Key Findings
Launched in 2012 in the Philippines, the CARE project developed a Rabies Prevention Program Manual that was distributed to all schools in Ilocos Norte, allowing teachers to integrate the materials into their existing lesson plans.
Following the implementation of the Manual, there was a significant increase in rabies awareness among students. Although students received information from various sources, the school curriculum played a crucial role in enhancing their understanding of rabies.
Over the year following the Manual’s implementation, rabies knowledge increased and bite incidents decreased. However, researchers were unable to establish a direct correlation between the rise in knowledge and the reduction in bite incidents.
Summary
Community participation in rabies control is crucial for eliminating the disease, yet awareness is often low. Educational interventions are common but not always formally assessed. Some studies have shown increased rabies awareness through various methods, like school programs and campaigns in countries such as India, the Philippines, and Sri Lanka. However, these studies often lack long-term follow-up, making it unclear if the knowledge gained is retained or influences behavior.
In the Philippines, children are particularly vulnerable to rabies, with high rates of bites and scratches. School-based health education, like the Global Health for School Initiative (GHSI) and the “Fit for School Program,” plays a vital role in promoting health awareness. These programs leverage the high school enrollment rate to educate children, who can then influence their families and communities, potentially reducing the risk of rabies and other health issues.
CARE Project Education Campaign
The Communities Against Rabies Exposure (CARE) Project, launched in April 2012 in Ilocos Norte, was a collaboration between the Global Alliance for Rabies Control and local health and education authorities. A key component of the project was integrating rabies education into the school curriculum, aligning with the national mandate under the Anti-Rabies Act of 2007.The goal was to equip children with lifelong rabies knowledge, support responsible pet ownership, and enhance the sustainability of rabies control efforts.
The Ilocos Norte Rabies Prevention Program Manual was developed by the Global Alliance for Rabies Control in collaboration with local health and education authorities. It was adapted from a manual used in El Nido and designed to integrate rabies education into the curriculum for grades 1 to 6. The manual includes modules and lesson plans that incorporate rabies-related topics into subjects like Science, Health, Social Studies, Filipino, English, and Mathematics.
In May 2013, 12 Master Teachers helped develop the lesson plans under the supervision of the Ilocos Norte School Division. The manual was launched in January 2014, with 3,390 copies distributed across the province to ensure that each public elementary teacher received a copy. The manual was used in classrooms from February to October 2014.
Study Methods
The study, titled “Impact of Integrating Rabies Education Into the Curriculum of Public Elementary Schools in Ilocos Norte, Philippines on Rabies Knowledge, and Animal Bite Incidence”, assessed the impact of the Rabies Prevention Program Manual developed. This was evaluated through pre- and post-tests with elementary students, alongside qualitative feedback from teachers.
In Ilocos Norte province, one school was chosen from each of the four geographic areas for a study. Students in grades 1 to 5 took pre-tests in November 2013, and the same group (now in grades 2 to 6) took post-tests a year later. The tests covered rabies knowledge, responsible pet ownership, and bite management to assess the effectiveness of the rabies education program. Different questionnaires were used for younger (grades 1-3) and older (grades 4-6) students. CARE project staff administered the questionnaires to ensure unbiased answers. As a reward, students received comic books about a boy and his dog that reinforced rabies prevention and responsible pet ownership.
In November 2014, focus group discussions (FGDs) were held with teachers from these schools to assess the use and effectiveness of the Rabies Curriculum Integration Manual.
Study Results
Qualitative Assessment of the Manual’s Value From Focal Group Discussions With Teachers
FGDs were held with 19 teachers from four schools in Ilocos Norte to assess the value of the Rabies Prevention Program Manual. Teachers generally found the manual easy to use, relevant, and appropriate for various grade levels, though they often adapted its content to fit their existing lesson plans. The manual helped students quickly memorize content, and the stories were engaging.
Teachers appreciated that the manual dispelled the misconception that rabies is only transmitted through dog bites. Suggestions for improvement included separating materials for different grades into separate manuals, adding more visuals, and providing supplementary materials like videos or comics. There was also a desire for more rabies information and educational materials in the local dialect for younger students.
Teachers felt more confident discussing rabies with students after receiving the manual, though they also used other resources. They also suggested adding information on other diseases, like dengue and malaria, to the curriculum.
Students’ Awareness and Knowledge About Rabies
The pre- and post-tests conducted among students in Ilocos Norte showed a high awareness of rabies, with 92.3% of students aware in the pre-test and 96.1% in the post-test. Younger students showed significant gains in awareness, particularly in cohort 3.
The primary sources of rabies information were teachers, television, radio, and family members, with teachers being the most influential. About 40% of post-test students remembered learning about rabies from a comic book distributed during the pre-test. The data suggested that while students received information from various sources, the school curriculum had a significant impact on their understanding of rabies.
Specific rabies knowledge, such as responsible pet ownership, bite prevention, and rabies transmission, improved overall between the pre- and post-tests. However, understanding the fatality of rabies decreased among older students, likely due to the confusing phrasing of a key question (“Rabies is preventable but not curable”). Excluding this poorly phrased question, the average knowledge scores significantly increased from 7.54 to 8.25 across all students.
Despite some inconsistencies in manual implementation and differences across schools, the overall results indicated that students’ awareness and understanding of rabies significantly improved after the intervention, except for a non-significant increase in knowledge in cohort 3, which may have been due to the complexity of the post-test questionnaire.
Animal Bite Incidents and Health Seeking Behaviours
The study also attempted to measure behavioral changes resulting from increased knowledge. It revealed a significant decrease in reported bites after a rabies education intervention. Prior to the intervention, 14.9% of students reported bites, with higher incidences in urban schools and older students. After the intervention, this number dropped to 4.8%, particularly in urban schools, older students, and females.
The researchers were unable to definitively conclude that higher knowledge levels directly lead to a reduction in bite incidents. Notably, the largest decrease in bite incidents occurred at the school in Piddig, where there was no significant increase in rabies-specific knowledge. Also, in the pre-test, students with higher knowledge scores did not report fewer bite incidents. While the study suggests that increased rabies knowledge might help reduce bite incidents, it also points to the influence of other factors, especially in urban settings where the most significant decreases were observed.
Health-seeking behavior following bites showed that 66.6% of students sought medical treatment before the intervention, compared to 56.2% after, though this change was not statistically significant.
The study’s findings demonstrate the effectiveness of a rabies curriculum integration manual in increasing awareness among both children and teachers. As a result, the Department of Education of Ilocos Region officially endorsed the manual for use in public elementary schools in Ilocos Norte on February 13, 2015. Following this endorsement, 395 teachers from 380 public elementary schools received additional training, and were designated as rabies teacher-coordinators. They were made responsible for disseminating rabies education to their colleagues and monitoring the manual’s implementation in their schools.
Miscellaneous
Data From Study:
Rabies / Education / Philippines
Year of Publication:
2019
External Link:
Amparo ACB, Mendoza ECB, Licuan DA, Valenzuela LM, Madalipay JD, Jayme SI and Taylor LH (2019) Impact of Integrating Rabies Education Into the Curriculum of Public Elementary Schools in Ilocos Norte, Philippines on Rabies Knowledge, and Animal Bite Incidence. Front. Public Health 7:119. doi: 10.3389/fpubh.2019.00119
https://doi.org/10.3389/fpubh.2019.00119