Knowledge, Attitude and Practice Related to Dog Bite Victims Attending at Anti-Rabies Post Exposure Vaccine Taker in Poly Health Center in Gondar Town, Amhara Region, Northwest Ethiopia

    

    

    Figure 1: Maps of the study area.
Sources: QGIS software version 3.22
    

Literature Review

Etiology

The causative agent of rabies is a member of the Lyssavirus genus of the Rhabdo viridae family of bullet-shaped viruses, which have a single-stranded RNA genome [53,55]. The genus includes the classical rabies virus (genotype 1) and six so-called rabies-related viruses, Lagos bat virus (genotype 2), Mokola virus (genotype 3), Duvenhage virus (genotype 4), European bat Lyssa viruses 1 and 2 (genotypes 5 and 6), and the recently discovered Australian bat genotype 7 [72].

The genus Lyssa virus comprises rabies virus and closely related viruses, including Mokola virus, Lagos bat virus and Duvenhage virus from Africa, European bat virus 1 and 2 and Australian bat Lyssavirus. Each of these viruses is considered capable of causing rabies like disease in animals and humans [53]. It can be inactivated by sodium hypochlorite, 45-75% ethanol, iodine preparations, quaternary ammonium compounds, formaldehyde, phenol, ether, trypsin, Β-propiolactone, and some other detergents. It is also inactivated by a very low pH (below 3) or very high pH (greater than 11). This virus is susceptible to ultraviolet radiation. It is rapidly inactivated by sunlight and drying, and (in dried blood and secretions) it does not survive for long periods in the environment (CFSPH, 2012).

Epidemiology

Geographic Distribution: Rabies virus is distributed worldwide with the exception of islands. Some countries such as the United Kingdom, Ireland, Sweden, Norway, Iceland, Japan, Australia, New Zealand, and Singapore, most of Malaysia, Papua, New Guinea, Pacific Islands and some Indonesian islands have been free of this virus for many years [56]. It is a serious disease threat to humans, domestic animals and wildlife. Worldwide rabies kills about 50,000 – 100,000 people/year and countless domestic and wild animals [13].

In Europe the red fox is the most important reservoir host and vector of rabies. An increase in incidence of rabies in foxes result in an increase in incidence of rabies in domestic animals such as cattle, sheep, horse, cat, dog and others [76]. Sylvatic and urban rabies cycles occur concurrently in some regions, while the sylvatic cycle predominates in others. For example, wild animals accounted for more than 90% of the animal rabies cases reported in the U.S. and Canada in 2010. Vampire bat transmitted bovine paralytic rabies, which is endemic in tropical regions extending from Northern Mexico to Southern Argentina and Island of Trinidad and Tobago [58]. Rabies can be a serious concern in some rare or endangered species.

In Africa, the Ethiopian wolf (Canis simensis) and African wild dogs (Lycaon pictus) are threatened by this virus. Although cases of rabies tend to be sporadic, epizootics are possible (CFSPH, 2012). The first rabies outbreaks in dog were reported in many parts of Ethiopia in 1884, especially in the former province of Tigray, Begemder, Gojjam and Wollo. In Addis Ababa the capital city of Ethiopia, rabies problem has been greatest where the disease had been well established and become endemic. The reviewed rabies situation in Ethiopia revealed that 2172 cases of animal rabies had been confirmed in and around Addis Ababa during 1990-2000, where dogs constituted 89.83 % with the incidence rate of 73.2 % [5,15].

Host Range: All warm- blooded animals are susceptible to rabies [52], but only a limited number of species also act as reservoir hosts. They include members of the families Canidae (dogs, jackals, coyotes, wolves, foxes and raccoon dogs), Mustelidae (skunks, martens, weasels, ferrets stoats etc.), Viverridae (mongooses, meerkat etc.), Procyonidae (raccoon etc.), and Chiroptera (> 1,200 species of bats) [14].

Many animal species can be regarded as accidental hosts or ‘dead end’ hosts and these species have no epidemiological significance in sustaining rabies epidemics. These include humans and other primates, horses, cattle, sheep and pigs. The most common hosts are domestic dogs, cattle and man in Ethiopia [53].

Transmission: Rabies virus is usually transmitted from animal to animal through bites [26,82]. A rabies exposure is any bite, scratch, or other situation in which saliva, cerebral spinal fluid, tears, or nervous tissue from a suspect or known rabid animal or person enters an open wound, is transplanted into, or comes in contact with mucous membranes of another animal contamination of scratch wounds by virus infected saliva [14] and of both wild and urban rabies occurs mainly when an animal that is shedding virus in its saliva bites another susceptible animal or humans. Spread of the disease is often seasonal, with high incidence in late summer and autumn because of large scale movement of wild animals at the mating time and in pursuit of food (Shite et al., 2015).

Rabies virus is transmitted by contamination of a fresh wound with infected saliva from the bite of a rabid animal or from licking abraded skin or mucous membranes. Respiratory and oral transmission can also occur. The main determinant of transmission is the population density of non-immunized susceptible key host species that are free roaming within an ecosystem [52]. The animal usually contracts rabies from the bite of an infected animal. The virus may also enter the body if the mucous membranes (the wet part of the eyes, nose, or mouth) or a scratch or break in the skin have contact with saliva containing the rabies virus [82,15].

Once the rabies virus enters the body, it begins to multiply in the area near the entry site [15,53]. Usually transmission occurs by bite with rabid canine and also under unusual circumstances by inhalation of large amounts of aerosolized rabies virus and through organ transplantation from rabies infected patients [38]. Rabies-infected animals have rabies virus in their salivary glands at high titers which can be even greater than in the brain [21].

The presence of high population of dogs with improper management contributes for high endemic condition of canine rabies in Ethiopia. In canine rabies endemic countries like Ethiopia, rabies has also significant economic importance by its effect on livestock, and in Africa and Asia, the annual cost of livestock losses as a result of rabies is estimated to be US$ 12.3 million [26,38,63]. Rabies is mainly rural transmitter, the hematophagous bat (Desmodus rotundos), that transmits the disease to herbivores, as these are the most common food source. Cycle in wild disease is transmitted to animals like fox, wolf, monkey, coon, skunk, among others. These animals can be a source of food for the hematophagous bat (Shite et al., 2015).

Transmission to people occurs predominantly via infected animal bite or scratch as well as via their saliva through mucosa and broken skin (Tschopp et al., 2015). Rabid dogs are the principal sources for the transmission to human. The transmission almost always occurs by an animal bite that inoculates the virus into the wounds. Virus inoculated into a wound does not enter the bloodstream directly bur is taken up at a nerve synapse to travel to the brain; it causes encephalitis [63].

Pathogenesis: Rabies virus enters the body through wounds or by direct contact with mucosal surfaces, but cannot cross intact skin. The highly neurotropic RABV replicates in the bitten muscle tissue (local viral proliferation in non-neural tissue) and enters peripheral nervous system (viral attachment) where it remains localized for periods ranging from days to months. Bites in areas rich in nerve fibers, such as the hands and face, are especially dangerous, and the resulting incubation period tends to be short. At this stage the immune response is ineffective because the viruses are introduced into the wound in numbers too low to provoke it; also, they do not travel through the bloodstream or lymphatic system, where the immune system could best respond. Then after the virus is transported along afferent axons (centripetal spread) to reach the central nervous system [7].

The rate of centripetal progress of the virus along the axons of the peripheral nerve has been estimated experimentally in mice as 3 mm per day. Thereby the virus spreads to the spinal cord and ascends to the brain where it causes encephalitis. In people infected by aerosols, e.g. in bat-infested caves or in laboratory accidents, the virus probably reaches the CNS via nerves supplying the conjunctiva or the upper respiratory tract, including the olfactory nerves [83].

