RESUMO
This study compares data on animal rabies cases from the Chadian national rabies laboratory, hosted at the Insitut de Recherche en Elevage pour le Developpement (IRED), with bite case reporting from health facilities. The data collection accompanied a mass dog vaccination intervention over two years in N'Djaména, Chad. This allowed for a comparison of the dynamics of the incidence of animal rabies cases, human bite exposure incidence and post-exposure prophylaxis (PEP) demand during a dog rabies elimination attempt. Following the mass vaccination, the monthly animal rabies incidence dropped from 1.1/10,000 dogs, as observed prior to the campaign in 2012, to 0.061/10,000 dogs in 2014. However, the PEP demand was found to be largely unaffected. The suspicion of the rabies exposure as reported by health personnel in most cases did not reflect the status of the biting animal but rather the severity of the bite wound, resulting in inappropriate PEP recommendations. In addition, the levels of reporting dead or killed animals to the rabies laboratory was found to be very low. These results reveal a profound lack of communication between health facilities and veterinary structures and the absence of an integrated bite case management (IBCM) approach. Improved communication between human health and veterinary workers is imperative to prevent human rabies deaths through the appropriate use of PEP and to further translate success in animal rabies control into cost savings for the public health sector through a lower PEP demand. Improved training of health and veterinary personnel and the sensitisation of the public are needed to achieve good IBCM practice, to increase the rate of diagnostic testing, to provide adequate and timely PEP, and to reduce the wastage of scarce vaccine resources.
RESUMO
Canine rabies represents a major - but preventable - public health threat in Chad. In preparation for a nation-wide canine parenteral mass vaccination campaign we conducted a community-based, cross-sectional multi-stage cluster survey in 40 villages in two southern and two northern regions of Chad. Our objective was to investigate rabies awareness and dog-ownership among the rural population. Almost half of the households (45%) owned dogs, with an overall dog:human ratio of 1:7.8. Southern households owned almost two thirds (701/918) of all dogs and the number of dogs per household was twice as high compared to the north (2.7 vs. 1.3, respectively). This translates into a dog:human ratio of 1:5.2 in the south and 1:16.4 in the north. Only 76% of the respondents had heard of rabies. Respondents who (1) were male, (2)>19 years, (3) had primary education or higher and (4) were of Muslim faith were more likely to have heard of rabies (p<0.01). High level of rabies knowledge was positively associated with (1) southern residence, (2) any kind of education and (3) Christian or "other" religions. In contrast to rabies awareness, high level of knowledge was negatively associated with increasing age. 11% of respondents reported that at least one family member had been bitten by a dog in the past year and half of these bite victims were children. 31% of respondents knew someone who had died of rabies and twice as many (58%) reported having encountered a rabid animal. Most of the respondents could identify classical rabies symptoms (58-94%), however they lacked knowledge about rabies prevention and appropriate wound management. Only 2 out of 963 (0.5%) reported to have vaccinated their dog. A major proportion of our study population is at great risk of rabies (likely higher than 7 rabies death per million per year) due to lack of awareness of the disease, inappropriate post-bite treatment and insufficient knowledge about preventive measures. This reflects the urgent need for advocacy programs to raise rabies awareness among the community. Close intersectoral collaboration between the public health and veterinary sector and integration of local authorities, is a key element in the fight against rabies.