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Indian Journal of Community Medicine

Knowledge, Attitude, Behavior and Practice Study on Dog-Bites and Its Management in the Context of Prevention of Rabies in a Rural Community of Gujarat

Author(s): U. S. Singh, S.K. Choudhary

Vol. 30, No. 3 (2005-07 - 2005-09)

Abstract

Research question: What is the level of general awareness and knowledge of people about dog bites and its first aid measure with anti-rabies vaccines?

Objectives: 1) To know the general awareness pertaining to rabies in rural community. 2) To study the knowledge of people about dog-bites. 3) To ascertain the first aid measures adopted by people after dog bite. 4) To study the awareness of people regarding anti rabies vaccines & health services utilization. 5) To know the opinion regarding control of dog population. 6) To make recommendations based on study findings.

Methodology:Study design: cross sectional study. 2) Setting: village surrounding the PSMC, Anand. 3) Participants: total 225 families were contacted in nine villages with 25 families per village.

Results: All of the individuals were aware about rabies and 98.6% knew about its transmission by dog bite. Only 31.1% would like to apply first aid measure and 36.4% will visit to doctor and rest either do nothing or adopt some religious practices to prevent the development of rabies. 86.6% of individuals were aware about anti-rabies vaccine and 24.4% knew that pet dogs need vaccine against rabies.

Statistical analysis: The data was analyzed by using 'Epi-info' package.

Key words: Rabies, General awareness, First-aid Measure, Religious Practices, and Anti-Rabies Vaccines

Introduction

Rabies is an enzootic and epizootic disease of worldwide importance. In India, rabies is a zoonotic problem of considerable magnitude. Annual mortality more than 30,000 reported by national authorities may not be a complete picture because, since 1985 India continues to report the same every year1. It is estimated that number of deaths due to rabies may be 10 times more than those reported. Every year approximately 1.1 to 1.5 million people are receiving post exposure prophylactic treatment. Although 2 million bites occur each year in India more than 95% of these cases are bitten by dogs2.

In China, about 5 million people are estimated to be vaccinated annually3. People have very basic knowledge about anti-rabies treatment getting 14 injection after dog bite, as per the old concept, but not aware of the disease which could occur if they do not manage dog bites. About 0.40 million people continue to receive the sheep brain vaccine despite the fact WHO has recommended for discontinuation4.

There are many myths and false beliefs associated with wound management. These include application of oils, herbs, and red chillies on the wounds inflicted by rabid animals. More faith in indigenous medicines that are of unproven efficacy and not washing the wound properly because of fear that it would get infected5.

This study is undertaken to highlight the knowledge, behavior, attitude, and practices regarding dog bites.

Material and Methods

Study Area: This study was conducted in nine villages surrounding to the Pramukh Swami Medical College, Karamsad, Anand.

Study Period: The study was carried out from August 2002. to December 2002..

Study Design: This is a community based cross-sectional study.

Participants: Total 225 families were contacted in nine villages and in each village 25 families were contacted. Multistage sampling technique was applied. First, by simple random method nine villages were selected, and then each village was divided into four quadrants and one center for study purposes.

Again application of simple random method was adopted in selecting five families in each quadrant and one center. In each quadrant five families were selected randomly.The head of the household or in his/her absence any other adult member of the family was interviewed. In case the selected house was found locked on three successive visits, the adjacent household was interviewed. On an average, each interview lasted for 30 minutes.

Study Instrument: A two page structured questionnaire was prepared.The questions related with their awareness regarding rabies, knowledge about dog/other animal bites. Supposed first aid measures adopted by them, knowledge regarding antirabies vaccines, and lastly their opinion towards dog population control.

Statistical Analysis: The data was analyzed by using EPIINFO package.

Results

All of the individuals knew about rabies and 98.6% individuals knew about its transmission by dog bites. Only 2 illiterate farmers and one graduate serviceman were not sure about its real transmission.

