Preplanned Studies: Awareness Towards Rabies and Exposure Rate and Treatment of Dog-Bite Injuries Among Rural Residents — Guangxi Zhuang Autonomous Region, China, 2021

Rabies is almost always fatal once symptoms appear, causing approximately 59,000 deaths worldwide each year (1). However, rabies is preventable through three proven, effective interventions. Except for mass dog vaccination and post-exposure prophylaxis (PEP), awareness of rabies is also important (2-3). In 2015, the World Health Organization (WHO), the World Organisation for Animal Health (OIE), and the Food and Agriculture Organization of the United Nations (FAO) in collaboration with Global Alliance for Rabies Control (GARC) proposed eliminating dog-mediated rabies globally by 2030 (“Zero by 30”) (3). China is one of the countries in Asia that is most affected by rabies, with the vast majority of rabies cases occurring in rural areas (4). Among human rabies cases, more than 99% of cases were caused by bites from rabid dogs (5). However, in the last five years, there have been few reports on the rabies awareness and the exposure rate of dog-bite injuries, especially in rural areas. In order to fill the gaps, this study conducted a cross-sectional survey on awareness towards rabies and exposure rate and treatment of dog-bite injuries using a uniform structural questionnaire to interview 2,544 rural residents in Guangxi Zhuang Autonomous Region in 2021. The study found that in Guangxi, the total awareness rate of rabies-related knowledge among rural residents was only 57.9%, and the exposure rate of dog-bite injuries was as high as 7.2% in the past year. However, 14.8% of those bitten did not seek PEP services. Much more effort should be made for promoting the awareness of rabies disease and the accessibility of PEP service in rural China, especially in the endemic areas. In addition, it is necessary to design targeted prevention and control program for promotion.

A multistage random sampling method was used in this study. To estimate the sample size, the sample was divided into 3 layers according to age and 2 layers according to gender for a total of 6 layers. It was assumed that the awareness rate was 50%, and the test level α was set to 0.05 and the allowable error was set to 5%. According to the simple random sampling sample size calculation formula and considering the loss-follow-up rate of 10% known in previous studies, the minimum sample size was calculated to be 2,534 people. Overall, 127 villages were randomly selected in Guangxi, and 20 interviewees were selected in each village based on systematic sampling method. Finally, a total of 2,544 people aged from 15 to 75 years old with verbal consent were investigated face to face.

There were 6 basic rabies-related questions for respondents to answer. Points were awarded as follows: 0 for incorrect or unclear answers, 1 for correct answers, and a full score was 6. If the final total score ≥4, the respondents were classified as having awareness. The test level α was set to 0.05 and used the chi-squared test to analyze the awareness rate of different populations. Finally, a value was assigned to the awareness situation (0=unknown, 1=awareness), and the influencing factors were analyzed by binary logistic regression. The survey subjects were asked about whether they have been bitten by dogs in the past year, as well as the situation of treatment after being bitten. The exposure rate of dog-bite injuries among rural residents in Guangxi was calculated = (number of bitten/number of people investigated) × 100%. Excel (version 2017, Microsoft Corporation, Beijing, China) was used for data collation, and R (version 4.0.5, University of Auckland, New Zealand) was used for statistical analysis.

The survey subjects were all rural residents, including 1,246 males and 1,298 females, with an average age of 44.6±17.0 years old. The survey subjects were mainly young people (15–44 years old), followed by middle-aged people (45–59 years old) and elderly people (60 years old and above), accounting for 45.8%, 31.6%, and 22.6%, respectively. The education levels of the population were primarily junior high school, followed by primary school and below and high school and above, accounting for 37.5%, 37.4%, and 25.1%, respectively. The total awareness rate of rabies-related knowledge was 57.9%. The awareness rate of single questions ranged from 28.8% to 92.8%. Overall, 9.4% respondents had never heard of rabies, and 55.7% of respondents did not know that rabies was incurable (Table 1).

The results of single-factor analysis showed that there were significantly statistical differences in the awareness rate among subjects in different age groups and different education levels (P<0.05), and there was no significantly statistical difference in awareness rate between female and male (P>0.05). For both men and women, the older the age, the lower the awareness rate, among which the group over 60 years old was the lowest, with 42.6% and 32.9%, respectively. Among subjects with different education levels, the awareness rate of the subjects with education level of primary school or below was the lowest at only 37.2% (Table 1). The results of multifactor analysis showed that the education level of the respondents was an influencing factor of the awareness rate. Compared to the primary school and below, the respondents with junior high school [odds ratio (OR)=2.04, 95% confidence interval (CI): 1.67–2.50, P<0.05] and high school and above (OR=4.29, 95% CI: 3.27–5.66, P<0.05) had higher awareness rate.

The exposure rate of dog-bite injuries among the respondents was as high as 7.2% (183/2,544) in the past year. Among these 183 victims, 162 reported the situation of their PEP. Overall, 85.2% (138/162) of dog-bite injuries victims sought PEP services, of which 40.0% were treated in township hospitals, 23.7% in county CDCs, 23.0% in county hospitals, and 13.3% in village clinics (Table 2). In addition, 7.3% (10/138) among PEP seekers had not received the vaccine against rabies; 14.8% (24/162) of the victims failed to seek PEP service after dog bites. As for the reasons, 75.0% respondents answered as “no need to go to hospital”, 29.2% selected “expensive cost”, 29.2% chose “long distance”, and 29.2% thought there was no time to go to doctor (Table 3).