Rabies, a zoonotic viral disease, remains a significant public health concern in Zambia. It causes fatal encephalitis in humans and other mammals. Annually, rabies claims approximately 59,000 human lives globally. The majority of these fatalities occur in rural areas, where canines are the primary reservoir of the disease. In Zambia, rabies is an endemic notifiable disease in both humans and animals.
Rabies can be transmitted between all warm-blooded species, including humans, through bites or scratches from infected animals. Domestic dogs are responsible for the transmission of most human rabies cases in developing countries. Once the central nervous system is invaded, rabies infection progresses rapidly, leading to death due to respiratory failure or cardiac arrest.
Fortunately, rabies post-exposure prophylaxis (PEP) can prevent rabies in humans exposed to the rabies virus. The control of rabies, as recommended by the World Health Organization (WHO), includes mass dog vaccination campaigns and strict dog population control through restricted breeding, movement restrictions, and culling of unwanted dogs.
Despite these control measures being in place for about 50 years, only a few developed countries are currently rabies-free. In developing countries, where the prevalence of rabies is still significantly high, dog vaccination is a challenge.
Current Rabies Control Strategies in Zambia
The current rabies control strategy in Zambia is based on dog vaccination, dog population control, and dog movement restrictions, as articulated in the Control of Dogs Act within the Laws of Zambia. In Zambia, rabies is regarded as one of the endemic scheduled or notifiable diseases and stipulates that "animal owners vaccinate their animals against all scheduled or notifiable diseases". To earn this prestigious recognition, countries must adhere to the WOAH International Standards, and their applications undergo rigorous evaluation to ensure the effectiveness of their measures. Zambia has an estimated population of 968,372 dogs and 411,221 cats (source: Zambia National Rabies Control Plan), and grapples with this pressing issue. As in other rabies-endemic countries, domestic dogs are the main transmitters of rabies in Zambia.
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Zambia has undertaken several successful initiatives as part of its rabies control strategy. These include mass dog vaccination campaigns that have been conducted in various districts, utilising innovative tools such as the Rabies Vaccination Tracker Tool, DHIS2 and WVS application on smartphones to ensure that the veterinary services keep track of vaccination data, to measure progress towards achieving the recommended coverage of 70% vaccinated dogs. Previously, the focus was primarily on prophylaxis in humans, which proved costly and resource intensive.
The current control measures, including dog vaccination, population control, and movement restriction, guided by 'The Control of Dogs Act Chapter 247 of the Laws of Zambia', have not yielded the desired impact in many areas of the country including Manyinga and Mwansabombwe districts.
Map of Zambia showing provinces. Source: Wikimedia Commons
Challenges in Rabies Control
Despite the efforts, rabies persists as a longstanding issue in Zambia. Despite extant legislation mandating canine vaccination, the districts of Manyinga and Mwansabombwe persistently report suboptimal figures regarding vaccinated canines, unrestricted canine movements, and an escalating incidence of animal and human rabies cases, in addition to canine bites, National Livestock Epidemiology and Information Centre (NALEIC) reports.
Aligned with global aspirations to achieve zero human rabies cases by 2030, this study scrutinizes the determinants and obstacles hampering the execution of rabies control initiatives in Manyinga and Mwansabombwe.
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In Zambia, the actual dog population is not well known, but it is widely assumed that only a small percentage of the Zambian dog population is vaccinated against rabies. Despite the estimated low number of vaccinated dogs in the country, the number of notified dog bite cases has continued to rise.
Veterinary records in Nyimba district also show that there has been a steady increase in the number of notified dog bite cases from 84 recorded in 2013 to 134 cases recorded in 2014. The rise in dog bite cases has led to an increase in the demand for PEP in the district as most of the victims bitten by unvaccinated dogs require prophylaxis.
Although a number of mass dog vaccination campaigns have been carried out in the district, the coverage has been very poor and the majority of the dog population remains unvaccinated. Thus, both the dog and human population are at risk of rabies infection.
Community Knowledge and Vaccination Coverage
Studies have shown that the common assumption that dog vaccination in developing countries is hindered by operational constraints such as lack of dog population knowledge, low public rabies knowledge and inadequate implementation resources, may be erroneous.
In Nyimba district of Zambia, dog vaccination coverage is low, but the incidence of dog bites is high, which places the community at risk of rabies infection. The study found that the community had adequate knowledge about rabies prevention in dogs and humans. The area of residence, the age, and financial capacity of the dog owner determined whether or not the household dog was vaccinated or not.
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The survey of the 300 households revealed that only 8.7% of the dogs were vaccinated against rabies, and the dog bite case record review showed that the majority of the dog bite cases were caused by unvaccinated dogs most of which were owned.
