The Burden of Rabies in Tanzania and Its Impact on Local Communities

Abstract

BackgroundRabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. The burden of rabies is estimated to be around US$20 million in Africa, with the highest financial expenditure being the cost of post-exposure prophylaxis (PEP). However, these calculations may be substantial underestimates because the costs to households of coping with endemic rabies have not been investigated. We therefore aimed to estimate the household costs, health-seeking behaviour, coping strategies, and outcomes of exposure to rabies in rural and urban communities in Tanzania.Methods and FindingsExtensive investigative interviews were used to estimate the incidence of human deaths and bite exposures. Questionnaires with bite victims and their families were used to investigate health-seeking behaviour and costs (medical and non-medical costs) associated with exposure to rabies. We calculated that an average patient in rural Tanzania, where most people live on less than US$1 per day, would need to spend over US$100 to complete WHO recommended PEP schedules. High costs and frequent shortages of PEP led to poor compliance with PEP regimens, delays in presentation to health facilities, and increased risk of death.ConclusionThe true costs of obtaining PEP were twice as high as those previously reported from Africa and should be considered in re-evaluations of the burden of rabies.

Assessment of Basic Knowledge, Attitude and Practice of Community on Rabies and Retrospective Survey in and around Ambo Town, West Shoa Zone of Ethiopia

“…veterinarians (51.6%). This poor knowledge level coincides with the insufficient level of knowledge about rabies dangers and prevention, particularly wound management and prompt PEP following exposure that was reported from Tanzania [17].…”

Ecology and Demography of Free-Roaming Domestic Dogs in Rural Villages near Serengeti National Park in Tanzania

“…Domestic dogs are also the primary source of rabies in people, with bites from rabid dogs causing more than 95% of human rabies cases worldwide [19–21]. Rabies causes an estimated 55–59,000 human deaths in Africa and Asia [19,22,23], with an estimated 1,500 human deaths annually in Tanzania alone [24,25]. These concerns for public and wildlife health have led to mass domestic dog vaccination programs in many developing countries including Tanzania.…”

“…These concerns for public and wildlife health have led to mass domestic dog vaccination programs in many developing countries including Tanzania. Although such programs have been effective in eliminating rabies outbreaks in domestic dogs [25–28], understanding the demography of the targeted domestic dog populations will be key to future success. Such knowledge can influence logistics such as the quantity of vaccines required and the frequency of vaccination campaigns.…”

The Pan-African Rabies Control Network (PARACON): A unified approach to eliminating canine rabies in Africa

“…Secondly, due to the limited availability of post-exposure prophylaxis (PEP) in many countries, victims are typically unable to receive timely treatment, and the costs of PEP tend to be very high considering the low income profiles of rural communities in the developing world. Lastly, despite rabies not being viewed as a disease that affects economically important animals, livestock losses are valued at US$279,546,173 per year in Africa, resulting in gross domestic product losses of US$773,352,665 per year (Hampson et al, 2015;Sambo et al, 2013). This has a major impact on the livelihood of communities, especially in low and middle income countries (LMICs) where the burden of the disease tends to be highest.…”