Date of Award

11-13-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Ali Faisal Saleem

Department

Community Health Sciences

Abstract

BACKGROUND: Around 75% of the infectious diseases in humans are transmitted from animals. Amongst these zoonotic infections, rabies is the most important public health concern because of its mortality and preventability rate. Pakistan stands nowhere when it comes to the national policy on rabies control based on one health approach, although the burden of rabies in Pakistan is the second highest amongst all South-Asian countries. The multi-sectoral one health approach is a worldwide implemented strategy (especially in the LMICs) due to its efficiency, cost-effectiveness, practicality, and sustainability. Therefore, the global interest in preventing and eliminating rabies in developing countries has encouraged researchers about exploring the different barriers and facilitators in implementing preventive strategies for rabies control, according to One health.
METHODOLOGY: This is a mixed-method cross-sectional study that gives a holistic view of the current implementation status and barriers faced in addressing this public health issue in Pakistan. This study consists of two parts: an assessment of the knowledge and practice status of individuals living in the high-risk towns of Karachi and in-depth exploratory interviews based on one health approach, from the potential stakeholders involved directly or indirectly with human, animal, or environmental health sectors. The data from the household survey was analyzed using SPSS to find out about the knowledge and practice scores, whereas the data from the interviews was translated, transcribed and was further analyzed to find out the barriers and facilitators in the implementation of rabies policies.
RESULTS: The findings of this study highlighted various barriers in the implementation of rabies control strategies in accordance with one health approach. The barriers identified were related to the knowledge amongst the community (which was calculated to be 42.62%) and stakeholders, rabies implementation and prioritization issues, community awareness, resource availability and allocation, PEP & PrEP, health workers’ training, surveillance status, diagnostics in human and animals, improper waste disposal system, dog culling and reporting issues, absence of authorities in the animal sector, contextualizing issues of TNVR, inter-departmental coordination, lack of evidence and research and other legal issues. However, this study also highlighted many facilitators for the implementation of rabies control strategies which can help in making effective strategies. The facilitators that were found included the knowledge in the community about rabies vaccination, control, and prevention. It also found various perspectives of the stakeholders regarding the facilitators that included knowledge, existing forums for one health in AMR strategies, community awareness techniques, ways to improve resource allocations, laws related to waste management, ways to solve TNVR-related issues, and also different initiative at private (Rabies Free Pakistan, Rabies Prevention Clinic by Indus hospital, Rabies Free Lahore, etc.) and at public level (NIH initiative to know the burden of rabies, Punjab government initiative about rabies policy, DHIS, FEDSD, IDSR, etc.).
CONCLUSION: This study concluded that there is a dire need for a national rabies policy in Pakistan due to its increasing number of cases. The results of this study showed that the high[1]risk rabies town targeted, needs more knowledge regarding disease description, vaccination, severity, mode of transmission, clinical signs, and prevention and control. But the results also showed that their practices were better in terms of stray dogs, pre[1]and post-exposure prophylaxis, self-vaccination, and actions toward rabid animals. There were many barriers at the district, provincial and national levels which need to be improved, and there is an immense need for coordination between the different sectors as currently, there is none. In order to eliminate and control rabies from Pakistan, a multi-sectoral approach can not only be successful but will also be cost-effective.

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1

Last Page

107

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