Knowledge, Attitudes, and Practices Regarding Rabies in El Jadida Region, Morocco
by
Khadija Bouaddi
1,2,*, 
Abdelali Bitar
2,
Mohammed Bouslikhane
3,
Abdesslam Ferssiwi
2,
Aziz Fitani
4 and
Philip Paul Mshelbwala
5 1
Provincial Veterinary Service of El Jadida, National Food Safety Office, ONSSA, El Jadida 24000, Morocco
2
Nutritional Physiopathology and Toxicology Team, Department of Biology, Faculty of Sciences, Chouaib Doukkali University, El Jadida 24000, Morocco
3
Department of Pathology and Veterinary Public Health, Institute of Agronomy and Veterinary Medicine Hassan II, BP 6202, Rabat-Instituts, Rabat 10000, Morocco
4
Private Veterinarian, El Jadida 24000, Morocco
5
Department of Veterinary Medicine, Faculty of Veterinary Medicine, University of Abuja, Abuja 900001, Nigeria
*
Author to whom correspondence should be addressed.
Vet. Sci. 2020, 7(1), 29; https://doi.org/10.3390/vetsci7010029
Submission received: 25 December 2019
/
Revised: 17 January 2020
/
Accepted: 6 February 2020
/
Published: 1 March 2020
Abstract
:The aim of this study was to evaluate the knowledge, attitudes, and practices regarding rabies in the El Jadida region, Morocco. We conducted a cross-sectional survey using a structured questionnaire among randomly selected residents across 24 study sites. In total, 407 respondents took part in the survey. The majority (367, 92%) were male and had no formal education (270, 66%). Some (118, 29%) believed that rabies does not affect humans. Most respondents (320, 79%) were aware that vaccination could prevent rabies, but nevertheless did not vaccinate their dogs (264, 64.9%) and allowed their dogs to roam freely in search of food. Some (52.8%) would visit traditional healers for treatment in the event of a dog bite incident. Age and educational level were found to be significantly associated with knowledge, attitudes, and practices (p < 0.05). Although respondents demonstrated some level of knowledge about rabies, overall this study reveals critical gaps in their attitudes and practices. These shortcomings may be associated with a low level of education. Therefore, decision-makers need a new approach to control rabies, with a special focus on public awareness and health education, in order to sustain rabies control programs.
1. Introduction
Rabies causes a viral encephalitis that kills over 50,000 people every year [1].The majority of victims are in developing countries of Africa and Asia [2]. Most cases are due to domestic dog bites; as such, controlling the infection in the dog population is the most cost-effective way of controlling rabies [3]. In Africa, most cases of rabies are neither identified nor reported [4,5], consequently posing a huge challenge for rabies surveillance and control. Upgrading public knowledge coupled with improving knowledge, attitudes, and practice (KAP) surveys could support the prevention and control of rabies [6,7,8,9].
Rabies is widely distributed in Morocco, with an average of 391 animal and 22 human cases each year [10]. The close relationship between the human and canine population is a major risk factor for disease occurrence [11]. There is a large dog population (about 2,798,126) and low vaccination rate (<20%) in Morocco; coupled with unrestricted movement and reproduction, these factors may complicate rabies control efforts [12]. El Jadida is second in Morocco in terms ofthe incidence of human rabies cases [13]. Reports of rabies are very frequent in El Jadida, with 23 deaths each year between 2000 and 2017, and 15,625 dog bite cases.
There has been no proper assessment of KAP as it relates to rabies among the residents of El Jadida. Evaluation of KAP regarding rabies among high-risk groups could serve as an epidemiological tool and a basis for the development of rabies health promotion and intervention strategies in Morocco. This study aims to evaluate knowledge about rabies in the rural population, and the impact of people’s attitudes and practices on the persistence of rabies in the province of El Jadida, Morocco, in order to understand the disease, with the goal of achieving the World Health Organization (WHO) 2030 elimination plan.
2. Materials and Methods
2.1. Study Area
El Jadida province, one of 12 regions in Morocco, is part of the Casablanca–Settat region (Figure 1). It is among the most important agricultural provinces of the country. The proximity to the Atlantic has shaped the climate of the region, which is subject to maritime influences. In parallel with agriculture, most farmers practice intensive breeding of sheep, cattle, goats, and equines, in addition to the low court and beekeeping. Thanks to good weather conditions, livestock numbers in the region have increased slightly in recent years. Indeed, in 2012 the total livestock count, all species combined, was 3018 thousand head, representing 11% of the total count at the national level. It was distributed as follows: 2421 thousand head of sheep, 5497 thousand head of cattle, and 46 thousand head of goats [14].
2.2. Survey of the Rural Population
We conducted a cross-sectional study between March and May 2018 among residents of El Jadida. In total, 407 respondents in 24 rural communes took part in the survey.
2.3. Survey Method
A structured questionnaire was designed and pretested using oral interviews among residents in the study area. After validation, we administered the questionnaire to randomly selected respondents within 48 douars (villages) from a formal list provided by the local authorities (communal government officers).
Before conducting the survey, three supervisors organized an orientation session for interviewers on the use of the questionnaire and the consent form. Each questionnaire consisted of 49 questions in four sections: biodemo graphic information, rabies knowledge, animal bite attitudes, and bite treatment practices. Only participants who gave their consent took part in the study. The Ethics Committee of the Nutritional Physiopathology and Toxicology Team, Department of Biology, Faculty of Sciences, Chouaib Doukkali University, approved the study.
