On dogs, people, and a rabies epidemic: results from a sociocultural study in Bali, Indonesia

Infectious Diseases of Poverty

J. Gilbert⁹  F. Unger⁹  D. Grace⁹  I. P. Sumantra²  I. K. G. Natakesuma²  I. Willyanto⁵  A. T. S. Estoepangestie⁸  A. Rukmantara^1,10  A. A. G. Putra¹  R. A. Arief⁶  A. Jatikusumah⁶  E. Basuno³  C. Basri⁷  ᅟ Sunandar⁶  Kevin Louis Bardosh⁴  Maria Digna Winda Widyastuti⁶ 

[1] Disease Investigation Centre Denpasar, Ministry of Agriculture, Denpasar, Indonesia;Bali Provincial Livestock and Animal Health Services Office, Denpasar, Indonesia;Center for Socio Economic and Agricultural Policy Studies, Ministry of Agriculture, Bogor, Indonesia;School of Social and Political Science, The University of Edinburgh, Edinburgh, UK;InI Veterinary Service, Surabaya, Indonesia;Center for Indonesian Veterinary Analytical Studies, Bogor, Indonesia;Faculty of Veterinary Medicine, Bogor Agricultural University, Bogor, Indonesia;Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia;International Livestock Research Institute, Nairobi, Kenya;Edelman Indonesia, Jakarta, Indonesia

关键词: Community-driven activities;    KAPs;    Sociocultural;    Rabies;    Bali;   

Others  :  1216852
DOI  :  10.1186/s40249-015-0061-1

 received in 2014-10-31, accepted in 2015-05-28,  发布年份 2015

【 摘 要 】

Background

Previously free of rabies, Bali experienced an outbreak in 2008, which has since caused a large number of human fatalities. In response, both mass dog culling and vaccination have been implemented. In order to assess potential community-driven interventions for optimizing rabies control, we conducted a study exploring the relationship between dogs, rabies, and the Balinese community. The objectives of this study were to: i) understand the human-dog relationship in Bali; ii) explore local knowledge, attitudes, and practices (KAPs) relating to rabies; and iii) assess potential community-driven activities to optimize rabies control and surveillance.

Methods

Conducted between February and June 2011, the study combined a questionnaire (n = 300; CI = 95 %; error margin = 5 %) and focus group discussions (FGDs) in 10 villages in the Denpasar, Gianyar, and Karangasem regencies. The questionnaire included a Likert scale to assess community knowledge and attitudes. For the knowledge assessment, three points were given for a correct answer, while wrong answers and uncertain answers were given zero points.For the attitudes assessment, three points were given for a positive answer, two points for a neutral answer, and one point for a negative answer. Respondent knowledge was categorized as good (score >40), fair (score 20–40), or poor (score <20), based on a maximum total score 60. Respondent attitudes were categorized as positive (score >26), neutral (score 13–26), or negative (score <13), based on a maximum total score of 39. Mixed-gender FGDs in each sub-village (banjar) were conducted, each involving 7–15 participants to complement the questionnaire results. On a follow-up research trip in mid-2013, the data analysis was triangulated and validated using semi-structured interviews. Questionnaire data were analyzed descriptively using SPSS 17.0, while qualitative data from interviews and FGDs were analyzed manually according to accepted methods of coding and memo writing. The chi-square test was then used to analyze the statistical relationships between knowledge and attitudes of the respondents.

Results

Out of the total 300 respondents, most were predominantly male (82 %), Hindu (99 %), married (96 %), older than 30 years of age (92 %), and owned dogs (72 %). Dog ownership was motivated by culture, personal taste, and function, with dogs was being used as guards (85 %) and companion animals (27 %), and was sometimes related to religious or traditional obligations (2 %). Relating to their culture and local beliefs, and eventually becoming their way of life, 79 % of respondents kept free-roaming dogs. With the rabies outbreak in Bali and Western breeds becoming more popular, more responsible dog ownership (leashing, confining, regular feeding) became more acceptable and changed community perceptions on keeping dogs, even though the sustainability of this practice cannot be gauged. In addition, the economic situation posed major problems in rural areas. The level of community knowledge about rabies and its associated control programs were generally fair and community attitudes were positive. However, community KAPs still need to be improved. A total of 74 % respondents reported to have vaccinated their dogs in 2011, but only few were found to report rabid animals to livestock officers (12 %) and a significant number believed that washing a bite wound was not important (62 %). Moreover, free-roaming dog practices and discarding of unwanted female puppies still continue and possibly create difficulties for rabies elimination as these practices potentially increase the stray dog population. We identified three major sociocultural aspects with potential for community-driven interventions to optimize current rabies elimination efforts: integrating local notions of ahimsa (non-violence) into education campaigns, engaging communities through the local banjar sociopolitical system, and working with traditional legal structures to increase local compliance with rabies control.

