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Community Perception Regarding Rabies Prevention and Stray Dog Journal of Infection and Public Health (2012) 5, 374—380 View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Community perception regarding rabies prevention and stray dog control in urban slums in India ∗ Mrudu Herbert , Riyaz Basha S, Selvi Thangaraj Department of Community Medicine, Bangalore Medical College and Research Institute, Fort Road, Bangalore, Karnataka 560002, India Received 6 February 2012; received in revised form 30 March 2012; accepted 25 May 2012 KEYWORDS Summary Rabies; Background: The lack of community awareness about rabies control is a major issue that thwarts efforts to prevent human deaths caused by rabies. First aid; The objectives of this study were (1) to assess community knowledge and attitudes Stray dog; about rabies, rabies prevention and stray dog control in an urban slum community Animal control and (2) to determine the factors that influence rabies awareness in urban slums. Methodology: Using a systematic random sampling strategy, 185 participants were selected from 8 urban slums. The data were collected by direct interview using a pre-tested, structured questionnaire. Results: In the study population, 74.1% of the participants had heard about rabies, and 54.1% knew that rabies is a fatal disease. Only 33.5% of the interviewees felt that people in the community had a role to play in controlling the stray dog popu- lation. Gender, age and educational status were significantly associated with rabies awareness. Conclusions: Our study indicates that there are gaps in the knowledge and attitudes of individuals living in urban slums regarding rabies prevention and control. Efforts to promote awareness should be targeted at men, older people and uneducated individuals. © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved. Introduction Rabies is a zoonotic disease that is almost always ∗ Corresponding author. Tel.: +91 0966 330 4861. fatal. Globally, 55,000 people die from rabies each E-mail addresses: [email protected] (M. Herbert), year [1]. The majority of these deaths occur in [email protected] (R. Basha S), selangel [email protected] Asia and Africa, with the South-East Asian Region (S. Thangaraj). 1876-0341/$ — see front matter © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jiph.2012.05.002 Community perceptions regarding rabies prevention and stray dog control 375 (SEAR) accounting for 60% of global rabies deaths the dog population in a short period of time should [2]. India is one of the SEAR countries in which be utilized as the primary method to control rabies rabies is endemic. A WHO-sponsored multi-center in dogs [13]. study estimated that at least 20,000 rabies deaths The lack of community awareness about the occur every year in India [3]. Dogs are responsible disease is a major hurdle in fighting rabies [14]. for 99% of human rabies deaths. Children are par- Community participation is one of the major com- ticularly susceptible to exposure to rabid dogs [4]; ponents of any successful public health program. 40% of individuals bitten by suspected rabid animals Community-based surveillance systems have been are children under 15 years of age [1]. successful and cost-effective for rabies control in While human rabies is largely controlled in devel- other areas [15,16]. Awareness of simple preventive oped countries, primarily due to the successful measures, such as washing bite wounds with soap control of animal rabies, developing countries with and water, can be a decisive factor in preventing scarce resources are still battling this scourge [5]. rabies deaths in at-risk human populations. As a result, the WHO has classified rabies as a Slum communities have a unique convergence of neglected tropical disease because the major bur- risk factors for human rabies. First, they attract den of the disease is borne by Asia and Africa. It a large number of stray dogs because of the is a matter of global concern that rabies remains a unplanned dumping of garbage. Additionally, there neglected disease 125 years after the discovery of are often many unsupervised children in slums, the rabies vaccine by Louis Pasteur [6]. The reasons which creates a potentially dangerous scenario, as for this neglect lie at various levels. Insufficient children are more likely than adults to be victims surveillance systems, limited access to and supply of dog bites. In this environment, the knowledge of the modern rabies vaccine, lack of awareness and attitudes of the community are crucial factors among policymakers and the public and insufficient in averting the morbidity and mortality caused by political commitment all impede efforts to control human rabies. rabies [7]. Community participation in rabies control efforts The availability of safe and