Assessment on Community Knowledge, Attitude and Practice on Rabies in and Around Mendi Town, West Wollega, Oromia, Ethiopia

Rabies is one of the oldest recognized infectious diseases which affect all mammals [1]. The etiologic agent of this disease is the rabies virus belonging to the genus Lyssa virus and family Rhabdoviridae [2]. Rabies is one of the most serious zoonotic diseases. Once the clinical signs developed, it is almost 100% fatal disease [3].

Rabies is the most widely recognized example of salivary transmission of viruses. Inoculation of infected saliva through the bite of a rabid animal appears to be the predominant mode of rabies viral entry although contamination of broken skin and mucous membrane such as mouth, nasal cavity or eyes by fresh saliva or neurological tissues may result in infection [4]. Worldwide, an estimated 29 million people receive post-exposure prophylaxis (PEP) for rabies each year and more than 59 000 people die of rabies, primarily due to poor rabies control measures [5].

Rabies is endemic in developing countries of Africa and Asia and most human deaths from the disease occur in these endemic countries. Africa, next to Asia, is the second continent most affected by rabies with an estimated 24,000 (44 %) of the 55,000 annual rabies deaths. Domestic dogs are considered to be the main sources (>90%) of human rabies in Africa and more than 88% of the exposure cases in Ethiopia were due to dog bites. Canine rabies is endemic in Ethiopia, with an estimated 2771 human deaths annually [6,7].

Despite it is a fatal disease, rabies could be prevented by the timely application of appropriate prophylaxis [8]. The knowledge gap among the community should be assessed for subsequent intervention to increase awareness appropriately, and to take other targeted interventions. An increase of knowledge about rabies and public awareness in general will first aid what kind of measures to take after dog bites. [9], suggested that an increased knowledge about dog behavior and how to avoid getting bitten by dogs are methods to prevent rabies in humans.

Although rabies is primarily a disease of dogs in Ethiopia including Mendi town and its surrounding villages of West Wollega zone, no adequate research has been done to address the knowledge gab about the disease through assessing the knowledge, attitude and practice of the community. Therefore, the main aim behind the present study is to address the existing knowledge, attitude and practice gaps in the study area through conducting in depth assessment thereof which eventually contribute for efficient and effective control of the disease.

Study area

The study was conducted in and around Mendi town, which is found in western Wollega zone of Oromia regional state, Ethiopia. This area has a latitude and longitude of 9048’N and 35o6’E respectively and an elevation of 1583 meters above sea level. It is the administrative center of Manasibu Woreda. Manasibu is bordered on the south by Jarso, on the Southwest by Begi on the North by the Benishangul Gumuz Region and on the southwest by Nedjo. The town is approximately 596km away from Addis Ababa to west direction [10].

Study population

The study population comprises people living in and around Mendi town. Roughly an estimated number of 4746 males and 4377 females inhabit in the town and its surroundings. The target population however entails the entire Manasibu woreda inhabitants containing an estimated number 86476 male and 82710 females.

Study design and methodology

The study was conducted from January - March 2021. Non observational study type consisting of purposive study was used. The units of interest were people with an age group greater than or equal to 18 (eighteen) years. They were identified randomly following a systematic approach and a questionnaire was administered to assess their Knowledge, Attitude and Practices (KAP) on rabies and associated factors. To this end, a structured questionnaire was developed.

Sample size determination

The sample size has been determined considering the worstcase scenario where 50% of the population (P) is assumed to have gap in Knowledge, Attitude and Practice (KAP). In addition, 95% Confidence Level (CL), 5% desired precision were considered to calculate the sample size according to Thursfield, [11].

When: n=required sample size; Pexp= expected prevalence d= desired absolute precision. Hence, by using this formula, the sample size was calculated to be 384.

Data collection

A pre-tested structured questionnaire consisting of closed and open-ended questions was used for this study. The questionnaire consisted of resident profile (age, sex, education, religion) and question concerning knowledge, attitude and practice. The questions were read out to the respondents in their local language (Afan Oromo) by the interviewer and their answers were recorded in English.

Data management and analysis

After collecting, the data was cleaned and checked for its completeness. Those incomplete and inconsistent were corrected when possible and removed otherwise. After complete check-up the data were coded and entered to Microsoft Excel and exported to SPSS version 20 statistical packages for windows and analysis made. The frequency distribution of both dependent and independent variables was worked out by using descriptive statistical techniques (Frequencies and percentage). Association between independent variables and KAP scores on rabies was calculated using Pearson’s Chi square. Statistical significance was set at P<0.05.

A total of 384 community members were interviewed during the study period. Table 1 shows the profile of respondents from urban and peri urban. The majority of the respondents in the study were males 247(64%), while the number of females was 137(36). The majority of the respondents’ age groups included in the range of (35 to 50 and 51-60. Regarding the educational status of the respondents, 94(24%) cannot read and write, 98(26%) were read and write, 96(25%) had primary school, 66(17%) had secondary school and 30(8) had higher education). Concerning the religion, the majority of the respondents were protestant 188(49%) followed by orthodox 110(29%).