Dog vaccination coverage overall was 8.7% (57/655), with 3.4% (22/655) in urban areas, 1.8% (12/655) in peri-urban and 3.5 (23/655) in the rural regions. Financially stable households were more likely to have their dogs vaccinated. Only 10.3% (31/300) of the respondents had vaccinated their dogs and these had a reliable source of income as 6% (18/300) were peasant farmers, 2% (6/300) were dependants whose guardians were financially stable and 2.3% (7/300) were in steady employment.
The WHO recommends that vaccinating at least 70% of the dog population against rabies over consecutive years may interrupt rabies transmission chains amongst dogs. In Zambia, the actual dog population is not well known but it is widely assumed that only a small percentage of the Zambian dog population is vaccinated against rabies.
The respondents generally had a fairly good idea as to what rabies was and consequences of infection. The local name for rabies in Nsenga is 'Kambwambwa' which means a disease of madness in dogs. Approximately 94.7% (284/300) of the respondents related rabies in humans and animals to loss of sanity which eventually led to death. The transmission of rabies was linked to dog bites by 97% (291/300) of the respondents. The general belief was that rabies causes madness in dogs and once bitten by a rabid dog the ...
Analysis of Rabies Cases in Zambia
An analysis of suspected rabies cases recorded in Zambia between 1985 to 2004 found 1,088 rabies positive samples from various species, 747 of which were from dogs and 98 were from humans. Another analysis of brain samples collected from suspected rabid dogs between January 2005 and December 2013 found 153 rabies positive cases.
A total of 225 rabies cases were reported between 2013 and 2022. The cumulative incidence rate was estimated at 23.2 cases per 100,000 dogs.
The rabies suspected cases analysis recorded in Zambia between 1985 to 2004 found 1088 rabies-positive samples from various species, of which 747 were from dogs and 98 were from humans [10,11]. Another analysis conducted on brain samples collected from suspected rabid dogs between January 2005 and December 2013 found 153 rabies-positive cases [13]. The aforementioned indicates that the dog-mediated human rabies and dog rabies burdens in the country are still a challenge.
The Zambian report on rabies was presented at the Southern and East African Rabies Group (SEARG) meeting of 2013; the number of notified dog bite cases in Zambia rose from 620 in 2010 to 732 in 2011.
Global distribution of rabies. Source: CDC
Spatial and Temporal Analysis of Rabies
The temporal patterns observed in the regression model suggest seasonal variability in rabies transmission, with peaks in the early and late months of the year. These seasonal peaks are influenced by a combination of behavioral and ecological factors such as increased dog movement during mating seasons, greater human-dog interactions, or enhanced surveillance during specific times of the year. Understanding these dynamics is critical for planning and implementation of time-sensitive interventions.
The identification of both high and low risk spatial clusters provides critical insights for prioritizing rabies control interventions in Zambia. High-risk clusters, likely corresponding to areas with low vaccination coverage or higher dog populations, indicate regions where intensified control efforts are urgently needed. These areas would benefit from enhanced community engagement, robust routine vaccination campaigns, and strengthened disease surveillance.
The application of spatial scan statistics, offers valuable evidence for guiding resource allocation in alignment with the national rabies elimination strategy. Additionally, Namibiaâs successful implementation of oral rabies vaccination (ORV) campaigns, particularly targeting hard-to-reach and free-roaming dog populations as demonstrated a high bait uptake and vaccination coverage, providing a promising complementary strategy for rabies control in Zambia.
Integrated Bite Case Management (IBCM)
To bolster their efforts, Zambia has embarked on an Integrated Bite Case Management (IBCM) programme, involving collaboration between health centres, the police, and veterinary officials to respond swiftly to dog bite incidents.
Zambiaâs approach to rabies control exemplifies the One Health principle, emphasizing collaboration among different sectors to address zoonotic diseases comprehensively.
Study in Manyinga and Mwansabombwe Districts
This studyâs main objective was to identify barriers to rabies prevention and control in the Manyinga and Mwansabombwe districts. Methodologically, the research interrogated the knowledge, attitudes, and practices concerning rabies within the general populace and pet owners.
The study was conducted within the geographic confines of the Manyinga district, situated in the Northwestern Province, and the Mwansabombwe district, located in the Luapula Province of Zambia. Manyinga is positioned at an approximate distance of 331 km from the provincial capital, Solwezi, and 950 km from the national capital, Lusaka. Mwansabombwe is situated approximately 939.5 km from the national capital, Lusaka.
