Incentives Increase Participation in Mass Dog Rabies Vaccination Clinics and Methods of Coverage Estimation Are Assessed to Be Accurate

In this study we show that incentives (dog collars and owner wristbands) are effective at increasing owner participation in mass dog rabies vaccination clinics and we conclude that household questionnaire surveys and the mark-re-sight (transect survey) method for estimating post-vaccination coverage are accurate when all dogs, including puppies, are included. Incentives were distributed during central-point rabies vaccination clinics in northern Tanzania to quantify their effect on owner participation. In villages where incentives were handed out participation increased, with an average of 34 more dogs being vaccinated. Through economies of scale, this represents a reduction in the cost-per-dog of $0.47. This represents the price-threshold under which the cost of the incentive used must fall to be economically viable. Additionally, vaccination coverage levels were determined in ten villages through the gold-standard village-wide census technique, as well as through two cheaper and quicker methods (randomized household questionnaire and the transect survey). Cost data were also collected. Both non-gold standard methods were found to be accurate when puppies were included in the calculations, although the transect survey and the household questionnaire survey over- and under-estimated the coverage respectively. Given that additional demographic data can be collected through the household questionnaire survey, and that its estimate of coverage is more conservative, we recommend this method. Despite the use of incentives the average vaccination coverage was below the 70% threshold for eliminating rabies. We discuss the reasons and suggest solutions to improve coverage. Given recent international targets to eliminate rabies, this study provides valuable and timely data to help improve mass dog vaccination programs in Africa and elsewhere.Author Summary: It is estimated that 59,000 people die from canine-mediated rabies each year, over 99% in developing countries where rabies is endemic and nearly half of the victims are children. The annual global cost has been estimated at 8.6 billion dollars. Yet with highly effective vaccines and a single species of reservoir host (the domestic dog) rabies is entirely preventable through mass dog vaccination. These disease burden statistics, and the evidence that dog vaccination is highly effective at eliminating human rabies, have led the World Health Organisation (WHO), together with the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE), to unite in their joint commitment to the global elimination of canine rabies. To be successful in this, vaccination campaigns must routinely achieve the 70% coverage levels required for rabies elimination. We used a mass dog rabies vaccination campaign in northern Tanzania to assess the accuracy of methods used for estimating coverage. Additionally we assessed the impact that incentives had on vaccination turn out. Our data showed that, despite under- and over-estimating the coverage respectively, both household questionnaire and mark-re-sight surveys were accurate when compared to a gold-standard method for estimating coverage. Given this tendency to provide a conservative estimate, whilst also providing opportunities for valuable demographic data to be collected, we recommend the household questionnaire survey method. Our data also indicated that the provision of incentives did significantly increase the number of dogs brought for vaccination.