Social demographic characteristics.

In the Nakasongola cattle corridor, brucellosis transmission affects both genders, with certain patterns associated with each as indicated in the interviews. As per key informant interviews, women are commonly more susceptible to brucellosis, although men are not immune. However, men’s health-seeking behaviours, which typically involve seeking medical attention only when their condition becomes severe, might have implications for disease transmission and control. A male local leader noted,

“Normally, I have seen more women than men maybe because men usually move with their illnesses, act strong and secretive and slow to report their ailments than the women” (KII WB, P2-Local leader).

This excerpt is further emphasized by a medical officer who noted that,

“Men usually have a poor health seeking behaviour, and personally if I see a man seated in the line claiming he is sick, I will attend to him very fast so by the time they come to hospital they are critically ill”. (KII WB.P4- medical officer)

The findings of the study also highlight Nakasongola cattle corridor as characterized by livestock farming, with both large and small-scale farmers playing a significant role. The key players in this agricultural landscape are those involved in the production and sale of milk. It was also noted that there is a strong relationship between the Nakasongola herders commonly known as the “balalo” and their cattle. This ethnical attachment to cattle emerged as another significant social factor linked to the transmission of brucellosis. Varied perspectives and the distinct cultural significance attributed to milk and cattle played a crucial role in influencing the transmission of brucellosis within specific ethnic groups. During the FGD with farmers, participants noted that convincing individuals from the “balalo” ethnic group to slaughter and bury their cattle in the event of a brucellosis infection was a challenging task. Similarly, requesting them to refrain from pouring or consuming the milk of an infected cow posed difficulties. The social connection to cattle surpasses that of family members and the broader community. A notable phenomenon in the district is the strong attachment that livestock farmers have to their cattle. For instance, in situations where both cattle and a family member are unwell, the farmers tend to prioritize the well-being of the livestock over that of the human family member as it was denoted in the FGDs.

“Us the balalo, I can’t say livestock farmers, the passion of the cows between the livestock farmers and the balalo is different, like if you slept with your wife and she complained of sickness and you found a cow sick, the attention you would give to the cow is different compared to the wife, you could even wake up at 3am and attend to a cow if its sick and yet tell your wife, to get a mere painkiller. A cow is not just an animal, the bondage between the balalo and their cows is very strong”. (FGD 4, P7).

The prioritization of cattle in this community might reflect their deep social significance. It is characterized as unique, and this suggests the potential for a strong connection between cattle and the community’s social fabric.

“Milk” as a way of life.

The study revealed that milk serves as a staple and is commonly consumed as breakfast, a beverage, and a food source within the livestock communities. Notably, it was observed that children, especially the younger ones, are often fed with raw milk due to cultural beliefs held by their parents. Consumption of raw milk, while a source of essential nutrients like protein, vitamins, and calories for children’s development, might pose a potential risk of brucellosis transmission. In a key informant interview, a farm owner acknowledged the responsibility of ensuring that only safe milk is either sold or retained for family consumption. Despite this responsibility, the owner highlighted the challenge of mothers not consistently boiling the milk before giving it to their children. There is a tendency of mothers sending their children to accompany their fathers to the farms during milking, and if a man refuses to provide milk, he may be perceived as prioritizing money over family welfare.

The consumption of raw milk developed as a significant dietary component for herders, particularly among the young males tasked with cattle herding responsibilities. Across all Focus Group Discussions (FGDs) and key informant interviews, it was consistently highlighted that these young males often lack the time to return home for meals or engage in cooking while working in the fields. Consequently, they rely on cow milk as a substantial source of sustenance. This observation was further validated during fieldwork, where herders explicitly mentioned that milk serves as a remedy for hunger, providing a feeling of fullness that lasts for an extended period. Additionally, the herders emphasized that the warmth of the milk contributes to maintaining body temperature, proving particularly beneficial during rainy periods and cold days.

“I was born from a cattle farming family; I have lived and we have survived on cattle. Even if we are told that milk has brucellosis, milk is part of us. It does not matter whether you are educated on or not, drinking of raw milk is our identity. This is indoctrinated among us from birth. Milk keeps us warm, healthy and not go hungry. As you can see, how far is it from here to the house? How do you expect us to go back to the house for food yet there is food here, hahahaha”? (FGD 1, P2).

Knowledge on brucellosis transmission.

The local construction of brucellosis commonly known as “omusujja gw’nte” literally meaning” the disease of cows”, presentation is overtly scary. One of the survivors noted that the pains especially in the back never ceased, the disease also manifested with chills in the evening and severe backache causing psychological trauma. The majority of the survivors indicated no knowledge on how they got the disease but were informed that brucellosis is got through drinking of milk and eating meat. However, some members of the community were questioning the cause of brucellosis being from milk and meat because they took all the measures but they still got the disease….

