Awareness towards Rabies in the residents of Kathmandu Metropolitan City, Nepal.

Introduction

Community Knowledge on Rabies

The Pet owners have a better knowledge regarding rabies than non-pet owners, which is highly significant.

Attitude and practices of the respondents

A majority (98.28%) of the respondents mentioned that they would inform either animal public health officials about a rabies outbreak in the future. A non-significant difference has been observed between pet-owning and not owning respondents in this regard (p = 0.16; Table 3). Also, 47.41% of the respondents had mentioned that they would kill rabid stray dogs and either bury or inform the municipality for its proper disposal, which can be accepted as a good attitude and practices towards prevention of rabies (Table 3).

Health seeking behavior of the respondents

All the 348 respondents mentioned that they would seek medical treatment in case they are bitten by a stray dog or cat, which can be considered as a sign of good practice. On the other hand, 260 (74.71%) respondents would visit a hospital in case they are scratched by a stray dog or cat, and 196 (56.43%) respondents would do so in case they are bitten by an owned dog or cat (Table 3). In case of being bitten by a dog, more than 87.36% of the respondents mentioned that they would visit a hospital on the same day (i.e., on the day of bite), 0.86% on the next day and 3.7% within 3-10 days, and 8.28% of the respondents would visit after 10 days of being bitten (Table 3). All the 30 respondents (themselves or someone in their family) who were bitten by a dog visited a health center, while only 10% of them washed the wound with soap and water as a first-aid treatment before visiting the hospital.

Discussion

Results of this study show that rabies is an important public health concern in the study areas of Kathmandu valley, and the community knowledge and awareness on rabies were high among the respondents. The findings illustrate that 91.25% of the respondents in the study areas have heard about rabies. Pet owners were more likely to have high knowledge of rabies than non-pet owners. This high degree of awareness may be due to the endemic nature of the disease and frequent reports of dog bite cases, as well as rabies outreach programs and messages delivered via different means of communication as well as their linkage with the animal health officials. The findings were similar as reported by others (Muriuki, 2016; Matibag et al., 2009). The survey study shows that about 66% of the respondents considered stray dogs as a community problem due to the nuisance behavior of the dogs like barking and fouling, attacking people and animals. Similar findings were mentioned by a previous study (Widyastuti et al., 2015).

It was reported that religious adoration of the dogs in Nepalese culture is among one of the causes of the problematic number of dogs in Kathmandu Valley (Bögel and Joshi, 1990). This ideology of religious belief might be the major cause that only about 47.41% of the respondents answered that they would kill a rabid dog.

Knowledge gaps were seen among the respondents: 8.04% of the respondents had not heard of rabies, indicating that rabies awareness programs are further necessary and public education, information, and communication materials should be prepared to aware the community. All the respondents were well aware of the zoonotic nature of rabies and knew that it is transmitted to humans by the bite of a rabid animal. They also mentioned that they would visit a hospital in case of being bitten by a stray dog or cat, which can be correlated with their knowledge, as well as the provision of free Post-exposure and Prophylaxis (PEP) vaccination for up to three doses against rabies in all the governmental hospitals. However, 14.37% of the respondents did not know that rabies is a fatal disease and can lead to death. Lacking knowledge that rabies is a fatal disease may affect the health-seeking behavior of the community leading to rabies in some cases. This result was similar to the findings were observed by Agarwal and Reddaiah (2003) in India. About 60% of the respondents believe that rabies is curable if treated on time, i.e., before the onset of symptoms. Owing to this belief, many may visit a hospital only after a period of delay making themselves vulnerable to rabies. A good understanding of the health-seeking practices of the community is very important for rabies prevention in humans (Matibag et al., 2007). The similar research also reported that understanding the community knowledge, attitudes, and perception towards rabies is inevitable because of their influence on post-exposure treatment-seeking behavior (Matibag et al., 2008), and also, community support is essential for rabies prevention and control programs (Kayali et al., 2003). This study has shown a high degree of treatment-seeking behaviors of the respondents as all the respondents mentioned that they would visit a hospital in case of the stray dog bite. This finding is evidenced by the 30 dog-bitten cases of this study, that all of them visited a hospital. This study also revealed that the attitudes and practices of the respondents were positive. A majority of the respondents mentioned that they would inform the concerned authorities about a suspected rabies outbreak in the community. A majority of respondents considered stray dogs as a problem for the community, and their population should be controlled. Besides the cooperation from the community, their active involvement in the rabies awareness campaign, control programs, and public health are crucial to maintain an acceptable level of vaccination, which is necessary to break the chain of infection and to prevent the maintenance of rabies in the dog (Totton et al., 2010). About 3.7% of the respondents reported that they would visit a hospital within 3-10 days of dog bite, while 8.28% would visit after 10 days of the bite.

Conclusions

The majority of the respondents from the study area were found to have a better knowledge of rabies; however, a relatively high proportion was not aware of the full Post-exposure prophylaxis (PEP). People having pets had more knowledge about rabies than the ones without pets. Respondents with pets showed more positive attitudes and practices towards rabies than non-pet owners.

All the respondents would seek medical treatment in case of a dog bite, although a majority of them were not aware of any first aid treatment at the home level.

Lacking knowledge regarding the washing of bite wounds immediately after dog bite might increase by 5-fold the risk of rabies infection. Thus, ‘hand washing’ as the first critical step following a dog bite should be emphasized with top priority during future rabies education campaigns in Nepal.

Acknowledgment

The work was supported by Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand for providing the research grant. The authors would like to express their deepest and sincere appreciation to Assoc. Prof. Dr. Phitsanu Tulayakul and Dr. Mathilde Paul and Dr. Suwicha Kasemsuwan for their guidance, sound advice, and encouragement.

Conflict of interest statement

All authors declare no conflict of interest.

Ethical Approval

Not applicable