2.4. Statistical Analysis
We used Epi Info (version 7.2.2.2 package) statistical software from the Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) to analyze the data. We present demographic variables using descriptive statistics and calculate the mean of KAP. We used chi-square test to test for association between KAP and certain sociodemo graphic factors (gender, age, education). We considered a p-value < 0.05 to be statistically significant.
3. Results
3.1. Community Members
Out of the 407 respondents, 376 (92.4%) were male, 290 (71.2%) were older than 40 years, 24 (5.9%) were civil servants, while 351 (86.2%) were farmers. Based on the level of education of respondents, 270 (66.3%) had no formal education, while only 19 (4.7%) had tertiary education. About 93.4%had at least one dog or more than one dog and 20.4% had a history of dog bite (Table 1). There was no significant difference in history of dog bite for those who currently owned a dog and those who did not (p > 0.05). Most people who had been bitten admitted that the bites were caused by neighbors’ dogs or stray dogs.
3.2. Knowledge about Rabies
Table 2 summarizes the survey results of the rural population’s knowledge of rabies. Indeed, all participants in this study had heard about rabies. Almost 75.9% of them confirmed the presence of rabies in Morocco and 89.2% knew that it is a fatal disease. Also, 93.4% knew that dogs are a common source of rabies virus in Morocco. More than 50% of respondents had little knowledge about rabies transmission and did not know that rabies affects the nervous system, while 30% believed that rabies does not affect humans. Only 45.9% were able to describe some rabies symptoms (severe behavioral changes and unexplained paralysis that worsens over time). In addition, 35% of respondents said that rabies does not affect other mammals.
3.3. Attitudes toward Dogs
According to the results in Table 3, 30% had the view that dogs can roam freely and 40% said they allowed their children to play with dogs irrespective of their vaccination status. About 54.3% admitted that dogs should be killed on sight if implicated in a biting incident. In addition, 64.9% of respondents reported that dogs should search freely for food and 52.1% had no objection to feeding unknown dogs.
3.4. Rabies Practices
About 44% of respondents did not know that post-exposure treatment starts with nonspecific treatment (washing the site of the bite with water and disinfectant). More than half would first seek treatment from traditional healers instead of going to a hospital. In response to the question about sterilizing dogs as a means of controlling the dog population, 45% of respondents did not agree with the practice and 54.3% preferred dog culling (Table 4).
3.5. Factors Associated with Rabies-Related KAP
Age and education were found to be significantly associated with KAP (p < 0.05) (Table 5). The level of KAP was low in adults compared to young people with a higher level of education (Figure 2). All respondents with a higher level of education had a good KAP with regard to rabies. Thus, level of education is closely associated with age (Figure 3).
4. Discussion
In this study, respondents demonstrated some level of knowledge about rabies signs; however, they were unable to describe the mode of rabies transmission. This is consistent with studies in other countries such as India [15], Malawi [16], Uganda [17], and Cameroon [18]. The low level of education as well as poverty, which is predominant in the study area, are possible reasons. Although the majority of respondents were aware that dogs are the major source of rabies in Morocco, they were oblivious to the role of other mammals. This finding is consistent with other reports in SriLanka [19] and Guatemala [20].
The level of awareness about rabies is influenced by several factors, such as age, sex, educational level [16], economic status [21], and religion [22]. In our study, no significant difference was found by gender, unlike a study done in North Carolina [23], which showed that women tended to have more knowledge. However, a study in Tanzania demonstrated that men were more knowledgeable when compared with women [24].
Our results indicate that young people had acceptable knowledge about rabies. This may be associated with the level of education among young people compared to adults. This finding is consistent with previous studies [15,23,25]. According to a survey in India, the proportion of respondents with adequate knowledge decreased with increasing age, less for women and those with less education. However, none of these associations was statistically significant in our study [26].
In this study, there was no association between dog possession and bite incidence. Most dog bite victim sad mitted that the bites were from neighbors’ dogs or stray dogs, unlike other studies [19,27,28], where dog owners were more likely to be bitten than non-owners. This is of great concern, as most of the dogs were reported to be unvaccinated and allowed to roam freely in the study area [10], which can provide a suitable condition for rabies transmission in El Jadida.
Certain respondents asserted that they had been bitten by dogs as children, which corroborates with evidence that children are the most vulnerable demographic for animal bites [5,29]. The increased frequency of dog bites among children may be due to their close relationship with dogs and their inability to protect themselves in case of dog attack. In addition, this study reveals that some families allow their children to play with dogs irrespective of their vaccination status. This may increase the incidence of bites and thus exposure to rabies.
Mass vaccination of dogs is necessary to interrupt the animal–human transmission cycle of rabies. According to WHO, vaccination coverage should reach at least 70% of the canine population in order to break this cycle [2]. In Morocco, the veterinary services organize free annual vaccination campaigns for dogs against rabies, but vaccination coverage rates have never exceeded 6% of the total canine population [8]. A possible explanation could be a low level of awareness among owners about the importance of dog vaccination. In addition, it might be difficult to restrain dogs that roam freely in search for food and present them at vaccination sites. In addition, people who are unaware of the risk of rabies may be less motivated to seek preventive care for their dogs.
