Community Perception Regarding Rabies Prevention and Stray Dog

Home , Street dog

Journal of Infection and Public Health (2012) 5, 374—380

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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.

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).

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

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. A P-value < 0.05 was considered signiﬁ- an alternative. cant.

Data collection

One adult member of each household was selected Results

and interviewed to collect the data. A pre-

tested structured questionnaire that had been The mean age of the study population was 35.4

validated in a pilot study was used to collect the ( 11.4) years. Of the 185 people interviewed,

information. The study variables included the fol- 53.5% were female (Table 1) with a mean age of

lowing: the socio-demographic characteristics of 34.6 (±11.3) years. Males comprised 46.5% of the

the respondents; awareness about rabies (including respondents, and their mean age was 36.5 (±11.5)

its transmission and symptoms), ﬁrst aid measures years.

used to treat animal bites and the anti-rabies vac- Of the respondents, 74.1% (137) were aware of

cine; and attitudes toward stray dog control. rabies. The most common sources of information

were mass media (television/radio/newspaper) and

Statistical analysis family members.

Our data indicated that only 54.1% of the respon-

The data were analyzed using Epi Info, version 3.5.1 dents knew that rabies is a fatal disease (Table 2).

(CDC, Atlanta, Georgia, USA). The means, percent- Male gender, belonging to an older age group (>25

ages and standard deviations were calculated to years) and having no education were found to be

describe the proﬁles of the respondents. Chi-square predictors of low awareness about rabies (Table 3).

tests or Fisher’s exact tests were used, as appropri- Of the study subjects, 67% understood that dogs

ate, to evaluate the statistical signiﬁcance of the are responsible for transmitting rabies. Approxi-

differences between the responses of the partici- mately one half of the residents did not know to

pants. Logistic regression models were used, with wash the wound from an animal bite with water, and

Community perceptions regarding rabies prevention and stray dog control 377

Table 2 Awareness regarding transmission, symptoms and treatment of rabies among the study population.

Variable Frequency Percentage

n = 185 (100%)

Heard about rabies

Yes 137 74.1

No 48 25.9

Source of information

Mass media (television/radio/newspaper) 58 31.4

Friends/family members 62 33.5

Health personnel 13 7.0

Don’t know 52 28.1

Awareness about animals transmitting rabies

Dog only 124 67.0

Dog + cat 8 4.3

Dog + cow/monkey 5 2.7

Don’t know 48 25.9

Mode of transmission

Bites only 96 51.9

Bite + scratch/licks 28 15.1

Scratch only 48 4.9

Licks only 9 2.2

Don’t know 4 25.9

Symptoms of human rabies

Hydrophobia/convulsions/paraesthesia/fever 124 67.0

Others (dementia, behaving like a dog) 9 4.9

Don’t know 52 28.1

Is rabies fatal? Yes 100 54.1 No 21 11.3

Don’t know 64 34.6

First aid after animal bite

Wash the wound with water 95 51.4

Tie a cloth around the wound 12 6.5

Apply turmeric or other powders 13 7.0

Don’t know 65 35.1

Practice after an animal bite

Consult a doctor 137 74.1

No response 48 25.9

Aware about anti rabies vaccine

Yes 79 42.7

No 106 57.3

Aware about a health facility for treatment of animal bites

Yes 70 37.8

No 115 62.2

Type of health facility where treatment will be sought for animal bite

Government health facility 120 64.9

Private health facility 17 9.2

Don’t know 48 25.9

Table 3 Predictors of low awareness about rabies.

Variable Univariate analysis Multivariate analysis

OR 95% CI P OR 95% CI P

Age > 25 years 6.32 2.14—18.63 <0.01 5.3 1.77—16.01 0.03

Male gender 3.07 1.54—6.13 <0.01 3.88 1.80—8.35 .001

No education 3.47 1.43—8.36 0.01 3.30 1.23—8.80 .01

OR, odds ratios; CI, conﬁdence interval; P, probability.