effective vaccines for can be multi-faceted. Community members can human rabies has prevented many human deaths. help participate in rabies control programs, enact Bögel and Meslin state that the most cost-effective local by-laws, enforce anti-rabies laws and plan approach for human rabies control is a combina- and publicize and implement dog vaccination cam- tion of post-exposure prophylaxis and canine rabies paigns, dog registration and stray dog control. elimination [8]. The WHO has stated that pre- Individuals in the community can also report rabies venting human rabies by controlling rabies among cases and ensure that dog bite victims receive first domestic dogs is a realistic goal for large parts aid and treatment. Educating the public about the of Africa and Asia and is financially justified by epidemiological features of rabies, as well as sim- the future savings resulting from discontinuation of ple preventive and precautionary measures, may post-exposure prophylaxis for residents [1]. help protect them and reduce the incidence of There are three practical methods of dog popu- rabies. lation management: movement restriction, habitat Previously available data from Indian studies control and reproduction control [9]. In Asia, animal were primarily collected from patients seeking birth control (ABC) programs and rabies vaccina- post-exposure treatment for animal bites in hos- tion have been advocated as methods to control pital settings. These studies may present biased male and female urban street dog populations results about community attitudes and knowledge and, ultimately, human rabies. Animal rabies con- that fail to reflect those of the broader population. trol interventions in Sri Lanka and Thailand have Thus, this study was conducted to ascertain the demonstrated considerable success in controlling knowledge and attitudes about rabies prevention human rabies in an area in which canine rabies is and control in a selected urban slum community. endemic [10,11]. The dog population in India is estimated at approximately 25 million [12]. In India, initial attempts to control rabies have included programs Materials and methods to exterminate the stray dog population. However, this method has proven ineffective because stray Study design dog population is so large that new packs of dogs quickly moved into the areas in which dogs had This descriptive cross-sectional study was carried previously been eliminated. Thus, a combination of out from July 2010 to October 2010 in Bangalore, a ABC and mass vaccination that covers at least 70% of prominent south Indian city and the capital of the 376 M. Herbert et al. state of Karnataka, India. The population of Ban- Table 1 Socio-demographic characteristics of the galore is well over 6 million, according to the 2011 study population. Census conducted by the government of India. Esti- Variable Frequency Percentage mates suggest that one in every three people in N = 185 Bangalore lives in slums in the city, often in sub- Gender human conditions [17]. This study was conducted Male 86 46.5 in urban slums near the H. Siddiah Road Referral Female 99 53.5 Hospital in Bangalore, which is in the practice area Religion covered by Bangalore Medical College and Research Hindu 161 87.0 Institute There are eight slums in this area, com- Muslim 20 10.8 prising a total of 5540 houses and a population of Christian 4 2.2 38,426. Type of family Nuclear 98 53 a Sample size and sampling technique Joint 87 47 Educational level The sample size was determined using the following Illiterate 24 18.4 2 2 Primary or middle school 84 38.4 formula: n = Z pq/d (where Z = the normal varia- High school or higher 77 43.2 tion estimated at 4, p = prevalence of awareness Average per capita income in household (in Rupees) about rabies, estimated at 68.7% using the data 675—2024 24 13.0 − from a previous study, q = 1 p and d = 10% of p, 2025—3374 26 14.1 6.87) [18]. The total sample size was 182, with a 5% 3375—5049 44 23.8 level of significance and 95% confidence limits. The 5050—6749 8 4.3 sample size was rounded up to 185. The household 6750—13,499 54 29.2 included in the study was selected by systematic >13,500 29 15.6 sampling with a sampling interval of 30. One adult a Joint family in India is one in which a number of married member from each household was selected ran- couples and their children live together in the same house. domly using the KISH method [19]. If the residents All the men are related by blood. of the selected house were unavailable at the time of the first visit, the house was re-visited two addi- awareness about rabies as the dependant variable tional times. If the residents were still unavailable and age, gender and education as the independent after the third visit, the next house was visited as variables.
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