COMMUNITIES AGAINST RABIES EXPOSURE (CARE) PROJECT

2015 PROGRESS REPORT Island, North ,

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TABLE OF CONTENTS

ABBREVIATIONS 3 I. PROJECT OVERVIEW 4 II. EXECUTIVE SUMMARY 5 III. PROJECT ACCOMPLISHMENTS A. Research on Baseline Data 5 B. Capacity Building for Field Officers 6 B. Conduct of Mass Dog Vaccination 6 C. Disease Monitoring 7 D. Communication Management 8 E. Project Management 11 IV. FINANCIAL REPORT 12 ANNEXES 13

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ABBREVIATIONS

AusAID Australian Agency for International Development CARE Communities Against Rabies Exposure DAH Directorate for Animal Health DGLAHS Directorate General of Livestock and Animal Health Services DIC Disease Investigation Center DOH Department of Health FAO Food and Agriculture Organization FETP Field Epidemiology Training Program GARC Global Alliance for Rabies Control IBCM Integrated Bite Case Management MDV Mass Dog Vaccination MOA Memorandum of Agreement MOH Ministry of Health SAFETYNET South Asia Field Epidemiology Training Network UBSOF UBS Optimus Foundation WAP World Animal Protection

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I. Project Overview

In February 2010, an outbreak of rabies was reported in Nias Island, which was previously fee from rabies. By the end of the said year, 26 human deaths were reported due to rabies. It was suspected that the rabies incursion came from mainland Sumatra which was still rabies endemic.

Initial vaccination in dogs since 2010 was conducted but was not sufficient to control the disease. There were several challenges in the prevention and control of the disease such as the lack of manpower to carry out mass dog vaccination and the logistical requirement for the laboratory confirmation of suspect cases in animals.

In collaboration with the Directorate General for Livestock and Animal Health Services- Directorate for Animal Health (DGLAHS-DAH) and the North Sumatra Province, the Global Alliance for Rabies Control signed a Memorandum of Agreement on 4 September 2013 for the implementation of the Nias Rabies Project. The project is part of the Communities Against Rabies Exposure (CARE) Project implemented also in two provinces in the Philippines (Ilocos Norte and Sorsogon). The project is funded by the UBS Optimus Foundation (UBSOF) and the World Animal Protection (WAP).

Main objectives of the project include the prevention of human and canine rabies; improvement of dog management practices by reducing the number of stray dogs, reducing the number of dog bites increasing responsible pet ownership; increases educational awareness on all levels of the society.

Project components include the following:

1) Social Preparation 2) Public Education 3) Dog Population Control and Mass Dog Vaccination 4) Dog Bite Management 5) Strengthened Monitoring and Surveillance

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II. Executive Summary

On the second year of the CARE project implementation in Nias Island, focus was in determining the actual disease picture of rabies in humans and animals; research on knowledge, attitude and practices of community members on rabies and dogs; continuation of rabies program initiatives such as mass dog vaccination; as well as development of information materials specific for different stakeholders.

Through Integrated Bite Case Management (IBCM), monitoring of rabies cases have been more sensitive which resulted to more cases being detected in humans and more dog samples submitted for laboratory confirmation in 2015 as compared to the previous year.

The results of the community based survey showed that challenge still lies in providing correct information on rabies as a disease, advanctages of mass dog vaccination; handling of suspect rabies cases; animal bite management since there are still many misconceptions on rabies for the residents of Nias Island.

As a results of the study, several information materials were developed for key stakeholders such as educational interactive video for children; field officers guide for animal health officers; pamphlets for community members.

III. Project Accomplishments

A. Research on Baseline Data

A Community Based Survey (CBS) was conducted on March 2015 to determine the Knowledge, Attitudes, and Practices of Nias residents regarding rabies and dogs. The stude was conducted in collaboration with South Asia Field Epidemiology and Training Network (SAFETYNET), Field Epidemiology Training Program (FETP) North Sumatra, and Mahasiswa IKIP Gunungsitoli. The CBS include the conduct of six Focus Group Discussions in three villages as well as 44 villages for the conduct of cluster-based survey through the use of questionnaires with 440 respondents.

