Government of the Poeple's Institute of Allergy and Clinical Republic of Immunology of Bangladesh A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC) in Raipura, , Bangladesh.

Oct - Dec 2010

An Official Organ of the Bangladesh Anti Rabies Alliance (BARA) Suit No.18 (3rd Floor), Green Super Market Green Road, -1205, Bangladesh Tel: 880-2- 8122074 Email: [email protected], Web: www.iacib.org Chairman Professor (Dr.) Moazzem Hossain Director Disease Control Ministry of Health & Family Welfare & Chairman, Bangladesh Anti Rabies Alliance (BARA) M e s s a g e

Bangladesh Anti Rabies Alliance (BARA), as the name implies, is a platform of doctors, scientists, professors of reputed academic institutions, and members of various other organizations of Bangladesh who have the ambition to free our country from neglected tropical diseases, specially Rabies. Rabies mainly affect the health of poor children of Bangladesh who live in remote rural areas with limited access to health facilities. Children from 5 to 15 years are the victims of animal bite followed by Rabies. More than 80% of animal bite cases are due to dog bite. The Ministry of Health & Family Welfare, Government of Bangladesh has stated its goals for control of Rabies. But it must be shared by everyone in the society and other relevant ministry as Ministry of Live stock and Local Government. The members of BARA are committed to make their best efforts to reduce the sufferings of the people inflicted with Rabies and animal bite by conducting research, raising social awareness and by forming partnerships with the stakeholders who are devoted to achieve the same goals of rabies control in human by using TCV and replacing NTV and in animal through animal vaccination and animal birth control etc. As Chairman of BARA, it is my great privilege to offer a hearty welcome to the participants of 2nd International Conference of Climate Change and Neglected Tropical Diseases (ICCCNTDs) whose kind presence will greatly inspire everyone involved with the control of Rabies in Bangladesh. Bangladesh being a country under grave risks of climate change, will immensely benefit from the knowledge and practice we hope to share from the distinguished participants of this conference. I would like to sincerely thank the organizers and the sponsors of 2nd ICCCNTD on behalf of BARA and wish great success of this international conference in Bangladesh.

Professor (Dr.) Moazzem Hossain Chairman, BARA A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

E d i t o r i a l B o a r d

Principal Investigator Professor (Dr.) Moazzem Hossain Director Disease Control Ministry of Health & Family Welfare & Chairman, Bangladesh Anti Rabies Alliance (BARA)

Co-Investigators Dr. Aung Swi Prue Marma Deputy Program Manager, Rabies Program Directorate General of Health services (DGHS).

Dr. Mahbubul Alam Deputy Director, CDC , DGHS.

Dr. Md. Sohrab Hossain Veterinary Surgeon, Tongi Pourasava, Dhaka & Member BARA.

Dr. Md. Azmat Ali Veterinary Officer, Dhaka City Corporation, Dhaka & Member BARA

Prof. A.K.M.Shamsuzzaman Prof. of Microbiology Sahid Shwarawardy Medical College, Dhaka.

Dr. Musleh Uddin Ahmed Assistant Director Emerging & Re-emerging Disease, DGHS.

Ms. Karan Courtney International Adviser, BARA

Ms. Nasima Akther Chairman IACIB & Member BARA.

Md. Nezam Uddin Biswas GIS Consultant Institute of Allergy & Clinical Immunology of Bangladesh Page

Massage of Chairman

Editorial Board

Contents

Aims and objectives ------1

Expected outcomes ------1

Rational and Background ------1

Location map of the study area ------2

Methodology ------2

Results of dog count ------4

Results of ABC ------6

Discussion ------8

Lessons learned ------9

Conclusion ------10

References ------10

2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Aims: a) To reduce the risk of the dog population present to human health and the health of other animals. b) To reduce the risks that the current roaming dog population presents to the community and to avoid poor welfare of the current roaming population.

