|Ahead of print publication
Knowledge, attitude and practice study on dog bite and its management among population in a rural community of Western Maharashtra
Saurabh Mahajan1, Surinder Kumar2, Arun Kumar Yadav3
1 Resident, Department of Community Medicine, AFMC, Pune, Maharashtra, India
2 Clinical tutor, Department of Community Medicine, AFMC, Pune, Maharashtra, India
3 Associate Professor, Department of Community Medicine, AFMC, Pune, Maharashtra, India
|Date of Submission||06-Apr-2020|
|Date of Decision||04-Aug-2020|
|Date of Acceptance||18-Oct-2020|
|Date of Web Publication||22-Mar-2021|
Arun Kumar Yadav,
Associate Professor, Department of Community Medicine, AFMC, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Awareness of dog bite-related rabies in rural population of developing countries, including India, can lead to reduction in mortality from dog bite. The present study was conducted to know the general awareness pertaining to dog bite and rabies, antirabies vaccines, and health services utilization in a rural community. Also, to ascertain the first-aid measures adopted after dog bite and to know the opinion regarding control of dog population. Methods: The study was conducted as a community-based cross-sectional study in the rural field practice area of a Medical College in Western Maharashtra among the age group of 30–40 years using pretested questionnaire. Results: A total of 108 respondents participated in the study. Of the study participants, 37 (34.3%, 95% confidence interval [CI]: 25.3%–44%) participant were aware of rabies. Only 19 (17.59%, 95% CI: 11%–26.1%) participants were aware of the symptoms of rabies. Only 20 (18.5%, 95% CI: 11.7%–27.1%) participants would like to apply first-aid measure and 85 (78.7%, 95% CI: 69.8%–86%) participants will visit to doctor, and rest responded as doing nothing. Of the participants, 66 (61.11%, 95% CI: 51.3%–70.3%) were aware of antirabies vaccine and 77 (71.1%, 95% CI: 61.8%–79.6%) responded that dogs should be caught and taken away from locality, whereas the rest responded that dogs should be sterilized as a control measure. Conclusions: The gaps in knowledge, attitude, and practice with respect to prevention and control of rabies need to be addressed by educating the rural population. The present study reflects the need for making the rural population aware about the disease, vaccination, and first aid.
Keywords: Dog bite, knowledge, attitude, and practice, rabies, rural
| Introduction|| |
Rabies is a globally important disease that is almost always fatal following the onset of clinical symptoms. Dogs are responsible for rabies virus transmission to humans in up to 99% of cases and pose a potential threat to over 330 crore people globally. Rabies is one of the neglected tropical diseases, mainly affecting poor and vulnerable communities living in remote rural areas. Every year, more than 2.9 crore people worldwide receive a postbite vaccination, which is estimated to prevent hundreds of thousands of rabies deaths annually, still knowledge and practices about these vaccines remain far away from satisfactory.
The situation is particularly pronounced in India, which reports about 18,000–20,000 cases of rabies in a year and about 36% of deaths from the disease worldwide. The incidence of rabies in India has remained constant for a decade, with no obvious declining trend. It is likely that the reported incidence is an underestimate of the true incidence, since rabies in India is still not a notifiable disease. Although there are safe human vaccines and immunoglobulins for rabies, they are not readily available or affordable to those in need.
The widespread faith in traditional healing practices for the treatment of animal bite injuries undermines the importance of seeking postexposure prophylaxis. Despite wide recognition of the role of stray dogs in the transmission of rabies in rural human populations, the attitude of the latter toward this reservoir remains influenced by the prevailing social, cultural, and religious beliefs. Many myths and false beliefs overshadow the correct practice of wound management and further treatment which is of proven efficacy. These practices generally include the application of various oils, herbs, turmeric paste, and red chilies on the wounds inflicted by animals and not washing the wound properly because of fear that it would get infected.,
While there have been a variety of hospital-based studies that have assessed knowledge, attitude, and practice (KAP) of dog bite victims, there are virtually no community-based studies in India.
