeness of the data are likely variable, there appears to be substantial, and increasing, number of dogs moving from Ireland to other countries, including UK, Sweden, Italy, Germany and Singapore. We also note an increase (albeit much smaller) in the number of dogs being moved into Ireland. CONCLUSIONS: This study highlights the challenges faced when using existing national data to gain insights into the dog population of Ireland. The linking of existing national databases (individual dog identification, dog licencing, dog control statistics) has the potential to improve both the representativeness and accuracy of information about the Irish pet dog population. In the next phases of our work, we will focus on the work of dog welfare organisations, given both the increased role played by these organisations and the substantial public funding that has been committed in this sector.

4.
Ir Vet J ; 75(1): 6, 2022 Apr 04.
Article in English | MEDLINE | ID: mdl-35379319

ABSTRACT

BACKGROUND: The cattle sector is the most important economic production unit of the Irish farming and agri-food sector. Despite its relevance, there has been limited quantitative information about the structure of differing cattle production types and of the connections between them. This paper addresses this gap by providing, for the first time, an overview of the Irish cattle population structured by enterprise type. METHODS & RESULTS: We collected data from the cattle register for the period 2015 to 2019 and assigned registered herds to one of 18 different herd types using a recently published herd type classification approach. This allows, for the first time, to exploring changes in enterprise types and subtypes over time, and describing the movements between these subtypes and from these subtypes to slaughter. CONCLUSIONS: The overview and associated classification presented in this study will form the basis for a number of future comparative studies, including cross-sectoral assessments of profitability, estimation of the extent of animal health losses on Irish cattle farms or structural analysis of Greenhouse Gas (GHG) emissions across production systems.

5.
BMC Vet Res ; 17(1): 157, 2021 Apr 13.
Article in English | MEDLINE | ID: mdl-33849526

ABSTRACT

BACKGROUND: Prior to the first recorded outbreak of Rift Valley fever (RVF) in Uganda, in March 2016, earlier studies done until the 1970's indicated the presence of the RVF virus (RVFV) in the country, without any recorded outbreaks in either man or animals. While severe outbreaks of RVF occurred in the neighboring countries, none were reported in Uganda despite forecasts that placed some parts of Uganda at similar risk. The Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) undertook studies to determine the RVF sero-prevalence in risk prone areas. Three datasets from cattle sheep and goats were obtained; one from retrospective samples collected in 2010-2011 from the northern region; the second from the western region in 2013 while the third was from a cross-sectional survey done in 2016 in the south-western region. Laboratory analysis involved the use of the Enzyme Linked Immunosorbent Assays (ELISA). Data were subjected to descriptive statistical analyses, including non-parametric chi-square tests for comparisons between districts and species in the regions. RESULTS: During the Yellow Fever outbreak investigation of 2010-2011 in the northern region, a total sero-prevalence of 6.7% was obtained for anti RVFV reacting antibodies (IgG and IgM) among the domestic ruminant population. The 2013 sero-survey in the western region showed a prevalence of 18.6% in cattle and 2.3% in small ruminants. The 2016 sero-survey in the districts of Kabale, Kanungu, Kasese, Kisoro and Rubirizi, in the south-western region, had the respective district RVF sero-prevalence of 16.0, 2.1, 0.8, 15.1and 2.7% among the domestic ruminants combined for this region; bovines exhibited the highest cumulative sero-prevalence of 15.2%, compared to 5.3 and 4.0% respectively for sheep and goats per species for the region. CONCLUSIONS: The absence of apparent outbreaks in Uganda, despite neighboring enzootic areas, having minimal restrictions to the exchange of livestock and their products across borders, suggest an unexpected RVF activity in the study areas that needs to be unraveled. Therefore, more in-depth studies are planned to mitigate the risk of an overt RVF outbreak in humans and animals as has occurred in neighboring countries.


