Rabies is a fatal viral zoonotic infection caused by a Lyssavirus. Rabies exerts a
major public health and economic burden; it is responsible for at least 55,000
deaths worldwide, predominantly in Africa and Asia. More than 90% of rabies
deaths are caused by domestic dogs. Global expenditure on rabies prevention
and control exceeds US$500 million per annum. Although human rabies is 100%
preventable, through vaccination of animal reservoirs and post-exposure
prophylaxis (PEP) of people exposed to bites, no effective large-scale control of
rabies has been achieved in sub-Saharan Africa.
Effective implementation of sustainable rabies control and prevention programs,
involves full participation of individuals, veterinary and medical services.
Veterinary services must control rabies transmission through mass dog
vaccination campaigns because human deaths are caused by epidemics in
domestic dogs, medical services must provide PEP to prevent disease in exposed
individuals and exposed individuals must seek PEP and dog owners must take
their dogs to be vaccinated. This thesis focuses on factors affecting individuals
and medical services.
This thesis examines challenges in the control and prevention of rabies in subSaharan
Africa. Firstly, to address these challenges, we developed an analytical
framework to portray the influence of individual and institutional factors within
both the veterinary and medical services, in controlling and preventing rabies.
The research carried out in chapters two and three investigate different aspects
of this framework. Specifically in Chapter 2, we conducted a knowledge,
attitude and practice (KAP) survey in seven districts covering southern, central
and northern Tanzania. We used the collected data to investigate factors that
influence knowledge of rabies and how knowledge of rabies influences attitudes
and practice in control and prevention of rabies. Our findings show that
knowledge about rabies in Tanzania is limited. However, we found an indication
that those who were more knowledgeable of rabies claimed to practise better
rabies control and prevention. In Chapter 3, we collected information using
contact tracing and questionnaires to evaluate the burden of rabies and its