EFFECTIVENESS OF A COMMUNITYBASED EDUCATIONAL

INTERVENTION TO IMPROVE
SCHOOL CHILDRENS KNOWLEDGE
OF RABIES
AND DOG BITE PREVENTION
Aashima Auplish, Alison S. Clarke, Trent van Zanten
Kate Abel, Charmaine Tham,
Thinlay N. Bhutia, Colin R. Wilks,
Mark A. Stevenson, Simon M. Firestone

RATIONALE BEHIND COMMUNITY-BASED

EDUCATIONAL INTERVENTION
Major factors contributing to endemicity:
Knowledge gaps in rabies awareness
Lack of nationally coordinated control and
prevention strategies

Changing the public perception of rabies

prevention and control is a fundamental aspect
of ongoing control efforts

RATIONALE BEHIND COMMUNITY-BASED

EDUCATIONAL INTERVENTION
Target demographic:
Risk and burden falls on the most vulnerable sectors
of society with 40% of human rabies deaths
occurring in children <15 years, particularly from
rural, low-resource communities

RATIONALE BEHIND COMMUNITY-BASED

EDUCATIONAL INTERVENTION
Aim:
To evaluate the implementation of a communitybased educational intervention, with target
demographic of local school children in urban and
rural Sikkim

WHERE DOES EDUCATION FALL INTO

DOG POPULATION MANAGEMENT?
Impact 4: Reduce risks to Public Health
Dog bite prevention
Impact on rabies risk
Impact 5: Improve Public Perception
Attitudes towards dogs
Human-dog interactions

MAJOR GAPS IN KNOWLEDGE

AND CONTROL STRATEGIES
Most patients are victims of rabies due to:
Lack of knowledge
Disregard of post-exposure prophylaxis
An inadequate availability of primary health care
services

EDUCATIONAL SESSIONS
Section I: Interpretation of dog behaviour
Section II: Knowledge of rabies and its transmission
Section III: Post-exposure precautionary steps
Sample size (n): 226 students
Of 8,700 students participating in the education
program
Comparison of pre- and post-test scores to evaluate
the effectiveness of educational intervention

SECTION 1:
INTERPRETATION OF DOG BEHAVIOUR
Impact 4: Reduce risks to Public Health
Dog bites & Impact on rabies

Impact 5: Improved Public Perception

Attitudes towards dogs & Human-dog interaction

Most important reservoir of rabies are dogs

17 million dog bites occur annually in India
Children more likely to suffer bites to the face and head
Key knowledge gap:
Appropriate behaviour around scared dogs

SECTION 1:
INTERPRETATION OF DOG BEHAVIOUR
Results:
Increased awareness of the risk of approaching
scared dogs (30.4%)
Improved ability to identify and approach a
happy dog (22%)

SECTION 1:
INTERPRETATION OF DOG BEHAVIOUR

SECTION 2:
KNOWLEDGE OF RABIES AND
TRANSMISSION
Impact 4: Reduce risks to Public Health
Direct impact on reducing rabies risk

Only 15% of patients reported learning about rabies at

school*
Key knowledge gap:
Understanding animals other than dogs are a
potential source of rabies
*As demonstrated in a multi-country, multicenter study conducted in
the SEAR

SECTION 2:
KNOWLEDGE OF RABIES AND
TRANSMISSION

Results:
Increased ability of identifying rabies as a virus
(19%)
Increased recognition of only mammals
transmitting rabies (16%)
Increased ability to identify that cows transmit
rabies (47.2%)

SECTION 2:
KNOWLEDGE OF RABIES AND
TRANSMISSION

SECTION 3:
ABILITY TO CORRECTLY ORDER POSTEXPOSURE PRECAUTION STEPS
Impact 4: Reduce Risks to Public Health
Reduce dog bites and Impact on rabies risk

Estimated only 20% of 19 million humans bitten (in

SEAR) receive one or more doses of PEP vaccine due to
lack of awareness
Key knowledge gap:
Correctly understanding post-exposure prophylaxis

SECTION 3:
ABILITY TO CORRECTLY ORDER POSTEXPOSURE PRECAUTION STEPS

Results
Increased ability to correctly order postexposure precautionary steps (40%)
Absolute rise of 87.5%

SECTION 3:
ABILITY TO CORRECTLY ORDER POSTEXPOSURE PRECAUTION STEPS

LIMITATIONS & REVISIONS

Accessibility and time constraints

Large classes of students
Selection bias
Reliance on students to self complete questions
Poor English comprehension
Unwillingness for students to answer questions
that they were unsure of the correct response

CONCLUSION
Gauged requirements for future programs
Evidence for incorporation into school curriculum

INTERNING AT
October December 2014 within the Dept of Control of
Neglected Tropical Diseases, under Dr Bernadette Abela Ridder
Organising the 4th International Meeting on the Control of
Neglected Zoonotic Diseases
Creation of bite prevention
and rabies oriented
educational booklets with
WHO, GARC for South Africa
as part of the Kwa Zulu Natal
Rabies Elimination Program

ACKNOWLEDGEMENTS
Vets Beyond Borders:

Charmaine Tham
Kate Abel
Thinlay Bhutia
Helen Byrnes

University of Melbourne Vet Faculty

Simon Firestone
Colin Wilks
Mark Stevenson

External veterinarians

Gabrielle Carter, Robert Holmes, Alan Sherlock