Objectives: Specific Objectives: (i) to reduce by 10% the dog population by chemical sterilization (Esteril sol) of male dog (ii) to vaccinate all dogs on the island char areas of Raipura (iii) to kill suspected rabid dogs in the island (iv) to treat all animal bite cases by TCV and RIG where indicated.

Expected Outcome/s: At the end of the Pilot study the selected island areas' risk of rabies to humans and other animals will be reduced.

Rational and Background for proposed studies: Rabies is a viral zoonotic disease, which infects domestic and wild animals (dog, cat, fox, jackal, mongoose, cattle). The disease is transmitted through bite, scratches and licks of infected host on mucous membrane. It is cent percent fatal and equally preventable. In Bangladesh, it is one of the most neglected tropical disease that affect hardcore poor people living in the country. More than 85% of people infected with rabies are from rural areas and more than 90% are due to dog bite. The group mostly affected by rabies in Bangladesh, is children aged between 8-15 years. It is therefore important to develop an understanding of testing the modern prevention and control strategy of rabies from an island area. The learned skills and knowledge from the current study can be adopted as part of rabies control strategy throughout the country. The study purposes to carry out a Pilot study on testing the updated prevention and control strategy of rabies in an island of the country. To reduce the risk of a roaming dog population to human health and other animal health it is important to understand the situation. This study aimed to answer the following questions in order to better understand the potential risk posed by the dog population in one sub-district level of Bangladesh; What is the current size of the dog population in the Raipura area and what are the categories within it? This includes both owned and unowned, confined and roaming dogs, and where these overlap. Where are the roaming dogs coming from? What are the sources of these dogs and why do these sources exist?

01 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Figure 01: Location map of the study area

Location of Raipura su-district

Methodology: Study areas: Six union of Raipura (Sub-district) under , which are surrounded by the river Meghna. The proposed six union are completely isolated from mainland Raipura. The only way to reach the island areas is country boat.

Study population: People residing in six union of Raipura. The populations of the selected unions are given below in a table.

Table-1. Population distribution of Pilot study areas in Raipura, Narsingdi Sl. No. Name of union Number of villages Population 1. Bashgari 8 16,189 2. Paratuli 15 27,410 3. Mirzarchar 5 8,893 4. Charmadhuwa 5 11,048 5. Shrinagar 18 27,432 6. Chanpur 11 18,530 Total 62 1,09,502

02 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Inclusion criteria: 1. Unions, which are completely separated from mainland Raipura by the river Meghna. 2. Community leaders and stakeholders, who agreed to include and participate in the study.

Exclusion Criteria: 1. Those who refuse to participate in the study. 2. Island areas, which have direct communication with mainland Raipura.

ABC Procedures: Information collection: Information about the pilot unions were retrieved from the upazila headquarter, Raipura from official record. Pilot unions were selected at the pre-Piloting advocacy meeting with Chairmen, members and school teachers of 12 island union of Raipura, which are completely separated from mainland Raipura.

Dog Survey: Dog surveyors with previous experience in dog surveys and dog catching were recruited. Volunteers from respective unions and wards were also recruited to help the entire survey procedures. UP chairmen, members and secretaries of respective unions were advised to co-operate the survey team including provision of temporary lodging and meals. Dog surveyors were instructed to use the following format to count dogs in the island areas. Surveyors were given half day training in the counting methodology and data recording format.

Table 02: Dog survey form

Sl. Name of dog owner Description of dog Remarks No. and address Photograph of Sex Color Age Number dog

During survey, they were also asked to take picture of each dog to avoid repetition of counting. The total survey procedure was monitored and supervised by an expert Veterinary Surgeon, who remained present during the procedure.

03 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Pilot activities included: (a) Training of veterinary surgeons on ABC using Esterilsol (b) ABC activities: - chemical sterilization of male dogs by using Esterilsol - culling of suspected rabid dogs by anesthesia and euthanasia (c) Vaccination of pet and stray dogs (d) Post Exposure Treatment (PET) of human using - ARV ( TCV) - RIG ABC activities commenced on October 29, 2010, and were carried out two days per week on the following dates: October- 29th and 30th November-5th and 6th; 12th and 13th ; 19th and 20th ; 26th and 27th December- 3rd and 4th

Results of dog count: ABC activities in the pilot unions of Raipura were completed as per the methodology.