Once the virus replicates in the spinal cord and throughout the CNS, it may disseminate rapidly (centrifugal spread) along the neuronal axons of the peripheral nerves to other tissues, including the salivary glands and hair-bearing tissues. The dissemination of virus in peripheral tissues outside the CNS depends on the inoculums dose and the length of the incubation period. Large inoculums produce a short incubation period and a rapid course of illness leads to death before spread of virus throughout the brain; dogs die suddenly after a short incubation period and without showing any signs of illness. The presence of virus in saliva, especially in carnivores, is an important factor in rabies transmission. Inoculation dogs with various doses of canine street rabies virus will excrete virus in their saliva up to 14 days before signs appear.

The severity of infection and, in some measure, the location of changes depends for the most part on the inoculums dose. A small dose of virus can produce longer incubation periods and results in more pathologic changes. The degree of inflammation of the brain and, less commonly, the spinal cord is directly proportional to the length of the incubation and morbidity periods. Neuronal degeneration in the CNS ranges from minimal to severe, with satellitisms and neurophagia is evidence of early neuronal necrosis, Negri bodies can be found in the brain stem, pons, cerebral cortex, and cervical part of the spinal cord. In general, the number of Negri bodies present is directly proportional to the severity of inflammation.

Clinical signs and symptoms: The clinical course in domestic carnivores, which usually lasts for days or for a few weeks, may encompass prodromal, furious (exitative) and dumb (paralytic) phases. In certain rabid animals, some of these phases may not be observed. In the prodromal phase affected animals are often confused and disorientated; shows behavioral changes such as aggressiveness and no fear of humans in wild animals or abnormalities in appetite [14]. The period lasts approximately 1-3 days, animals show only vague central nervous system signs, which intensify rapidly [26,53].

The furious phase is characterized by an increase in aggressiveness and hyperexitability and there is a tendency to bite at inanimate objects and at other animals [14]. Affected animal may roam over long distances and characterized by restlessness, wandering (aimless movement with speed), howling, polypnea, drooling and attacks on other animals, people or inanimate objects [53]. Affected animals often swallow foreign objects such as sticks and stones [52].

Nocturnal animals may be visible during the day [14]. In paralytic (dumb) phase muscle weakness, difficulty in swallowing, profuse salivation and dropping of the jaw are the usual features. Those clinical signs may be mistaken for those caused by a foreign body in the throat or mouth [40].

Diagnosis: Rabies can be difficult to diagnose clinically, because in the early stages, it is easily confused with other diseases. Therefore, suspected and probable clinical cases of rabies should be confirmed by laboratory tests. Rabies diagnosis is primary analytical ante mortem and postmortem testing of samples collected from suspect animals and humans [79].

It is used to detect rabies virus infection both before rabies specific signs (hydrophobia or aerophobia) are present or post mortem through detecting the whole viruses, viral antigens, or nucleic acids in infected tissues. The best sample for diagnosis of human rabies is the skin biopsy from a richly innervated zone. Saliva is the second-best sample for rabies diagnosis. Secretions and biological fluids, such as saliva, spinal fluids, and tears are used to test rabies while the animal is alive [77].

In Ethiopia, the experience of sending the suspected and dead animal's brain for examination was very low due to the limited available diagnostic center in the country [5]. There are different rabies diagnosis methods, including virus isolation, virus and its antigens detection, detection of anti-rabies antibodies, and detection of viral nucleic acid [50].

Fluorescent Antibody Test (FAT): The Fluorescent antibody Test (FAT) is the recommended gold standard for rabies diagnosis. In this method, rabies virus is detected by binding fluoresce in isothiocyanate with rabies specific antibody to form conjugate, and rabies antigen is observed under fluorescent microscopy. The fresh brain tissue sample is preferable for diagnostic of rabies to get result within 3 hours (Rupprecht et al., 2018). Based on the result, there is no need for PEP treatment when FAT results with sensitivity of 100% are negative [18].

Rapid Immunodiagnostic Test (RIDT): Rapid Immunodiagnostic Test (RIDT) is the method of antigen detection in fresh animal brain tissue. It is important for the field and frontline laboratories. The result of all positive RIDT tests requires being confirmed employing direct fluorescent anti-body testing at a qualified laboratory [12].

Microscopic analysis of samples: This method is the direct diagnostic approach used for the identification of rabies virus-specific antigen in a short time with limited cost, disregarding geographical origin. It has to be considered as the first step in diagnostic procedures for all laboratories. The sample used for this technique can be taken from saliva, urine, and cerebrospinal fluids, but less sensitive and reliable than brain samples [12].

ELISAs and direct rapid immune histochemistry tests: These tests have provided consistently reproducible results in several laboratories [51]. Virus might have to be isolated to confirm the results of antigen detection tests and for further amplification or characterization of an isolate. Virus can be isolated in cell cultures, such as neuroblastoma cells, or by intracranial inoculation into mice. Virus isolation in animals should be replaced by alternative methods, whenever possible [17].

Molecular methods: The Reverse Transcription Polymerase Cain Reaction (RT-PCR) and other amplification techniques are playing an increasingly important role in many countries but are not recommended currently for routine post-mortem diagnosis of rabies if brain tissue is available, when the direct fluorescent antibody test should be used Matter et al., (2000).

Differential Diagnosis: Rabies must be considered in the differential diagnosis of any suspected mammalian meningitis/ encephalitis cases. Among this, the followings are mostly misdiagnosed with rabies virus.

1. Equine encephalitis virus: Misdiagnosed with RABV due to the stage of paralysis, unable to swallow, weakness, recumbency and death within 2–4 days after onset. But Equine encephalitis virus causes impaired eyesight, circling and Recovery rate (60–75%); which are mostly absent in case of RABV.

2. Canine distemper virus in dogs: Misdiagnosed with RABV due to neurological signs. This disease can cause uveitis, sudden blindness, and respiratory signs.

3. Coughing and nasal discharge: puppies are mostly affected showing signs of pneumonia, diarrhea, and dehydration and vomiting.

4. Botulism in cattle: Misdiagnosed with RABV due to signs of weakness, stumbling and recumbency. But in Botulism, normal mentation, paralysis of tongue and thoracic muscles and some recoveries are mostly evident.

5. Aujeszky’s disease (pseudo rabies)- Misdiagnosed due to signs of intense and local pruritus at site of bite, excitement, bellowing, convulsions, paralysis, and death within 2–3 days after onset. But pseudo rabies mostly affects pigs and cattle and responds to magnesium sulphate early.

6. Lead poisoning (in acute and sub-acute) in cattle: Misdiagnosed because the clinical findings are similar to those of furious and dumb rabies. In acute lead poisoning, the common clinical findings are blindness, convulsions, death within 2 and 4 days after onset, pharyngeal paralysis, dysphagia, weakness and recumbency.

7. Vitamin A deficiency in cattle: occurs in groups of young cattle from 6 months to 18 months of age not receiving adequate carotene intake or vitamin A supplementation and is characterized by blindness in the ocular form and episodes of tremors and convulsions.

Treatment: No treatment should be attempted after clinical signs are evident; hence rabies is fatal once clinical signs are seen. Only high-risk individuals, such as laboratory workers, animal control professionals, and veterinarians, are routinely vaccinated against rabies before known exposure. If a person is bitten, immediately the wound should be thoroughly washed with 20% soft soap, water (for about 15 minutes) and 40% to 50% alcohol solution of all bite wounds and scratches is perhaps the most effective measure for preventing rabies in people bitten by rabid animals. The proper cleaning of the wound would remove most of the virus but these simple and cheap treatment procedures are often omitted in most cases [51].

