Frontline recognition and specimen referral readiness for selected priority zoonoses among health workers in southwestern Uganda

Background Southwestern Uganda is a livestock-intensive region vulnerable to recurrent zoonotic disease outbreaks. Because confirmation of several priority zoonoses depends on higher-level or reference laboratories, preparedness requires both frontline recognition and effective specimen referral. We assessed frontline recognition, specimen-referral readiness, and selected indicators of One Health coordination and cross-sectoral information exchange among health workers. Methods We conducted a cross-sectional survey of 345 health workers in Mbarara, Kazo, Kiruhura, and Ibanda districts. Participants were purposively recruited from 54 facilities based on roles in recognition, specimen handling, referral, or reporting of suspected zoonoses. Recognition was summarized using an 11-item recognition index covering causative agents and transmission/exposure pathways. The primary outcome was self-reported absence of specimen-referral linkage, defined as a respondent answering ‘No’ to the question, ‘Do you refer samples elsewhere for testing?’ We estimated prevalence ratios (PRs) using modified Poisson regression with facility-clustered, small-sample-corrected robust standard errors (CR2), with generalized estimating equations used to assess robustness. Results Almost all respondents had heard of the selected zoonoses (99.7%), and the median recognition index was 9/11 (interquartile range [IQR] 8–10). Overall, 48/345 (13.9%) respondents reported no specimen-referral linkage. This was more common among those working at peripheral facilities than at HCIVs/hospitals (20.1% vs. 6.8%; aPR = 2.74, 95% CI 1.24–6.04; p = 0.016). Among respondents reporting referral, 294/296 (99.3%) with feedback data reported receiving results. Among 280 with referral-to-result interval data, the median interval was 10 days (IQR 7–14). Common barriers were inadequate diagnostic resources (312/345; 90.4%), unreliable transport (259/345; 75.1%), and inadequate intersectoral collaboration (256/345; 74.2%). Conclusions Frontline recognition was generally strong, but self-reported specimen-referral linkage was less consistently reported at peripheral facilities. Strengthening specimen transport, referral tracking, information exchange, and subnational human-veterinary-public health coordination may improve connectivity with existing diagnostic networks.