378 M. Herbert et al.

Table 4 Attitude of the respondents to control of stray dog population.

Variable Frequencyn = 185 Percentage (100%)

Are stray dogs a problem?

Yes 123 66.5

No 62 33.5

Stray dogs are a problem because:

They bark and create nuisance 69 37.3

Attack and bite people 54 29.2

Not a problem 62 33.5

Can vaccination prevent rabies in pet dogs?

Yes 105 56.8

No 52 28.1

Don’t know 28 15.1

What will you do if the biting animal develops symptoms of rabies?

Capture and send to laboratory 22 11.9

Kill the animal 78 42.2

Chase away the animal 65 35.1

Others 20 10.8

Which is the best method to control the stray dog population?

Immunization of dogs 47 25.4

Animal birth control 32 17.3

Killing them 66 35.7

Others — specify 12 6.5

Don’t know 28 15.1

Who do you think is responsible for the control of the stray dog population?

Government only 107 57.8

People in the community/NGOs only 50 27.0

Government + people in the community/NGO 12 6.5

Don’t know 16 8.6

13.5% mentioned that they would apply turmeric promote rabies awareness. Males were found to

and oils or tie a cloth around the wound site as ﬁrst have less awareness about rabies than females. This

aid measures. Awareness about the rabies vaccine is a point of concern, as males are more likely to

was reported by 42.7% of the participants. All of the be the victims of animal bites than females. Hence,

individuals who had knowledge of rabies responded increasing rabies awareness among men is crucial

that they would consult a doctor if they were bitten to preventing cases of human rabies. The study

by an animal. The majority (64.9%) of the people found that rabies awareness among individuals with

in urban slums preferred to seek treatment from as little as a primary education was greater that

government health facilities for animal bites. How- than of illiterate individuals. This is an indicator

ever, only 11.9% knew that it is necessary to capture that informational, educational and communication

the animal and send it to a laboratory for further (IEC) activities must be complemented by efforts

testing. to improve the overall socio-economic conditions.

Of the respondents, 56.8% were aware that the Older age groups were found to be less aware of

vaccination of pet dogs can help to prevent animal rabies than younger age groups, possibly because

rabies (Table 4). The role of the community in con- of the increasing literacy rate among the younger

trolling the stray dog population was acknowledged generations.

by only 24.9% of the participants; the majority The participants in this study reported that their

(57.8%) felt it was the responsibility of the govern- major source of information about rabies was the

ment to do so. mass media, suggesting that this channel of commu-

nication is the most effective method of conveying

the appropriate information to the community.

Discussion The results of our study show that 74.1% of the

study participants were aware of rabies. A multi-

center study by Sudarshan et al. conducted in India

This study has identiﬁed certain high-risk groups

reported that 68.7% of the participants were aware

that should be targeted in future efforts to

Community perceptions regarding rabies prevention and stray dog control 379

of rabies [14]. The ﬁgure in our study may be higher before or during its implementation [23]. The public

because a greater number of subjects in our study believes that stray dog control is largely the respon-

population had more education (43.2% had a high sibility of the government. As a result, people are

school education or higher). not mindful of the role they can play in stray dog

Our study found that most of the respondents control (e.g., avoiding the indiscriminate dumping

knew that dogs were mainly responsible for trans- of food waste in public spaces, vaccinating their pet

mitting rabies, but half of them were unaware that, dogs).

in addition to bites, licks and scratches can also This study revealed that most people (57.8%)

transmit rabies. Without knowing this information, placed the responsibility for controlling the dog

individuals may trivialize some forms of exposure population on the government. This result contrasts

and subsequently fail to seek post-exposure prophy- with a study conducted in Sri Lanka by Matibag et

laxis. al., in which most participants felt accountable for

The recommended ﬁrst aid for rabies is immedi- the increase in the stray dog population and did

ate ﬂushing and washing of the wound with soap and not believe it was right to pass the responsibility

water for a minimum of 15 minutes [9]. This process solely to the authorities [24]. This is precisely the

helps to remove the rabies virus from the wound. attitude that must be promoted because no public

