Date Published: June 26, 2015
Publisher: Public Library of Science
Author(s): Tadele Kabeta, Benti Deresa, Worku Tigre, Michael P. Ward, Siobhan M. Mor, Jakob Zinsstag. http://doi.org/10.1371/journal.pntd.0003867
Abstract: BackgroundRabies is an important but preventable cause of death in Ethiopia. We assessed the knowledge, attitudes and practices of animal bite victims attending an anti-rabies health center in Jimma Town, Ethiopia.Methodology/Principal FindingsBetween July 2012 and March 2013 a cross-sectional questionnaire was administered to 384 bite victims or their guardians in the case of minors (aged <15 years). Factors associated with knowledge, attitudes and practices were evaluated using generalized linear models. Almost all participants (99%) were aware that rabies was transmitted by the bite or lick of a rabid dog, however only 20.1% identified “germs” as the cause of disease. A majority of participants stated rabies could be prevented by avoiding dog bites (64.6%) and confining dogs (53.9%); fewer (41.7%) recognized vaccination of dogs/cats as an important preventive strategy. Regarding attitudes, most (91.1%) agreed that medical evaluation should be sought as soon as possible. However, most (75.0%) also believed that traditional healers could cure rabies. Rural residence (adjusted odds ratio [OR] = 2.1, p = 0.015) and Protestant religion (OR = 2.4, p = 0.041) were independently associated with this belief. Among 186 participants who owned dogs, only 9 (4.8%) had ever vaccinated their dog and more than 90% of respondents indicated that their dog was free-roaming or cohabitated with the family. Only 7.0% of participants applied correct first aid following exposure, and the majority (47.7%) reported that the animal was killed by the community following the incident. Female sex and Muslim religion were independently associated with higher and lower practices scores, respectively, due largely to differences in animal management practices following the incident.Conclusions/SignificanceAlthough respondents demonstrated reasonably sound knowledge of rabies and its transmission, attitudes and practices were inconsistent with rabies prevention. Culturally- and gender-sensitive activities that promote proper first aid and healthcare seeking behavior as well as appropriate animal management, particularly in rural areas, are needed to prevent deaths associated with rabies in this setting.
Partial Text: As a disease that mostly impacts poor communities, rabies is a classic example of a neglected tropical disease . A vaccine-preventable disease, most deaths from rabies arise due to lack of awareness and poor access to proper health services . It is estimated that around half of the global human population lives in canine rabies-endemic countries and is at risk of exposure . Because cases often go unreported, it is agreed that official records vastly under-estimate the true burden of rabies [3–6]. Modelling studies estimate the annual human death toll from rabies to be around 50,000–60,000, with 99% of these fatalities occurring in tropical developing countries, overwhelmingly in Africa and Asia [3,6–8]. An estimated 21,000–24,000 these deaths occur annually in Africa alone [6,8]. More recently the global burden of rabies (reflecting the number of human deaths as well as lost productivity due to premature death, adverse events related to the nerve-tissue vaccine and psychological effects of the disease) was estimated at 3.7 million disability-adjusted life years (DALYs), while global economic losses associated with the disease were estimated at 8.6 billion USD annually .
This study is the first to assess the knowledge, attitudes and practices among attendees at an anti-rabies health center in Jimma Town, Ethiopia. Similar to other studies conducted elsewhere in Ethiopia [16,18,21], we found moderately high levels of knowledge regarding the role of dogs in transmission as well as clinical signs in both animals and humans. However, unfavorable attitudes and practices were found in terms of the need for appropriate first aid, medical care and animal management.