Implementation of an Integrated Rabies Control Model in Côte d’Ivoire

Abstract

Since 2008, Côte d'Ivoire has classified rabies as a notifiable disease and one of the five priority zoonoses in 2017. Following an assessment of the burden of the disease and the prioritization of rabies, we drew an integrated national rabies control plan. Despite the activities implemented, the disease has persisted. In this context, we set ourselves the research question of what model, adapted to the characteristics of rabies, could be recommended, based on the determinants of mortality, to accelerate progress towards its elimination in Côte d'Ivoire. We propose an integrated rabies control model adapted to the characteristics of the disease. We conducted a mixed cross-sectional study from January to September 2023. Data were collected by interview, document review, and narrative review of all published work on rabies in Côte d'Ivoire from 2018 to 2023. The situational analysis was first carried out using the SWOT tool, which enabled us to define the strengths, weaknesses, opportunities, and threats of rabies control in Côte d'Ivoire. Then, using data from the articles, we constructed a problem tree of human rabies deaths in Côte d'Ivoire. Finally, we used this problem tree as a basis for building an integrated model of rabies management in Côte d'Ivoire. The study was conducted by following the ethical rules (administrative authorization, informed consent, confidentiality) in force in Côte d'Ivoire.The main challenges identified in the fight against rabies in Côte d'Ivoire were the low level of animal vaccination, a lack of knowledge about the disease, and the lack of access to PEP. The problem tree highlighted the factors associated with mortality, based essentially on the low vaccination coverage of dogs and the poor knowledge of the disease, which leads to low uptake and nonadherence to PEP. A Model to accelerate progress towards the elimination of rabies in Côte d'Ivoire incorporating interventions that, if implemented, could improve uptake and compliance with PEP as a complement to increasing vaccination coverage in dogs. This model includes a combination of several methods, the main pillars of which are improving geographical and financial accessibility, increasing knowledge, and getting people to take ownership of the fight against rabies. Pending control of the reservoir and vector of the disease, the integrated model of rabies control should be systematically implemented, based on PEP before any exposure to rabies, raising public awareness and improving access to PEP.