If the animal is positive for rabies, the person must undergo PEP -meaning a series of anti-rabies vaccine and immune globulin injections is recommended. “Another indication for anti-rabies treatment is any unprovoked bite by a skunk, bat, fox, coyote, bob-cat, or raccoon not available for examination. Treatment after a dog or cat bite, if the animal cannot be found, is determined by the prevalence of rabies in the area. Euthanasia of suspect animals must be avoided, particularly if human exposure has occurred, because the development of the disease in the animals is necessary to establish a diagnosis.

Control and Prevention: Domestic animal vaccination: The primary components of a rabies control program for companion animals are immunization and licensing; stray animal control; reporting, investigation, and isolation of animals involved in bite incidents; and public education [14]. Multiple vaccines are licensed for use in domestic animal species. Vaccines available include: inactivated or modified live virus vectored products; products for intramuscular and subcutaneous administration; products with durations of immunity from one to 4 years; and products with varying minimum age of vaccination [26,53].

Animal control: Principles of rabies prevention should focus on excluding wild animals from areas of human and domestic animal habitation and activity, and avoidance of contact with possibly rabid wild animals. Immunization of wildlife by widespread distribution of vaccine impregnated oral baits has shown variable success toward arresting the propagation of rabies in raccoons and coyotes in other states. The use of oral rabies vaccines (ORV) for the mass vaccination of free-ranging wildlife should be considered in selected situations [14,37].

Public health education: Understanding communities’ perceptions of cause, mode of transmission, symptoms, treatment and possible intervention measures of rabies is an important step towards developing strategies aimed at controlling the disease and determining the level of implementation of planned activities in the future [6] and creating responsible pet ownership, routine veterinary care and vaccination, and professional continuing education. Having about controlling animal and human exposures to rabies can be prevented by raising awareness concerning: rabies transmission routes, and avoiding contact with wildlife. Public education on the risks of rabies transmission from wild animals is paramount to effective disease prevention [2,14,26,63].

Vaccines, antiviral drugs such as ribavirin, interferon-alpha, passively administered anti-rabies virus antibodies (human immunoglobulin or monoclonal antibodies), ketamine and/or the induction of a coma have been tried in the past, but were usually ineffective [26]. It is better to register, license and immunize all dogs in enzootic countries, collect and euthanize ownerless animals and stray dogs. To create awareness, pet owners and the public should be educated to educate about the importance of restriction for dogs and cats and advise them against keeping wild animals as a pet [53]. According Chernet and Nejash (2016), rabies control strategies include quarantine, confirmation of diagnosis, determining the origin and spread of an outbreak, and specific measures to terminate transmission. All local jurisdictions should incorporate stray animal control, leash laws, animal-bite prevention and training of personnel in their programs [26].

Pre exposure prophylaxis vaccine in human: Pre exposure vaccination is indicated for persons whose occupation, travel, or recreational activities place them at higher risk of exposure to rabies. Occupational groups include veterinarians, veterinary technicians, animal control officers, bat researchers, wildlife workers, and animal disease laboratory workers. International travelers are recommended to receive pre-exposure vaccination if they are likely to come in contact with animals in countries where canine or other animal rabies is prevalent, and immediate access to appropriate medical care, including rabies vaccine and immune globulin, might be limited [8].

Pre-exposure prophylaxis is given for two reasons: To provide protection against unrecognized or unapparent exposures to rabies and to simplify Post-Exposure Prophylaxis (PEP) by eliminating the need for Rabies Immune Globulin (RIG) and by decreasing the number of required vaccine doses when an exposure occurs. Pre-exposure immunization does not eliminate the need for prompt post exposure prophylaxis following a recognized exposure; it only reduces the PEP regimen. Anyone who receives the pre-exposure prophylaxis series is considered immunologically primed against future rabies exposure. Therefore, if they are exposed to a rabid animal, they simply require PEP for a person previously vaccinated (i.e., days 0 and 3 vaccination) it explained on table1 below [8].

Table 1: Socio-demographic characteristics of the respondents.

  

    
Variables
    
Categories’
    
Proportion (%)
  
  

    
Sex
    
Male
    
247 (64.3)
  
  

    
Female
    
137 (35.7)
  
  

    
Age
    
<30    year
    
40 (10.42)
  
  

    
 
    
30-45 year
    
153 (39.84)
  
  

    
>45    year
    
191 (49.74)
  
  

    
Marital    status
    
Single
    
37 (9.6)
  
  

    
Married
    
338 (88.02)
  
  

    
Divorced
    
6 (1.56)
  
  

    
Windowed
    
3 (0.78)
  
  

    
Level of    educated
    
Illiterate
    
157 (41)
  
  

    
read and write
    
110 (28.65)
  
  

    
1- 4 grades
    
67 (17.45)
  
  

    
 
    
5-8 grades
    
36 (9.38)
  
  

    
9-12    grades
    
10 (2.6)
  
  

    
college/university
    
4 (1.04)
  
  

    
Religion
    
Christians
    
316 (82.29)
  
  

    
Muslim
    
65 (16.93)
  
  

    
Protestant
    
3 (0.78)
  
  

    
Occupational    status
    
Farmer
    
283 (73.7)
  
  

    
Merchant
    
52 (13.5)
  
  

    
Labor
    
41 (10.7)
  
  

    
Student
    
6 (1.6)
  
  

    
Gov’t    employer
    
2 (0.5)
  
  

    
Residence
    
Rural
    
294 (76.6)
  
  

    
Urban
    
90 (23.4)
  
  

    
Dog    ownership
    
Yes
    
313 (81.5)
  
  

    
No
    
71 (18.5)
  

Table 1: Socio-demographic characteristics of the respondents.

Close

Post exposure prophylaxis treatment in human: The essential components of rabies post-exposure prophylaxis are wound treatment and, for one previously unvaccinated persons, the administration of both human Rabies Immune Globulin (RIG) and vaccine are present [7]. Local treatment of wounds, thorough washing and flushing (for about 15 minutes, if possible) with soap or a cleansing agent and copious amounts of water of all bite wounds and scratches should be done immediately or as early as possible. Where available, an iodine containing, or similarly veridical, topical preparation should be applied to the wound, Tetanus prophylaxis and measures to control bacterial infection should be given as indicated [78].

Specific treatment, the immediate treatment is started after exposure, is the better. Post-exposure anti-rabies vaccination should always include administration of both passive antibody and vaccine, with the exception of persons who have ever previously received complete vaccination regimens (pre-exposure or post-exposure) with a cell culture vaccine or persons who have been vaccinated with other types of vaccines and have previously had a documented rabies virus neutralizing antibody titer. These persons should receive only vaccine, when get pre-exposure before. The combination of RIG and vaccine is recommended for both bite and non-bite exposures reported by persons who have never been previously vaccinated for of prophylaxis. If post-exposure prophylaxis has been initiated and appropriate laboratory diagnostic Testing (FAT) indicates that the exposing animal was not rabid, post-exposure prophylaxis can be discontinue [44]. Post exposure vaccination is usually accompanied by injection of anti-rabies immunoglobulin of either human (HRIG) or equine (ERIG) origin, and is referred to collectively as PEP [45]. Rabies Immune Globulin (RIG), a recombinant monoclonal antibody targeting a specific epitope of the G protein, is highly effective in neutralizing RABV in vitro or before the virus enters the CNS [39].

