BUD cases were significantly clustered in AKN-O-AKS (NNR: 0.34, Z-score: -17.2, p-value &amp;lt;0.01) and JAS-BIA (NNR: 0.37, Z-score: -10.5, p-value &amp;lt;0.01) geographical areas, with a higher proportion of cases in JAS-BIA area (30.7%; 23/75) within 1000m buffer around rivers/streams compared to the AKN-O-AKS area (8.5%; 16/188). Farming with less protective clothing (aOR=3.64, 95%CI=1.30-10.18) and presence of river/stream in an individual’s immediate environment (aOR=4.22, 95%CI=1.50-11.84) increased BUD risk. In contrast, being married (aOR=0.30, 95%CI=0.13-0.68), managing injuries with soap and water (aOR=0.26, 95%CI=0.08-0.91), and alcohol (aOR=0.15, 95%CI=0.03-0.67) reduced BUD risk.