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Assessment of Knowledge, Attitude and Practice (KAP) Of Canine Rabies among Inhabitants of Addis Ababa, Ethiopia

Beteleheim Newayeselassie Asefa Deressa Yared Mekonen Eshetu Yimer Abebe Bekele Mahendra Pal
Vol 2(3), 102-108
DOI- http://dx.doi.org/10.5455/ijlr.20121014121345

To determine the degree of KAP and awareness of animal-human transmission of rabies, a survey was designed among dog owners and inhabitants of Addis Ababa. A cross-sectional study was undertaken on 315 inhabitants of the Addis Ababa city at house-hold level. A simple random sampling was used to select the study subject and accordingly the eligible individuals were interviewed using a structured questionnaire. Descriptive statistical analysis was performed to observe the frequency of Focal Group Discussion (FGD) at house-hold level. A total of 315 study subjects were interviewed. Out of which, 73.3% were male and the rest are female dog owners. Majorities of the household (91%) have the knowledge of rabies and only 26.9% dog owner’s exercise regular dog vaccination. Among all interviewed house-holds, 71% were considered themselves at risk of rabies. There is no significant difference of knowledge of rabies by sex, age and education (p>0.05). Even though the majority of the communities have good KAP about rabies, very few have got their dog vaccinated keeping the community at the verge of risk. It is hoped that findings of this study improves our understanding of the problem of the disease and can serve as an important input in the design of education campaign that targets at alleviating the problem of rabies in the city.


Keywords : Addis Ababa Canine rabies House-hold survey KAP

Introduction

Rabies is one of the oldest known and most feared of human diseases (Kennet and Michael, 1985; Pal, 2007). Other than rabies, there are 5 rabies related viruses; Duvenhage virus, Mokola bat virus, Lagos bat virus, European bat lyssavirus1, European bat lyssavirus2 and Australian bat lyssavirus (Robert, 1990). The Mokola and Lagos bat viruses have already been reported to be presented in Ethiopia (Acha and Szyfres, 1987). It is an acute incurable and fatal viral encephalitis once symptoms become evident. The causative agent is Rhabdovirus in the Rhabdoviridae family (Pal, 2007; Deressa et al; 2011) that affects the central nervous system of the infected host and its transmission is mainly through bites of infected animals (Pal, 2007). The length of incubation period varies and depends on several factors, including the amount of virus transmitted and the location of the body where exposure occurred. Diagnosis is mainly based on the clinical presentation and laboratory findings (Robert, 1990; Deressa et al; 2011).

Rabies is a neglected and severely under-reported zoonotic disease in developing countries. Each year, according to WHO, an estimated 50,000 to 60,000 people die, mostly children with terrible suffering and a much higher number of domestic animals. Rabies remains a permanent health threat to people even in rabies free countries, in some part of the world it is even considered as re-emerging zoonotic diseases after few years absence of the disease in humans (Mebatsion et al; 1992; Badilla et al; 2009).

Rabies in Ethiopia remains as a public health problem both in domestic animals and in humans.The dog is the principal reservoir of rabies. However, other animals such as cats, cattle and wild animals (fox, hyena) are also implicated as reservoir.

 

Addis Ababa is an ancient Metropolitan inhabited with an estimated population of 3 million (Eshetu et al; 2002) . It is the center of social, cultural and political seat of the country. Thus, the Urban Agriculture bureau is entrusted with the responsibilities of controlling the occurrence of canine rabies in Addis Ababa. According to studies conducted during the last 20 years, the majority of reported cases of rabies occurred in dogs and cats, and also in other domestic animals (Badilla et al; 2009). Similar survey in Addis Ababa showed that about 91% of individuals who received post exposure treatment were reported and all of them were associated with dog bite (Bethelehem et al; 2004).  To determine the degree of knowledge and awareness of animal-human transmission of rabies, we designed a survey among inhabitants of Addis Ababa who own dogs.

Materials and Methods

Study area and design

This study was conducted in Addis Ababa, Ethiopia during the period January 2009 to December 2010 over the period of two-years. The eligible subjects for this study were dog owners of Addis Ababa inhabitants. The inclusion criteria was designed to target those who brought their dogs to Ethiopian Health and Nutrition Research Institute (EHNRI) Zoonoses Research Laboratory for clinical examination and post exposure consultation purpose when there is human involvement by suspected and /or rabid dog within the period.

Data collection and analysis

A cross-sectional structured questionnaire-based study was used to interview 315 eligible dog owners. This study used a sequential sampling approach by recruiting study participants as they present themselves for the laboratory. Each of them was informed of the study objects prior to filling the questionnaire. Participation into the study was based on informed oral consent and the questionnaires were completed by the investigators. The questionnaire was designed to obtain information regarding to dog ownership having two sections, (i) Socio-demographic situation comprising of sex, age, educational status, household possessions and economic status. Economic status was constructed based on household possessions of some house materials like Television, Telephone, Radio, and others. (ii) Rabies related questions, consisted of knowledge on the existence of rabies, knowledge on animals affected by rabies, knowledge on identification of rabies subjects, knowledge on how rabies is transmitted, self-risk perception about rabies and few other rabies related questions. Data were entered and analyzed using SPSS version 10 Software package. Analysis focused on descriptive statistics to observe the frequency and proportion of focal group discussion at house-hold level, to observe knowledge and awareness of rabies.