Some respondents were completely unaware that they should wash a bite wound with soap and water for at least 15 min and seek medical help; this is a great public health concern. The percentage of respondents who were unaware is high when compared to other countries such as Cameroon, 18% [18]; Bangladesh, 2% [27]; and Ethiopia, 30.7% [30].
In Morocco, management of the canine population is carried out by eliminating stray dogs by either shooting them or poisoning them with strychnine. This is inefficient and counterproductive for vaccination programs [2], because dogs that are easy to vaccinate are also the easiest to kill, which leads to a reduction of the category of immunized dogs. Some respondents did not agree with dog sterilization and slaughtering as methods of preventing rabies in the dog population.
Although most respondents admitted awareness of the lethality of rabies disease, more than half confirmed that they consulted traditional healers in the event of a bite. In provinces where the incidence of rabies is high, such as El Jadida, a large majority of rural people strongly believe in the power of traditional healers, locally called chorfa or maachat. Spitting on the wound with the use of salt and isolating patients in dark rooms constitute their “therapy.” It is sad to note that one of the main recommendations by those healers to the families of exposed victims is that they should not consult a physician. Traditional practices differ between countries. For instance, in Bangladesh and India, traditional medicine includes the use of oils, salt, herbs, and red peppers in wounds [26,27]; in Nigeria, the use of herbs and concoctions [31]; and in Ethiopia, treatment includes herbs and a water locally called tsebel [30]. These traditional practices can cost people’s lives and are responsible for most cases of deadly human rabies [22,32]. Therefore, community awareness is crucial in the prevention and control of rabies.
Various factors are known to influence dogs’ roaming habits, including foraging, interacting with humans, and their sex and reproductive behavior. These factors may cause some dogs to wander more intensely, resulting in heterogeneous individual roaming patterns [3,33]. In our study, most of the respondents had no objection to letting their dogs roam freely to search for food, and many of the dogs were concentrated around poultry farms, as well as around areas where the local population throws the dead bodies of their sick animals.
Dogs that move freely are at high risk of contracting rabies virus because of the likelihood of contact with other feral dogs or mammals, subsequently contributing to the persistence of rabies [17,18]. Studies in Ethiopia and Tanzania found that a significant number of respondents stated that they would discard the carcasses of any of their animals suspected of rabies [22,24]. As a result, the presence of human-provided food resources increases the possibility of contact between dogs in the community and other stray dogs [34]. Responsible ownership is essential for population management of dogs, and rabies awareness campaigns should incorporate aspects of responsible dog ownership [35].
5. Conclusions
We identified an important knowledge gap and unsatisfactory attitudes and practices in El Jadida province regarding rabies. Increasing public knowledge of wound washing, seeking post-exposure prophylaxis, and the need to vaccinate dogs will likely improve rabies prevention and control in El Jadida, Morocco.
Author Contributions
Conceptualization, K.B. and P.P.M.; data curation, K.B.; formal analysis, K.B.; investigation, K.B.; project administration, K.B.; writing—Original draft, K.B.; writing—Review and editing, K.B., A.B., M.B., A.F. (Abdesslam Ferssiwi), A.F. (Aziz Fitani), and P.P.M. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Conflicts of Interest
The authors declare no conflicts of interest.
References
- Müller, T.; Freuling, C.M.; Wysocki, P.; Roumiantzeff, M.; Freney, J.; Mettenleiter, T.C.; Vos, A. Terrestrial rabies control in the European Union: Historical achievements and challenges ahead. Vet. J. 2015, 203, 10–17. [Google Scholar]
- World Health Organization. Expert Consultation on Rabies, third Report; WHO Technical Report Series, No. 1012; World Health Organization: Geneva, Switzerland, 2018; Licence: CCBY-NC-SA3.0IGO. [Google Scholar]
- Dürr, S.; Dhand, N.K.; Bombara, C.; Molloy, S.; Ward, M.P. What influences the home range size of free-roaming domestic dogs? Epidemiol. Infect. 2017, 145, 1339–1350. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Taylor, L.H.; Hampson, K.; Fahrion, A.; Abela-Ridder, B.; Nel, L.H. Difficulties in estimating the human burden of canine rabies. Acta Trop. 2017, 165, 133–140. [Google Scholar] [CrossRef] [PubMed]
- Knobel, D.L.; Cleaveland, S.; Coleman, P.G.; Fèvre, E.M.; Meltzer, M.I.; Miranda, M.E.; Shaw, A.; Zinsstag, J.; Meslin, F. Re-evaluating the burden of rabies in Africa and Asia. Bull. World Health Organ. 2005, 83, 360–368. [Google Scholar] [PubMed]
- Bouaddi, K.; Bitar, A.; Ferssiwi, A.; Bouslikhane, M.; Fitani, A.; Mshelbwala, P.P.; Audu, S.W. Socioecology of the Canine Population in the Province of El Jadida, Morocco. Vet. Med. Int. 2018, 2018, 4234791. [Google Scholar] [CrossRef] [Green Version]
- Fenelon, N.; Dely, P.; Katz, M.A.; Schaad, N.D.; Dismer, A.; Moran, D.; Laraque, F.; Wallace, R.M. Knowledge, attitudes and practices regarding rabies risk in community members and health care professionals: Pétionville, Haiti, 2013. Epidemiol. Infect. 2017, 145, 1624–1634. [Google Scholar] [CrossRef] [Green Version]
- Morters, M.K.; McKinley, T.J.; Restif, O.; Conlan, A.J.K.; Cleaveland, S.; Hampson, K.; Whay, H.R.; Damriyasa, M.; Wood, J.L.N. The demography of free-roaming dog populations and applications to disease and population control. J. Appl. Ecol. 2014, 51, 1096–1106. [Google Scholar] [CrossRef]
- Lembo, T.; Hampson, K.; Kaare, M.T.; Ernest, E.; Knobel, D.; Kazwala, R.R.; Haydon, D.T.; Cleaveland, S. The Feasibility of Canine Rabies Elimination in Africa: Dispelling Doubts with Data. PLoS Negl. Trop. Dis. 2010, 4, e626. [Google Scholar] [CrossRef] [Green Version]
- Amraoui, F. Situation épidémiologique de la rage au Maroc. Presented at the 12th CPC-REMESA, Toledo, Spain, 10–11 May 2016; Available online: http://www.rr-africa.oie.int/docspdf/en/2016/REMESA/12th-REMESA-Rabies-Morocco.pdf (accessed on 2 January 2019).