It is an essential component of PEP, since it delivers passive immunity which is particularly important at early stages, before the host develops active immunity to the vaccine. However, once the virus accesses the CNS, these antibodies are restricted to crossing the immune-privileged BBB to neutralize virus infection. Although, in theory, the antibody could be given intracerebrally, it is definitely not a practical therapy. On the other hand, it has been firmly established that enhancement of BBB permeability is required to allow the passage of VNAs into the CNS of activated B cells, in order to cross the BBB and release antibodies in situ for RABV clearance [34,35,43]. RIG is also an important component of post-exposure prophylaxis to inhibit viral spread in the interval before sufficient immunity is developed in response to vaccination. It should be injected into and around the wound site, ideally on the day of exposure or up to 7 days after the initial dose of vaccine [73]. Twenty IU/kg on day zero in conjunction with the first vaccine one dose. If possible, the full calculated dose of RIG should be used to infiltrate the wound. If it is two not possible to do so, any remaining portion of the dose should be administered intramuscularly at a site different from the site used to administer the vaccine. Because, the antibody response following the recommended vaccination regimen with HDCV has been satisfactory, routine post-vaccination serologic testing is not recommended. Serologic testing is indicated in unusual circumstances, as when the patient is known to be immune suppressed (Beyene et al., 2018).

Post exposure prophylaxis treatment in animal: Any animal potentially exposed to rabies virus (Rabies Exposure) by a wild Carnivorous mammal or a bat that is not available for testing should be regarded as having been exposed to rabies. Unvaccinated dogs, cats, and ferrets exposed to a rabid animal should be euthanatized immediately. If the owner is unwilling to have this done, the animal should be placed in strict isolation for 6 months and vaccinated one month before being released. Protocols for the post exposure vaccination of previously unvaccinated domestic animals have not been validated, and there is evidence that the use of vaccine alone will not prevent the disease [71].

Materials and Methods

Study Area

The study was conducted in Gondar town poly health center in Amhara region, Northwest Ethiopia from January 2023 to March 2024. The study area was selected purposively based on their availability of post exposure nervous tissue vaccines in poly health center in Gondar town. Gondar town is found in northwestern part of Ethiopia at 748km away from Addis Ababa and 180km from Bahir Dar the administrative center of Amhara region. The estimated human population is of the estimated to be 230,315 and the total area of the city covers 5560 ha (CSA, 2022).

Gondar town is located between 12? 36’ North latitude and 27° 2’ East longitude. The annual mean minimum and maximum temperature vary between 12.3–17.7°C and 22–30°C, respectively, with an annual average temperature of 19.7°C. It is located 749 kilo-meters away from Addis Ababa, the capital city of the country, and 207 kilo-meters away from Bahir Dar, the capital city of the region (Demeke et al., 2020). The estimated human population is of the estimated to be 230,315 and the total area of the town covers 5560 hectare (CSA, 2022).

Study Design and Data Sollection

A cross-sectional study was conducted over a period of three months from September to November 2023 among dog bite cases attending Gondar town poly health center using a semi-structured questionnaire. The questionnaire was designed to collect quantitative data on dog bite victims' knowledge, attitude and practice related to rabies (Annex 1). The questionnaire had 4 sections such as socio-demographic characteristics, knowledge, attitude and practices of respondents regarding on dog bites and rabies. Depending on the option of each questionnaire sections in related questions about knowledge and practice, respondents were asked to answer ‘yes’ or ‘no’ or to choose from a list of options provided. Attitude questions were developed by Likert’s scale having five components, strongly disagree, disagree, uncertain, agree and strongly agree. The socio-demographic questions included were respondents' sex, age, socioeconomic status, marital status and educational status. Age class of the respondents was classified to three groups as less than 30 years, 30–45 years and greater than 45 years following previous recommendations for social science research [83]. Before collecting the actual data, it was pre-tested and corrected based on the feedback of pre-test. The pilot testing was primarily targeted to test clarity of questions, to estimate the time needed to administer the questions and enough to acquire the required information. The final questionnaire was administered by face-to-face interviews using the local language (Amharic). The selected victims were individually interviewed using questionnaire. Both open and closed ended questions were included in the questionnaire.

Sampling Methods and Sample Size Determination

Simple random sampling was used to select study participants. First, administrative zones and the study area were selected purposively based on their ease of accessibility and availability of nervous tissue vaccines. Next Individuals within health center were selected purposively targeting household heads having dog bite victims. Individual having dog bite victims in the health center were selected randomly using computer based random numbers. Individual in the vicinity were substituted when no one is unwilling to participate.

Sample size was calculated using the method described by [69].

Where:

n = sample size

P = expected prevalence

D = standard error

We used 50% expected prevalence (P) and a 5% standard error (d), which were estimated using formula above. Therefore, 384 sample sizes were considered for this study.

Data Analysis

The collected data was entered into Microsoft Excel, coded and summarized using descriptive statistics. All statistical analyses was done using Stata 17 statistical software. A mixed effect logistic regression model (dog bite victims was taken as random effect). Correlation, confounding and interaction tests were checked.

The socio-demographic questions were included respondents' sex, age category, educational status, marital status, religion, dog ownership and rabies knowledge level (for desirable attitude and good practice) were the predictor variables where associations were examined. Factors with a p-value of less than 0.25 in the univariable analysis were incorporated into the full multivariable mixed effect logistic regression mode. In the multivariable mixed effect logistic regression, P-value < 0.05 was considered as cut off for statistical significance and Odds Ratio (OR) and 95% CI were also calculated. Age class of the respondents was classified to three groups as less than 30 years, 30–45 years and greater than 45 years following previous recommendations for social science research [83]. The responses for KAP questions were given scores and dichotomized using cut off 50% of the maximum obtainable score reflecting good and poor KAP levels. The binary knowledge questions were given score of 1 when correctly answered 0 when answered incorrectly. Respondents who scored yes and/correct responses were considered as having adequate knowledge and those who scored no and/ incorrect responses were considered as having inadequate knowledge. Similarly, respondents who scored yes and/correct responses were categorized as having good practice and individuals scored no and/ incorrect responses as having poor practice. The attitude questions were set in Likert scale and were scored as 1 = strongly disagree, 2 = disagree, 3 = uncertain, 4 = agree and 5 = strongly agree which depends on the nature of the statement. A dog bite victims’ attitude was determined good attitude as a proportion of agree and strongly agree greater than 50%, poor attitude as a proportion of disagree and strongly disagree less than 50% and neutral attitude based on the scores by respondents given for questions measuring attitude by Likert scale.

Results

Socio-Demographic Characteristics of the Respondents

A total of 384 dog bite victims were interviewed during the study period. Majority of respondents (64.3%) were males and 49.7% were aged greater than 45 years. About (80.02%) the respondents were married and 41% of respondents were illiterate. Besides, 73.7% of the study respondents were farmers and 76.6% were from rural areas. Most of the respondents were Christians. Two third of the study participants were lived in rural areas. About 81.5% of the respondent owned dogs (Table 1).

Assessment of Knowledge’s for Dog Bites Victims’ Response on Rabies.

About 100% of the participants heard about rabies virus. Regarding source of information for rabies, 53.65% of respondent’s perceived health practitioners are the most information sources followed by mass media, conference meeting and personal effort with a proportion of 26.56%, 11.72% and 8.07%, respectively. About 73.3% of the participants reflected that rabies is zoonotic and 68.5% of them caused by virus. Regarding susceptible animal species, about 100% of the participants knew dog and cat and humans highly susceptible to rabies virus. Regarding transmission, 100% of respondents knew dog bite is the main means of transmission and 68.23% and 20.6% of them perceived that wound contact with dog saliva and skin scratches, respectively were also routes for the transmission of rabies. About 98.44% of the participants knew that aggressiveness the most of the clinical signs associated with rabies followed by profuse salivation, dropping of tail and head, abnormal eating habit, hydrophobia, difficulty of swallowing and paralysis with a proportion of 81.77%, 61.2%, 44.01%, 6.77%, 4.95% and 2.86% respectively. About 88.8% of the participants perceived that rabies were not curable after developing overt clinical signs (Table 2).

Table 2: Assessment of knowledge questions for dog bite victims’ response on rabies.

