Three Things to Know
Given that approximately 40% of rabies-related deaths occur in children under 15, education emerges as a crucial intervention for reducing mortality. A study in Malawi evaluated the impact of a rabies education program on grade 7 students, assessing their knowledge and attitudes before, immediately after, and approximately 10 weeks following the intervention.
This rabies education programme significantly enhanced students’ rabies knowledge compared to those who only received vaccination campaign information. Furthermore, the lessons positively influenced vaccination efforts, recognizing children’s role in dog health.
Knowledge retention declined several weeks post-intervention, highlighting the necessity for regular reinforcement. The study also noted the effectiveness of role-playing in conveying appropriate behavior, requiring minimal equipment and resources.
For Dog Welfare Practitioners
Dog welfare advocates developing educational programs can draw several key takeaways from this research:
- The researchers highlighted the importance of aligning educational interventions with relevant community activities, specifically citing vaccination drives. Therefore, humane educators should prioritize the creation of synergistic programs (e.g. with a spay/neuter clinic) that connect multiple activities to maximize impact.
- Similar to another study conducted in Bhutan, the study’s measurement of knowledge retention revealed the necessity for ongoing reinforcement. Dog welfare and humane educators are strongly advised to implement a series of instructional sessions with the same group to solidify learning.
- Role-playing was identified as a particularly effective educational strategy. Consequently, dog welfare educators should consider incorporating more interactive, hands-on activities to facilitate deeper understanding and improved retention
The Full Picture
Rabies causes an estimated 59,000 deaths annually, mostly from dog bites, with children under 15 making up around 40% of these deaths. Educating children through school-based programs can promote prevention behaviors like wound washing and seeking treatment.
Knowledge, Attitudes, and Practices (KAP) studies reveal widespread gaps in rabies awareness across endemic countries. Despite support for educational interventions, few studies have measured their effectiveness, especially in children. This study, titled ‘A rabies lesson improves rabies knowledge amongst primary school children in Zomba, Malawi”, aims to assess the immediate and medium-term impact of short educational lessons on primary school children’s understanding of rabies prevention in Zomba City, Malawi.
Study Methods
Study Site
The study was conducted in Zomba City, Southern Malawi — a rabies education–naïve area with no prior rabies vaccination or education campaigns. Mission Rabies, an NGO active in Malawi, selected Zomba due to reports of high rabies rates and local government requests for intervention.
Rabies Education Programme
The education programme took place before a mass dog vaccination campaign in Zomba City. Rabies education was delivered to students in 15 schools, with 2 schools serving as controls and did not receive lessons due to closure during that time. Lessons were delivered by trained educators to Standard 7 (grade 7) students and lasted approximately 45 minutes, focusing on rabies transmission, prevention, symptoms, and dog safety. Lessons were standardized, and educators underwent a four-day training program.
Programme Evaluation
Students participating in the rabies education programme completed standardized paper questionnaires at three time points: before the lesson (“pre”), immediately after the lesson (“post”), and 7.5 to 10.5 weeks later (“retention”). Control schools completed the questionnaire only once after the vaccination campaign, allowing comparison between education and vaccination-only exposure.
Only Standard 7 students were included to minimize age bias. The target sample was 30 students per intervention school and 190 in total for the control group. Researchers analyzed survey responses before the lesson to form: (a) an overall score, (b) safety around dogs score, (c) rabies knowledge score, and (d) rabies attitude score.
Study Results
Demographics
The study involved school children aged between eight and fifteen years old, with a mean age of 13. Across all groups — whether they received the rabies lesson or not — most children either owned or had contact with dogs, and the primary reason for owning a dog was for guarding. The majority of dogs were kept tied or caged outside.
Religious affiliation varied slightly between groups, with Catholicism being most common among those who received the lesson, while other Christian denominations were more prevalent in the control group. A small but consistent percentage of children across all groups identified as Muslim.
Pre-Programme Baseline Knowledge
Most students (86.6%) could already identify appropriate behaviors around dogs to avoid being bitten, such as standing still or being calm. The majority believed rabies was serious and agreed that dogs should be vaccinated, resulting in a high attitude score of 3.81 out of 4.
However, understanding of rabies was limited, with an average score of just 19.2 out of a possible 71. Although most children knew people could get rabies, fewer could identify which animals could transmit it or the correct steps to take after a dog bite. Furthermore, only 1.8% knew to clean a wound for fifteen minutes, and just 4.5% mentioned applying antiseptic.
Male students and those without a religious affiliation generally scored higher, while those without contact with dogs scored lower. This may be due to their experience with animals. Researchers noted that dogs are more often brought to vaccination clinics by boys rather than girls, and boys are more likely to take up responsibilities relevant to maintaining the health of dogs.
Impact of Education Programme
The rabies education programme led to a significant and immediate improvement in overall knowledge, safety awareness, and understanding of rabies. The control group, which did not receive the lesson, showed no such improvements.
In particular, there was a fivefold increase in the proportion of children answering to wash bite wounds for 15 minutes, from 2% to 10% following the lesson. This is potentially lifesaving given the significant barriers to accessing appropriate post-exposure prophylaxis (PEP) following a dog bite. Furthermore, there was a marked increase in the proportion of children reporting the importance of telling an adult, from 17% to 32%.
However, some specific elements, such as the need for five post-exposure vaccines and visiting the hospital after a dog bite, remained poorly understood. This highlights areas that may require reinforcement through repeated messaging or practical demonstrations.
After the lesson, children also identified a broader range of animals that could get or transmit rabies, especially cats, bats, and monkeys. However, one unintended consequence was a drop in the number of children who still correctly identified bites as a mode of rabies transmission.
Retention of Knowledge
While the study found that some of the gained knowledge faded over time, many key concepts were still retained by school children nine weeks after the lesson. For example, significantly more children continued to correctly identify multiple ways to prevent rabies in both dogs and people compared to baseline. Likewise, improvements in knowledge related to appropriate post-bite actions — such as washing the wound and informing an adult — remained higher than pre-lesson levels, indicating a degree of long-term retention.
Evaluating Overall Success
Despite the statistically significant increases in correct responses, the proportions of students giving completely correct answers and achieving a high score in the survey remained lower than ideal. Out of a total score of 71, the students’ rabies knowledge score improved from 19.2 to 26.5 after the lesson, before rescinding to 23.7 during the retention survey. Thus, the lesson should be reviewed to achieve even greater improvements in children’s knowledge, particularly in crucial areas such as the need to thoroughly wash dog bite wounds.
This study found that children scored better on questions about how to stay safe around dogs after the lesson. The use of roleplay and theater was a low-cost and engaging way to convey aspects of dog behavior without the need for electricity or video equipment, as described in other studies.
Lastly, children often play a positive role in mass dog vaccination campaigns by bringing dogs for vaccination and increasing vaccination coverage. Therefore, timing school education initiatives shortly before mass vaccination campaigns could have the dual benefit of increasing turnout to vaccination camps and increasing their chances of seeking appropriate PEP in the event of exposure.
Conclusion
The finding that rabies knowledge was significantly greater in children who received the lesson compared to children who had only experienced a mass dog vaccination campaign highlights the benefits of conducting school-focused education activities on rabies.
Miscellaneous
Data From Study:
–
Year of Publication:
2018
External Link:
Burdon Bailey JL, Gamble L, Gibson AD, Bronsvoort BMd, Handel IG, Mellanby RJ, et al. (2018) A rabies lesson improves rabies knowledge amongst primary school children in Zomba, Malawi. PLoS Negl Trop Dis 12(3): e0006293. https://doi.org/10.1371/journal.pntd.0006293