Table 1:Socio-demographic characteristics of the study participants in and around Mendi town (N = 384).

About 290(76%) of the respondents have heard about rabies. The majority of the respondents 190(49%) described a virus as the cause of the disease and 108(28%) of the respondents responded that they do not know the causative agent. Among 384 respondent’s majority of them 216(56%) responded humans and other domestic animals as the species affected by rabies. Most of the respondents 226(56%) replied bite and contact with open wound as transmission method. Dog bite has been replied to only by 80(21%) respondents as a mechanism for disease transmission. Among 384 repondents135 (35%) replied that sudden change in behavior was the obvious clinical manifestation of rabies while 193(50%) were aware that rabies can be prevented by vaccine (Table 2).

Table 2:Knowledge of the study participants towards rabies in and around mendi town (N = 384).

This study revealed that 244(63.5%) of respondents said that stray dogs are dangerous and 134(34.9) were willing to register their pets. 192(50) of respondents said killing prevents rabies. As indicated in Table 3, 130(33.85) of respondents kill the animal after being rabid. Regarding the preferred action taken for bitten human, 204(53%) of participants preferred traditional treatment whereas, post exposure vaccination was preferred by 86(24%) of participants. Moreover, 68(7.8%) of respondents reported that they would wash the wound using soap and water. Among 384 respondents only 30(7.8%) of them vaccinate their dogs.

Table 3:Attitude and Practice of study participant in and around Mendi town (N=384).

The present study revealed that the majority of the respondents (76%) were heard about rabies, and this was in agreement with the reports of Matibag GC [12], Ali A [13], Sumon G [14] and Christopher Rine [15] which is 75.2%, 73%, 76.5% in Sri Lanka, Ethiopia, Bangladesh and Nigeria respectively. This finding is lower than the reports of 96.4% and 99.0% reported by Shumuye GS [11] in Ethiopia and Moran D [16] in Guatemala respectively. However, the present finding is higher than the reports of Mucheru GM [17] in Kenya, Sambo M [18] in Tanzania with the reports of 49% and 27% respectively. These differences could be associated with awareness level of the community, educational status, information access.

Among the study participants, only 30% of the respondents vaccinated their dog once through their lifetime by the support of Wollegga University in urban area. This study is in line with the study conducted in Kenya (35%) reported by Mucheru GM [17]. However, this finding is much lower than with the study conducted in Indonesia (74%) and Sri Lanka (76%) reported by Reta TD [19] and Matibag GC [12] respectively. This may be attributed to a number of factors that include availability of animal vaccines, the study times and good information sharing and lack of rabies control programs in this study area.

This study showed all respondents (100%) in peri urban areas did not vaccinate their dogs. This is in agreement with Shumuye GS [11] in north Gondar Ethiopia who noted that dog vaccination practice in peri-urban practice was generally very low and totally nonexistent in rural district. This is due to large dependency of the respondents in peri urban area on the traditional treatment using herbs, limitation of availability and high cost of vaccine.

The present finding indicates that Majority of the respondents 204(53.3%) used traditional treatment as the best option for dog bites. The respondents from peri urban areas were more likely to seek treatment from traditional healers than those from urban areas. This could be attributed to the low level of education and awareness of the respondents which is in consistent with the report of Shumuye GS [11], Sekhon A [20], Sudarshan MK [21] and Rumana R [22]. These types of treatment seeking behavior may be the outcome of persisting many myths and false beliefs among respondents associated with dog bite management and lack of education regarding effective prevention of rabies. Furthermore, financial constraint, insufficient vaccine and immunoglobin supply to the government hospitals, distance from the dog bite victim place of government hospitals may be responsible for the low vaccine coverage among dog bite victims in the study area.

In the current study, only 17.7% of respondents would wash the wound using soap and water as first aid for bitten humans bitten by rabid animals. This finding is much lower than the report of Yalemebrat N [23] in Debark District of Ethiopia and Shumuye GS [11] in Gondar zuria with the report of 76.4%, 49.6% and 30.7% respectively. This difference could be associated with the awareness level of the community. Washing rabies infected wounds with soap and water can increase survival by 50% [23].

In conclusion the present study revealed that the majority of the respondents were heard about rabies. However, there is a big gap on KAP level related to transmissions, clinical sign, vaccination of their dogs, Prevention methods after suspected animal bite, action taken in home after bitten by a suspected animal. Residence, sex, age, education of respondents was the variables found to be significantly associated with KAP of respondents about rabies.

Based on the above conclusion the following recommendations are forwarded:
A. Community based education program with emphasis on transmissions, clinical sign, vaccination of their dogs, prevention methods after suspected animal bite, action taken in home after bitten by a suspected animal.
B. Public health sectors, veterinary sectors and other stake holders should work together to prevent and control the public health and economic impact of rabies.
C. The Government should work with information sources like radio, TV, newspaper and others to provide adequate information for the livestock owners in order to prevent their animals from exposure.

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