“I was told brucellosis is got through drinking milk and eating meat but I have an in-law who does not eat meat or even drink milk but she also got brucellosis, so I wondered what I was being told. Also, I boil my milk thoroughly, I cook my meat until it is ready, so I got perturbed. I was also told to avoid being around cattle because it’s also a route cause but how do you stay away from your cattle when there is no one to feed them or even graze them. The medical personnel were not very clear. I was told to stop drinking milk and eating meat but basing on the fact that my in-law got the disease yet she does not use any animal products, it led me to continue taking my milk and meat and also taking care of my cattle”. (FGD 2, P3)

The participants also showed concern that, though the disease is known as omusujja gw’ente locally, it is also found in other animals like goats and sheep. Meat from small ruminants like goats, sheep and pigs is the major source of meat in public spaces. A farmer in one of the FGDs noted that goats were found positive for brucellosis yet roasted goats’ meat is a common delicacy especially at the social gatherings like weddings and bars.

Religious and healthcare practices.

During data collection it was noted the religious affiliation of individuals, in this case Muslims, seems to have a noteworthy influence on their occupational risks, leading to increased exposure to brucellosis-infected animals. A key informant and a social leader noted Muslims are typically the ones responsible for slaughtering animals, excluding pigs. This group also includes a significant number of livestock traders, butchers, and other professions that require close interaction with cattle meant for slaughter. He said,

“Such close and frequent contact with animals can increase the chances of exposure, leading to a higher risk of infection”. (KII, NB-P5- Social leader)

From the above insight, we see that the religious practices of Muslims, which often dictate their occupations, can inadvertently increase their exposure to animals infected with brucellosis, which could result in continuing transmission within the region.

Role distribution.

The women involvement and activities done within the cattle corridors poses a risky attribute to brucellosis. A key informant mentioned, women for instance in the abattoirs are involved in slaughter and collection of cattle body parts like the skin, skin, blood, and hooves. These animal body parts are specifically for sale in the local food markets. However, it was observed that the collection of these items is done without protective gear thus predisposing them to infection as observed during data collection and denoted by female veterinary extension worker.

“Here at the abattoirs, the women are involved and collect skin, the hooves and the head of the cattle for sell in the food markets/ street foods. Economic and financial factors play a big role in this aspect as some women collect these items to improve their financial status. However, the blood is usually fed to the dogs, poultry and pigs at home”. (KII, NK 1- female veterinary extension worker)

Further still, women participation in familial activities and traditional processing of milk and milk products like making of ghee and the traditional ghee sauce commonly known as “eshabwe” predisposes them to brucellosis. Eshabwe is one of traditional delicacies in some ethnic groups and its consumption is significant. Likewise, the consumption of skimmed milk after the ghee is extracted commonly known as “amacunda” is believed to increase sexual arousal and libido among women.

The findings of the study also highlight a disproportion in livestock herders’ access to training and their initiative in seeking information about brucellosis. An interesting finding emerged; that, while women in this community appear to utilize health facilities more often, men seem to be more likely to participate in disease management training programs. as it was denoted by a key informant;

“Often times you see few women during the trainings maybe because of their familial obligations, they tend to be less informed on the prevention and spread of brucellosis because they don’t attend trainings which creates a gap of awareness in the community about disease management, particularly brucellosis”. (KII, NB 3- male medical personnel).

The study suggests a gender gap in brucellosis knowledge, with women scoring lower than men on related assessments; yet it plays a pivotal role in both the transmission and prevention of diseases. Although the key informants like medical personnel mentioned and agreed that the brucellosis at the human side is neglected, they mentioned that rather the veterinary sector works a lot in terms of vaccination and sensitization. They mentioned that they have health talks at the hospitals but are reluctant to go to the village. The interventions and measures for control of transmission require funding and support yet the government and local government have not put in a lot of effort.

Cultural norms and gender disparities in the milking practices.

It was also observed and noted that there are some cultural norms at the production stage and on the farm. Principally, women were restricted from participating in milking, particularly during menstruation, placing men in the forefront of these activities. Men were identified as being affected mainly because of their constant and close proximity with the animals especially during milking, treatment and feeding. The involvement of men in such activities also rendered them vulnerable and susceptible to brucellosis. For instance, unclean milking methods (such inadequate hand washing and dirt in production areas) might also aid in the spread of zoonotic illnesses. Furthermore, in the production stage or on the farm, women were primarily responsible for collecting milk. However, it was observed that the hygiene practices during milk collection and the storage conditions for the milk were suboptimal.

Although it was noted that men are majorly involved in livestock rearing, women were also observed and it was noted that they are involved in backyard livestock farming especially with small ruminants like goats and sheep. It was also noted that families with one or two cattle in the backyard, women were more involved in taking care of the cattle.

