Knowledge and practices towards rabies and determinants of dog rabies vaccination in households: a cross sectional study in an area with high dog bite incidents in Kakamega County, Kenya, 2013

Introduction: an estimated 55,000 people die from rabies annually. Factors promoting dog vaccination, estimates of vaccination coverage and knowledge on rabies are important for effective rabies control. We sought to establish these estimates at household (HH) level and whether rabies knowledge is associated with proper control practices. Methods: cross-sectional cluster survey with two-stage sampling was employed in Kakamega County to enroll HH members above 18 years. A set of questions related to rabies knowledge and practice were used to score participant response. Score above the sample mean was equated to adequate knowledge and proper practices respectively. Independent t-test was used to evaluate the differences of sample mean scores based on dog vaccination status. Bivariate analysis was used to associate knowledge to practices. Results: three hundred and ninety HHs enrolled and had a population of 754 dogs with 35% (n=119) HH having vaccinated dogs within past 12 months. Overall mean score for knowledge was 7.0 (+/- 2.8) with range (0-11) and 6.3 (+/- 1.2) for practice with range (0-8). There was a statistically significant difference in mean knowledge (DF=288, p<0.01) and practice (DF=283, p=0.001) of HH with vaccinated dogs compared to ones with unvaccinated dogs. Participants with adequate rabies knowledge were more likely to have proper health seeking practices 139 (80%) (OR=3.0, 95% CI=1.4-6.8) and proper handling practices of suspected rabid dog 327 (88%) (OR=5.4, 95% CI=2.7-10.6). Conclusion: rabies vaccination below the 80% recommended for herd immunity. Mass vaccination campaign needed. More innovative ways of translating knowledge into proper rabies control practice are warranted.