Rabies exposure and prophylaxis among dog owners in Ogun State, Nigeria: a descriptive and categorical analysis of knowledge, attitudes and practices

INTRODUCTION

Rabies is a zoonosis caused primarily by the rabies virus. Rabies can also be caused by infection from other members of the Lyssavirus genus^[1,2]. Rabies affects the central nervous system (CNS) of humans, as well as warm-blooded domestic and wild mammals. It is well-known that dogs are the most affected animals^[3]. Rabies is most commonly spread through infected saliva, particularly from bites by affected dogs. The disease can be prevented and eliminated by vaccinating at least 70% of dogs to break the transmission cycle^[1]. Despite being vaccine-preventable, rabies remains endemic in Africa, where an estimated 21,000 to 25,000 people die from the disease annually^[4]. In Nigeria, a West African country, rabies still poses a significant public health threat. Thousands of people die of rabies annually and prevalence rates ranging from 3% to 28% have been reported among dogs in different regions of the country^[5]. The domestic dog is the most common transmitter of rabies in Nigeria and many cases of rabies are due to bites by dogs, especially free-roaming dogs^[6]. The Dogs Law, which was enacted in Nigeria in 1943 and has explicit provisions on compulsory dog registration, dog confinement, and dog rabies vaccination, is rarely enforced and it was only recently revised in a few states^[7]. Consequently, the country has yet to attain the World Organisation of Animal Health’s international standard of prohibiting the straying of dogs^[8]. Researchers have also reported the knowledge, attitudes, and practices considered to increase rabies exposure risk among people in some parts of the country^[9].

Furthermore, dog bites and rabies cases are rarely reported to hospitals and this has led to an increase in the risk of dog-mediated human rabies^[10]. Reporting dog bites and rabies cases ensures the availability of data necessary for sample collection, laboratory diagnosis, and planning and implementing rabies elimination programmes, including prompt post-exposure vaccination of dog bite victims and organisation of rabies education campaigns. The limited reportage of rabies cases has contributed to limited investment in rabies elimination interventions in Nigeria, like many other African countries^[11]. Data are also essential for developing models pivotal to any in-depth understanding of disease dynamics and identifying and implementing prevention and control measures. Such models were developed to analyse the spread and control of rabies^[12] and other infectious diseases, such as the novel coronavirus disease (COVID-19) that has had devastating global impacts^[13]. Ogun State has been identified as one of the states with the largest population of dogs in Southwestern Nigeria^[14]. That rabies vaccination coverage among the dog population in the state is lower than the 70% recommended by the World Health Organisation has been reported in the state^[15]. Hence, the residents are at a high risk of rabies exposure, and this raises concerns about the progress towards achieving the global strategic plan to end human deaths from dog-mediated rabies by the year 2030^[16]. Since health literacy is pivotal in the prevention and control of infectious diseases^[17], this study was conducted to assess the knowledge of and attitudes to rabies exposure and prophylaxis, as well as the practices and other associated factors that affect rabies exposure and prophylaxis among dog owners in Ogun State, Nigeria.

METHODS

The study was conducted in Ogun State, Southwestern Nigeria, from July 2020 to July 2021. The sample size was calculated using the formula n = Z²P(1-P)/d^2[18], where n was the sample size, Z was the level of confidence (95%), P was the expected prevalence (50% was used), and d was precision (5%). The formula yielded a minimum sample size of 384. Seven (i.e., one-third) of the 20 Local Government Areas (LGAs) in Ogun State were selected using systematic random sampling. Two wards per LGA (n = 14) were randomly selected and six streets per ward (n = 84) were then selected using systematic random sampling. A total of five hundred (n = 500) dog-owning houses were selected from the streets. Using the face-to-face interviewer method, a pre-tested and structured questionnaire with close-ended questions, which were grouped into four sections, was used to collect data on the dog owners’ socio-demographic characteristics, knowledge of and attitudes to rabies exposure and prophylaxis and the dog owners’ practices during rabies exposure and prophylaxis. Scoring of their knowledge, attitudes, and practices was done as described in a previous study^[19]. To score the respondents’ knowledge, attitudes and practices in relation to rabies exposure and prophylaxis, each correct option to the questions was assigned one (1) point, while the incorrect options were assigned zero (0) point. Only respondents with at least an average of the total correct points were deemed to possess the knowledge, attitudes, and practices associated with lower rabies risk. In addition, any dog owner whose dog was not vaccinated against rabies up to date was regarded to demonstrate practices associated with higher rabies risk.

RESULTS

DISCUSSION

Rabies remains a disease of great public health concern and economic burden in Nigeria. This study identified knowledge gaps and attitudes and practices associated with higher rabies risk among dog owners in Ogun State, Southwestern Nigeria. The findings are essential for planning community-based strategies and resource allocation for rabies elimination in Ogun State, Nigeria. From this study, the majority (84.6%) of the dog owners were aware of rabies. This is similar to the 86.9% reported in a study on rabies awareness among dog owners in Abeokuta, Ogun State^[15]. The most common sources of the first information about rabies (46.5%) were friends and family members. This finding is consistent with that of a similar study in Oyo State, Nigeria^[21] and another one in Ghana^[22]. Such informal channels have the disadvantages of limited reach and the possibility of spreading incorrect information. This indicates the need to adopt the One Health approach involving veterinarians, medical doctors, and other concerned professionals in the dissemination of authentic information about rabies to stop its spread in animal and human populations.