Table 03: Number of dogs according to age

Age/size No. of dog Percentage Big 665 58.2 Small 89 7.8 Medium size 389 34.0 Total 1143 100.0

A total of 1143 dogs were counted in the pilot unions of Raipura.

Table 04: Number of dogs according to sex Sex No. of dog Percentage Male 570 49.87 Female 290 25.37 Puppy 283 24.76 Total 1143 100.0

04 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Approximately 50% of the dogs counted were identified as male dogs, 25% as female and 25% as puppies, whose sex was undetermined.

Table 05: Number of dogs according to Union

Union No. of dog Percentage Bashgari 131 11.5 Chand 252 22.0 Chor Modua 273 23.9 Mirjar Chor 67 5.9 Paratoli 292 25.5 Sree Pur 128 11.2 Total 1143 100.0

Table 05 indicates the number of dogs counted in each of the union areas in Raipura. Paratoli had the greatest number of dogs, followed by Chor Modua and Chand Pur.

05 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Table 06: Number of dogs according to ownership Ownership of Dog No. of dog Percentage Household owned Dog 682 59.67 Un-owned street Dog 409 35.78 Community Dog 52 4.55 Total 1143 100

Almost 60% of dogs counted were recorded as being owned by a household. 4.5% were identified as community owned. This is a loose ownership where there may be more than one individual claiming ownership of an animal. 36% were categorized as un- owned street or roaming dogs. It must be noted that a proportion of 'roaming' dogs may in fact be owned by an individual or community however ownership status has not been confirmed at the time of the count.

Results of ABC Of the 1143 estimated dog population 271 male dogs were administered with Esterilsol. A total of 827 were killed. 309 were vaccinated against rabies.

Table: 07 Union wise numbers of male dogs Sterilization

Sl. Union Number of Male Dogs Sterilized 01 Bashgari 32 02 Chanpur 58 03 Charmadhua 30 04 Mirzarchar 17 05 Paratoli 67 06 Shreenagar 67 Total 271

06 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Table: 08 Union wise numbers of dogs vaccinated against rabies

SL Number of Dogs Vaccinated Total Union . Male Female Puppy 01 Bashgari 26 13 3 42 02 Chanpur 67 0 4 71 03 Charmadhua 31 3 1 35 04 Mirzarchar 19 0 0 19 05 Paratoli 65 2 1 68 06 Shreenagar 62 1 11 74 Total 270 19 20 309

Table: 09 Union wise numbers of dogs killed for dog birth control

Number of Dogs killed Total SL. Union Male Female Puppy 01 Bashgari 21 65 88 174 02 Chanpur 27 45 36 108 03 Charmadhua 36 47 40 123 04 Mirzarchar 10 20 28 58 05 Paratoli 66 89 52 207 06 Shreenagar 50 53 54 157 Total 210 319 298 827

Fig: 2 Union wise number of dogs killed for dog birth control

Taking into account the number of dogs killed during the study period, the estimated total population of dogs in the Raipura area is re-adjusted from 1143 to 316. A total of 72% of dogs were killed during the study period. From the remaining population, 85% of male dogs were sterilized using Esterilsol. 97% of dogs were vaccinated against rabies.

07 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Discussion The island areas of Raipura were selected because it was not subject to dog migration from surrounding areas. This is an important confounding factor to control for when attempting to monitor the impact of a population control method, which in this case is the use of a chemical sterilization agent called Esterilsol. Has sterilization been an effective method of controlling the dog population in Raipura? This question is impossible to answer due to other confounding factors related to the study protocol and the mix of ABC methods used. It is impossible to determine if a reduction in dog population is due to the use of Esterilsol or if it is attributable to the large number of dogs killed during the same period. This is a significant limitation of this study design. When re-adjusted to account for the number of dogs killed, the estimated dog population of Raipura was approximately 316. This figure must be used for future comparisons of counts and not the original total of 1143 that was recorded.