Initial result of the study (Annexes 1 and 2) indicated the following:  Residents have very limited knowledge about rabies, benefits of dog vaccination, and misconceptions on how to prevent the disease.  Dogs are viewed as valued possessions but not all are aware of the free vaccines for dogs.  Community assemblies and television advertisements were the preferred sources of information.  Use of local remedies to “cure rabies” are still rampant. Message on proper animal bite management needs to be further emphasized as well as highlight the importance of Post Exposure Propylaxis (PEP) and its availability in Bite Centers.  Selling, killing and eating of suspected rabid dogs are still rampant and not usually observed for fourteen days.

Results of the CBS served as a basis in re-evaluating the project activities for the CARE Project in Nias. More focus was given in the conduct of interpersonal communication activities for the community, students as well as animal health and medical personnel with key messages on mass dog vaccination, animal bite management

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B. Capacity Building for Field Officers

1. Technical Seminar on Rabies

A total of 127 agriculture and medical (doctors, nurses, midwives, village health workers) from the districts of Gunungsitoli. Nias and South Nias attended the technical briefing on rabies so that they could share lifesaving information to the community. Highlighted in the seminars were the importance of mass dog vaccination proper animal bite management protocol as well as the basic facts on rabies (signs, symptoms and transmission of rabies in dogs and humans).

2. Trainings on Mass Dog Vaccination and Dog Catching for Field Officers

North Sulawesi have the highest human rabies cases in Indonesia. To share the lessons learned and technical capacity from the rabies control programme implemented in Nias Island, a training on mass dog vaccination and dog catching was conducted on 11 November 2015 by key Nias project implementers from DAH and GARC which was attended by 35 field officers.

A Field Officers’ Guide for the conduct of mass dog vaccination was also developed and distributed for the field officers of Nias Island (Annex 3).

3. Data Management Training

To ensure sustainability of the project initiatives specifically on mass dog vaccination, provincial veterinary staff from the North Sumatra Province attended a Data Management Training. The training included data encoding and analysis for the conduct of mass dog vaccination as well as post vaccination survey.

C. Conduct of Mass Dog Vaccination (MDV)

A total of 225 village volunteers serve as vaccinators in 2015 wherein a total of 36,674 animals including 35,377 dogs, 2,111 cats and 91 monkeys were vaccinated.

As compared to 2014, there was a 19% increase in the number of dogs vaccinated in 2015 (Table 1). There were 638 villages covered by the mass dog vaccination out of the 951 villages in the island (67% of the villages covered).

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Table 1. Number of dogs vaccinated in Nias Island (2012-2015) Total Number of Dogs Vaccinated, 2012-2015 40,000 35,377 35,000 29,743 30,000

25,000

20,000

15,000 11,416 10,000 7,754

5,000

0 2012 2013 2014 2015

The MDV campaign was launched at Laverna Auditorium, Gunungsitoli on 24 April 2015. It was attended by 267 participants from Directorate for Animal Health (DAH), Ministry of Health (MoH), DoA Province and District, DoH Province, Local Government, vaccinators and students.

D. Disease Monitoring

1. Human Rabies Cases

Due to the increased joint monitoring of animal bite cases and suspect rabies cases between local animal heath and medical staff through the Integrated Bite Case Managament (ICBM) , more human rabies cases (5) were detected in 2015 as compared to 2014 (4) (Table 1).

Rabies cases were detected in three districts ( North Nias, South Nias and Nias) (Figure 1) with more cases occurring in adults (4 cases) as compared to children (1 case) less than 15 years of age (Annex 4). It is estimated that patients die between 2-4 months after a bite and occurred in the first quarter of the year.

2. Animal Rabies Cases

Out of the 11 dog samples submitted in Disease Investigation Center (DIC) , there were 5 samples that tested positive for rabies from the districts of Nias (4 cases) and South Nias ( 1 case) in 2015 which is higher as compared to 2014 (3) (Table 2). As compared to the human cases, there were no animal rabies cases reported in North Nias (Annex 4).

Based on the report of the community residents, there may be more suspect rabies cases wherein no samples were submitted to the laboratory since the carcass were already consumed by villager before the investigation team arrived.

