KAP 2007

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KAP survey on rabies in a community in Sri Lankaスリランカにおける狂犬病に対する地域住民のKAP調査 北　海　道　大　学大学院医学研究科　国際保健医学分野Gino Cuarto Matibag6 February 2007

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Rabbas: to do violence

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Global incidence of human rabies 2000-2005* * - WHO † - Ministry of Health Sri Lanka Sri Lanka 55 cases (2005)† * - WHO † - Ministry of Health Sri Lanka Sri Lanka 55 cases (2005)†

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DOG FOX BAT DOG WOLF FOX BAT MONGOOSE、DOG、 FOX、JACKAL BAT BAT DOG BAT、RACCOON、SKUNK、 COYOTE、FOX MONGOOSE Important reservoirs of rabies in the world

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Neglected diseases:Rabies’ health burden with intervention * - Disability-adjusted life years WHO, 2004

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Neglected diseases:Rabies’ health burden without intervention * - Disability-adjusted life years WHO, 2004

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Define a global standard for the production, quality control, & regulation of therapeutic sera Train inspectors & manufacturers on critical parameters of the production of therapeutic sera Facilitate transfer of technology to developing countries Etc. WHO to increase treatment access for victims of rabies & snake bites* * - WHO, Geneva

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Pathogenesis 100% fatality once symptoms manifest Photo courtesy of Dr Elizabeth Miranda

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Rabies in Japan 1897-2006* * - Ministry of Health, Labour and Welfare

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Tsunami 26 Dec 2004

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Projects of Hokkaido University in Sri Lanka

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Human rabies in Sri Lanka, 1964-2005*スリランカにおける狂犬病の年次別発生数と症例数（１９６４－２００５年） National Rabies Control Program * - Ministry of Health Sri Lanka

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Animal rabies in Sri Lanka, 1995-2003*動物の種類別狂犬病発生件数（1995～2003年） * - Ministry of Health Sri Lanka

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National Rabies Control Program * - Rabies Control Program, Ministry of Health Sri Lanka Human rabies, vaccinated & eliminated dogs in Sri Lanka, 1973-2004*ヒトの狂犬病の発生件数とワクチン接種および処分された犬数（１９７３－２００４年）

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Cost of rabies treatment in Sri Lanka* Annual expenditure by the Health Ministry Over 150 million rupees ($1.38 million) 84% - post-exposure prophylaxis 13% - dog vaccination & sterilization 3% - dog elimination Out-of-pocket spending Cost of vaccination with rabies immunoglobulin is 30-40,000 rupees ($280-370) * - Prof Ananda Jayasinghe, University of Peradeniya

Objectives : 

Objectives To determine the level of knowledge, attitude and practice (KAP) on rabies in selected communities. To compare the KAP on rabies of Urban and rural areas Pet owners and non-pet owners. 地域における狂犬病に対する「KAP」（Knowledge、Attitude、Practice）のレベルを調査すること 都市部・農村部別およびペットの有無別によってKAP調査結果を比較すること

Methods : 

Methods Design: cross-sectional study Venue: Kandy District, Sri Lanka Period: May 2006 Sample population: 1570 household heads Respondents: Household heads (≥15 years old) Survey tool: in-person interview by questionnaire Statistical analysis: Descriptive statistics (frequency distribution) & Chi-square/Fisher’s exact test Logistic regression

Table 1: Household profile : 

Table 1: Household profile * - Dept of Census and Statistics Sri Lanka, 2005 † - Dept of Census and Statistics Sri Lanka, 2002

Table 2A: Knowledge of rabies : 

Table 2A: Knowledge of rabies

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Table 2B: Knowledge of rabies

Table 3A: Health attitude and practice : 

Table 3A: Health attitude and practice

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Table 3B: Health attitude and practice * - Medical Research Institute

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Table 3C: Health attitude and practice

Table 4: Pet care : 

Table 4: Pet care

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Table 5A: KAP odds ratios by pet ownership * - Doctor/hospital ‡ - Native/traditional healer/None/Uncertain

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Table 5B: KAP adjusted odds ratios by pet ownership* * - Adjusted odds ratios for urban or rural areas, gender, education, religion, ethnicity & pet ownership † - Doctor/hospital ‡ - Native/traditional healer/None/Uncertain

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Discussion There is a high level of awareness (source of rabies, its fatal nature, prevention by vaccination & where to obtain dog vaccines.) High level of knowledge may be due to availability of information from various sources. Rural respondents were more aware of the fatal nature of rabies probably because they are more receptive to government vaccination campaigns.

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Discussion Respondents seem to be cooperative to rabies control program due to their positive attitude toward pet registration, animal birth control, & destruction of rabid pets & stray animals. Health practices are not consistent with knowledge & attitude. Few would report animal bite incidents, send animal specimen, & poor pet care practices such as low vaccination rate & more dogs are allowed to roam freely. Due to free health care from government hospitals, majority would seek medical care.

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Study limitation Non-random selection of respondents Topography & distribution of houses Weather condition Interviewers’ security

Conclusions : 

Conclusions The level of awareness about rabies & the acceptability of control measures are high. There is a significant difference in the attitudes and practices to rabies control between urban & rural areas. Poor practices may reflect the inaccessibility to facilities & services that would enable community participation in rabies control.

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To increase accessibility to rabies control facilities: Local authorities could facilitate the transfer of specimens to laboratory. Decentralization or establishment of satellite laboratories is another option. Recommendations

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Regular vaccination of animals is an acceptable measure. Increased access to vaccination sites especially in remote areas & intensified oral vaccination for inaccessible animals would complement parenteral vaccination measures. Rabies control program should give close attention to rural areas & non-pet owners who may perceive that animal bite is a remote possibility. Recommendations

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Zero grazing of human rabies in 2008

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Acknowledgment All respondents & local government officials of the 26 survey areas Students & staff members of the University of Peradeniya Ethics Committees of Hokudai & the University of Peradeniya Dr Rosanna A Ditangco Prof H Abeygunawardena Hokudai’s 21st Century COE Program Japan Health Sciences Foundation Global Health Risk Management Network Project

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Doomo arigatoo gozaimashita