Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar

Leblanc Claire, Kassie Daouda, Ranaivoharimina Mendrika, Rakotomanana Elliot Fara Nandrasana, Mangahasimbola Reziky Tiandraza, Randrianarijaona Anjasoa, Ramiandrasoa Ravo, Nely Alphonse José, Razafindraibe Nivohanitra Perle, Andriamandimby Soa Fy, Ranoaritiana Dany Bakoly, Rajaonarivony Virginie, Randrianasolo Laurence, Mattern Chiarella, Ratovoson Rila, Guis Hélène. 2024. Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar. PLoS Neglected Tropical Diseases, 18 (3):e0012064, 34 p.

Url - jeu de données - Entrepôt autre : https://figshare.com/articles/dataset/Socio-economic_score_assessment_in_the_remote_and_central_areas_/25510898

Résumé : Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.53 per 100 person-years, 95% CI: 0.31–0.85) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09–0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (89.5%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33–3.26) and living in central area (OR = 1.91, CI = 1.22–3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98–7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14–4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination.

Mots-clés Agrovoc : chien, rage, vaccination, vaccin, zone rurale, santé animale, santé publique, ménage, morsure, maladie de l'homme

Mots-clés géographiques Agrovoc : Madagascar

Mots-clés libres : Mixed methods, Knowledge, Attitudes, Practices, Rabies, Remote communities, Moramanga, Madagascar

Classification Agris : L73 - Maladies des animaux
S50 - Santé humaine

Champ stratégique Cirad : CTS 4 (2019-) - Santé des plantes, des animaux et des écosystèmes

Agences de financement européennes : European Regional Development Fund

Agences de financement hors UE : Institut Pasteur de Madagascar, Centre de Coopération Internationale en Recherche Agronomique pour le Développement

Projets sur financement : (EU) INTERREG

Auteurs et affiliations

• Leblanc Claire, Institut Pasteur de Madagascar (MDG) - auteur correspondant
• Kassie Daouda, CIRAD-BIOS-UMR ASTRE (MDG) ORCID: 0000-0001-6340-9610 - auteur correspondant
• Ranaivoharimina Mendrika, Institut Pasteur de Madagascar (MDG)
• Rakotomanana Elliot Fara Nandrasana, Institut Pasteur de Madagascar (MDG)
• Mangahasimbola Reziky Tiandraza, Institut Pasteur de Madagascar (MDG)
• Randrianarijaona Anjasoa, Institut Pasteur de Madagascar (MDG)
• Ramiandrasoa Ravo, Institut Pasteur de Madagascar (MDG)
• Nely Alphonse José, Institut Pasteur de Madagascar (MDG)
• Razafindraibe Nivohanitra Perle, Ministère de l'agriculture et de l'élevage (Madagascar) (MDG)
• Andriamandimby Soa Fy, Institut Pasteur de Madagascar (MDG)
• Ranoaritiana Dany Bakoly, Ministère de la santé publique (Madagascar) (MDG)
• Rajaonarivony Virginie, Ministère de la santé publique (Madagascar) (MDG)
• Randrianasolo Laurence, Institut Pasteur de Madagascar (MDG)
• Mattern Chiarella, Institut Pasteur de Madagascar (MDG)
• Ratovoson Rila, Institut Pasteur de Madagascar (MDG)
• Guis Hélène, CIRAD-BIOS-UMR ASTRE (KHM) ORCID: 0000-0002-0355-0898 - auteur correspondant

Source : Cirad-Agritrop (https://agritrop.cirad.fr/609200/)

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