Another limitation in the study design was the targeting of only male dogs. It is well known that female dogs are the limiting factor in reproduction. Female dogs can each produce 8-10 puppies and all that is needed for this to happen is the presence of one fertile male. Targeting females for sterilization is one of the recommended methods for managing a dog population according to the WSPA (ICAM, 2008) With every female sterilized the population's reproductive capacity is directly reduced, whereas it is very difficult to sterilze enough males to have any effect. Sterilizing males can be beneficial to reduce roaming behavior but only in areas where resources are readily available.

In addition to sterilization for population control, environmental conditions need to be managed. Understanding the source of dogs, the resources available to the dog population in the form of food, water and shelter, and community attitudes towards dogs is important for designing an effective ABC program.

In retrospect, it was too hasty of the investigators to commence sterilization of dogs without first understanding the situation. The risk of rabies to humans and other animals is a real threat to life and livelihood, however, dog population control has not been shown to reduce rabies transmission to humans. There is no evidence that rabies transmission is density dependent, hence if rabies control or elimination was the primary objective, as it was in this study, then it was an inefficient and ineffective use of resources. It would have made more sense to prioritize mass rabies vaccination. Achieving 70% herd immunity in the dog reservoir is the best barrier to rabies.

08 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Mass vaccination and community awareness on bite prevention, responsible dog ownership etc, are two initiatives that this study should have prioritized. This is in accordance with recommendations from WSPA, ICAM and has been widely practiced in other south Asian countries such as India, Sri Lanka and Nepal.

The activities implemented in this study are indicative of the limited expertise and capacity that exists in Bangladesh regarding animal birth control and animal welfare issues. The investigators recognize these limitations and acknowledge the need for more emphasis on training and developing skills to conduct an ABC program. Bangladesh Anti-Rabies Alliance (BARA) is prepared to undertake training and to receive support from external agencies such as the WSPA in order to be proficient and competent in implementing a nation -wide ABC program in the future.

Lessons learned What can be gained from this pilot study of the use of a chemical sterilization agent to control dog population is the learning about the procedure for administering the agent to male dogs, and about the side effects in dogs observed by veterinary clinicians. On reflection the decision to kill almost 50% of the counted dog population was a poor one. Future dog population estimate surveys will need to have clearer protocols and instructions for when to euthanize dogs. It is recommended that for future dog population surveys, the International Companion Animal Management (ICAM) Humane Dog Population Management Guidelines be followed.

Another important aspect of the study that was not fully explored or investigated was the attitude of the community towards dogs, their knowledge, attitude and practice regarding rabies and the welfare situation of the existing dog population. These activities were not done due to time and resource constraints. BARA recognizes their failing in seeking technical guidance and assistance before carrying out this study. What the investigators have learned from this process, however, is significant with respect to purpose, design and implementation of future studies.

09 2010 A Pilot study on Prevention and Control of Rabies by Animal Birth Control (ABC)

Conclusion The dog population in Raipura will be monitored over the next 12 months. The presence of investigators in this area has also stimulated interest by the community in dog population control matters, animal welfare and human rabies prevention and management. Resources permitting, a rabies education program will be implemented in Raipura as a follow up from the sterilization project. This will afford the investigators the time to repeat dog surveys using ICAM recommended methodologies. Dependent on available resources, mass rabies vaccination will also be considered for the study area.

Investigators will take the learning's from this study and use them to improve future dog population management protocols for Bangladesh. In addition to repeating dog count surveys, a comprehensive investigation is necessary to determine the source of roaming dogs in the community, the attitude of community members towards dogs and their understanding of rabies, its' prevention and treatment.

References

The International Companion Animal Management Coalition (ICAM): Humane Dog Population Management Guidance, 2008.

10 Annexure - 01: Dog population survey form Annexure - 02: Rabies control by population control of dog by Chemical Sterilization & Vaccination survey form Annexure - 03: Dog population re-survey after Chemical Sterilization & Vaccination survey form