Conclusion

The human-dog relationship in Bali is multifaceted. Due to the uniqueness of the culture and the local beliefs, and encouraged by a socioeconomic aspect, a number of local practices were found to be constituting risk factors for continued rabies spread. Community knowledge and attitudes, which can consequently result in behavioral changes, needs to be improved across different genders, ages, educational backgrounds, and roles in the community, regardless of the individual village’s experiences with rabies. Furthermore, community-driven activities based on sociocultural conditioning and community capacity at the banjar and village levels, such as public awareness activities, vaccination, dog registration, dog population management, and rapid response to dog bites, were identified as being able to complement the rabies control program in Bali. The program also needs recognition or acknowledgement from governments, especially local government as well as regular mentoring to improve and sustain community participation.

【 授权许可】

   
2015 Widyastuti et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Knobel D, Cleaveland S, Coleman P, Fèvre E, Meltzer M, Miranda ME, et al.: Re-evaluating the burden of rabies in Africa and Asia. Bull World Health Organ 2005, 83:60-368.
• [2]Lembo T, Hampson K, Kaare M, Ernest E, Knobel D, Kazwala RR, et al.: The feasibility of canine rabies elimination in Africa: dispelling doubts with data. PLoS Negl Trop Dis 2010, 4(2):e626.
• [3]Davlin S, Vonville H: Canine rabies vaccination and domestic dog population characteristics in the developing world: a systematic review. Vaccine 2012, 30(24):3492-502.
• [4]World Organization for Animal Health.. http://www.oie.int/en/animal-health-in-the-world/rabies-portal/about-rabies/ webcite
• [5]Putra AA, Hampson K, Girardi J, Hiby E, Knobel D, Mardiana W, et al.: Response to a rabies epidemic, Bali, Indonesia, 2008–2011. Emerg Infect Dis 2013, 19(4):648-51.
• [6]Waltner-Toews D, Maryono A, Akoso B, Wisynu S, Unruh D: An epidemic of canine rabies in central Java, Indonesia. Prev Vet Med 1990, 8:295-303.
• [7]Windiyaningsih C, Wilde H, Meslin F, Suroso T, Widarso H: The rabies epidemic on Flores Island, Indonesia (1998–2003). J Med Assoc Thai 2004, 87:1389-93.
• [8]Clifton M: How not to fight a rabies epidemic: a history in Bali. Asian Biomedicine 2010, 4(4):663-70.
• [9]Susilawathi NM, Darwinata AE, Dwija IBNP, Budayanti NS, Wirasandhi GAK, Subrata K, et al.: Epidemiological and clinical features of human rabies cases in Bali 2008–2010. BMC Infect Dis 2012, 12:81. BioMed Central Full Text
• [10]Townsend SE, Sumantra IP, Pudjiatmoko , Bagus GN, Brum E, Cleaveland S: Designing programs for eliminating canine rabies from islands: Bali, Indonesiaas a case study. PLoS Negl Trop Dis 2013, 7(8):e2372.
• [11]Irion DN, Schaffer AL, Grant S, Wilton AN, Pedersen NC: Genetic variation analysis of the Bali street dog using microsatellites. BMC Genet 2005, 6(1):6. BioMed Central Full Text
• [12]Putra AAG, Gunata IK, Asrama IG: Dog demography in Badung District, the province of Bali, and their significance to rabies control. Buletin Veteriner, Disease Investigation Center Denpasar 2011, 23:14-24.
• [13]Runstadler J, Angles J, Pedersen N: Dog leukocyte antigen class II diversity and relationships among indigenous dogs of the island nations of Indonesia (Bali). Australia and New Guinea Tissue Antigens 2006, 68(5):418-26.