On the question to its occurrence by the bite of other animal, 31.1% have blamed cat, 26.6% monkey, 25.7% fox. This percentage was higher as per their educational performance. 24.4% individuals knew about bites on danger sites such as head, neck, face, and genitals. The difference of knowledge regarding danger sites among illiterate with up to primary educated and literate above to it was highly significant (P<0.001).

On question to symptoms of rabies in human 8% knew about intolerance and convulsions and 12% about hydrophobia but 30.2% were sure that it can be cured by treatment. The difference of knowledge regarding the opinion that it can be cured among illiterate with up to primary educated and literate above to it was significant. (P<0.05).

On question to symptoms or rabies in dog 37.7% of individuals mentioned that tail becomes straight or down, dog runs against wind or in wind direction. Such answers were received from mostly illiterate or primary educated persons.The difference of knowledge regarding such others symptoms among illiterate with up to primary educated and literate above to it was significant (P<0.01).

31.1% persons endoresed application of first aid measures such as washing, antiseptic bandaging & T.T. in case of animal bite. They belonged to higher educational class and were serving persons. 36.4% would consult a doctor and 13.3% would to do nothing the difference of knowledge regarding this among illiterate and literate was highly significant. 19.2% were the believer of some religions and age old methods of treatment like-application of chilli (red), tie a bell at 'Hadkawa Mata Temple' and others.

86.6% individuals were aware about anti-rabies vaccine. Mostly, they were educated and this difference between the literate and illiterate was statistically, highly significant (<0.02).

79% knew that 14 injections have to be taken and 5.7% know of 10 injections on abdomen. Only 24.4% of individuals knew that pet dog-needed vaccine against rabies. The difference of knowledge regarding pet dog needed vaccine among illiterate with up to primary educated persons and literate above to it was highly significant.

Health services utilization

75.1% individuals know that health services facility are there in the vicinity. On question to where they will visit for services, still primary health Centre is first choice, as 49.7% people want to use the facility of PHC. Others, as 12% want to visit private practitioners and 13.3% want to visit Shri Krishna Hospital. Among all 15.2% of farmers want to utilize the services of SK hospital, Karamsad.

The difference of knowledge regarding health services facility available at PHC where they would like to visit among illiterate with up to primary educated persons and literate above to it was statistically highly significant.

Methods of control of dog population

66.6% individuals stressed about the need to control the dog population in India. And as regard the method to control the dog population is concerned, 33.3% were in favour of poisoning, 17.7% supported shooting, and 5.7% thought that castration of dogs was the best method. Only 4% favored killing the dogs by drowning. Only 5.7% accepted immunization as a good control method. The difference of knowledge regarding acceptance of poisoning as a method of control of dog population among illiterate and literate was statistically highly significant.

Discussion

In a survey of knowledge, attitudes, and practices of dog and cat owners in Ottawa Carleton6, stated that 95% of respondents were aware that they were likely to get rabies from a bite or 77% from a scratch of a rabid animal. This is comparable in our study as all of the people are aware about rabies and 98.6% knew that it is transmitted by rabid dog bite. This knowledge varies according to their educational status.

In our study only 36.4% people would like to visit the doctor and 31% would like to apply first-aid measures than see the doctor. Others will either do religious customs (19.2%) or do nothing (13.3%).

In a KAP Survey6 overall vaccine coverage rates among pets were 88% and 31% respondents were able and willing to find recent vaccination certificate for their pets, but in our study only 24.4% of people knew that pets need vaccine against rabies and only 5.7% of persons have opinion that immunization to dogs may be a method of control of human rabies.

In our study proper first-aid measure was acceptable to 31.1% but 13.3% wants to do nothing and 19.2% would like to do some religious customs such as chilli application or tobacco leaf application or tie a bell to Hadakwa Mata temple.These resutls are quite comparable to other studies1,5.