Subject(s)
Animal Diseases/epidemiology , Rift Valley Fever/epidemiology , Rift Valley fever virus/immunology , Animal Diseases/virology , Animals , Cattle , Enzyme-Linked Immunosorbent Assay/veterinary , Goats , Immunoglobulin G/blood , Immunoglobulin M/blood , Prevalence , Rift Valley fever virus/isolation & purification , Seroepidemiologic Studies , Sheep , Uganda/epidemiology
6.
Ir Vet J ; 73(1): 25, 2020 Nov 26.
Article in English | MEDLINE | ID: mdl-33319697

ABSTRACT

BACKGROUND: In recent years, there have been multiple (political, environmental, cultural) drivers of change in Irish agriculture, including the establishment of Animal Health Ireland (AHI) in 2009, to provide leadership of non-regulatory livestock health issues (diseases and conditions of livestock that are endemic in Ireland but which are not currently subject to international legislation). In this study, we describe the opinion of stakeholders (farmers, veterinary practitioners and agricultural industry professional service providers), elicited by means of a survey, on their perceptions of changes in selected non-regulatory bovine health issues over the last 10 years and priority issues relevant to non-regulatory bovine health to be tackled over the next 10 years. RESULTS: A total of 673 individuals participated in the online questionnaire. For the majority of the non-regulatory bovine health issues, most participants felt there had been improvements over the last 10 years. However, professional service providers were generally more conservative in their response to improvements on-farm compared to farmers. Several issues, particularly BVD and udder health/milk quality, were viewed more positively by all relevant respondents. There was reasonable agreement between responses from different respondent types and sectors regarding the top three priorities relevant to non-regulatory bovine animal health for the next 10 years in Ireland, which included antimicrobial resistance (highlighting measures to reduce both on-farm usage and resistance), anthelmintic resistance, greenhouse emissions and calf welfare. CONCLUSIONS: The results are encouraging, demonstrating a perception of improvement in a number of non-regulatory bovine health issues in Ireland over the last ten years. With respect to the next 10 years, stakeholders prioritised antimicrobial and anthelmintic resistance, greenhouse gas emissions and calf welfare, which aligns closely with broader societal concerns. This information is useful to AHI, particularly with respect to future priorities. However, these concerns are broad in scope and will require further considerations, including collaborations, between AHI and partnering organisations. Given that there were differences between farmers and professional service providers in responses, it is useful to consider how the aims and the benefits of future AHI programmes are framed and communicated to all stakeholders.

7.
Vet Res ; 51(1): 124, 2020 Sep 25.
Article in English | MEDLINE | ID: mdl-32988417

ABSTRACT

Many studies report age as a risk factor for BoHV-1 infection or seropositivity. However, it is unclear whether this pattern reflects true epidemiological causation or is a consequence of study design and other issues. Here, we seek to understand the age-related dynamics of BoHV-1 seroprevalence in seasonal calving Irish dairy herds and provide decision support for the design and implementation of effective BoHV-1 testing strategies. We analysed seroprevalence data from dairy herds taken during two Irish seroprevalence surveys conducted between 2010 and 2017. Age-dependent seroprevalence profiles were constructed for herds that were seropositive and unvaccinated. Some of these profiles revealed a sudden increase in seroprevalence between adjacent age-cohorts, from absent or low to close to 100% of seropositive animals. By coupling the outcome of our data analysis with simulation output of an individual-based model at the herd scale, we have shown that these sudden increases are related to extensive virus circulation within a herd for a limited time, which may then subsequently remain latent over the following years. BoHV-1 outbreaks in dairy cattle herds affect animals independent of age and lead to almost 100% seroconversion in all age groups, or at least in all animals within a single epidemiological unit. In the absence of circulating infection, there is a year-on-year increase in the age-cohort at which seroprevalence changes from low to high. The findings of this study inform recommendations regarding testing regimes in the context of contingency planning or an eradication programme in seasonal calving dairy herds.


Subject(s)
Herpesvirus 1, Bovine/physiology , Infectious Bovine Rhinotracheitis/epidemiology , Vaccination/veterinary , Age Factors , Animals , Cattle , Dairying , Female , Infectious Bovine Rhinotracheitis/virology , Ireland/epidemiology , Prevalence , Seroepidemiologic Studies
8.
Viruses ; 12(3)2020 03 07.
Article in English | MEDLINE | ID: mdl-32156067

