Summary

Presently many communities and authorities try to control rabies by undertaking mass culls; this is an instinctive reaction which when scientifically evaluated proves in the long term to be counterproductive. Ongoing applied research points towards the need for integrated responses. In 2000, the World Society for the Protection of Animals started working in Zanzibar on a broad animal welfare agenda. In 2009, the scope of engagement was broadened to include dog population management and rabies control. The Zanzibar Rabies Prevention and Elimination Project (ZRPEP) was launched in March 2013 and involved collaboration between Zanzibar's Ministry of Livestock and Fisheries, the Ministry of Health and World Animal Protection. ZRPEP integrates public health and veterinary resources with village administrative systems to form a strong multisectorial approach which included training of person in government and community change drivers. This has led to rabies being controlled on the island with the programme now transitioning to the elimination and surveillance stage.

Introduction

The Archipelago nation of Zanzibar is made up of the two main islands of Unguja and Pemba and several smaller islets. Administratively, Unguja is divided into 3 regional districts that are divided twice to form 6 administrative districts. The districts are then divided into 198 Shehias each led by a Shehia who is charged with maintaining law and order at local level.¹ In Zanzibar 75% of the dog population is found in rural areas with only 25% in urban areas.² The majority consists of owned dogs with a small population of strays that live mainly around the hotels where they access food at hotel garbage dump sites.² The major welfare issues that face the dogs are poor nutrition, helminthiasis, external parasites, canine distemper, and rabies.² In Tanzania dogs are considered the main vector for rabies transmission.³ In the latest demographic survey of owned dogs and cats undertaken in July 2013 by the Directorate of Veterinary Services, the dog population was recorded as 9,637 and the cat population 20,398.⁴

Rabies was first recorded in Zanzibar in 1921 but was controlled in the islands until reintroduction in 1991 to Unguja and 1998 to Pemba. Rabies become endemic in both Unguja & Pemba.⁵ The main reasons for the failure of response measures was underfunding, lack of sufficient qualified personnel in the health and veterinary infrastructure, and inadequate diagnostic facilities resulting in poor monitoring and surveillance. The World Society for the Protection of Animals (WSPA) first engaged with Zanzibar in the year 2000 when its main goal was introducing animal welfare to policy. It supported community awareness campaigns in responsible pet ownership across the island and established a cat birth control clinic in Stone Town. In 2005 WSPA began implementing a humane stray dog control programme with the Department of Livestock Development which helped improve competencies, skills, and availability of small animal services across the island. In 2008 a knowledge, attitudes and practices study was conducted in Unguja to determine the local population's needs, which led to WSPA supporting the rabies initiative on the island in collaboration with the veterinary and health departments in the 6 districts of Unguja.⁶

Resource and Methods

Personnel and Logistics

The Zanzibar national rabies team includes two veterinarians, a medical officer from the Ministry of Health (Epidemiology Department), one paraveterinarian-rabies focal person per district, village (Shehia) leaders, District Health Management Teams (DHMT) and the dog owners' associations. The main role of the Shehia leaders is to enforce law at village level. In the rabies elimination programme their knowledge of their constituents is critical in obtaining data on dog demography. They also ensure that the villagers participate in rabies elimination and responsible dog ownership campaigns are the focal points for collecting and transmitting surveillance information. Dog owners' organizations were created as a peer accountability tool.⁷The project management unit is located in the urban district at the veterinary department headquarters in the Ministry of Livestock and Fisheries, Zanzibar. Headquarters coordinates all activities and is primarily responsible for planning public awareness campaigns and seminars for school children, with the collaboration of the Ministry of Education. Zanzibar has one Central Veterinary Investigation Centre with two laboratory technicians to process rabies samples collected in the villages. Confirmatory diagnosis is done at the Central Veterinary Laboratory in Dar es Salaam.

Project Methodology

The canine rabies elimination project started through strategic planning discussions between the key stakeholders involved; the Department of Veterinary Services (Ministry of Livestock and Fisheries), the Department of Public Health (Ministry of Health), the Ministry of Local Government (Regional Administration), and WSPA to develop an integrated approach. A baseline dog population survey was undertaken in collaboration with Professor Naimani of the University of Dar es Salaam.⁸ A knowledge, attitudes and practices survey and needs assessment was conducted⁶ which provided an understanding of what stakeholders wanted and how they could be engaged in project delivery. This was followed by awareness meetings with stakeholders which included the regional authority, district councils, ward representatives (Shehias), dog owners' organizations, the police force, and civic educators. Following this, paraveterinarians and community animal health workers were trained on humane dog handling, treatment, and rabies vaccination.

Training of dog owners on dog owners' responsibilities was initiated. Education and information materials were prepared and distributed to the community while at the same time newspaper, television and radio programmes were developed and broadcast.

