Key Findings
Survey results from Namibia’s Northern Communal Areas suggest a potentially underestimated dog population, emphasizing the need for robust tracking to accurately assess vaccination campaign coverage.
While most residents had general awareness of rabies, deeper understanding was lacking among more than half the population. Although most sought medical care after dog bites, treatment gaps existed due to factors such as failure to complete the full post-exposure prophylaxis regimen or avoiding medical attention altogether.
Discrepancies between reported and official rabies cases, both in humans and dogs, underscore the need for enhanced rabies surveillance.
Summary
Dog-mediated rabies is a persistent threat in Namibia, particularly in the Northern Communal Areas (NCA), where it has caused over 200 human deaths since the early 2000s. In response, the Namibian government initiated a dog rabies control program in 2016. While initial successes were achieved, the program’s momentum has faltered in recent years.
The study, titled “Dog ecology and rabies knowledge, attitude and practice (KAP) in the Northern Communal Areas of Namibia”, focused on two key objectives. Firstly, researchers aimed to understand dog populations and their distribution relative to humans within affected areas. By incorporating human census data, they estimated the total dog population in the NCA. Secondly, the study sought to assess community knowledge, attitudes, and practices concerning rabies to identify areas for targeted interventions.
A cross-sectional study was conducted between April and June 2021 across the eight regions of NCA, covering 31.9% of the country’s territory and home to 56.9% of its population. Data was collected through door-to-door surveys administered by 37 teams of two enumerators, who spent five to seven days in each assigned region.
Survey Results
Number of Dogs
The survey revealed that 66.5% of households owned at least one dog, with higher rates in rural (63.3%) compared to urban areas (55.3%). Based on this data, a human-to-dog ratio of 5.45 and a dog-to-household ratio of 1.47 were calculated.
However, estimating the dog population proved challenging due to inconsistencies between different data sources. Using the human-to-dog ratio and 2016 census data, the estimated dog population ranged from 242,875 to 271,597. In contrast, calculations based on the dog-to-household ratio and census data from 2016 and 2019 yielded a significantly higher estimate of over 400,000 dogs.
This discrepancy likely stems from differing household definitions between the survey and census data. To account for this uncertainty and ensure adequate vaccination coverage, the researchers recommend using a conservative approach in government vaccination campaigns.
Vaccination Rates
While 49.6% of dog-owning households reported vaccinating their dogs, the overall vaccination coverage rate was lower at 38.6%. Urban dogs were more likely to be vaccinated than their rural counterparts. Other factors influencing vaccination rates included livestock ownership, owner gender, and rabies awareness. Most respondents (69.1%) reported living within 1 km of a vaccination site, with the remaining households located farther away.
Accurately assessing vaccination coverage in the Northern Communal Areas (NCAs) is hindered by several challenges. The owners’ lack of vaccination certificates complicate data collection. Additionally, the high proportion of respondents claiming to live within 1 kilometer of a vaccination site, despite the widespread nature of settlements, raises questions about data accuracy. Consequently, the survey’s findings on vaccination coverage should be interpreted with caution.
To enhance vaccination efforts, the researchers recommend rigorous monitoring of mass vaccination campaigns and the utilization of Geographic Information Systems to assess and improve local coverage. Additionally, considering the challenges of reaching all dogs, incorporating oral vaccination into the national rabies control program, as Namibia has successfully done in the past, could be beneficial.
Rabies Information Source
The primary sources of information about dog vaccinations were radio broadcasts (60.1%) and veterinary professionals (55.8%). Notably, 43.6% of households that did not vaccinate their dogs were unaware of mass vaccination campaigns. To improve vaccination rates, consistent community engagement and ongoing awareness of these campaigns are essential.
Knowledge, Attitude and Practices
The survey assessed NCA residents’ knowledge, attitudes, and practices regarding rabies. While 87.3% of respondents were aware of rabies, knowledge levels varied significantly. Less than half of the population demonstrated good rabies knowledge, with factors such as gender (male), urbanization, and dog ownership positively correlated with knowledge levels. Conversely, limited schooling was associated with poorer knowledge. Most residents exhibited a correct attitude towards encountering or being bitten by rabid dogs.
Handling Dog Bites
Dog bites pose a substantial public health threat in Namibia’s Northern Communal Areas (NCAs), with an annual rate of 674 per 100,000 residents. While a portion of bites were provoked, the majority (53.6%) occurred without provocation. Despite vaccination efforts, a significant number of biting dogs had unknown vaccination status (41.9%), and only a small percentage (21.8%) were confirmed as vaccinated.
While two-thirds of respondents exhibited proper bite wound management, significant gaps persist in post-bite care. Over 10% of those seeking initial medical attention failed to complete the recommended treatment course. Factors such as insufficient knowledge about post-exposure rabies vaccination and underestimation of bite severity contributed to absent medical care. To optimize rabies prevention, comprehensive education promoting complete medical follow-up is essential.
Suspected Rabies Cases
Nearly eight percent of respondents reported suspected rabies-related dog deaths in 2020, and seven human rabies fatalities were linked to dog bites within the past two years. Both figures significantly exceed official estimates.
Rabies is a complex disease with variable geographic and temporal prevalence, often misdiagnosed due to overlapping symptoms with other illnesses. Despite Namibia’s advanced rabies surveillance system, the discrepancy between reported and confirmed cases highlights a potential surveillance gap. Furthermore, the low testing rate (4.3%) for biting dogs, even after euthanasia, underscores the need for improved diagnostic capacity.
Miscellaneous
Data From Study:
Street Dogs / Rabies : Knowledge, Attitude & Practices / Namibia
Year of Publication:
2024
External Link:
Citation: Tenzin T, Hikufe EH, Hedimbi N, Athingo R, Shikongo MB, Shuro T, et al. (2024) Dog ecology and rabies knowledge, attitude and practice (KAP) in the Northern Communal Areas of Namibia. PLoS Negl Trop Dis 18(2): e0011631.
https://doi.org/10.1371/journal.pntd.0011631