Results

Socio-demographic characteristics of the respondents

The socio-demographic characteristics of the study subjects are detailed in Table 1. In this study, a total of 315 dog owners were interviewed and 73.7% were male and 26.3% were female respondents. The most respondents were below age 50 (29.5%, 21% and 27.6%). The vast majority of the study participants were literate (93%). Regarding educational status, respondents were stratified according to their educational background and 21% were between grades 1 to 6, 24.8% were between grades 7 to 10, 29.2% were between grades 11 to 12 and 18% were over 12 grades. Using household possessions, an attempt was made to categorize the study participants as low, medium and better economic status and majority (48.6%) of the respondents were from low economic status.

Ownership of domestic animals

Dogs were owned by 93.3% of the respondents (Table 2). Most of the respondents (54.4%) owned dog and only 26.9% have their dogs vaccinated while none of their cat were vaccinated. Regarding dog management, about 28% of the respondents do not restrict their dog while the majority claimed that they always keep their dogs in the compound. Nearly 40% of the respondent’s dog does mix with other owned dogs or stray dogs

Knowledge indicator responses

The vast majority of the respondents (91.1%) have ever heard of the disease called rabies as shown in Table 3. When asked to mention the different hosts for rabies, 88.3% of the respondents reported dog. Followed by 72.1% of the respondents were reported human, 53% cats, 53.7% other domestic animal and 23.3% wild animal. Half of the respondents, 48.6%, reported that they had seen a rabid dog or cat. The proportion of the respondents who had seen a rabid human was only 13.7%. There is in general a good level of knowledge among the study participants regarding the possibility of rabies transmission from animals-to-animals, as mentioned by over 87% of the respondent.

Respondents Experience and Their Perception

Dog/cat bite appeared to be quite high among the study participants with 41.6% reported bitten by a dog or cat at least ones in their lifetime (Table 4). A considerable proportion of respondents (71.1%) considered themselves at risk of rabies. When asked generally, over 60.9% of the respondents believed that rabies is a public health problem in Ethiopia in general and in Addis Ababa in particular.

Health Seeking Behavior

The attitude of the responding subjects toward health seeking behavior in case of animal bite (rabid or non-rabid) was also assessed (Table 5). Of the total respondents 94% wanted to be treated the wound in health institution while 2.2% wanted home based treatment surprisingly nearly 4% of the respondents do not want any treatment. Regarding wound or bite treatment occurred by rabid animals, 93% of the total respondents would like to get anti-rabies vaccination whereas 1.3% prefer traditional healers treatment while 5.7% do not want to get treatment.

Table 1. Socio-demographic characteristics of the subjects

Variable Per cent

Sex

Male ——————————

Female —————————-

Age group

15-24 ——————————

25-34  —————————–

35-49  —————————–

50-64 ——————————

65+ ——————————–

Educational status

Illiterate —————————

1-6 ———————————

7-10 ——————————-

11-12 ——————————

12+ ——————————-

Economic status

Better ——————————

Medium —————————

Low ——————————-

 

 

73.3

26.3

 

29.5

21.0

27.6

15.9

6.0

 

7.0

21.0

24.8

29.2

18.0

 

32.4

19.0

48.6

 

Table 2. Ownership of domestic animal

Per cent
% Who own dogs

Number of dogs owned

None—————————————————————–

1 ———————————————————————

2 ———————————————————————-

3+ ——————————————————————–

Owned dog handling always in the compound —————————————

Not restricted in the compound ———————————-

 

%Who reported owned dogs mixed with other stray dogs————-

 

%Who reported regular vaccination of dogs against rabies——————

93.3

 

 

6.7

58.4

26.0

8.9

72.1

 

 

27.9

 

 

37.8

 

26.9

Table 3. Knowledge indicator response about rabies

Per cent
Ever heard of a disease called rabies

 

Knowledge about last infected/affected by rabies

Dogs  ——————————————————–

Cats ———————————————————

Wild animals ——————————————–

Other domestic animals ——————————-

Human —————————————————

 

Ever seen   rabid dog/cat

 

Ever seen a rabid person

 

Knows that rabies can be transmitted from animal to animal

91.1

 

 

88.3

53.0

23.3

53.7

72.1

 

48.6

 

13.7

 

87.3

 

Table 4. Respondents experience and their perception about rabies

Per cent

Ever been bitten by   dog/cat

 

Consider oneself at risk of contracting rabies

 

Consider rabies as a public health problem in Ethiopia

 

Consider rabies a public health problem in Addis Ababa

41.6

 

71.1

 

62.9

 

61.6

 

Table 5. Health seeking behavior in case of a bite with dog/cat

Per cent
Attitude towards treatment in case

Wanted to be treated in health institution

Wanted to be at home

Do not want to be treated

Attitude towards post exposure treatment(PEP) in case of bite with rabid dog/cat

Wanted to get anti-rabies vaccine

Wanted to be treated by traditional medicine

Do not want to be treated

 