- Gongal, G.; Sampath, G. Introduction of intradermal rabies vaccination–Aparadigm shift in improving post-exposure prophylaxis in Asia. Vaccine 2018, 37, A94–A98. [Google Scholar] [CrossRef]
- Darkaoui, S.; Cliquet, F.; Wasniewski, M.; Robardet, E.; Aboulfidaa, N.; Bouslikhane, M.; Fassi-Fihri, O.A. Century Spent Combating Rabies in Morocco (1911–2015): How Much Longer? Front. Vet. Sci. 2017, 4, 78. [Google Scholar] [CrossRef] [Green Version]
- Direction de l’Epidémiologie et de Lutte contre les Maladies (DELM). Programme National de Lutte Contre la Rage. 2018. Available online: Retrievedfromfile:///C:/Users/DELL%20E5430/Downloads/Rage%20JMLR%202018%20(3).pdf (accessed on 2 January 2019).
- Ministère de l’Agriculture, de la Pêche Maritime, du Développement Rural et des Eaux et Forêts (MAPMDREF). Monographie Agricole de la Région Casablanca-Settat. 2018. Available online: http://edata.casainvest.ma/docs/monographie_agricole_casablanca-settat.pdf (accessed on 2 January 2019).
- Herbert, M.; RiyazBasha, S.; Thangaraj, S. Community perception regarding rabies prevention and stray dog control in urban slums in India. J. Infect. Public Health 2012, 5, 374–380. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nilsson, M.R. Effect of Rabies Education Programs on Rabies Awareness, Attitudes towards Dogs and Animal Welfare among Children in Lilongwe; Swedish University of Agricultural Sciences: Malawi, Uppsala, 2014; p. 26. [Google Scholar]
- Wallace, R.M.; Mehal, J.; Nakazawa, Y.; Recuenco, S.; Bakamutumaho, B.; Osinubi, M.; Tugumizemu, V.; Blanton, J.D.; Gilbert, A.; Wamala, J. The impact of poverty on dog owner ship and access to canine rabies vaccination: Results from a knowledge, attitudes and practices survey, Uganda 2013. Infect. Dis. Poverty 2017, 6, 97. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Barbosa Costa, G.; Gilbert, A.; Monroe, B.; Blanton, J.; NgamNgam, S.; Recuenco, S.; Wallace, R. The influence of poverty and rabies knowledge on health care seeking behaviors and dog ownership, Cameroon. PLoS ONE 2018, 13, e0197330. [Google Scholar] [CrossRef] [PubMed]
- Muthunuwan, J.T.; Ganhewa, A.G.K.H.; Perera, H.D.S.G.; Hishaam, M.; Bandara, W.M.M.S.; Gunasekera, H.A.K.M. Preliminary survey on knowledge, attitudes and practices regarding rabies. Sri Lankan J. Infect. Dis. 2017, 7, 38–46. [Google Scholar] [CrossRef] [Green Version]
- Moran, D.; Juliao, P.; Alvarez, D.; Lindblade, K.A.; Ellison, J.A.; Gilbert, A.T.; Petersen, B.; Rupprecht, C.; Recuenco, S. Knowledge, attitudes and practices regarding rabies and exposure to bats in two rural communities in Guatemala. BMC Res. Notes 2015, 8, 955. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Newayeselassie, B.; Deressa, E.; Mekonen, Y.; Yimer, E.; Bekele, A.; Pal, M. Assessment of knowledge, attitude and practice (KAP) of canine rabies among in habitants of Addis Ababa, Ethiopia. Int. J. Livest. Res. 2012, 2, 102–108. [Google Scholar] [CrossRef]
- Kabeta, T.; Deresa, B.; Tigre, W.; Ward, M.P.; Mor, S.M. Knowledge, Attitudes and Practices of Animal Bite Victims Attending an Anti-rabies Health Center in Jimma Town, Ethiopia. PLoS Negl. Trop. Dis. 2015, 9, e0003867. [Google Scholar] [CrossRef] [Green Version]
- Palamar, M.B.; Peterson, M.N.; Deperno, C.S.; Correa, M.T. Assessing rabies knowledge and perceptions among ethnic minorities in Greensboro, North Carolina. J. Wildl. Manag. 2013, 77, 1321–1326. [Google Scholar] [CrossRef]
- Sambo, M.; Lembo, T.; Cleaveland, S.; Ferguson, H.M.; Sikana, L.; Simon, C. Knowledge, Attitudes andPractices (KAP) about Rabies Prevention and Control: A Community Survey in Tanzania. PLoS Negl. Trop. Dis. 2014, 8, e3310. [Google Scholar] [CrossRef] [Green Version]
- Ali, A.; Ahmed, E.; Sifer, D. A study on knowledge, attitude and practice of rabies among residents in Addis Ababa, Ethiopia. Ethiop. Vet. J. 2013, 17, 19–35. [Google Scholar] [CrossRef]