This study was therefore undertaken to assess the KAP of rural population not only toward dog bite and rabies but also toward control of stray dogs in the locality.
| Methods|| |
A community-based cross-sectional study was carried out in the rural field practice area of a medical college of Western Maharashtra from June 2019 to August 2019. The study population is comprised individuals in the age group of 30–40 years, with varied socioeconomic strata and mixed social and cultural beliefs. The questionnaire was made after literature search and wide consultation taken from community health workers, residents of community, epidemiologists, and statisticians. The questionnaire was made in English and was then translated into Marathi by two approved translators. The same was then back translated into English. The questionnaire was pretested in the field on twenty participants and minor modifications were made. It consisted of both open- and close-ended questions covering domains of KAP related to dog bite and rabies.
Sample size was calculated based on the study by Tiwari et al. which was conducted in Shirsuphal village in Western India. The sample size was calculated for 95% confidence interval (CI) with 5% margin of error and assuming the percentage of population who heard rabies as 95%. The calculated sample size was 73. However, 110 respondents were administered the questionnaire, wherein 2 failed to complete the survey. Sampling frame was obtained from local village Panchayat office. Simple random sampling was done, and individuals from age group 30 to 40 years were administered this questionnaire.
Statistical analysis was done using SPSS software version 20.0 (SPSS Software version 20.0. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Descriptive statistics such as percentages, frequencies, median, interquartile range, mean, and standard deviation (SD) were used. Chi-square test was applied to test the association between categorical variables and P < 0.05 was considered statistically significant. KAP scores were calculated using the following methodology.
Knowledge, attitude, and practice scoring
Every question carried one mark each, and there were total of 14 questions. Each correct answer carried a score of 1, while every incorrect answer 0 was given. Median and interquartile range (mean score and SD) were calculated for KAP. The participants who had KAP score more than the median were considered as having satisfactory KAP and less than median score was considered having unsatisfactory KAP.
| Results|| |
The study participants (N = 108) comprised 63 (58.3%) males and 45 (41.7%) females. Among the study participants, 89 (82.4%) were educated, the distribution of which is given in [Figure 1].
Of all the study participants, 37 (34.3%, 95% CI: 25.3%–44%) had heard about rabies as a disease. Among the people who knew about rabies, 9 (8.33%, 95% CI: 3.9%–15.2%) participants were aware of other animals, leading to transmission of rabies which included fox, cats, and monkeys, whereas 28 (25.92%, 95% CI: 17.9%–35.3%) participants were aware that rabies transmission occurs only through dog bite. Only 18 (16.66%, 95% CI: 10.2%–25.1%) participants were aware that rabies can be transmitted through scratches and licks on open wound and not only through dog bite. Knowledge about various symptoms of the disease among humans and animals was assessed using open-ended questions and 19 (17.59%, 95% CI: 11%–26.1%) participants knew the symptoms in humans and the majority identified fear of water, wound infection, and fever as main symptoms, whereas regarding symptoms in dogs, 9 (8.33%, 95% CI: 3.9%–15.2%) participants responded excessive barking and 6 (5.55%, 95% CI: 2.1%–11.7%) participants believed that dog becomes mad and bites without provocation. Majority 70 (64.8%, 95% CI: 55%–73.8%) of the study participants believed that disease arising after dog bite is curable and can be treated effectively, whereas 9 (8.33%, 95% CI: 3.9%–15.2%) participants responded that it can lead to death. About 66 (61.11%, 95% CI: 51.3%–70.3%) of study participants knew that there is vaccine available for disease arising after dog bite. The relationship between education and awareness about the role of vaccine in preventing rabies was found to be statistically significant (P < 0.022) as shown in [Table 1]. Awareness regarding the number of doses required for postexposure prophylaxis was poor with 15 (13.89%, 95% CI: 8%–21.9%) participants responding that five injections need to be taken in case of a dog bite, whereas 22 (20.37%, 95% CI: 13.2%–19.2%) participants responded more than five injections need to be taken. The majority (30) (27.78%, 95% CI: 19.6%–37.2%) of the participants believed abdomen as the site of administration of injection.