Our study found that only half of the participants health program can be successful without ensuring

were aware of this important ﬁrst aid measure. This community participation. Creating awareness in the

observation correlates with the practices observed community about the role they can play in health

by Sudarshan et al. in their multi-center study con- programs can make the difference between a suc-

ducted in India [12]. Our study also reported that cessful program and a program that fails. Changing

the practice of applying powders and other topical the current public perceptions of rabies preven-

treatments to the wound still exists, although only tion and control should be a fundamental aspect

among a minority of the participants. Previous stud- of ongoing rabies control efforts. Key activities

ies have also conﬁrmed that these practices persist to educate the public should include increas-

in India and other countries [16,18,20]. ing rabies awareness through media activities,

A study by Singh and Choudhary in Anand, India, fundraising and education programs. Public aware-

reported that 30.2% of study participants were cer- ness activities should prioritize the individuals

tain that rabies can be cured with treatment. In most at risk of exposure, including the underprivi-

contrast, our study found that 54.1% understood leged segments of society, school children and the

that rabies is fatal and has no cure [21]. However, as elderly.

previously noted, the higher education level could Unfortunately, the community practices for

account for this difference. responding to animal bites could not be simulta-

Many of the respondents (42.2%) felt that killing neously assessed during the study. This information

rabid animals is the best method for controlling could have helped to correlate knowledge and atti-

rabies within the stray dog population. This is a tudes with actual practices in the community.

ﬂawed attitude that needs to be altered. There is

no evidence that the removal of dogs alone has ever

had a signiﬁcant impact on dog population densities

or on the spread of rabies. The population turnover Conclusions

of dogs may be so high that reproduction rates could

easily compensate for even the highest recorded People who live in slum communities have gaps in

removal rates (approximately 15% of the dog popu- their knowledge and attitudes regarding rabies pre-

lation) [9]. However, there may be indirect beneﬁts vention and stray dog control. Our results indicate

from selectively eliminating unvaccinated dogs that that males, older individuals and illiterate indi-

are not in compliance with control regulations and viduals should be the target groups for awareness

that congregate around markets, abattoirs and food generation activities.

businesses [22]. Advocacy programs are needed to generate pub-

In Bangalore, animal birth control programs are lic awareness and political commitment for rabies

run under the aegis of the civic body, the Bruhat control. Policymakers should be informed about the

Bangaluru Mahanagara Palike. In 2001, its activities burden of rabies and educated about the needs for

were transferred to registered animal welfare orga- a systematic and sustained control program, for

nizations in the city. A performance audit of the sufﬁcient resource allocation and resource mobi-

ABC program in 2007 reported that the impact of lization, and for multi-sector coordination. Finally,

the ABC program could not be measured because media, religious leaders, local community leaders

there was no estimate of the stray dog population and other inﬂuential groups should be mobilized to

380 M. Herbert et al.

create awareness and promote community involve- [10] Rabies [Internet]; 2009 [cited 2011 June 24]. Available

from: http://www.rabies.gov.lk/about.html

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[11] Kamoltham T, Singhsa J, Promsaranee U, Sonthon P, Math-

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We, Mrudu Herbert, Riyaz Basha S, Selvi Thangaraj,

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declare that we have no conﬂict of interest to

for Prevention and Control of Rabies in India J 2004;6:44—5.

declare. We declare that we have not received any [13] Coleman PG, Dye C. Immunization coverage required to

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Machakos District, Kenya. Preventive Veterinary Medicine

2000;44:73—85.

We thank Dr. T.S. Ranganath for his cooperation

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[17] Rao S. Every 3rd B’lorean lives in sub-human slum. The

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