Barriers of attendance to dog rabies static point vaccination clinics in Blantyre, Malawi.

Isabel Rodriguez-Barraquer,Stella Mazeri,Ian G Handel,Luke Gamble,Andrew D Gibson,Barend M.Dec Bronsvoort,Richard J Mellanby,Natascha Meunier

doi:10.1371/journal.pntd.0006159

Isabel Rodriguez-Barraquer, Stella Mazeri + Show 6 more

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https://doi.org/10.1371/journal.pntd.0006159

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Abstract

Rabies is a devastating yet preventable disease that causes around 59,000 human deaths annually. Almost all human rabies cases are caused by bites from rabies-infected dogs. A large proportion of these cases occur in Sub Saharan Africa (SSA). Annual vaccination of at least 70% of the dog population is recommended by the World Health Organisation in order to eliminate rabies. However, achieving such high vaccination coverage has proven challenging, especially in low resource settings. Despite being logistically and economically more feasible than door-to-door approaches, static point (SP) vaccination campaigns often suffer from low attendance and therefore result in low vaccination coverage. Here, we investigated the barriers to attendance at SP offering free rabies vaccinations for dogs in Blantyre, Malawi. We analysed data for 22,924 dogs from a city-wide vaccination campaign in combination with GIS and household questionnaire data using multivariable logistic regression and distance estimation techniques. We found that distance plays a crucial role in SP attendance (i.e. for every km closer the odds of attending a SP point are 3.3 times higher) and that very few people are willing to travel more than 1.5 km to bring their dog for vaccination. Additionally, we found that dogs from areas with higher proportions of people living in poverty are more likely to be presented for vaccination (ORs 1.58-2.22). Furthermore, puppies (OR 0.26), pregnant or lactating female dogs (OR 0.60) are less likely to be presented for vaccination. Owners also reported that they did not attend an SP because they were not aware of the campaign (27%) or they could not handle their dog (19%). Our findings will inform the design of future rabies vaccination programmes in SSA which may lead to improved vaccination coverage achieved by SP alone.

Highlights

Rabies has been estimated to cause around 59,000 human deaths per year [1]
We have previously reported that 97% of the dog population is owned, only 53% out of the 79% overall vaccination coverage we achieved in our 2015 vaccination programme was attributed to dogs vaccinated at a static point (SP), with the remaining 26% achieved by vaccinating dogs at door-to-door [20]
It is important to remember that the accuracy of this estimate greatly depends on the accuracy of google maps data in each region and might not be applicable in all areas. This is first large scale study investigating the barriers to obtaining adequate rabies vaccination coverage through SPs in an urban setting in Sub Saharan Africa (SSA)

Summary

Introduction

Rabies has been estimated to cause around 59,000 human deaths per year [1]. Rabies has been estimated to cause 3.7 million disability-adjusted life years and 8.6 billion US dollars economic losses annually [1]. Almost all human rabies cases are acquired from contact with rabies infected dogs [2]. Case fatality for patients who develop clinical signs related to rabies infection approaches 100% and successful treatment has rarely been reported [2]. Rabies disproportionately affects Sub Saharan African countries [1, 2]. Despite significant regional and international healthcare intervention initiatives, no African country has been reported rabies free to date [3]

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