- Krishnamoorthy, Y.; Vijayageetha, M.; Sarkar, S. Awareness about rabies among general population and treatment seeking behavior following dog-bite in rural Puducherry: A community based cross-sectional study. Int. J. Community Med. Public Health 2018, 5, 2557–2563. [Google Scholar] [CrossRef] [Green Version]
- Ghosh, S.; Chowdhury, S.; Haider, N.; Bhowmik, R.K.; Rana, M.S.; Prue Marma, A.S.; Hossain, M.B.; Debnath, N.C.; Ahmed, B. A wareness of rabies and response to dog bites in a Bangladesh community. Vet. Med. Sci. 2016, 2, 161–169. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Shen, J.; Li, S.; Xiang, H.; Pang, S.; Xu, G.; Schwebel, D. A Multi-Site Study on Knowledge, Attitudes, Beliefs and Practice of Child-Dog Interactions in Rural China. Int. J. Environ. Res. Public Health 2013, 10, 950–962. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dodet, B.; Goswami, A.; Gunasekera, A.; de Guzman, F.; Jamali, S.; Montalban, C.; Purba, W.; Quiambao, B.; Salahuddin, N.; Sampath, G. Rabies awareness in eight Asian countries. Vaccine 2008, 26, 6344–6348. [Google Scholar] [CrossRef] [PubMed]
- Digafe, R.T.; Kifelew, L.G.; Mechesso, A.F. Knowledge, attitudes and practices towards rabies: Questionnaire survey in rural household heads of Gondar Zuria District, Ethiopia. BMC Res. Notes. 2015, 8, 400. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mshelbwala, P.P.; Ogunkoya, A.B.; Maikai, B.V. Detection of rabies antigen in the saliva and brains of apparently healthy dogs slaughtered for human consumption and its public health implications in abia state, Nigeria. ISRN Vet. Sci. 2013, 5, 468043. [Google Scholar] [CrossRef]
- Hudson, E.G.; Brookes, V.J.; Dürr, S.; Ward, M.P. Domestic dog roaming patterns in remote northern Australian indigenous communities and implications for disease modelling. Prev. Vet. Med. 2017, 146, 52–60. [Google Scholar] [CrossRef]
- Bombara, C.; Dürr, S.; Gongora, J.; Ward, M. Roaming of dogs in remote Indigenous communities in northern Australia and potential interaction between community and wild dogs. Aust. Vet. J. 2017, 95, 182–188. [Google Scholar] [CrossRef]
- Tiwari, H.K.; O’Dea, M.; Robertson, I.D.; Vanak, A.T. Knowledge, attitudes and practices (KAP) towards rabies and free-roaming dogs (FRD) in Shirsuphal village in western India: A community based cross-sectional study. PLoS Negl. Trop. Dis. 2019, 13, e0007120. [Google Scholar] [CrossRef]
- Audu, S.W.; Mshelbwala, P.P.; Jahun, B.M.; Bouaddi, K.; Weese, J.S. Two fatal cases of rabies in humans who did not receive rabies postexposure prophylaxis in Nigeria. Clin. Case Rep. 2019, 7, 749–752. [Google Scholar] [CrossRef] [Green Version]
Figure 1.
Map showing the geographical location of El Jadida province.
Figure 2.
Distribution of respondents’ education level by age.
Figure 3.
Distribution of respondents’ education level by gender.
Table 1.
Sociodemo graphic characteristics of the population participating in the survey on knowledge, attitudes, and practices of rabies.
Table 1.
Sociodemo graphic characteristics of the population participating in the survey on knowledge, attitudes, and practices of rabies.
| Variable | Frequency | Percentage | |
|---|---|---|---|
| Age (years) | <19 | 4 | 1.0% |
| 20–30 | 36 | 8.8% | |
| 31–40 | 77 | 18.9% | |
| >40 | 290 | 71.3% | |
| Gender | Male | 376 | 92.4% |
| Female | 31 | 7.6% | |
| Educational level | No formal education | 270 | 66.3% |
| Primary | 88 | 21.6% | |
| Secondary | 30 | 7.4% | |
| Tertiary | 19 | 4.7% | |
| Marital status | Single | 25 | 6.1% |
| Married | 369 | 90.7% | |
| Divorced | 7 | 1.7% | |
| Widowed | 6 | 1.5% | |
| Occupation | Business man/woman | 13 | 3.2% |
| Civil servant | 24 | 5.9% | |
| Unemployed | 17 | 4.2% | |
| Farmer | 351 | 86.2% | |
| Student | 2 | 0.5% | |
| Number of children | 0 | 33 | 8.1% |
| 1 | 18 | 4.4% | |
| 2 | 57 | 14.0% | |
| 3 | 68 | 18.7% | |
| >3 | 231 | 56.8% | |
| Number of dogs owned | 0 | 27 | 6.6% |
| 1 | 42 | 10.3% | |
| 2 | 176 | 43.2% | |
| 3 | 61 | 15.0% | |
| >3 | 101 | 24.8% | |
| Bitten by a dog before | No | 324 | 79.6% |
| Yes | 83 | 20.4% | |
Table 2.