Furthermore, only 37.4% of the respondents knew that, besides dogs, other mammals could be infected with rabies. This is similar to a work in Oyo State, Nigeria, which reported that only 37.5% of its respondents were aware that other mammals could be infected by rabies^[21]. This reveals a knowledge gap as rabies has been reported in other mammals in Nigeria^[23]. Only a few (12.4%) knew rabies could spread through licks and contacts of the saliva of an infected animal with skin wounds and mucous membranes; thus, this indicates that non-bite exposure to rabies is not commonly known and should be included in rabies education programmes. More than a third (36.2%) of the respondents did not know rabies could be prevented by vaccination. This is in tandem with a previous report in Ogun State^[24] and calls for more extensive enlightenment on the importance of vaccination for canine and human rabies prevention. The majority of the respondents had attitudes associated with higher rabies risk, as more than half (50.4%) indicated that they could play with any dog regardless of its vaccination status. Meanwhile, most rabies cases in Nigeria have been attributed to stray, free-roaming, and unvaccinated dogs^[5]. Attitudes towards reporting the cases of dog bites in animals and humans to the hospital and submitting samples from suspected rabid animals for laboratory testing pose a higher risk of rabies exposure. These negative attitudes contribute to the underreporting of rabies cases, resulting in extremely limited data essential for the adequate supply of the resources needed for rabies elimination^[25].

With as high as 60.0% of the respondents allowing their dogs to roam freely, there is an increase in the environmental risk of rabies transmission. Many cases of dog-mediated human rabies have been associated with bites by free-roaming dogs, and the risk of rabies spillover from free-roaming dogs to other domestic animals as well as wildlife has been reported in Nigeria^[26]. The enforcement of laws prohibiting straying and free-roaming of dogs is therefore pivotal to environmental protection geared towards rabies prevention and One Health optimisation. Furthermore, with only about a quarter (24.0%) of the respondents complying with up-to-date rabies vaccination of their dogs, the risk of rabies from dog bites is high. Dog vaccination coverage lower than the 70% WHO-recommended level is equally a major challenge in some other African countries^[27], and this may make achieving the “Zero by Thirty” goal difficult.

Almost a third (29.0%) of the respondents had experienced dog bites. This is lower than the 78% reported in a study in Kwara State, Nigeria^[9]. However, only a few respondents who had experienced dog bites (8.3%) practised immediate wound washing with soap and water after the bite, as recommended by the WHO^[1]. Hence, public health education on first aid rabies prevention in dog bite victims is expedient. Some 22.1% of the dog bite victims used herbs or concoctions to prevent rabies. This serves as proof that the use of traditional medicine to treat diseases is a common practice in Nigeria^[28]. Such a practice may be contributing to the high prevalence of human rabies in Africa. Only a few (23.4%) of the dog bite victims reported to the hospital for wound management and assessment for rabies vaccine uptake. This is lower than the 61.8% reported in another study in which respondents were from Ogun State^[24] and indicates a decline in healthcare-seeking behaviour in the state. The delayed reporting to the hospital by the majority of the dog bite victims (88.2%) may increase the risk of dog-mediated human rabies. Furthermore, only six of the dog bite victims (4.1%) took the Post-exposure Prophylaxis (PEP). This is lower than the 66.25% previously reported in the state^[24]. A third of those who took the PEP (33.3%) failed to complete the regimen due to the high cost of the human rabies vaccine and the long distance from the hospital to their homes. This means that low economic power and limited access to healthcare facilities hinder rabies’ PEP uptake and increase the risk of dog-mediated human rabies. Educating the public on the importance of taking complete doses of rabies PEP and wider distribution of subsidised or free human rabies vaccine to remote communities can contribute to addressing these challenges.

The overall levels of knowledge, attitudes, and practices associated with higher rabies risk in this study were 37.8%, 59.4%, and 97.6%, respectively. Similar findings have been reported in some other states of Nigeria^[9]. Age, education, dog ownership, and occupation were the factors associated with rabies-preventive practices. Knowledge, attitudes, and practices associated with higher rabies risks were observed among younger respondents, those with low or no formal education, those who had only owned dogs for a few years, and private business owners. This observation is consistent with those of a number of previous studies in Nigeria^[29]. Researchers in China^[30] also reported that bite victims of suspected rabid dogs with lower levels of education were less likely to exhibit practices associated with lower rabies risk. Hence, these factors should be captured in rabies education programmes. This study has also revealed that a greater proportion of dog owners with higher levels of rabies knowledge had attitudes and engaged in practices associated with lower rabies risk, as similarly reported by two previous studies^[31,32]. Organising programmes aimed at improving rabies knowledge and ensuring behavioural changes in various settings, such as schools and communities, will immensely contribute to rabies prevention and control. For instance, including rabies education in school curricula has been proven to have significantly increased rabies knowledge. Rabies knowledge improvement has resulted in the reduction of dog bite cases and rabies risk among school children^[33].

In conclusion, the rabies knowledge level among the dog owners interviewed in this study was moderately high. However, knowledge gaps regarding rabies hosts, transmission, signs, and prevention were identified. Their attitudes to and practices, especially regarding dog vaccination compliance, post-exposure first aid measures, and prophylaxis, are of great public health concern. Targeting dog owners of younger age, with low levels of education, owning private businesses, and who have only kept dogs for a few years in rabies education programmes is of utmost importance. To achieve rabies elimination in Ogun State and fulfil the global goal of zero human dog-mediated rabies deaths by 2030, there is an urgent need for the adoption of the One Health approach involving all the concerned stakeholders in implementing rabies education programmes, free mass dog vaccination, rabies surveillance, enforcement of dog’s law and extensive supply of free or subsidised human rabies vaccines.