Furthermore, the cultural and social notion of bathing and smearing of milk products among the balalo women was also noted as a gendered social factor for transmission of brucellosis. For example, women in the FGD highlighted that prospective bride are traditionally secluded indoors for a duration of three or more months leading up to their weddings, a ritual known as “ogutegura omugyenyi”. Throughout this ritual, they are regularly provided with gallons of milk to enhance their physique and beauty, and their skin is coated with ghee to achieve a smooth and softened texture. The drinking of raw milk continues even to the husbands’ home in order to maintain her beauty. While these practices highlight the cultural importance attributed to milk and its derivatives, they also have the potential to influence the transmission of brucellosis.

“To say that milk and ghee is bad, is like an insult. When you live here and are a livestock farmer, a mulalo, you do not talk about milk and ghee or any other thing related to cattle as risk because you don’t know the importance of milk. The beauty of a mulalo woman is seen by the weight and soft skin. Once the woman comes to your home as a wife, it’s the role of the man to look after the woman and maintain her beauty. A big, smooth skinned women indicate a well-cared for women. This increases our ego and show our masculinity roles” (FGD 3, P2-).

Cultural connotations and assisted births.

The study revealed that transmission and vulnerability of brucellosis among men constituted assisting in births of young calves, often without protective gears and had a cultural implication. A key informant mentioned that some ethnic groups associate wearing gloves during parturition with less attachment to cattle and contempt for the calf. This also included cleaning of cow dung and any other animal product.

A participant noted that,

“I visited a family of the balalo and during my stay within the family, one day I was asked to clean dung from the compound of the home, I got a spade to shove off the dug, the elder of the family lamented, “ogu no mwiru manya” implying that I do not belong to the cattle keeping ethnical group commonly known as balalo”. (FGD 1, P5-).

Family and power dynamics.

It was also observed that the patriarchal forces within families also facilitated the transmission of diseases in terms of knowledge sharing and access. In some families, it was observed that talking to a woman especially during interviews was after seeking permission from the man. Although these were interviews for research, it showcased a possibility of being the same even in sharing information and accessing information regarding health issues. Actually, women in the focus group noted that it’s the men who usually go to the sub-counties in case of any meeting or sensitization program, the women and wives were usually not allowed there. During an interview, it was noted that this situation is intensified by the prevalent illiteracy among women, leading to a lack of awareness regarding their rights.

“Women’s access to knowledge is very important in the control of brucellosis in the livestock farming communities. Their involvement in decisions affecting their lives is limited, and their confidence in asserting their rights is particularly low mostly because they are not aware of their rights which intensifies their marginalization. The absence of influence among women in the cattle corridor communities has cast them primarily as victims of health concerns”. (KII WB 2- medical personnel).

Thus, gender inequality is believed to be firmly ingrained in these societies, as women face constraints preventing them from contributing to crucial discussions concerning community development, economic progress and food resources.

The findings also showcased that within the community, authority, impact, and the concept of “manhood” are all associated with possessing cattle. Social and cultural practices like sharing and exchange of cows during ceremonies like marriages were identified as points of showing off one’s social status and interconnectedness. In this cultural practice people give out cows as gifts; this reciprocal exchange is known as “empaano,” involving the rotational exchange of cows among friends, relatives, and in-laws. During feasts especially marriages; the farmers would frequently give out cattle and also butcher animals at home during these customary rituals without the use of meat inspection agencies or personnel.

“While celebrating feasts, particularly during marriages, farmers often slaughter animals at home as part of these traditional rituals, without the involvement of meat inspection agencies or personnel and the more cattle slaughtered the more powerful one is.” (FGD 3, P6)

Structural aspects.

The study also revealed that another dimension influencing the transmission of brucellosis revolves around structural and organizational factors. Observations of poor hygiene practices, including collecting animal blood with bare hands and inadequate disposal of abortus especially at the slaughter houses was noted. This often has direct implications for the transmission of Brucella bacteria from infected animals to humans. These practices increase the likelihood of individuals coming into direct contact with the pathogen, leading to potential infections. A female veterinary extension worker noted that there was lack of strict measures of adherence to hygiene protocols, including the mandatory use of personal protective equipment (PPE), especially gloves, during the handling of animals and their bodily fluids.

Further, it was noted that there is a significant oversight in addressing human involvement, despite the fact that brucellosis impacts humans as it was highlighted by men in the focus group discussion.

“Humans are mostly neglected yet the disease also affects humans but is not given the utmost attention. Also, interventions and measures require funding and support, we need to harmonize systems, for instance the one-health approach has failed to kick off yet it’s very important though under human health, we usually have health talks at the hospitals but are still reluctant or slow to go to the community”. (KII, NK 4- Medical personnel)