In our study 86.6% people are aware about anti-rabies vaccine but due to false beliefs in religious customs (19.2%) only 67.5% people are interested to apply it as a post-exposure prophylaxis, which is comparable to findings of report in CDC1.

In a study on the victims of bite by a dog in Delhi4, reported that irrespective of type of vaccine administered, for example either tissue culture of nervous tissue vaccine, if a case of rabid animal bite given early and proper treatment, for example proper wound toilet with soap and water, prophylactic tetanus toxoid injection the incidence of mortality can be prevented even when bitten severely by rabid dog.

In present study proper first aid measure was known by 31.1% of population only.

Narayan (1988)8 suggested definite programme for control of dog population in an integrated approach involving environmental measures to reduce habitat, proper garbage disposal, discouraging community owned dogs, helping dog catching squad, castration, promoting industrial utilization of dog carcasses to help reduce the dog population. In our study castration and immunization was suggested by 5.7% population respectively. Others have suggested poisoning 33.3% and shooting 17.7%.

Conclusion

There were total 225 head of the family contacted in 9 villages surrounding the medical college.Their educational status was as such 40.4% were primary class educated, 31.3% illiterate, and 15.1% secondary educated. 5.3% higher secondary educated & 8.4% were college graduates. By occupation 52.4% farmer, 24.8% laborer, 18.6% service man and 4% businessman.

There is definitely a gap in people.s knowledge, attitude, and practices about dog bite and its management. All of the individuals were aware about rabies and 98.6% people knew about its transmission by dog bite. But only 31.1% of total would like to apply first aid measure and 36.4% would visit the doctor, others either will do nothing or do some religious practices, although these practices were dependent upon their educational status.

86.6% of individuals were aware about anti-rabies vaccine and 24.4% knew that pet dogs need vaccine against rabies. 75% of the individuals know about services availability and mostly want to visit PHC (49.7%) knowledge regarding services utilization again depended upon their educational status and occupation.

About knowledge regarding other animal's bite which can cause rabies 31% have taken the name of cat, 26% monkey and 25.7% fox, 24.4% of the persons aware abuot danger sites such as head, neck face and genitals. Around 30% of the perosns have opinion that it can be cured, which is much away from the turth.

Regarding first aid measure adopted after dog bite 19% of person wants to do certain religious customs like application of red chilli, lime or mirchi or tie bell to .Hadkawa Mata. temple or want to apply tobacco leaves.

66.6% of individual would like to control dog population to reduce human rabies, but 5.7% ofthem are thinking that immunization to the dog against rabies can solve the problem. Others are thinking about shooting 17.7%, castration 5.7%, and poisoning the dog 33.3%.

References

  1. Goa Health News: Survey on rabies deaths in Goa. The Navhind Times April 13, 2003 issue Page 3.
  2. Park. K: 2002 Park.s textbooks of Preventive and Social Medicine 17th edition, pages 207-215.
  3. WHO, Weekly Epidemiological Record, Vol. 74 No. 45, 1999.
  4. S. Sehgal, D. Bhattacharya, M. Bhardwaj and V. Parsi Studies on victims of bite by a dog in Delhi Indian Journal of Public Health, volume xxxviii No. 1 January-March 1994, pages 18-21.
  5. A.S. Sekhon, Amarjit Singh, Paramjit Kaur, Sonia Gupta Misconceptions and Myths in the management of animal bite case Indian Journal of Community Medicine volume xxvii No. 1, Jan-March 2002, pages 9-11.
  6. A Survey of Knowledge, Attitudes and Practices of dog and cat owners With respect to vaccinating their pets against rabies Ottawacarleton, Ontario July 2000, volume 28-01, 1 January 2002.
  7. CDC. Rabies: introduction page 1-3 by US Department of Health and Human Services.
  8. Narayan, K.G. (1988) Rabies: How to tackle it effectively. Seminar Urban Affairs, National Society of Urban Development, Hospet, Jan 1988.
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