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Table 2. Animal and human rabies cases in Nias Island from 2010-2015 Animal and Human Rabies Cases, 2010-2015 30

25

20

15

10

5

0 2010 2011 2012 2013 2014 2015 Animal Rabies Cases 5 1 3.5 0 3 5 Human Rabies Cases 26 17 6 1 4 5

Animal Rabies Cases Human Rabies Cases

Figure 1. Map of reported human and animal rabies cases in Nias Island (2015)

E. Communication Management

1. Information Campaign in Schools

To protect children who are highly vulnerable to animal bites and rabies, information campaign were conducted in 105 elementary, junior and senior high schools, high school and orphanages in Nias Island. A total of 18,182 students are given information on rabies, animal bite prevention and first for animal bites through lectures, games, and role playing (Annex 5). Notebooks to prevent animal bites were also developed for students.

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2. Development of Children’s Video on Rabies

Spearheaded by DAH, an interactive video entitled “Desa Warna Warni” (Colorful Village) was developed for children (Annex 6). The video includes songs and dances with key messages on animal bite management, recognizing signs of rabies in dogs, and IBCM (integrated bite case management between the human and animal health sectors).

The video have five songs including the following: “Sedih” and “Rabies Itu Berbahaya” (song about signs of rabies in dogs such as biting without being provoked, change in behavior, hiding in dark places, and fear of water); “Ingat-Ingat Langkah” (song about animal bite management such as washing the wound with soap and flowing water for 15 minutes, going to the Pukesmas, and getting ant-rabies vaccine); “Sahabatku” (song about responsible pet ownership or friendship between human and dog); and “Hijau Segar” (song told about having a healthy life). Information Campaign for the Community. The lyrics are also flashed on the screen allowing the children to sing along with the characters.

3. Community Lectures

A total of 100 community leaders and residents including village chiefs, religious leaders and Rabies center volunteers in Nias and North Nias were briefed on rabies as a disease and measures to control and prevent rabies in humans and animals. A leaflet was also developed for the community members as a support material to expound on key messages about rabies and its prevention Annex 7).

4. World Rabies Day 2015

The national government of Indonesia held a two-day World Rabies Day celebration (WRD) last 20 to 24 October 2015 at the Melka Exelsior Hotel, Buleleng in Bali, Indonesia with an information campaign on rabies prevention/elimination and a dog vaccination competition of the A-team vaccinators.

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Around 160 participants composed of delegates from various international organizations including the World Health Organization (WHO), United Nations Food and Agriculture Organization (FAO), Australian Agency for International Development (AUSAid), World Animal Protection, and GARC attended the national WRD launching. Representatives from the national government of Indonesia (Directorate of Animal Health and Directorate of Livestock and Animal Health Services) as well as local officials from the district of Buleleng were present.

Among the highlights of the national WRD launching on 20 October were the symbolic distribution of the anti-rabies vaccines from the Ministry of Health to the provincial government of Bali and the launching of “Desa Warna Warni,” (Colorful Village).

The dog vaccination competition of the A-team vaccinators was held on the second day until 24 October 2015. 120 vaccinators from all the districts in Bali were able to vaccinate 3,090 dogs during the first day-long competition. The 18 teams were led by mentors/supervisors including GARC Field Veterinarian for Nias Island, Dr. Wahid Fakhri Husein who assessed the vaccinators in terms of dog catching and vaccination techniques as well as vaccine handling.

In Nias Island, activities such as a rabies education campaign, drawing competition, and a musical drama show were conducted in a school (SDN No. 071025) and reformatory in the district of North Nias. A total of 333 students along with 19 teachers, village chief, sub-district chief, and representatives from the Department of Agriculture participated in the school activity.

Meanwhile, around 50 children along with nurses, physicians, Buddha Priest and representatives from the Department of Agriculture and Ehipassiko (local non- government organization) joined in the WRD activities conducted at the St. Margaretha Reformatory, Laverna Church in Gunungsitoli City. A rabies seminar refresher for physicians and other medical personnel was also part of their WRD celebration.

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F. Project Management

1. Project Monitoring and Coordination

Regular meetings were conducted between the government counterparts and GARC Project staff to plan and monitor the implementation of the project (Annex 8).

To provide an overview of the accomplishments of the Nias Rabies Projects; identify challenges; provide recommendations; and next steps to take as basis for the planning of the project activities in 2015, a Project Review meeting was conducted on 19 May and 16 October 2015. The meetings were attended by officials from DAH, DIC Medan, North Sumatra Province (DLAHS and DOH), WAP as well as representatives from GARC.

