Community-based Rabies Control in Kenya

Kisumu district, with its capital Kisumu city, is situated along the shores of Lake Victoria, Western Kenya. About sixty percent of the population live in semi-rural low income villages and domestic dogs are frequently kept, mainly for security purposes. In 2009, Kisumu district Hospital received an alarmingly high number (1623) of patients with dog bite injuries. The hospital had no rabies vaccines for post-exposure prophylaxis (PEP) and the patients had to buy the vaccine from local chemists at very high prices (USD 95). Dogs in this community are rarely vaccinated and turn out for previous dog vaccination campaigns organised by the veterinary department have been very poor. Hence there was concern about dog bite victims contracting rabies, and seven suspect human rabies cases were reported following dog bites in 2009.

In January 2010, the Veterinary department was called upon by the District disease control committee to start a rabies control and responsible dog ownership program. Dogs were rarely restrained and it was common to see many free-roaming dogs in the peri-urban market centres. In order to improve the situation, the Vet department employed a "community-based approach". Inadequate information sharing between the public health department, the district Veterinary office (DVO) and hospital cases was identified as a weakness in rabies surveillance activity. An arrangement was therefore put in place between the veterinary and human health departments that a dog bite register be opened at the Kisumu district hospital. Any person visiting the hospital with a dog bite injury would also be told to report to the DVO.

The DVO conducted a census to estimate the dog population in villages through a household survey, enlisting the services of the village elders and the assistant chiefs. The village elders used a simple proforma to collect the dog data in the households under their jurisdiction. The survey included information on the number of dogs per household, their sex, age, and vaccination status. The results indicated that over 90% (14,000) of dogs in the district had homes or owners, and that only about 7% of the owned-dog population had been vaccinated against rabies in the past 12 months. Following these findings the DVO devised a two part approach; community education on rabies control, and application of the law to enforce dog vaccination and responsible dog ownership. The veterinary team headed by Mr. Omemo conducted a series of meetings with the village elders to raise awareness on the risks associated with dog bites, rabies vaccination against rabies and the role the village elders could play in community policing of irresponsible dog ownership.

In September 2010, the month of World Rabies Day, Mr. Omemo was given free air time by a local community FM radio station to discuss dog bite injuries and rabies in the community. The talk show was on air for four months and created a huge impact on case reporting of suspected rabid dog bites to the veterinary office. The main concern of the people who report dog bite injury to the district veterinary office was how to get rabies PEP following the advice given during the talk shows.

The DVO came up with an arbitration process within the provision of the Kenyan law (the Rabies Act, cap 365) to make the owners of the offending unvaccinated dogs meet the cost of rabies PEP for the victims. This approach was made possible because village elders were able to trace the households owning the offending dogs. The arbitration strategy enabled the dog owners to understand the risks associated with bites from their unvaccinated dogs. Such dogs usually disappear from home after getting infected with the rabies virus. Dog owners opted to meet the cost of PEP rather than get charged in a court of law, for a possible two offences, failure to vaccinate their dogs under the Rabies Act (cap 365) and criminal negligence under the Kenya Penal code subsection 243(b).

Between April 2010 and April 2011, a total of 72 cases were successfully arbitrated and the owners of the dogs met the cost of treatments. The village elders were requested to assist in community policing of unvaccinated dogs in their respective villages. The strategy led to a higher response by dog-owners seeking dog vaccination from the vet department. However, the vet department did not have enough vaccine to meet this new demand. They approached Kenya Medical Research Institute (KEMRI) for a donation. Dr Eric Ogola , a veterinarian at KEMRI/CDC liaised with other partners including Dr Sarah Cleveland and Intervet who donated 4000 doses of rabies vaccine through the KEMRI/CDC program in Kisumu. This facilitated community vaccination of dogs. The DVO also benefits from logistical and epidemiological support from the Centres for Disease Control (CDC) through the intersectoral collaboration.

By the end of October 2011, 6,457 (49% of) village dogs had been vaccinated, surpassing the tally of the previous three years campaign in the district. This achievement was driven by the multi-sectoral approach (mass media, village elders, arbitration efforts and the rabies Act) applied by the Veterinary team. The results demonstrate that community-based approaches to rabies control should include effective communications strategies, collaborations and application of existing laws as a feasible way of achieving rabies vaccination compliance and responsible dog ownership in rural communities.

Contributed by Peter Omemo [MPH (Epidemiology &Popln.Hlth), Bsc (Env.Hlth), Dip.( Animal Hlth.), Dip.(Env. Res.Mgt.), Cert. GIS].He is currently working with the veterinary department (VPH) in Kisumu district, Kenya. He is exploring application of community –based models to achieve sustainable rabies prevention and control.