|Table 1: Association between education and awareness about availability of vaccine for rabies|
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Participants were interviewed to assess the attitude regarding the health-seeking behavior after dog bite and control of stray dogs. On interviewing all the individuals regarding their attitude toward first-aid measure after a dog bite, 20 (18.5%, 95% CI: 11.7%–27.1%) responded that they would like to apply first-aid measure in the form of washing wound and 85 (78.7%, 95% CI: 69.8%–86%) will visit a doctor and rest responded as doing nothing. For control measures, 77 (71.1%, 95% CI: 61.8%–79.6%) participants suggested that the dogs should be caught and taken away from their locality, and 30 (27.78%, 95% CI: 19.6%–37.2%) suggested that stray dogs should be sterilized.
Questions were asked regarding the practice adopted in the vaccination of pet dogs and the measures adopted in case of dog bite in family. In our study population, 35 (32.4%, 95% CI: 23.7%–42.1%) were pet owners and 10 (28.57%, 95% CI: 4.5%–16.4%) of them had vaccinated their pets. History of dog bite in any one of the family member was given by 24 (22.22%, 95% CI: 14.8%–31.2%) study participants, of which 12 (50%) sought services of health-care facility, three (12.5%) took unconventional treatment, five (20.83%) applied first-aid measures at home, and the remaining four (16.67%) chose to do nothing.
Knowledge, attitude, and practice score of study participants about animal bite and rabies
Median and interquartile scores for KAP score were 5 and 3 (Mean ± SD = 5.7 ± 1.88), 2 and 1(Mean ± SD = 2.42 ± 0.66), and 1 and 0 (Mean ± SD = 1.31 ± 0.75). About 17 (15.7%) participants had satisfactory knowledge score, 20 (18.5%) had unsatisfactory knowledge score, and 71 (65.7%) had no knowledge. Forty (37%) participants had a satisfactory attitude score and 68 (63%) had unsatisfactory attitude score. Fourteen (13%) participants had satisfactory practice score and 94 (87%) had unsatisfactory practice score.
| Discussion|| |
Our study finds that only 34.3% of the participants had heard about rabies as a disease; whereas in a study conducted by Chandan and Kotrabasappa in 2016 among agricultural workers, 89% of the participants had heard about rabies as a disease.
Vaccine coverage rate in our study among pet dogs was only 28.57%, whereas in a study conducted in Tanzania in 2014 mentioned that 70% of the dog population should be vaccinated to achieve herd immunity and sufficient vaccination coverage to prevent transmission of rabies virus.
Our study documented only 18.5% of participants would adopt washing wound as the first-aid measure and the remaining would approach a health-care facility. In Ethiopia study by Ali et al., 70.8% of respondents said that they would wash wound with soap and water as first-aid measure after suspected animal bite, and the rest would seek health care following suspected animal bite.
In the present study, 21.3% of participants are aware about the role of vaccine in preventing rabies, which is much lesser than the findings of Singh and Choudhary, who found that 86.6% of people are aware about antirabies vaccine. Our study finds that, among those who have heard about rabies vaccine, the majority were not aware of the correct number of injections to be given and the site of administration of injections.
In our study, one of the highlight findings was that only 50% of participants sought services of a health-care facility after dog bite, which can be attributed to a lack of knowledge and needs to be addressed on an urgent basis.
National Rabies Control Programme implemented under 12th 5-year plan with an objective to prevent the human deaths due to rabies and to prevent transmission of rabies through canine (dog) rabies control. It addresses human and animal health component by carrying out training of health professionals, implementing the use of intradermal route of inoculation of cell culture vaccines, strengthening surveillance and laboratories, carrying out IEC activities, dog population management, and mass vaccination of dogs. The program needs to be carried out meticulously to address the lack in awareness and practice component among the masses.
| Conclusions|| |
It is evident that there is a large gap among the rural population as far as knowledge, attitude, and practices about rabies are concerned. The present study reflects the need for making rural population aware about the disease, vaccination, and first aid. Health-seeking behavior of the population after dog bite needs to be addressed urgently. The health education strategies and behavior change policies may be implemented.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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