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IV. Financial Report (2015 still Pending)

2013 USD 2014 USD 2015 USD TOTAL USD

BUDGET EXPENSES BUDGET EXPENSES BUDGET EXPENSES BUDGET EXPENSES 91,023.00 91,023.00 90,213.00 272,259.00 Equipment and Supplies 2576.86 24,786.12 8,152.28 35,515.26 Mass dog vaccination 50,545.22 50,545.22 Post vaccination survey 13,090.09 13,090.09 Workshops And Meetings 637.29 37,348.79 7,248.90 45,234.98 Research (Baseline Survey 4796.04 3,138.43 7,934.47 Socialization 1,619.83 1,619.83 Trainings 49,719.70 49,719.70 Unliquidated funds - Nias 15,530.28 12,398.55 27,928.83 Total Expenses 8010.19 127,384.89 96,193.31 231,588.39

Remaining Budget 83,012.81 - 36,361.89 - 5,980.31 40,670.61

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ANNEXES

Annex 3. Copy of the Field Officers’ Guide for Vaccinators

Annex 4. Details of human rabies cases in Nias Island for 2015

District Village No. of cases Sex/Age Date of Bite Date Died

September 12 January North Nias Siofabanua Village 1 Male/57 2014 2015

August 2014 15 January South Nias Uludano Village 1 Male/12 2015

September 25 January South Nias Hilimagiao Village 1 Male/51 2014 2015

November 14 February North Nias Lukhu Lase Village 1 Male/30 2014 2015

January 2015 7 March Nias Sihareo III Village 1 Female/65 2015

Total 5

Annex 5. Details of the animal rabies cases in Nias Island for 2015

District Village and Subdistrict Species Submitted date Diagnose

Hilifaosi village, Bawolato Sub district Dog 7 January 2015 Positive

Nias 22 February Hilinaa Tafuo village, Idanogawo Sub district Dog Positive 2015

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Sisarahili village, Bawolato Sub district Dog 19 June 2015 Positive

Sihareo III Hilibadalu village, Ma’u Sub district Dog 19 June 2015 Positive

South Pekan Hilisimaetano village, Maniamolo Sub Dog 19 June 2015 Positive Nias district

Annex 6. Number of children and schools reached by rabies information campaign

Elementary

District No. of schools No. of participants

Nias 11 2241

Gunungsitoli 2 196

North Nias 40 5735

South Nias 0 0

West Nias 35 5042

Total 88 13,214

Junior high School

District No. of schools No. of participants

Nias 1 251

Gunungsitoli

North Nias 8 1102

South Nias

West Nias 1 133

Total 10 1,486

Senior High School

District No. of schools No. of participants

Nias 2 339

Gunungsitoli 354

North Nias 3 305

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South Nias

West Nias

Total 5 998

Over-all Total 105 18,182

Annex 7. Copy of the leaflet for the community

Annex 8. List of Meetings with Project Partners

Meeting Objective Date Venue Agencies/Partners Involved

Pre-coordination 5-6 January 2015 DAH Office, DAH, FAO, GARC meeting for 2015 project; Coordination meeting for data management of 2015 project

Consolidation and 8 January 2015 Province Office, DAH, North Sumatra Province, Pre-coordination Medan GARC meeting for 2015 project;

Advocacy Planning to Governor of North Sumatera

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Consolidation and 8 January 2015 DIC Office, Medan DAH, DIC Medan; GARC Pre-coordination meeting for 2015 project

Budget and 29 January 2015 Province Office, DAH, North Sumatra Province, Activities Planning Medan DoH Province, GARC for 2015

Community Based 30 January 2015 Soliga Hotel, DAH,Province, DoA District level, Survey meeting and Gunungsitoli DoH District level, IKIP planning Gunungsitoli, WAP, SAFETYNet, GARC

Coordination 9-10 February 2015 DoA, South Nias South Nias District (Chief of Meeting and District Office DoA, 2 Staffs of DoA, 4 Paravets project planning of South Nias), GARC for South Nias

Project 19 May 2015 Mega Nasional DAH, Province, WAP, GARC implementation Hotel, Gunungsitoli review

Project 16 October 2015 Province Office, DAH, Province, DIC, DoH implementation Medan Province, GARC review

National Rabies 22-23 December Bogor, Indoenesia DAH, FAO, GARC Program Review 2015

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