  

    
Variables
    
Category
    
Proportion (%)
  
  

    
Heard about rabies virus
    
Yes
    
384 (100)
  
  

    
No
    
0(0)
  
  

    
Source of information for rabies
    
Health practioners
    
206(53.65)
  
  

    
Mass media
    
102(26.56)
  
  

    
Conference meeting
    
45(11.72)
  
  

    
Personal effort
    
31(8.07)
  
  

    
rabies is a zoonotic disease
    
Yes
    
344 (89.58)
  
  

    
No
    
40(10.42)
  
  

    
Causes of    Rabies virus
    
virus
    
263 (68.5)
  
  

    
Bacteria
    
97 (25.26)
  
  

    
Parasites
    
24 (6.25)
  
  

    
susceptible animal species
    
Dog and cat
    
384 (100)
  
  

    
Human
    
384(100)
  
  

    
Cattle
    
367 (95.6)
  
  

    
Equine
    
284 (73.96)
  
  

    
Shoat
    
276 (71.88)
  
  

    
mode of rabies transmission
    
Bite
    
384 (100)
  
  

    
Contact with dog saliva
    
262 (68.23)
  
  

    
Skin scratch
    
79(20.6)
  
  

    
Others
    
35(9.11)
  
  

    
clinical signs observed 
    
Aggressiveness
    
378 (98.44)
  
  

    
Profuse salivation
    
314 (81.77)
  
  

    
Dropping of tail and head
    
235 (61.2)
  
  

    
Eating of abnormal items
    
169 (44.01)
  
  

    
Hydrophobia
    
26 (6.77)
  
  

    
Difficulty in swallowing
    
19 (4.95)
  
  

    
Paralysis
    
11(2.86)
  
  

    
curable after clinical Signs observed 
    
Yes
    
36 (9.4)
  
  

    
No
    
341 (88.8)
  
  

    
Don’t know
    
7 (1.82)
  
  

    
source of rabies infection
    
Stray dog
    
304 (79.17)
  
  

    
Free ranging dog
    
291 (75.78)
  
  

    
Red fox
    
93 (24.22)
  
  

    
rabies    control measures applied
    
Vaccination
    
347 (90.36)
  
  

    
Treatment
    
155 (40.36)
  
  

    
Traditional    remedies
    
357 (92.97)
  
  

    
Don’t know
    
24 (6.25)
  
  

    
Actions taken immediately after dog bite 
    
Washing wound with soap
    
278 (72.4)
  
  

    
Use traditional medicine
    
357(92.97)
  
  

    
Immediate came to health center
    
84(21.88)
  
  

    
Nothing    done
    
17(4.43)
  

Table 2: Assessment of knowledge questions for dog bite victims’ response on rabies.

Close

Assessment of Attitudes for Dog Bites Victims’ Response on Rabies

Over 88% of the participants perceived as rabies can be a fatal disease. Over 93% of the participants were agreed that rabies were notifiable diseases. About 88.02% of the respondents were agreed with that rabies is not treatable after onset of clinical signs. Over 81% of participants believed that habit of eating dead animal meats is a source of infections for rabies virus (Table 3).

Table 3: Summary of respondents for attitude questions.

  

    
Attitude Questions
    
Response categories n (%)
  
  

    
Negative attitude
    
Proportion (%)
    
Uncertain
    
Positive attitude
    
Proportion (%)
  
  

    
Strongly disagree
    
Disagree
    
Agree
    
Strongly Agree
  
  

    
Rabies is    fatal.
    
11 (2.86)
    
17 (4.43)
    
28 (7.29)
    
18 (4.69)
    
142 (37)
    
196 (51.04)
    
338 (88.02)
  
  

    
Rabies is notifiable    diseases
    
7 (1.82)
    
11 (2.86)
    
17 (4.43)
    
8 (2.08)
    
160 (41.67)
    
198 (51.56)
    
358 (93.23)
  
  

    
Rabies is not treatable after onset of clinical    signs
    
18 (4.7)
    
22 (5.73)
    
40 (10.42)
    
6 (1.56)
    
138 (35.94)
    
200 (52.08)
    
338 (88.02)
  
  

    
Habit of    eating dead animal meats is a source of infections for rabies
    
26 (6.8)
    
33 (8.6)
    
59 (15.56)
    
23 (6)
    
118 (30.73)
    
184 (47.92)
    
312 (81.25)
  
  

    
Vaccination of human and dogs are a better method    for rabies control measures.
    
18 (4.7)
    
20 (5.21)
    
38 (9.9)
    
18 (4.7)
    
132 (34.38)
    
196 (51.04)
    
328 (85.42)
  
  

    
Crossing    river within    40 days of bite inactivate the effect of PEP/traditional treatment
    
110 (28.65)
    
132 (34.38)
    
242 (63.02)
    
51 (13.28)
    
47 (12.24)
    
44 (11.46)
    
91 (23.7)
  

Table 3: Summary of respondents for attitude questions.

Close

Assessment of Practice for Dog Bites Victims’ Response on Rabies

About 56.25% of the participants practiced that the purpose of owning dogs for guarding and 63.8% of dog owner uses outdoor dog management system. Regarding vaccination, about 65.9% of the participants do not vaccinate their dogs once per year unless the rabies virus outbreaks were epidemic in the area (Table 4).

Table 4: Assessment of practice questions for dog bite victims’ response on rabies.

  

    
Variables
    
Category
    
Proportion (%)
  
  

    
Purpose of owning dogs
    
Guarding
    
216 (56.25)
  
  

    
Hunting
    
153 (39.84)
  
  

    
Don’t know
    
15(3.91)
  
  

    
Dog management system
    
Indoor
    
98 (25.52)
  
  

    
Outdoor
    
245 (63.8)
  
  

    
Nothing done
    
31 (8.07)
  
  

    
Can your    Dogs vaccinate per year
    
Yes
    
131 (34.11)
  
  

    
No
    
253 (65.9)
  
  

    
Avoid    contact from unknown dogs or wild animals
    
Yes
    
162 (42.2)
  
  

    
No
    
222(57.81)
  
  

    
Take any safety measure for caring your dogs
    
Yes
    
48 (12.5)
  
  

    
No
    
336 (87.5)
  
  

    
Safty measures applied 
    
No use safety measures
    
336 (87.5)
  
  

    
Protect from bite
    
32 (8.33)
  
  

    
Avoid contact with saliva
    
16 (4.17)
  
  

    
Take actions after rabid dog bites 
    
Yes
    
286 (74.48)
  
  

    
No
    
68 (17.71)
  
  

    
Don’t know
    
30 (7.81)
  
  

    
Actions applied after rabid dog bites
    
Immediate washing the wound
    
40 (10.42)
  
  

    
Killed immediately
    
134 (35)
  
  

    
Came to health center
    
30 (13.02)
  
  

    
Use herbal Rx
    
170 (44.3)
  

Table 4: Assessment of practice questions for dog bite victims’ response on rabies.

Close

Disscussion

A community-based cross-sectional study was conducted to assess rabies prevention and control practices and associated factors among Dog bite victims in poly health center in Gondar Town, Amhara region, North West Ethiopia. A total of 384 dog bite victims were selected using simple random sampling methods. In the present study, most of the respondents had good knowledge and a desirable attitude towards rabies, whereas their preventive practice was poor. About 82.6% of the respondents have adequate knowledge. The current study is consistent with reports in previous studies reported by Ali et al. (2018) and Digafe et al. (2015) who reported 83% and 90.8% of having adequate knowledge from Addis Ababa and Gondar, respectively. However, it was higher than 64.1% reported from Bahir Dar by Guadu et al. (2014) and 56.1% from Mekelle by Hagos et al. (2020). The result in the current study is roughly similar reports in the previous studies conducted by Digna et al. (2015), Moran et al. (2015) and Sambo et al. (2014) who reported 82.6%, 82% and 86% from Indonesia, Guatemala and Tanzania respectively. The study indicates the disease is endemic in the study area and there is adequate knowledge in dog bite victims.