ABSTRACT

In the recent past, peste des petits ruminants (PPR) emerged in East Africa causing outbreaks in small livestock across different countries, with evidences of spillover to wildlife. In order to understand better PPR at the wildlife-livestock interface, we investigated patterns of peste des petits ruminants virus (PPRV) exposure, disease outbreaks, and viral sequences in the northern Albertine Rift. PPRV antibodies indicated a widespread exposure in apparently healthy wildlife from South Sudan (2013) and Uganda (2015, 2017). African buffaloes and Uganda kobs <1-year-old from Queen Elizabeth National Park (2015) had antibodies against PPRV N-antigen and local serosurvey captured a subsequent spread of PPRV in livestock. Outbreaks with PPR-like syndrome in sheep and goats were recorded around the Greater Virunga Landscape in Kasese (2016), Kisoro and Kabale (2017) from western Uganda, and in North Kivu (2017) from eastern Democratic Republic of the Congo (DRC). This landscape would not be considered typical for PPR persistence as it is a mixed forest-savannah ecosystem with mostly sedentary livestock. PPRV sequences from DRC (2017) were identical to strains from Burundi (2018) and confirmed a transboundary spread of PPRV. Our results indicate an epidemiological linkage between epizootic cycles in livestock and exposure in wildlife, denoting the importance of PPR surveillance on wild artiodactyls for both conservation and eradication programs.


Subject(s)
Animals, Wild/virology , Livestock/virology , Peste-des-Petits-Ruminants/epidemiology , Peste-des-Petits-Ruminants/virology , Peste-des-petits-ruminants virus , Africa, Eastern/epidemiology , Animals , Antibodies, Viral/immunology , Disease Outbreaks , Enzyme-Linked Immunosorbent Assay , Female , Geography, Medical , Goats , Male , Peste-des-petits-ruminants virus/classification , Peste-des-petits-ruminants virus/physiology , Seroepidemiologic Studies , Sheep
9.
Vet Surg ; 49(3): 487-495, 2020 Apr.
Article in English | MEDLINE | ID: mdl-31724764

ABSTRACT

OBJECTIVE: To evaluate two different barbed sutures for closure of pelvic flexure enterotomies and compare results achieved with two previously described closure techniques. STUDY DESIGN: Ex vivo. SAMPLE POPULATION: Twenty-four fresh cadaver adult equine large colons. METHODS: Cadavers were randomly assigned to four closure groups (n = 6 each group): single-layer absorbable suture, double-layer absorbable suture, single-layer unidirectional barbed suture, or single-layer bidirectional barbed suture. Construction time, luminal reduction (percentage), bursting pressure, and method of failure were measured. Cost, leakage, exposed suture, and general appearance were recorded. Comparisons were performed with one-way analysis of variance and post hoc Bonferroni test (P < .05). RESULTS: Double-layer absorbable closure had the highest bursting pressure (mean = 178.5 mm Hg, SD = 9.79, P < .001) but took more time (P = .001) compared with all other groups. The construction time of both barbed suture closures did not differ from the single-layer closure (P > .06). Bursting strengths of both unidirectional (mean = 91.6 mm Hg, SD = 5.57) and bidirectional (mean = 87.5 mm Hg, SD = 8.69) barbed sutures were lower (P > .006 for both) than those of both single- (mean = 117.6 mm Hg, SD = 11.69) and double-layer (mean = 178.5 mm Hg, SD = 9.79) closures. Unidirectional barbed suture closure had a reduction in lumen diameter (P = .004) compared with bidirectional and single-layer closures. CONCLUSION: Enterotomy closures with the two different barbed suture patterns were comparable in bursting strength and construction time. However, the barbed suture patterns had lower bursting strength compared with traditional single- and double-layer closures. Unidirectional barbed suture closure also reduced lumen diameter. CLINICAL SIGNIFICANCE: Closure of a large colon enterotomy with barbed suture patterns may be less secure than single- and double-layer suture closure.


Subject(s)
Digestive System Surgical Procedures/veterinary , Intestines/surgery , Sutures/veterinary , Wound Closure Techniques/veterinary , Animals , Cadaver , Horses , Pelvis/surgery , Suture Techniques/veterinary , Sutures/standards
10.
Vet Rec ; 185(13): 406, 2019 10 05.
Article in English | MEDLINE | ID: mdl-31320545

ABSTRACT

Surgical sterilisation to manage free-roaming dog populations is widely used in many countries. However, few studies have examined optimal postoperative pain management regimens at low-resource, high-throughput veterinary clinics. The aim of this study was to examine the efficacy of two intravenous analgesic regimens, preoperative administration of meloxicam and tramadol, or meloxicam alone, in free-roaming dogs undergoing sterilisation. A total of 125 dogs were included, with 64 dogs in the meloxicam-tramadol arm and 61 dogs in the meloxicam-only arm in a non-inferiority study design. Pain levels in sterilisation surgery patients were assessed at four time points after surgery using the Colorado State University Canine Acute Pain Scale, a Visual Analogue Scale and a modified version of the Glasgow Composite Measure Pain Scale - Short Form. Non-inferiority was supported for each of the main scoring outcomes using non-inferiority margins of 0.5, 5 and 0.8, respectively. One dog from the meloxicam-tramadol group and four dogs in the meloxicam-only arm required rescue analgesia, with no difference between groups (P=0.21).The study demonstrated that meloxicam was effective in controlling postoperative pain in a high proportion of dogs. The addition of tramadol alongside meloxicam treatment was not found to be of clinical benefit.


