Peter Omemo, MSc, MPH, BSc (P. Hlth), Dip. (An. Hlth), PhD
Animal bites of humans are a serious public health problem and have been well documented worldwide (Knobel et al. 2005). They are a major cause of rabies, an invariably fatal disease resulting from infection with the Lyssavirus. Rabies is a zoonosis via a wide range of mammals (Rupprecht 2002). Among all deaths from rabies, over 99% occur in the developing world and result from bites from rabid dogs. The cost of rabies post-exposure prophylaxis (PEP) is estimated at U.S. $583.5 (95% CI: 540–626) million in Asia and Africa (Knobel et al. 2005).
In Kenya, the disease has existed with varying incidence levels since 1912 when the first case of rabies was diagnosed in a dog (Hudson 1944; Karuiki 1988). The first human case was a woman in western Kenya, around Lake Victoria basin in 1928 (Hudson 1944). Like in most of the developing world, the domestic dog is the major transmitter of rabies to both humans and livestock in Kenya.
Rabies control strategies in Kenya include the traditional mass vaccination of dogs and animal movement control (Kitala 2001). The major constraints to the effective control of rabies in the country are inadequate resource allocation, poor infrastructure and lack of proper logistics, rather than technical competence.
Kisumu County, situated along the shores of Lake Victoria, Kenya is still rabies endemic. Veterinary and public health departments in the region are generally poorly funded to undertake rabies control programmes (Omemo et al. 2012). The county has a high human population density, approximately 3060/km2, and keeping pet animals (particularly dogs and cats) is a common practice among the residents. In 2011–2012, there was a rabies outbreak in the Kisumu municipality, and at its peak the Kisumu District Hospital was receiving an average of six rabid animal bites of human cases daily. Nevertheless, rabies post exposure prophylaxis (PEP) vaccine is not listed among the essential supplies in the health services in Kenya. Animal bite victims have to purchase the PEP vaccine from local chemists, at a cost which a majority of the victims could hardly afford. Three human deaths were confirmed within the Kisumu municipality. It was against this background that Animal Welfare and Public Health (AWAPH), a local community-based organisation, joined the rabies control campaign in Kisumu County.
The AWAPH programme aimed at (i) providing epidemiological support to the veterinary and public health departments in Kisumu County, (ii) facilitating canine vaccination campaigns, (iii) conducting primary school children's rabies awareness campaign, (iv) conducting village-to-village rabies awareness campaigns, (v) conducting advocacy (responsible dog ownership) and lobbying the county administrators to support rabies control campaigns.
Between June and December 2012, 5 district commissioners (n = 5), 64 chiefs (n = 70), 94 village elders (n = 112) in Kisumu County had been sensitized (trained) on rabies prevention and control. Three hundred and eighty-four primary school teachers (n = 384) in Kisumu County had been trained on rabies prevention and animal bite first aid. Ten thousand rabies awareness posters were distributed in primary schools in the county. An assessment carried out on the primary school children showed that seven out of ten children could correctly explain "what to do when bitten by an animal" and "how to stop rabies." Hitherto, there is a steady increase in annual dog vaccination figures (18,400 in 2012, compared to less than 7000 in 2010/2011). There is also a steady decrease in monthly dog bite incidence in Kisumu municipality (from over 120 in December 2011) to less than seven persons in December 2013.
Discussion and Conclusion
Rabies control in Kisumu County, Kenya, like the rest of the country, is impeded by scarcity of both human and animal vaccines in government institutions, poor community awareness of the fatality of the disease, and ineptitude of the county government to the application of rabies control laws. However, enhanced dog rabies vaccination campaign and AWAPH model, and community policing of "responsible animal ownership" has proved very successful in Kisumu County.
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