The present study revealed that (100%) were heard about rabies and this was in agreement with the previous studies reported by Shumuye et al. (2014), Bahiru et al. (2022) and Moran et al. (2017) respectively. The present finding was disagree with the previous study reported by Matibag et al. (2007), Ali et al. (2013) and Sumon et al. (2017) which is 75.2%, 73%, 76.5% in Sri Lanka, Ethiopia and Bangladesh respectively. These differences could be due to the information access and awareness level of the dog bite victims in its community. Regarding the source of information for rabies 53.65%, 26.56%, 11.72% and 8.02% of the dog bite victims were heard about rabies from health practitioners, mass media, conference meeting and personal efforts respectively. This difference is most likely explained by low media coverage and other awareness creation sources in the community in the study district.

In the present study, 89.58% of respondents recognize rabies as a zoonotic disease. The current finding was in line with the study conducted in Bahir Dar town (94.5%) by Tadesse et al. (2014) and New York, USA (94.1%) by Eidson et al. (2004). However, this result was disagreed with the study reports 30.97% from Addis Ababa by Ali et al. (2013). The main reason for the difference could be nearest approach to animal health practitioners and health worker, so that they could consult animal health practitioners and health workers for the health care to community for rabies zoonosis.

In this study, all (100%) of the respondents knew that the main source of transmission for rabies in humans is dog bites. This is in agreement with the WHO report that 99% of rabies in humans is from rabid dog bites [77]. Non negligible numbers (15.7%) of respondents believe that species other than a dog can never be a threat for human rabies. This is not consistent with the epidemiology of the disease as it can also be contracted from other rabies susceptible species [30]. This suggests the need for creating awareness about the potential sources of rabies to humans other than dogs.

About 98.9% of the respondents knew the clinical signs of rabies in dogs. Among this aggressiveness, profuse salivation and dropping of tail and head were the most clinical signs observed in dogs with a proportion of 98.44%, 81.77% and 61.2% respectively. Most of the dog bite victims were identify clinical signs of the rabies disease in dogs because humans living with dogs in home and observed the signs in their day-to-day life.

About 88.02% of dog bite victims believed that rabies cannot be treated after the onset of clinical signs. This is consistent with the facts that once the clinical signs are seen there is no way for recovery [29]. This is due the fact that the dog bite victims observe up to date once animals and humans can not treat after onset of clinical signs developed.

Majority of the present study participants (81.25%) believed consumption of meat from an animal that died of rabies is a source of infection. This could be taken as a good attitude to minimize risk of rabies. In this study, most of (85.42%) the respondents believed that vaccinating their dogs are a better method for rabies control measures. The present finding was agreed with the previous studies reported by Ahmed et al. (2022), Ahmed et al. (2012) and Hagos et al. (2020) which is 71.1%, 79% and 85.3% in Adigrat, Mekelle and chiro towns. The present study was disagreement with the study conducted by Degife et al. (2015), Gashaw and Edaso (2023) and Gebeyaw et al. (2020) which is 18%, 36.8% and 60.83% in Shone, Jima and Mersa town in Ethiopia respectively. The variation may be due to the availability of vaccines or lack of awareness in the communities in the study area. About 10.42% of the respondents do not practice immediate washing the wound with water at the site of infection. The result is in agreement with previous studies in Ethiopia reported by Digafe et al. (2015) and Bahiru et al. (2022) where proper wound washing after a dog bite was not practiced. The WHO recommends that an immediate washing at the site of bite is the first and most important component of PEP [29]; wound washing and flushing reduces the impact of the disease by five folds [77]. The low-level wound washing practice in this study indicates the important and easily accessible portion of the PEP is missed. Therefore, the community needs detailed training awareness about proper washing with soap after immediate dog bites. About 35% of the respondents practice an immediate killing of the dog when they encounter a bite of human. This finding is in agreement with previous reports in Ethiopia reported by Herbert et al. (2012) and WHO (2010) which is 42% and (47.7%) respectively. However, it contradicts the recommended measure that a dog bitten a human should be tied for ten days and monitored to see overt clinical signs [12].

The present finding indicates that 44.3% dog bite victims were used traditional treatment as the best option for dog bites. The present finding was consistent with the previous study conducted by Shumuye et al. (2014), Sekhon et al. (2002) and Rumana et al. (2023) from Ethiopia, India and Bangladesh respectively. This is due to negative beliefs among respondents associated with dog bite management and lack of education about post exposure vaccine in health center and financial limitations of dog bite victims for accessing vaccines in hospital.

Conclusion and Recommendations

Rabies is a fatal viral zoonotic disease and had a serious public health problem. The present study revealed that there is a good level of knowledge and attitude whereas the level of preventive practice was low in the study area. The majority of animal and human exposures to rabies can be prevented by raising awareness about community on rabies transmission and avoiding contact with wildlife. The communities should be killing stray dogs in order to reducing risk of rabies disease outbreak in their locations. Attention should be given by public health authority to create awareness in the community about simple but important rabies preventive measures such as immediate washing of wound following dog bite and quarantine of the biting dog. However, it should be giving high focusing points when they are washing their hands after touching their dogs. Generally, play a principal role in mass vaccination of dogs, proper post exposure management, appropriate surveillance system, and increasing the awareness of the community about the disease needs special attention for prevention and control of the disease.

Based on the above conclusions the following recommendations are forwarded;

Strategic rabies control measures should be carried out mainly stray and free-ranging dogs.

Post exposure treatment should be given after immediately exposure to dog bite or scratch by rabid animals.

The public health and economic impacts of rabies should be further studied at zonal and regional level.

Further research works should be carried out.

Author Statements

Acknowledgements

I express my sincere gratitude to Asayehegn Asnakew, for their considerable guidance, appropriate supervision, valuable suggestion and constant encouragement, intellectual advice and devotion of time to his overall support.

I thank dog bite victims for accepting our request and give permission to give response of questionnaires. I would like to thank human health practitioners for their cooperation and technical supports.

I would like to express greatest thanks to Lay Armachiho Woreda Livestock Resources and development Office for their motivation for my research work. I would like to express my gratitude to Poly health center for giving permission to collect the data and motivate me to work researches not only now but also future time.