Knowledge of rabies by study participants.
| Statement | Agree | Disagree | Don’t Know | |||
|---|---|---|---|---|---|---|
| Frequency | Percentage | Frequency | Percentage | Frequency | Percentage | |
| Rabiesexists in Morocco | 309 | 75.9% | 83 | 20.4% | 15 | 3.7% |
| Pathogen that causes rabies affects the nerves | 190 | 46.7% | 11 | 2.7% | 206 | 50.6% |
| Rabiescankill | 363 | 89.2% | 22 | 5.4% | 22 | 5.4% |
| All animals can be infected with and transmit rabies virus | 237 | 58.2% | 142 | 34.9% | 28 | 6.9% |
| Dogs are a possible common source of rabies virus in Morocco | 380 | 93.4% | 9 | 2.2% | 18 | 4.4% |
| All humans can be infected with rabies | 289 | 71.0% | 94 | 23.1% | 24 | 5.9% |
| Bites from an infected animal can spread rabies organism to another animal | 303 | 74.5% | 75 | 18.4% | 29 | 7.1% |
| Rabies is spread through saliva of a rabid animal | 243 | 59.7% | 87 | 21.4% | 77 | 18.9% |
| Age of first vaccination of dogs is 3 months | 60 | 14.7% | 89 | 21.9% | 258 | 63.4% |
| An infected human can transmit rabies to another human through contact | 218 | 53.6% | 72 | 17.7% | 117 | 28.8% |
| Dog bites increase your chances of getting rabies | 293 | 72.0% | 77 | 18.9% | 37 | 9.1% |
| A friendly dog that suddenly turns aggressive may have rabies | 346 | 85.0% | 19 | 4.7% | 42 | 10.3% |
| Excessive foamy salivation and tendency to bite anything are signs of rabies in dogs | 187 | 46.0% | 91 | 22.4% | 129 | 31.7% |
| It is against the law to not vaccinate dogs against rabies | 320 | 78.6% | 15 | 3.7% | 72 | 17.7% |
| Will present rabies vaccination certificate on request | 291 | 76.6% | 26 | 6.8% | 63 | 16.6% |
| Dog registration and licensing can help in the control of rabies | 302 | 74.2% | 9 | 2.2% | 96 | 23.6% |
| Vaccination of dogs against rabies should be repeated yearly | 276 | 67.8% | 15 | 3.7% | 116 | 28.5% |
Table 3.
Attitudes of study participants.
| Statement | Agree | Disagree | Don’t Know | |||
|---|---|---|---|---|---|---|
| Frequency | Percentage | Frequency | Percentage | Frequency | Percentage | |
| I do not allow stray dogs to roam freely into my compound | 282 | 69.3% | 111 | 27.3% | 14 | 3.4% |
| A dog that bites someone should be caught and killed | 221 | 54.3% | 96 | 23.6% | 90 | 22.1% |
| It is not good to nurse an unknown sick dog | 166 | 40.8% | 212 | 52.1% | 29 | 7.1% |
| If I am bitten by a dog, I will go to the hospital | 288 | 70.8% | 96 | 23.6% | 23 | 5.7% |
| It is good to let dogs roam to get food because it makes them grow stronger | 264 | 64.9% | 102 | 25.1% | 41 | 10.1% |
| It is inhumane/bad to confine your dog(s) | 274 | 67.3% | 84 | 20.6% | 49 | 12.0% |
| It is good not play with unknown dogs | 342 | 84.0% | 38 | 9.3% | 27 | 6.6% |
| Keeping dogs that are not vaccinated against rabies is dangerous and should be avoided | 173 | 42.5% | 105 | 25.8% | 129 | 31.7% |
| Children should be allowed to play with dogs | 163 | 40.1% | 210 | 51.6% | 34 | 8.4% |
Table 4.
Practices of study participants.
| Question | Agree | Disagree | Don’t know | ||||
|---|---|---|---|---|---|---|---|
| Frequency | Percentage | Frequency | Percentage | Frequency | Percentage | ||
| It is good to keep dogs? | 262 | 64.4% | 133 | 32.7% | 12 | 3.0% | |
| Is it good to vaccinate your dog(s)? | 275 | 67.6% | 12 | 3.0% | 120 | 29.5% | |
| It is good to wash dog bite wounds with soap? | 228 | 56.0% | 11 | 2.7% | 168 | 41.3% | |
| It is good to have a cage for your dog(s)? | 144 | 35.4% | 218 | 53.6% | 45 | 11.1% | |
| It is not a good practice to castrate/spay dogs? | 183 | 45.0% | 172 | 42.3% | 52 | 12.8% | |
| If a person is bitten by a dog, what should be done? | Do nothing | 123 | 30.2% | 206 | 50.6% | 78 | 19.2% |
| Take the victim to a chemist for treatment | 5 | 1.2% | 301 | 74.0% | 101 | 24.8% | |
| Treat using traditional medicine | 215 | 52.8% | 181 | 44.5% | 11 | 2.7% | |
| Take the victim to a veterinary clinic | 240 | 58.97% | 135 | 33.17% | 32 | 7.86% | |
| Take the victim to a hospital | 281 | 69.04% | 103 | 25.31% | 23 | 5.65% | |
Table 5.