• [14]Puja I, Irion D, Schaffer A, Pedersen N: The Kintamani Dog: Genetic profile of an emerging breed from Bali. Indonesia Journal of Heredity 2005, 96(7):854-9.
• [15]Howe L: The changing world of Bali: religion, society and tourism. Routledge, New York; 2005.
• [16]Sternfeldt A: The dogs in Bali: unforgettable dog stories from a flawed paradise. Amazon Ltd, UK; 2012.
• [17]Lansing J: Perfect order: recognizing complexity in Bali. Princeton University Press, New Jersey; 2006.
• [18]Geertz C: The interpretation of cultures. Basic Books, New York; 1973.
• [19]Barth F: Balinese worlds. The University of Chicago Press, Chicago; 1993.
• [20]Forge A: Tooth and fang in Bali. Canberra Anthropology 1980, 3(1):1-16.
• [21]Herbert M, Basha S, Thangaraj S: Community perception regarding rabies prevention and stray dog control in urban slums in India. J Infect Public Health 2012, 5(6):374-80.
• [22]Tenzin , Dhand NK, Rai BD, Tenzin S, Tsheten K, Ugyen P, et al.: Community-based study on knowledge, attitudes and perception of rabies in Gelephu, south-central Bhutan. Int Health 2012, 4(3):210-9.
• [23]Lunney M, Fèvre SJ, Stiles E, Ly S, San S, Vong S: Knowledge, attitudes and practices of rabies prevention and dog bite injuries in urban and peri-urban provinces in Cambodia, 2009. International Health 2012, 4(1):4-9.
• [24]Mai LT, Dung LP, Tho NT, Quyet NT, Than PD, Mai ND, et al.: Community knowledge, attitudes, and practices towards rabies prevention in North Vietnam. Int Q Community Health Educ 2012, 31(1):21-31.
• [25]Matibag GC, Kamigaki T, Kumarasiri PV, Wijewardana TG, Kalupahana AW, Dissanayake DR, et al.: Knowledge, attitudes, and practices survey of rabies in a community in Sri Lanka. Environ Health Prev Med 2007, 12(2):84-9.
• [26]Bardosh K, Sambo M, Sikana L, Hampson K, Welburn SC: Eliminating rabies in Tanzania? Local understandings and responses to mass dog vaccination in Kilombero and Ulanga districts. PLoS Negl Trop Dis 2014, 8(6):e2935.
• [27]Morters MK, Restif O, Hampson K, Cleaveland S, Wood JLN, Conlan AJ: Evidence-based control of canine rabies: a critical review of population density reduction. J Anim Ecol 2013, 82(1):6-14.
• [28]Fielding W: Dog breeding in New Providence, The Bahamas, and its potential impact on the roaming dog population II: The fate of puppies. J App Anim Welf Sci 2010, 13(4):300-13.
• [29]Townsend SE, Lembo T, Cleaveland S, Meslin FX, Miranda ME, Putra AA, et al.: Surveillance guidelines for disease elimination: a case study of canine rabies. Comp Immun and Microb of Infect Dis 2013, 36:249-61.
• [30]Rifkin S: Paradigms lost: toward a new understanding of community participation in health programs. Acta Trop 1996, 61(2):79-92.
• [31]Rifkin S: Ten best readings on community participation and health. Afr Health Sci 2001, 1(1):42-5.
• [32]Ajayi IO, Jegede AS, Falade CO, Sommerfeld J: Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study. Infect Dis of Pov 2013, 2:25. BioMed Central Full Text
• [33]Lapiz SMD, Miranda MEG, Garcia RG, Daguro LI, Paman MD, Madrinan FP, et al.: Implementation of an intersectoral program to eliminate human and canine rabies: the Bohol rabies prevention and elimination project. PLoS Negl Trop Dis 2012, 6(12):e1891.
• [34]Engel S, Susilo A: Shaming and sanitation in Indonesia: A return to colonial public health practices? Development and Change 2014, 45(1):157-78.