 

94.0

2.2

3.8

 

 

 

 

93.0

1.3

5.7

 

Discussion

Rabies is a dangerous viral infection contracted from owned or stray dogs which brings a deadly end if it is not treated early. Knowledge and awareness of rabies-dog association is relatively high and well established in the community. To express this, we designed this survey to determine the degree of knowledge and awareness of animal-human transmission of rabies among inhabitants of Addis Ababa who own dogs. The influence of some socio-demographic variables on knowledge and awareness has been analyzed and the knowledge of the study participant about rabies and its transmission is high (91.1% and 87.3%). Because of high knowledge of rabies and its transmission there could not be seen any significant difference by sex and age of the respondents. Only economic status was found to be associated with knowledge of rabies.

The community knowledge on rabies-dog association, its transmission among the different animals and as public health problem in Ethiopia in general and in Addis Ababa in   particular is relatively high. The result of this study indicated that more than half of the community is at the verge of risk of contracting rabies from potentially rabid dogs. If a person is suspected of having come into contact with the virus, post exposure prophylaxis should begin as soon as possible and one must not be confused that with every bite, there is risk of rabies. According to the Ethiopian Health and Nutrition Research Institute Zoonoses Research Team Laboratory record book 2/3 of the human rabies cases that come yearly to the laboratory were those who visited traditional healer prior to onset of disease. However, our study has shown that the majority of the respondents seek anti-rabies vaccination for the treatment of rabies. This supports that the knowledge of rabies in the community is widespread and well established.

There is tradition established in the community says restricted dog, even if it is not vaccinated, is always healthy. In regard to this keeping in the compound does not confirm the well being of the dog unless they are vaccinated. The respondents still know that rabies is a public health problem, thus not even half of them got their dogs vaccinated.

Being the degree of knowledge and awareness of rabies and rate of vaccination of dogs is high; there is no single report on cat vaccination, as a result public awareness of rabies in cats and the risk of contracting rabies from cat is low.

Conclusions

In conclusion, the present study has demonstrated the well-established knowledge and awareness of rabies in the community. Knowing that there are many wandering domestic animals like dogs and cats in the neighborhood and their being danger to human beings, the number of the respondents that got their dog vaccinated are very low. Rabies is still represents a significant public health problem in many developing countries like Ethiopia and its underreporting led to lack of attention. The impulse for rabies control is strangled by lack of awareness of its true impact. Domestic animals especially dogs and cats must be vaccinated regularly. In most industrialized countries, domestic animals originated rabies is controlled with well-reinforced legislated vaccination campaign. The important suggested methods for rabies control are surveillance; appropriate post exposure prophylaxis, legislated vaccination of dogs and public education.

Acknowledgments

The authors would like to express their gratitude to the Addis Ababa inhabitants who willingly devoted to participate in the survey.

References

Acha, P.N. and Szyfres, B. 1987. Zoonoses and Communicable Diseases Common to Man and Animals. Scientific publication 2nd ed. Pan-American Health organization (WHO).  pp, 425-49.

Badilla, X; Pérez-Herra, V; Quirós, L; Morice, A; Jiménez, E; Sáenz, E; Salazar, F; Ferenandez, R; Orciari, L; Yager, P; Ehitfield, S. and Rupprecht, C.E. 2003. Human Rabies: a reemerging disease in Costa Rica? Emerging Infectious Diseases 9: 721-723.

Bethelehem, N; Eshetu, Y; Paulos, A; Abebe, B; Badeg, Z. and Mokoro, B. 2004 Occurrence of rabies in humans and animals in Addis Ababa in 2001-2002. Ethiopian Journal of Biological Science 3:59-67.

Deressa, A; Tesfaye, S. and Pal,  M. 2011   Application of fluorescent antibody technique for the diagnosis of rabies in cats and dogs. Indian Pet Journal 3: 71-75.

Eshetu, Y; Bethelehem, N; Girma, T; Yared, M; Yoseph, B; Badeg, Z; Mekoro, B. and Abebe, B. 2002 Situation of rabies in Ethiopia: a retrospective study 1990-2000. Ethiopian Journal of Health Development 16:105-112.

Kennet, W.B. and Michael, A.W.H. 1985 In: Mandell GL, Douglas RG, and Bennet JE eds. Principles and Practice of Infectious Diseases. John Wiley and Sons. UK.  Pp. 897-909.

Mebatsion, T; Cox, J.H. and Frost, J.W. 1992 Isolation and characterization of 115 street rabies virus isolated from Ethiopia by using monoclonal antibodies: identification of 2 isolates Mokola and Lagos bat virus. Journal of Infectious Diseases 166:972-977.

Pal, M. 2007. Zoonoses. 2nd ed. Satyam Publishers, Jaipur, India. Pp 72-75.

Robert, R.W. 1990 .Rhabdoviridae and their replication. In: Fields, B.N. and Knipe, D.N. ( eds.) Virology. Raven Press, New York. Pp 867-881.

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