Association between knowledge, attitudes, and practices (KAP) and selected sociodemo graphic parameters among study participants.
Table 5.
Association between knowledge, attitudes, and practices (KAP) and selected sociodemo graphic parameters among study participants.
| Statement | Age (years) | Gender | Educational Level | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| <19 | 20–30 | 31–40 | >40 | Male | Female | No Formal Education | Primary | Secondary | Tertiary | ||
| All animals can be infected with and can transmit rabies virus | Agree | 3 (75.0%) | 27 (75.0%) | 66 (85.7%) | 141 (48.6%) | 213 (56.6%) | 24 (77.4%) | 125 (46.3%) | 73 (82.9%) | 21 (70.0%) | 18 (94.7%) |
| Disagree | 0 (0%) | 3 (8.33%) | 5 (6.5%) | 134 (46.2%) | 137 (36.4%) | 5 (16.1%) | 132 (48.9%) | 5 (5.7%) | 4 (13.3%) | 1 (5.3%) | |
| Don’t know | 1 (25.0%) | 6 (16.7%) | 6 (7.8%) | 15 (5.2%) | 26 (6.9%) | 2 (6.4%) | 13 (4.8%) | 10 (11.4%) | 5 (16.7%) | 0 (0%) | |
| Chi-square | 61.9 | 5.5 | 76.1 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0000 | 0.0634 | 0.0000 | ||||||||
| Dogs are a possible common source of rabies virus in Morocco | Agree | 3 (75.0%) | 31 (86.1%) | 65 (84.4%) | 281 (96.9%) | 352 (93.6%) | 28 (90.3%) | 259 (95.9%) | 77 (87.5%) | 25 (83.3%) | 19 (100%) |
| Disagree | 1 (25.0%) | 2 (5.6%) | 4 (5.2%) | 2 (0.7%) | 7 (1.9%) | 2 (6.4%) | 2 (0.7%) | 4 (4.5%) | 3 (10.0%) | 0 (0%) | |
| Don’t know | 0 (0%) | 3 (8.3%) | 8 (10.4%) | 7 (2.4%) | 17 (4.5%) | 1 (3.2%) | 9 (3.3%) | 7 (7.9%) | 2 (6.7%) | 0 (0%) | |
| Chi-square | 29.0 | 2.9 | 18.8 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0001 | 0.24 | 0.0046 | ||||||||
| Rabies is spread through saliva of a rabid animal | Agree | 4 (100%) | 17 (47.2%) | 53 (68.8%) | 169 (58.3%) | 224 (59.6%) | 19 (61.3%) | 150 (55.6%) | 55 (62.5%) | 20 (66.7%) | 18 (94.7%) |
| Disagree | 0 (0%) | 4 (11.1%) | 7 (9.1%) | 76 (26.2%) | 8 (21.3%) | 7 (22.6%) | 79 (29.3%) | 5 (5.7%) | 3 (10.0%) | 0 (0%) | |
| Don’t know | 0 (0%) | 15 (41.7%) | 17 (22.1%) | 45 (15.5%) | 72 (19.1%) | 5 (16.1%) | 41 (15.2%) | 28 (31.8%) | 7 (23.3%) | 1 (5.3%) | |
| Chi-square | 27.21 | 0.17 | 40.82 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0001 | 0.91 | 0.0000 | ||||||||
| I do not allow stray dogs to roam freely into my compound | Agree | 3 (75.0%) | 31 (86.1%) | 67 (87.0%) | 181 (62.4%) | 262 (69.7%) | 20 (64.5%) | 154 (57.0%) | 82 (93.2%) | 27 (90.0%) | 19 (100%) |
| Disagree | 1 (25.0%) | 3 (8.3%) | 7 (9.1%) | 100 (34.5%) | 103 (27.4%) | 8 (25.8%) | 106 (39.3%) | 3 (3.4%) | 2 (6.7%) | 0 (0%) | |
| Don’t know | 0 (0%) | 2 (5.6%) | 3 (3.9%) | 9 (3.1%) | 11 (2.9%) | 3 (9.7%) | 10 (3.7%) | 3 (3.4%) | 1 (3.3%) | 0 (0%) | |
| Chi-square | 27.31 | 3.93 | 60.70 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0001 | 0.14 | 0.0000 | ||||||||
| A dog that bites someone should be caught and killed | Agree | 2 (50.0%) | 21 (58.3%) | 62 (80.5%) | 136 (46.9%) | 205 (54.5%) | 16 (51.6%) | 111 (41.1%) | 73 (82.9%) | 18 (60.0%) | 19 (100%) |
| Disagree | 2 (50.0%) | 7 (19.4%) | 10 (13.0%) | 77 (26.5%) | 86 (22.9%) | 10 (32.3%) | 82 (30.4%) | 8 (9.1%) | 6 (20.0%) | 0 (0%) | |
| Don’t know | 0 (0%) | 8 (22.22%) | 5 (6.49%) | 77 (26.55%) | 85 (22.61%) | 5 (16.13%) | 77 (28.52%) | 7 (7.95%) | 6 (20.0%) | 0 (0%) | |
| Chi-square | 30.95 | 1.66 | 64.44 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0000 | 0.44 | 0.0000 | ||||||||
