Barriers of attendance to dog rabies static point vaccination clinics in Blantyre, Malawi

Abstract

Rabies is a devastating yet preventable disease that causes around 59,000 human deaths annually. Almost all human rabies cases are caused by bites from rabies-infected dogs. A large proportion of these cases occur in Sub Saharan Africa (SSA). Annual vaccination of at least 70% of the dog population is recommended by the World Health Organisation in order to eliminate rabies. However, achieving such high vaccination coverage has proven challenging, especially in low resource settings. Despite being logistically and economically more feasible than door-to-door approaches, static point (SP) vaccination campaigns often suffer from low attendance and therefore result in low vaccination coverage. Here, we investigated the barriers to attendance at SP offering free rabies vaccinations for dogs in Blantyre, Malawi. We analysed data for 22,924 dogs from a city-wide vaccination campaign in combination with GIS and household questionnaire data using multivariable logistic regression and distance estimation techniques. We found that distance plays a crucial role in SP attendance (i.e. for every km closer the odds of attending a SP point are 3.3 times higher) and that very few people are willing to travel more than 1.5 km to bring their dog for vaccination. Additionally, we found that dogs from areas with higher proportions of people living in poverty are more likely to be presented for vaccination (ORs 1.58-2.22). Furthermore, puppies (OR 0.26), pregnant or lactating female dogs (OR 0.60) are less likely to be presented for vaccination. Owners also reported that they did not attend an SP because they were not aware of the campaign (27%) or they could not handle their dog (19%). Our findings will inform the design of future rabies vaccination programmes in SSA which may lead to improved vaccination coverage achieved by SP alone.

Development of non‐governmental organisation‐academic partnership to tackle rabies in Africa and Asia

“…The Mission Rabies and University of Edinburgh partnership has explored the reasons why vaccination coverage remains suboptimal when relying solely on static points (Mazeri et al . ). We have found that distance from static point is critical with increasing distance from home to static point resulting in lower vaccination coverage.…”

“…In addition, reasons such as lack of knowledge about the vaccination campaign, difficulty in handling dogs and concerns about suitability of young dogs for vaccination were also commonly cited reasons as to why dogs were not presented for vaccination at static point clinics (Mazeri et al . ). This information will be informative when shaping future vaccination programmes in this region.…”

Development of a high number, high coverage dog rabies vaccination programme in Sri Lanka.

“…Lanka. In a similar study using the same technique for a campaign in Malawi, Mazeri et al [10] found that there was a decreasing likelihood of attending a SP with increasing distance from home to said SP, in dogs of young age, and animals with poor health. These results parallel the findings from the Negombo study.…”

“…Static point (SP) vaccination approaches are commonly used, as they are easy to establish and are an efficient way to vaccinate a large number of dogs with limited personnel. However, reliance on SP clinics only often leads to a failure to vaccinate a sufficient proportion of the population, since they depend on high ownership levels and other socio-economic and cultural factors which may influence dog owners' attendance [10]. Although more logistically challenging and costly, "door-to-door" (D2D) approaches based on visiting all households in a community and vaccinating free-roaming and owned dogs are able to achieve high coverages very effectively [11,12].…”

Estimating the Size of Dog Populations in Tanzania to Inform Rabies Control

“…Notwithstanding these limitations, we found that transects were fast and relatively low cost to complete at scale, sampling populations more representatively than other approaches that were limited in spatial scope. We suggest that transects should be completed immediately after vaccination campaigns, aiming to cover the center and the periphery of villages, as vaccination coverage has been reported to decrease with the distance to the vaccination point [17,22,50,51], and that estimates should be adjusted to account for not observing pups.…”