A community-based knowledge, attitude, and practice survey on rabies among cattle owners in selected areas of Bhutan

Rabies remains a disease of significant zoonotic and economic concern in rabies endemic areas of Bhutan. Rabies outbreaks in livestock threaten the livelihoods of subsistence farming communities and pose a potential public health threat. As a part of identifying approaches to prevent rabies in cattle, a Knowledge, Attitude, and Practice (KAP) survey was conducted among cattle owners in selected rural areas of the southern rabies high-risk zone and low-risk zone in eastern Bhutan. Between March and April 2017, 562 cattle owners (281 in the east and 281 in the south) were interviewed using a questionnaire. Eighty-eight percent of the participants had heard of rabies but only 39% of the participants who had heard of rabies had adequate knowledge about rabies. Multivariable logistic regression analysis showed that residing in the south [OR = 9.25 (95% CI: 6.01–14.53)] and having seen a rabies case [OR = 2.46 (95% CI: 1.6–3.82)] were significantly associated with having adequate knowledge about rabies. Based on our scoring criteria, 65% of the total participants who had heard of rabies had a favorable attitude towards rabies control and prevention programs. The participants residing in the east were two times more likely to have a favourable attitude than their counterparts in the south [OR = 2.08 (95% CI: 1.43–3.05)]. More than 70% of the participants reported engaging in farm activities such as examining the oral cavity of sick cattle and assisting cattle during parturition. Only 25% of the participants reported using personal protective equipment while undertaking these activities. Despite a high level of rabies awareness, we observed that there is a lack of comprehensive knowledge about rabies regarding susceptible hosts, transmission routes, the health outcome of rabies infection in humans, and appropriate health-seeking behaviours. This study highlights the need to strengthen rabies education programs in rural communities to address the knowledge gaps that have been identified.Author summary: The impacts of rabies outbreaks in cattle and other livestock are multifold. At the local level, economic losses resulting from the direct loss of cattle and the animal’s future productivity is a significant threat to the livelihoods of subsistence farming communities. Besides, rabies in livestock poses a potential public health threat associated with human exposures that result during handling sick animals and dressing carcasses of animals that had died of rabies. Furthermore, the Government incurs costs for responding to outbreaks and providing post-exposure prophylaxis (PEP) to potentially exposed individuals. We conducted a KAP questionnaire surveys among cattle owners in two selected study areas of Bhutan to understand the level of rabies awareness among the cattle owners, their attitude towards rabies prevention and control and to identify existing on-farm practices that can result in potential exposure to rabies in animals and humans. We observed that there was a lack of comprehensive knowledge about rabies especially regarding the post exposure care and outcome of rabies infection in humans and animals. Given that most participants lacked knowledge about clinical signs of rabies in cattle their engagement in practices such as examining oral cavity, assisting cattle during parturition and dressing wounds without wearing minimal protective equipment, was concerning. Our study identifies the need to extend rabies education into the rural communities of Bhutan. Furthermore, our findings reiterate the importance of rabies education as a crucial component of the global initiative to eliminate dog-mediated rabies in humans and animals.