Knowledge, attitude, practice and one health perception regarding rabies prevention and control in rabies-free communities

Abstract

Rabies elimination is a global challenge in the medical and veterinary fields. Although several countries are recognized as rabies-free countries due to prevention and control measures, this disease is still endemic in many developing countries, particularly in Asia and Africa. Thailand has adopted these measures for decades, but they have not been successful throughout the country. Lessons learned from rabies-free communities can be beneficial as a guide for endemic communities that have similar socio-cultural contexts. This study aimed to evaluate the levels of rabies preventive knowledge, attitude and practice, to identify the contributing factors to good knowledge, attitude and practice, and to explore the public perception of One Health on rabies prevention in sustainable disease-free communities. A knowledge, attitude and practice survey with a structured questionnaire and in-person interviews with semi-structured questions were conducted to investigate quantitative and qualitative findings, respectively. The questions were developed based on a literature review and fieldwork experience. This study was carried out in three rabies-free communities, including urban, suburban and rural areas, in Chiang Mai in 2018. The study participants, who were not underage or members of vulnerable groups, voluntarily provided written consent. The quantitative results were analyzed using univariate analysis and multivariate logistic regression analysis, whereas the qualitative findings were analyzed using content analysis and thematic analysis. The results of the completed data from 1,392 questionnaires and 36 interviews in rabies-free communities identified that the majority of participants had a high level of knowledge, a positive attitude and good practice regarding rabies prevention. The keys to good knowledge and practice were age as related to personal experience, secondary education or higher with a rabies course, and residential areas with the appropriate interventions and communication methods. The most effective intervention was rabies vaccination campaigns, which included mass vaccinations at campaign locations and mobile vaccination services. The most popular method of public communication was wired broadcasting. Nevertheless, socio-demographic characteristics were not associated with attitude. In addition, almost all of the participants were familiar with the One Health concept through multi-sectoral collaboration due to rabies prevention activities in their communities without mentioning the term “One Health”. Multi-sectoral collaboration was divided into three sub-themes. The first sub-theme focused on the role of the municipal government in collaborating with other sectors and delegating duties to their networks, such as village health volunteers running mobile vaccination services and village headmen managing wired broadcasting. The second sub-theme was the involvement of the medical and veterinary sectors in supporting some medical equipment and providing knowledge and practice to campaign staff. The final sub-theme was inter-sectoral action with community engagement, particularly among active campaign participants who could support disease prevention, detection, and response in their communities. In conclusion, good knowledge, attitude and practice as well as public understanding and support for the One Health strategy were critical to successful and sustainable rabies prevention at the local level. The nation will come closer to achieving its goal of having no human rabies deaths by putting these lessons learned into practice in endemic communities.