References

1. Adesina M, Olufadewa I, Oga Y, Nwachukwu H. Incidence and mortality from a neglected tropical disease (rabies) in 28 African countries, Folia Vet. 2020; 2: 46–51.
2. Aga A, Hurisa B, Urga K. Current Situation of Rabies Prevention and Control in Developing Countries: Ethiopia Perspective. Journal of Infectious Diseases and Preventive Medicine. 2016; 4: 1-6.
3. Ahmed M, Dirirsa G, Mengistu D, Demena M, Geremew A. Rabies prevention and control practices and associated factors among dog owners in Chiro, West Hararghe, Ethiopia. Journal of Public Health Research. 2022: 11.
4. Ahmed S, Mohammed H, Firaol B, Friat K, Desta G. Assessment of community’s knowledge, attitude and practice towards prevention and control of rabies in and around Adigrat Town, Tigray Regional State, Ethiopia”. Acta Scientific Veterinary Sciences. 2021; 3: 2-10.
5. Ali A, Mengistu F, Hussein K, Getahun G, Deressa A, Yimer E, et al. Overview of rabies in and around addis ababa, in animal examined in ehnri zoonosis laboratory between, 2003 and 2009. Ethiopian veterinary Journal. 2010; 14: 91-101.
6. Ali A, Yimer E, Sifer D. Study on knowledge, attitude and practice of rabies among residents in Addis Ababa Ethiop. Ethiop Vet J. 2013; 17: 19-35.
7. Bahiru A, Molla W, Yizengaw L, Alemu S, Temesgen W. Knowledge, attitude and practice related to rabies among residents of Amhara region, Ethiopia. 2022; 2405-8440.
8. Beyene K, Derese A, Teshome G, Teshome D. Review on Rabies Vaccine: As Prevention and Control Option of Rabies. Austin J Vet Sci & Anim Husb. 2018; 5: 1049.
9. Bihon A, Meresa D, Tesfaw A. Rabies: knowledge, attitude and practices in and around South Gondar, north west Ethiopia. Diseases. 2020; 8: 5.
10. Bilal A. Rabies is a zoonotic disease: a literature review. Occup Med Health Aff. 2021; 9: 2.
11. Bourhy HJ, Reynes E, Dunham L, Dacheux F, Larrous V, Huong G, et al. The origin and phylogeography of dog rabies virus. The Journal of General Virology. 2008; 89: 2673-81.
12. Brown C, Slavinski E, Sidwa T, Sorhage F. Compendium of Animal Rabies Prevention and Control. Public Veterinary Medicine: Public Health. 2016; 248: 505- 17.
13. Bruce C, Margaret A. Biological Resource Management Division, Fort Collins, CO. 2001: 15-27.
14. Chernet B, Nejash A. Review of rabies control and prevention. Journal of Medicine, Physiology and Biophysics. 2016; 23: 45-53.
15. Deressa A, Ali A, Bayene M, Selassie N, Yimer E, Hussen K. The status of rabies in Ethiopia: A retrospective record review. Ethiop. J Health Dev. 2010; 24: 127-132.
16. Diallo M, Diallo A, Dicko A, Richard V, Espie E. Human rabies post exposure prophylaxis at the Pasteur Institute of Dakar, Senegal: trends and risk factors. BMC Infect Dis. 2019; 9: 321.
17. Digafe R, Kifelew L, Mechesso A. Knowledge, attitudes and practices towards rabies: questionnaire survey in rural household heads of Gondar Zuria District, Ethiopia. BMC Res. 2015; 8: 400.
18. Ehizibolo O, Nwosuh I, Ehizibolo E, Kia S. Comparison of the Fluorescent Antibody Test and Direct Microscopic Examination for Rabies Diagnosis at the National Veterinary Research Institute, Vom, Nigeria. African Journal of Biomedical Research. 2009; 12: 73-6.
19. Eidson M, Kate S, Mary K, Charles T, Amy W. Development and evaluation of bat rabies education materials. Evid based prev med. 2004; 1: 85-91.
20. Erik Von Elm M, Altman G, Egger M, Pocock J, Gøtzsche C, Vandenbroucke P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007; 147: 573e7.
21. Esayas F, Hiko A, Ali A, Kedir A, Kokorevica L. Infectiousness of brain and salivary gland Suspension from Rabies suspected dogs. International Journal of Public Health and Epidemiology. 2012; 1: 031–034.
22. Franka R, Smith T, Dyer J, Wu X, Niezgoda M, Rupprecht C. Current and future tools for global canine rabies elimination. Antivir Res. 2013; 100: 220-5.
23. Gan H, Hou X, Wang Y, Xu G, Huang Z, Zhang T. Global burden of rabies in 204 countries and territories, from 1990 to 2019: results from the Global Burden of Disease Study 2019. International Journal of Infectious Diseases. 2023; 126: 136-144.
24. Gebeyaw J, Kidanemariam F, Fesseha H. Assessment of community knowledge, attitude and practice towards rabies in Mersa town, Amhara Regional State, Ethiopia. International Journal of Research Studies in Microbiology and Biotechnology. 2020; 6: 6-13.
25. Gizaw T, Edaso T. Assessment of knowledge, attitude, and practice of respondents towards Rabies and associated risk factors in Shone Town, Hadiya Zone, Southern Ethiopia. 2023.
26. Guadu T, Shite A, Chanie M, Bogale B, Fentahun T. Assessment of knowledge, attitude and practices about rabies and associated factors: in the case of bahir dar town. Global Veterinaria. 2014; 13: 348–358.
27. Hagos W, Muchie K, Gebru G, Mezgebe G, Reda K, Dachew B. Assessment of knowledge, attitude and practice towards rabies and associated factors among household heads in Mekelle city, Ethiopia. BMC Public Health. 2020; 20: 57.
28. Haidich A. Meta-analysis in medical research. Hippokratia. 2010; 14: 29–37.
29. Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M. Estimating the global burden of endemic canine rabies. PLoS Neglected Trop Dis. 2015; 9: e0003709.
30. Hampson K, Ventura F, Steenson R, Mancy R, Trotter C, Cooper L. The potential effect of improved provision of rabies post-exposure prophylaxis in Gavieligible countries: a modelling study. Lancet Infect. Dis. 2019; 19: 102–111.
31. Haselbeck A, Rietmann S, Tadesse B, Kling K, Kaschubat-Dieudonné M, Marks F, et al. Challenges to the fight against Rabies-the landscape of policy and prevention strategies in Africa. International Journal of Environmental Research and Public Health. 2021; 18: 1736.
32. Herbert M, Basha R, Thangaraj S. Community perception regarding rabies prevention and stray dog control in urban slums in India. J Infect Publ Health. 2012; 5: 374–380.
33. Higgins J, Thompson S, Deeks J, Altman D. Measuring inconsistency in meta-analyses. BMJ. 2003; 327: 557–560.
34. Hooper D, Phares T, Fabis M, Roy A. The production of antibody by invading B cells is required for the clearance of rabies virus from the central nervous system. Plos Negl Trop Dis. 2009; 3: e535.
35. Huang C, Li Z, Huang Y, Zhang G, Zhou M, Chai Q. Enhancement of blood brain barrier permeability is required for intravenously administered virus neutralizing antibodies to clear an established rabies virus infection from the brain and prevent the development of rabies in mice. Antivir Res. 2014; 110: 132-141.
36. Huedo Medina T, Sánchez Meca J, Marín Martínez F, Botella J. Assessing heterogeneity in meta-analysis: q statistic or I2 index?. Psychol Methods. 2006; 11: 193-206.
37. Hurisa B, Mengesha A, Newayesilassie B, Kerga S, Kebedea G, Denis B, et al. Production of Cell Culture Based Anti-rabies Vaccine in Ethiopia. Procedia in Vaccinology. 2013; 7: 2-7.
38. Jemberu T, Molla W, Almaw G, Alemu S. Incidence or rabies in human and domestic animals and people’s awareness in north gondar zone, ethiopia. Plos Neglected Tropical Diseases. 2013; 7: e2216.
39. Kaur M, Garg R, Singh S, Bhatnagar R. Rabies vaccines: where do we stand, where are we heading. Expert Rev. Vaccines. 2015; 14: 369-381.
40. Kongkaew W, Coleman P, Pfeiffer D, Antarasena C. Vaccination Covarage and Epidemiological parameters of the owned dog population in Thungsongdistrict, Thailand. Prev vet med. 2004; 65: 105-115.
