Process evaluation of Community-Based continuous mass dog vaccination delivery Strategies in the Mara region of Tanzania

Abstract

Rabies can be eliminated if coverage of domestic dog vaccination is sustained above 40% all year-round for five-seven consecutive years. Current approaches usually fail to achieve this required vaccination coverage and an alternative, a community-based continuous mass dog vaccination (CBC-MDV) approach, was designed and piloted in the Mara region of Tanzania. This thesis used mixed, qualitative, quantitative and participatory methods to evaluate the development and delivery of the CBC-MDV approach over two years to generate evidence to inform the optimization of the design prior to its evaluation in a full-scale randomized control trial. Specifically, it investigated the feasibility and fidelity of delivery and potential effectiveness of the CBC-MDV strategies, drivers of innovations in the implementation process, whether and how community engagement can be used to address barriers to participation in mass dog vaccination (MDV) campaigns and what factors will determine the normalization of CBC-MDV as the standard approach for delivering MDV in Tanzania. Qualitative data were analyzed using thematic analysis, both inductive and deductive. Quantitative data on delivery of CBC-MDV were analyzed descriptively. Regression analysis was used to identify population-related factors that have implications for participation in MDV. Two-proportion Z-tests and Mann-Whitney U test were used to assess whether the community engagement strategies were effective and can address barriers to participation in MDV campaigns. The findings showed that the development process of CBC-MDV was iterative and involved cross-sectoral participation but without the direct involvement of communities. In relation to feasibility, fidelity and potential effectiveness, CBC-MDV was delivered with 69% fidelity and performed better in terms of sustaining high vaccination coverage compared to the centralized approach. Design-, implementer- and context-related factors influenced delivery and effectiveness of the CBC-MDV strategies. We found that the community engagement activities positively influenced factors that underpin participation in MDV campaigns. In relation to integrating and sustaining the new approach in practice, CBC-MDV was well understood, accepted, operationalized with relative ease and positively appraised compared to the centralized approach. We conclude that it was feasible to deliver CBC-MDV in the context of Tanzania, it can be sustained in practice, and barriers to participation in mass dog vaccination can be addressed through community engagement processes. However, community participation in the design, delivery and evaluation of CBC-MDV is needed to foster ownership and sustainability of the intervention.