| Keeping dogs that are not vaccinated against rabies is dangerous and should be avoided | Agree | 3 (75.0%) | 21 (58.3%) | 45 (58.4%) | 104 (35.9%) | 161 (42.8%) | 12 (38.7%) | 80 (29.6%) | 54 (61.4%) | 22 (73.3%) | 17 (89.5%) |
| Disagree | 1 (25.0%) | 8 (22.2%) | 10 (13.0%) | 86 (29.7%) | 94 (25.0%) | 11 (35.5%) | 90 (33.3%) | 11 (12.5%) | 3 (10.0%) | 1 (5.26%) | |
| Don’t know | 0 (0%) | 7 (19.4%) | 22 (28.6%) | 100 (34.9%) | 121 (32.2%) | 8 (25.8%) | 100 (37.0%) | 23 (26.1%) | 5 (16.7) | 1 (5.3%) | |
| Chi-square | 21.4 | 1.7 | 62.1 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0016 | 0.43 | 0.0000 | ||||||||
| It is good to keep a dog | Agree | 3 (75.0%) | 23 (63.9%) | 59 (76.6%) | 177 (61.0%) | 249 (66.2%) | 13 (41.9%) | 152 (56.3%) | 72 (81.8%) | 25 (83.3%) | 13 (68.4%) |
| Disagree | 0 (0%) | 9 (25.0%) | 15 (19.5%) | 109 (37.6%) | 119 (31.6%) | 14 (45.2%) | 111 (41.1%) | 13 (14.8%) | 3 (10.0%) | 6 (31.6%) | |
| Don’t know | 1 (25.0%) | 4 (11.1%) | 3 (3.9%) | 4 (1.4%) | 8 (2.1%) | 4 (12.9%) | 7 (2.6%) | 3 (3.4%) | 2 (6.7%) | 12 (2.9%) | |
| Chi-square | 28.0 | 15.5 | 30.0 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0001 | 0.0004 | 0.0000 | ||||||||
| It is good to wash dog bite wounds with soap | Agree | 2 (50.0%) | 18 (50.0%) | 43 (55.8%) | 165 (56.9%) | 217 (57.7%) | 11 (35.9%) | 152 (56.3%) | 44 (50.0%) | 18 (60.0%) | 14 (73.7%) |
| Disagree | 1 (25.0%) | 1 (2.8%) | 5 (6.5%) | 4 (1.4%) | 8 (2.1%) | 3 (9.7%) | 3 (1.1%) | 8 (9.1%) | 0 (0%) | 0 (0%) | |
| Don’t know | 1 (25.0%) | 17 (47.2%) | 29 (37.7%) | 121 (41.7%) | 151 (40.2%) | 17 (54.8%) | 115 (42.6%) | 36 (40.9%) | 12 (40.0%) | 5 (26.3%) | |
| Chi-square | 14.4 | 10.1 | 20.0 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0250 | 0.0065 | 0.0028 | ||||||||
| If a person is bitten by a dog, treat using traditional medicine | Agree | 1 (25.0%) | 11 (30.6%) | 23 (29.9%) | 180 (62.1%) | 194 (51.6%) | 21 (67.7%) | 188 (69.6%) | 20 (22.7%) | 6 (20.0%) | 1 (5.3%) |
| Disagree | 3 (75.0%) | 22 (61.1%) | 51 (66.2%) | 105 (36.2%) | 171 (45.5%) | 10 (32.3%) | 76 (28.1%) | 64 (72.7%) | 23 (76.7%) | 18 (94.7%) | |
| Don’t know | 0 (0%) | 3 (8.3%) | 3 (3.9%) | 5 (1.7%) | 11 (2.9%) | 0 (0%) | 6 (2.2%) | 4 (4.5%) | 1 (3.3%) | 0 (0%) | |
| Chi-square | 37.8 | 3.4 | 95.4 | ||||||||
| Df | 6 | 2 | 6 | ||||||||
| p-value | 0.0000 | 0.18 | 0.0000 | ||||||||
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Bouaddi, K.; Bitar, A.; Bouslikhane, M.; Ferssiwi, A.; Fitani, A.; Mshelbwala, P.P. Knowledge, Attitudes, and Practices Regarding Rabies in El Jadida Region, Morocco. Vet. Sci. 2020, 7, 29. https://doi.org/10.3390/vetsci7010029
AMA Style
Bouaddi K, Bitar A, Bouslikhane M, Ferssiwi A, Fitani A, Mshelbwala PP. Knowledge, Attitudes, and Practices Regarding Rabies in El Jadida Region, Morocco. Veterinary Sciences. 2020; 7(1):29. https://doi.org/10.3390/vetsci7010029
Chicago/Turabian StyleBouaddi, Khadija, Abdelali Bitar, Mohammed Bouslikhane, Abdesslam Ferssiwi, Aziz Fitani, and Philip Paul Mshelbwala. 2020. "Knowledge, Attitudes, and Practices Regarding Rabies in El Jadida Region, Morocco" Veterinary Sciences 7, no. 1: 29. https://doi.org/10.3390/vetsci7010029
APA StyleBouaddi, K., Bitar, A., Bouslikhane, M., Ferssiwi, A., Fitani, A., & Mshelbwala, P. P. (2020). Knowledge, Attitudes, and Practices Regarding Rabies in El Jadida Region, Morocco. Veterinary Sciences, 7(1), 29. https://doi.org/10.3390/vetsci7010029
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