Subject(s)
Analgesics/therapeutic use , Castration/veterinary , Pain, Postoperative/veterinary , Perioperative Care/veterinary , Tramadol/therapeutic use , Animals , Dogs , Female , Male , Meloxicam/therapeutic use , Pain, Postoperative/prevention & control , Perioperative Care/methods , Prospective Studies
11.
Res Vet Sci ; 123: 305-310, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30852350

ABSTRACT

The mark-resight methodology is a widely used tool to assess both population size and vaccination coverage of free-roaming dogs. Evaluating coverage is often critical to determine the progress and impact of vaccination interventions. The aim of this study was to assess the reproducibility of the mark-resight method during a rabies vaccination campaign. A total of 90 areas in Goa, India, were surveyed on two occasions following a vaccination campaign, during which vaccinated dogs were marked. The estimated vaccination coverage for both confined and free-roaming dogs in the study area after a first round of vaccination was 68.9% (95% CI, 66.7-71.0%). The number of dogs counted in each survey, as well as the proportion of marked dogs, were the main outcomes recorded. Linear and mixed-effects models were used to evaluate the effect of survey order, surveyor, time of day, days between surveys, and weather on the outcomes between repeated surveys. Fewer dogs were likely to be counted in afternoon surveys compared to morning surveys (19.2% fewer dogs, 95%CI 7.5-31.9%) and a 17.2% (95%CI 3.6-32.7%) higher proportion of marked dogs was associated with the repeated survey compared to the first survey. Increased variation of the marked percentage between surveys was associated with using different surveyors (8.3%, 95%CI 0.4-16.2). This study demonstrated that external or personnel factors can influence the number of dogs counted and the estimated vaccination coverage of individual survey areas. Regular staff training, to ensure equal effort and quality of survey techniques between surveyors, could help standardise survey outcomes.


Subject(s)
Dog Diseases/prevention & control , Rabies Vaccines/immunology , Rabies/veterinary , Vaccination Coverage , Vaccination , Animals , Dog Diseases/epidemiology , Dogs , India/epidemiology , Population Surveillance/methods , Rabies/epidemiology , Rabies/prevention & control , Reproducibility of Results , Surveys and Questionnaires
12.
Vet Rec ; 183(14): 450, 2018 Oct 13.
Article in English | MEDLINE | ID: mdl-30121636

ABSTRACT

Wounds in working donkeys are a common and preventable welfare problem in many countries. Mutilations, iatrogenic injuries carried out by owners, are a particularly distressing welfare issue. However, little is known about their nature and prevalence. The project aim was to assess the general health and establish the prevalence, nature and severity of mutilations and other skin wounds in donkeys from several communities in Tamil Nadu, India, that were part of a donkey welfare initiative run by the Worldwide Veterinary Service charity. Five hundred and eighty-two donkeys were examined from five locations and data collected using a predesigned, smartphone app between October 2016 and July 2017. The study revealed that 298 wounds were present in a total of 227 donkeys (39.0 per cent of the population). Mutilations, comprising nose-splitting, ear-splitting and branding, were the most common type of skin wound, comprising 62.8 per cent of all wounds. Poorly fitting harnesses and hobbles were also a common cause of injury. These data can be used to design future-targeted and focused, educational interventions to reduce mutilation practices which are a common and important welfare issue. Further outreach initiatives are urgently needed to improve welfare of donkeys in these regions.