41. Lancet A. Current status of rabies and prospects for elimination. 2014; 384: 1389-1399.
42. Lembo T, Hampson K, Kaare M, Ernest E, Knobel D, Kazwala R. The feasibility of canine rabies elimination in Africa: dispelling doubts with data. PLoS neglected tropical diseases. 2010; 4: e626.
43. Liao P, Yang H, Chou P, Wang M, Chu P, Liu H. Sufficient virus neutralizing antibody in the central nerve system improves the survival of rabid rats. J Biomed Sci. 2012; 19: 61.
44. Lumlertdacha B, Tepsumethanon V, Khawplod P. Post-exposure treatment for canine rabies in Thailand, in proceedings. 4th Int Symp Rabies Control Asia. 2001: 117-120.
45. Manning S, Rupprecht C, Fishbein D, Hanlon C, Lumlertdacha B, Guerra M. Human Rabies Prevention and Recommendations of the Advisory Six Committee on Immunization Practices. M.M.W.R. 2008; 23: 1-28.
46. Masiira I, Makumbi K, Matovu A, Ario I, Abukenya C. Long term trends and spatial distribution of animal bite injuries and deaths due to human rabies infection in Uganda, 2001-2015, PLoS One. 2018; 13: e0198568.
47. Matibag G, Taro K, Pallegoda V, Thula G, Anil W. Knowledge, attitudes, and practices survey of Rabies in a community in Sri Lanka. Environmental Health and Preventive Medicine. 2007; 12: 84-89.
48. Matter H, Wandeler A, Neunschwander B, Harischandra P, Meslin F. Study of the dog population and the rabies control activities in the Mirigama area of Sri Lanka. Acta Tropica. 2000; 75: 95–108.
49. McKenzie M, Bossuyt J, Boutron P, Hoffmann I, Mulrow T. The PRISMA 2020 Statement:An updated guideline for reporting systematic reviews. Syst Rev. 2021; 10: 89.
50. Melo G, Parize P, Jouvion G, Dacheux L, Chrétien F, Bourhy H. Infections of the Central Nervous System: Pathology and Genetics, 1 st ed. John Wiley & Sons Ltd, Paris, France. 2020.
51. Ministry of Agriculture (MOA). Rabies Control Strategy. Addis Ababa, Ethiopia. 2011: 1-38.
52. Ministry of Agriculture and Rural Development (MoARD). Rabies control strategies. In: department of animal health, Addis Ababa, Ethiopia. 2010: 12–33.
53. Moges N. Epidemiology, Prevention and Control Methods of Rabies in Domestic Animals: Review Article. European Journal of Biological Sciences. 2015; 7: 85-90.
54. Moran D, Juliao P, Alvarez D, Lindblade K, Ellison J. Knowledge, attitudes and practices regarding rabies and exposure to bats in two rural communities in Guatemala. BMC Res. Notes. 2015; 8: 955.
55. Nilsson M. Effect on rabies education program on rabies awareness, attitudes towards dogs and animal welfare among children in Lilongwe, Malawi. Epsilon, Examensarbete. 2014: 26.
56. OIE. The Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. Geneva. 2018.
57. Oyda S, Megersa B. Review of rabies in livestock and humans in Ethiopia. International Journal of Research-Granthaalayah. 2017; 5: 561-577.
58. Quinn P, Markey B, Carter M, Donnely W, Leonard F. Rabies: In Veterinary Microbiology and Microbial diseases. 1st ed., Black well science Ltd, UK. 2002: 390-395.
59. Rücker G, Schwarzer G, Carpenter J. Arcsine test for publication bias in meta-analyses with binary outcomes. Stat Med. 2008; 27: 746-763.
60. Rumana R, Sayeed A, Basher A, Islam Z, Rahman M. Perceptions and treatment seeking behavior for dog bites in rural Bangladesh. The Southeast Asian Journal of Tropical Medicine and Public Health. 2013; 44: 244-248.
61. Rupprecht C, Willoughby R, Slate D. Current and future trends in the prevention, treatment and control of rabies. Expert Review. Anti-infective therapy. 2006; 4: 1021-1038.
62. Sekhon A, Singh A, Kaur P, Gupta S. Misconceptions and myths in the management of animal bite cases. Indian Journal of Community Medicine. 2002; 27: 9-11.
63. Serebe G, Tadesse A, Yizengaw A, Tamirat M. Study on community knowledge, attitude and practice of rabies in and nearby Gondar town, North west Ethiopia. Journal of Public Health and Epidemiology. 2014; 6: 429–435.
64. Servat A, Labadie A, Hamen A, Boue F, Cliquet F. Inter-laboratory trial to evaluate the reproducibility of a new ELISA to detect rabies antibodies in vaccinated domestic and wild carnivores. Biologicals. 2008; 36: 19-26.
65. Shumuye G, Kassaw A, Haileluel A, Sintayehu M. Study on community knowledge, attitude and practice of rabies in and nearby Gondar town, Northwest Ethiopia. Journal of Public Health and Epidemiology. 2014; 6: 429-443.
66. Sumon G, Sukanta C, Najmul H, Rajub K, Rana S. Awareness of rabies and response to dog bites in a Bangladesh community. Veterinary Medicine and Science. 2016; 2: 161-169.
67. Tadesse G, Anmaw S, Mersha C, Basazinew B, Tewodros F. Assessment of Knowledge, Attitude and Practices about Rabies and Associated Factors: In the Case of Bahir Dar Town. Glob Vet. 2014; 13: 348-354.
68. Taylor L, Nel L. Global epidemiology of canine rabies: past, present, and future prospects. Vet Med Res Rep. 2015: 361.
69. Thrusfield M. Veterinary epidemiology, 3 nd edition, black well scientific, London, UK. 2007: 225-228.
70. Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Systematic reviews of effectiveness. Joanna Briggs Institute reviewer’s manual. The Joanna Briggs Institute Adelaide, Australia. 2017.
71. Vos A, Conzelmann K, Finke S. Immunogenicity studies in carnivores using a rabies Virus construct with a site-directed deletion in the phosphoprotein. Adv Prev Med. 2011; 2011: 898171.
72. Warrell M. Rabies encephalitis and its prophylaxis. Practical Neurology. 2001; 1: 14-29.
73. Warrell M. Current rabies vaccines and prophylaxis schedules: preventing rabies before and after exposure. Travel Med Infect Dis. 2012; 10: 1-15.
74. Wells G, Shea B, Connell D, Peterson J, Welch V. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analysis. Ottawa Ottawa Hosp Res Inst. 2012.
75. WHO, FAO, (2019): Global strategic plan to end human deaths from dog-mediated rabies by 2030 and United against Rabies Collaboration: first annual progress report: global strategic plan to end human deaths from dog-mediated rabies by 2030. 2019.
76. WHO. World health organization recommendations on rabies, first report. Technical report series 931. Geneva, Switzerland. 2004.
77. WHO. Expert Consultation on Rabies, World Health Organization - Technical Report Series. 2005.
78. WHO. Rabies Vaccines: Weekly Epidemiological Record. 2010; 32: 309-320.
79. WHO. WHO expert consultation on rabies, third report: WHO technical report series No. 1012, World Health Organization, Geneva, Switzerland. 2018.
80. WHO. Key Facts on Rabies. 2021.
81. WHO. Guide to introducing human rabies vaccine into national immunization programmes. World Health Organization. 2022.
82. Windsor R. “CHAPTER 70: RABIES”. In: Andrew AH, Blowey RW, Eddy RG. (editors). Bovine medicine diseases and husbandry of cattle, 2nd edn Black Well publishing company. 2004: 1164–1170.
83. Yalemebrat N, Bekele T, Melaku M. Assessment of public knowledge, attitude and practices towards rabies in Debark Woreda, North Gondar, Ethiopia. J Vet Med Anim Health. 2016; 8: 183–192.

Download PDF

Citation: Zemen D. Knowledge, Attitude and Practice Related to Dog Bite Victims Attending at Anti-Rabies Post Exposure Vaccine Taker in Poly Health Center in Gondar Town, Amhara Region, Northwest Ethiopia. Austin J Vet Sci & Anim Husb. 2024; 11(5): 1156.

Home

Journal Scope

Editorial Board

Instruction for Authors

Submit Your Article

Contact Us