Conclusions and Recommendations
Tuberculosis due to M. bovis is underreported in Uganda, mainly due to the lack of a specific policy on surveillance, prevention, and control of the disease in the animal populations.
This is likely compounded by the lack of data on the socioeconomic impact of the disease to justify financial or other forms of investment in its control. This, in turn, stems from the requirement for expensive and complicated diagnostic procedures that render attempts to investigate the status of BTB and its impact on communities and the national economy a complicated endeavor. Nonetheless, the available data show that approximately one in 15 slaughtered cattle originating from the UCC will have BTB and that one in 100 TB patients in Mbarara hospital will have zoonotic TB caused by M. bovis. The distribution of M. bovis molecular markers mirrors the inferred cattle movement pattern, an indication that uncontrolled animal movement plays an important role in the spread of BTB in Uganda.We therefore recommend the following to resolve with these issues:
1. There is a need to invest in understanding cattle movement patterns in Uganda. This, will not only enable cost-effective surveillance of infectious diseases like BTB, but will also allow the regulatory authorities to design targeted interventions along the cattle movement network.
2. Regardless of its shortcomings, abattoir meat inspection remains the cheapest method to diagnose BTB in low-income settings (OIE 2009). Its effectiveness is, however, dramatically reduced if personnel are not well trained. It is therefore important to increase the competency of meat inspection personnel across the country with regard to postmortem inspection techniques and the ability to detect lesions consistent with those of BTB. This should decrease the risk to the public of exposure to M. bovis and to other zoonotic diseases.
3. To identify zoonotic TB cases, there is a need to revise the current diagnostic algorithm. In particular, history taking that captures and reflects exposure to M. bovis should be included in the TB diagnostic regimen. This would identify cases that are likely to be due to M. bovis that requires pyruvate-infused media to enhance growth when attempting to culture them. Further definitive molecular diagnostic techniques should then be used to differentiate between M. bovis and M. tuberculosis to improve the effectiveness of treating cases with zoonotic BTB and of disease management schemes.
4. There is a need to conduct impact assessments and to document the effects of BTB at the human-animal interface and on the economy of the country. Only then can decisions be made to allocate adequate resources to control and eradicate BTB and zoonotic TB in Uganda.
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