A cross-sectional study was used that included household questionnaires, interviewing key informants, and evaluation of rabies vaccination and dog bite case records.
Households were randomly selected using cluster design because of how widely dispersed households are in the Manyinga central camp and Mwansabombwe districts. All respondents to the questionnaire were informed of the purpose of the study and consent for participation was obtained.
Rabies sensitization and awareness campaigns were conducted across the districts for 3 months following the initial questionnaire survey. These campaigns utilized local radio stations and disseminated posters translated into the local language to promote better acceptance and facilitate a clearer understanding of the presented message. The posters were strategically displayed in various locations, including schools, clinics, markets, churches, residences of village headmen, and all communal gathering points.
The study was approved by the board of graduate studies (School of Veterinary Medicine, University of Zambia) and ethical clearance was granted by ERES CONVERGE IRB (Ref.No.2021-Jun-023).
A total of 301 individuals participated in both the pre-sensitization and post-vaccination surveys in Manyinga district. In both surveys, the majority of respondents were female, had acquired some level of formal education, resided in rural areas, and were pet owners.
In relation to pre-sensitization knowledge, the majority (88%) of respondents in Manyinga were already familiar with rabies. Post-sensitization, there was a notable improvement in knowledge.
Among respondents who owned dogs, the majority were between the age range of 15-25 years, female, rural based that is (65.9% and 60.7%) pre and post-sensitization respectively, and had at least attained secondary level of education in both surveys. Post-sensitization, the knowledge and attitude of dog owners toward rabies prevention and control remained consistent.
In the pre-vaccination survey, a noteworthy association between education (P=0.011) and occupation (P=0.044) with rabies knowledge was identified.
From the two conducted surveys, there was a higher participation of females. In both districts, the majority of respondents had attained some form of formal education. Specifically, in Mwansabombwe, most respondents were farmers, while in Manyinga, respondents were predominantly students. Moreover, Mwansabombwe had fewer respondents from households owning pets compared to Manyinga.
In terms of rabies knowledge, 88% of respondents from both districts had prior awareness of rabies. Notably, Mwansabombwe respondents exhibited a higher level of information regarding prevention (82%), signs of rabies in animals (77%), and signs of rabies in humans (69%).
Among respondents who owned dogs, the majority demonstrated awareness of rabies, knowledge about signs of rabies in animals, prevention and control measures, the mode of transmission, signs of rabies in humans, and adherence to pet vaccination. Mwansabombwe had a higher number of well-informed participants compared to Manyinga.
Recommendations
Current rabies control strategies in Nyimba district, Zambia, appear quite limited. Improvements in the regional dog vaccination program may provide benefits. Enhancement of educational efforts targeting behavioural factors may also prove useful.
To effectively reduce the rabies incidence in the high-risk provinces identified in this study, there is a need to strengthen mass dog vaccination campaigns, especially in the months preceding peak transmission (January and October). Public awareness campaigns should be conducted through community radio, schools, and health outreach programs to increase knowledge about rabies prevention and reporting.
Further, involving local leaders and community animal health workers in surveillance and dog population control could enhance early detection and response. Improving rabies surveillance remains essential. This includes enhancing the capacity of veterinary personnel to conduct active case detection, improving community-based reporting systems, and integrating rabies surveillance into the national electronic surveillance system to ensure timely and reliable data reporting.
Sample collection and laboratory confirmation also require urgent attention. Most rural districts remain far from the Central Veterinary Research Institute (CVRI) in Lusaka, making timely submission of samples for confirmation difficult. Therefore, District Veterinary Officers and Veterinary Assistants should be trained and equipped with proper tools for brain sample collection from suspected rabid dogs.
Provision of cold boxes, personal protective equipment, and transport would greatly facilitate safe and timely sample referral. In addition, strengthening regional laboratory capacity to diagnose rabies at a decentralized level would ensure rapid case detection and reduce delays in response. Laboratories at the provincial or regional level should be capacitated with equipment, reagents, and trained personnel to conduct rabies diagnostics using field-based diagnostics tools such as Direct Rapid Immunohistochemical Test (dRIT) and Lateral Flow...
Nonetheless, overcoming these logistical challenges and addressing community perceptions about vaccination are ongoing efforts that are a priority for the Zambia government.
In conclusion, rabies remains a significant public health challenge in Zambia. Addressing this issue requires a comprehensive approach that includes mass dog vaccination, community education, improved surveillance, and intersectoral collaboration. By implementing these strategies, Zambia can move closer to achieving the global goal of zero human rabies cases by 2030.
Rabies Vaccination Steps. Source: CDC
Rabies, Causes, SIgn and Symptoms, Diagnosis and Treatment.
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