All village leaders (Shehia) were trained in rabies epidemiology, disease progression in humans and animals, and their main responsibilities in the rabies vaccination campaigns, along with handling of dog-bite patients and reporting of rabies cases to the district human medical teams and district veterinary officers/rabies focal contact. The rabies vaccination schedule was prepared and shared between the project coordination team, district officials, and village leaders. The district rabies focal contacts were responsible for reminding the village leaders about rabies vaccination days, collection of data and sending it to the project team and district authorities. Dog owners were not forced to sterilize all their dogs; but they were advised to select and sterilize those that they did not want for breeding.

Results

As a result of the program, from 2009 to 2013 there was a 75% reduction in rabies cases in livestock, a 90% reduction in rabies cases in dogs and a 90% reduction in rabies cases in cats.⁷ Due to the associated awareness campaign, the number of dog bite cases presented to health facilities reduced by almost 65%. By December 2013, 70% vaccination coverage of owned dogs had been achieved.⁷ Overall results are to be taken with caution as the Zanzibar disease surveillance systems are still weak.

Discussion

The outcomes of the Unguja programme have shown that even in countries where resources are limited, an integrated multisectorial approach to the planning and delivery of zoonotic public health programmes can result in programme success. The programme also demonstrates the need for full engagement with beneficiaries from an early stage in programme planning to ensure resources are focused where they deliver maximum impact. It also highlights the need for empirical baseline data and continued surveillance, which key stakeholders trust. Key in achieving this was incorporation of existing local administration infrastructures into programme management. In the Zanzibar programme, it initially took WSPA and partners longer than necessary to reach current mitigation levels because they failed to efficiently follow the above recommendations.

World Animal Protection has been invited to participate in the development of the Kenyan national strategy for elimination of rabies where lessons learned are being used to produce a more efficient and effective plan.⁹ World Animal Protection (formerly WSPA) has also been invited to take the project lead in one of the five pilot counties in Kenya that will test the strategy and methodology.

World Animal Protection will also look to assist Sierra Leone to develop its rabies elimination strategy as this country, particularly the capital Freetown, has one of the most dense unmanaged dog populations in Africa, with all the accompanying threats.

In addition to the long-term programme work reported here, World Animal Protection was invited by FAO to join them in emergency intervention in the Department of Pointe Noire, Republic of Congo in March 2014, to train Congo government staff in rabies management and humane dog capture. This was in response to an outbreak of rabies that began in October 2013 that caught the public health and veterinary department off guard as they had no internal systems to deal with rabies.¹⁰

Conclusion

It is possible to eliminate canine rabies in African countries if it is prioritized and there is political and resource commitment from authorities. To succeed, it is essential that there is engagement of all essential government machinery: ministries responsible for livestock, public health, government administration, and education. For any elimination programme to be successful, it is critical to generate buy-in from the full cross-section of stakeholders and to engage them in participatory planning from very early programme development. Also key to achieving ownership at the local level is generation of data that is owned and trusted by beneficiaries. Lastly, it has been shown that improving awareness in stakeholders across the board, both about the disease and solutions available to mitigate it, is critically important for success.

References

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2.  WSPA. Need Assessment for Delivering Veterinary Services to Dog Owners and Dog Owners Responsibilities. World Society for the Protection of Animals. February 2009.

3.  Rweyemamu MM, Loretu K, Jakob H, Garton E. Observations on rabies in Tanzania. Bulletin of Epizootic Diseases in Africa. 1973;21:19–27.

4.  Directorate of Veterinary Services. Baseline Dog and Cat Demographic Survey. Done by Zanzibar Rabies Prevention and Elimination Team, Zanzibar. 2013 (Unpublished report).

5.  Diwani AM. A three month report April–June 1991. Department of Livestock Development, Zanzibar. 1991 (Unpublished report).

6.  Sanghera A. A research paper on responsible pet ownership in Unguja, Zanzibar Archipelago. May 2008, Submitted to The World Society for the Protection of Animals.

7.  Kassim J, Mudoga E, De Souza N, Yussuf K, et al. A case study of a rabies control and elimination programme in Unguja island of Zanzibar. In: Proceedings of the 48th KVA Annual scientific conference and AGM; 23rd–25th April, 2014.

8.  Naimani GM. The sample design for dog survey in Unguja Zanzibar. August 2007, Submitted to The World Society for the Protection of Animals.

9.  Zoonotic Disease Unit: Strategic Plan for the Elimination of Human Rabies in Kenya 2014-2030. Nairobi: Ministry of Health and Ministry of Agriculture, Livestock and Fisheries; 2014.

10. WHO. (2013) Rabies Outbreak in The Republic of Congo. www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/3946-rabies-outbreak-in-the-republic-of-congo.html. Embargoed 4th June, 2014