Subject(s)
Equidae , Skin/injuries , Animal Welfare , Animals , Female , India/epidemiology , Male , Pregnancy , Prevalence , Wounds and Injuries/epidemiology , Wounds and Injuries/veterinary
13.
PLoS Negl Trop Dis ; 12(1): e0006159, 2018 01.
Article in English | MEDLINE | ID: mdl-29324737

ABSTRACT

Rabies is a devastating yet preventable disease that causes around 59,000 human deaths annually. Almost all human rabies cases are caused by bites from rabies-infected dogs. A large proportion of these cases occur in Sub Saharan Africa (SSA). Annual vaccination of at least 70% of the dog population is recommended by the World Health Organisation in order to eliminate rabies. However, achieving such high vaccination coverage has proven challenging, especially in low resource settings. Despite being logistically and economically more feasible than door-to-door approaches, static point (SP) vaccination campaigns often suffer from low attendance and therefore result in low vaccination coverage. Here, we investigated the barriers to attendance at SP offering free rabies vaccinations for dogs in Blantyre, Malawi. We analysed data for 22,924 dogs from a city-wide vaccination campaign in combination with GIS and household questionnaire data using multivariable logistic regression and distance estimation techniques. We found that distance plays a crucial role in SP attendance (i.e. for every km closer the odds of attending a SP point are 3.3 times higher) and that very few people are willing to travel more than 1.5 km to bring their dog for vaccination. Additionally, we found that dogs from areas with higher proportions of people living in poverty are more likely to be presented for vaccination (ORs 1.58-2.22). Furthermore, puppies (OR 0.26), pregnant or lactating female dogs (OR 0.60) are less likely to be presented for vaccination. Owners also reported that they did not attend an SP because they were not aware of the campaign (27%) or they could not handle their dog (19%). Our findings will inform the design of future rabies vaccination programmes in SSA which may lead to improved vaccination coverage achieved by SP alone.


Subject(s)
Dog Diseases/prevention & control , Patient Acceptance of Health Care , Rabies Vaccines/administration & dosage , Rabies/prevention & control , Rabies/veterinary , Vaccination Coverage , Animals , Dogs , Health Services/statistics & numerical data , Health Services Accessibility , Humans , Malawi
14.
Onderstepoort J Vet Res ; 84(1): e1-e10, 2017 Jan 23.
Article in English | MEDLINE | ID: mdl-28155286

ABSTRACT

The transmission of diseases between livestock and wildlife can be a hindrance to effective disease control. Maintenance hosts and contact rates should be explored to further understand the transmission dynamics at the wildlife-livestock interface. Bovine tuberculosis (BTB) has been shown to have wildlife maintenance hosts and has been confirmed as present in the African buffalo (Syncerus caffer) in the Queen Elizabeth National Park (QENP) in Uganda since the 1960s. The first aim of this study was to explore the spatio-temporal spread of cattle illegally grazing within the QENP recorded by the Uganda Wildlife Authority (UWA) rangers in a wildlife crime database. Secondly, we aimed to quantify wildlife-livestock interactions and cattle movements, on the border of QENP, using a longitudinal questionnaire completed by 30 livestock owners. From this database, 426 cattle sightings were recorded within QENP in 8 years. Thirteen (3.1%) of these came within a 300 m-4 week space-time window of a buffalo herd, using the recorded GPS data. Livestock owners reported an average of 1.04 (95% CI 0.97-1.11) sightings of Uganda kob, waterbuck, buffalo or warthog per day over a 3-month period, with a rate of 0.22 (95% CI 0.20-0.25) sightings of buffalo per farmer per day. Reports placed 85.3% of the ungulate sightings and 88.0% of the buffalo sightings as further than 50 m away. Ungulate sightings were more likely to be closer to cattle at the homestead (OR 2.0, 95% CI 1.1-3.6) compared with the grazing area. Each cattle herd mixed with an average of five other cattle herds at both the communal grazing and watering points on a daily basis. Although wildlife and cattle regularly shared grazing and watering areas, they seldom came into contact close enough for aerosol transmission. Between species infection transmission is therefore likely to be by indirect or non-respiratory routes, which is suspected to be an infrequent mechanism of transmission of BTB. Occasional cross-species spillover of infection is possible, and the interaction of multiple wildlife species needs further investigation. Controlling the interface between wildlife and cattle in a situation where eradication is not being considered may have little impact on BTB disease control in cattle.


Subject(s)
Animals, Wild/microbiology , Buffaloes/microbiology , Tuberculosis, Bovine/transmission , Animal Husbandry , Animals , Cattle/microbiology , Female , Male , Risk Factors , Spatio-Temporal Analysis , Surveys and Questionnaires , Tuberculosis, Bovine/epidemiology , Uganda/epidemiology
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