Rabies Control in Kisumu, Kenya
The city of Kisumu is the third largest in Kenya. Kisumu is located in the Nyanza Province. Studies show that 60% of the population lives in highly populated, low-income areas (i.e. slums). Keeping dairy cattle, sheep, goats, and pigs as well as dogs and cats are common practices among the urban and peri-urban residents of Kisumu. The Nyanza province is a rabies enzootic area. As a direct result of disease presence, since 1966, the Rabies Control Act prescribes disease mitigation measures in specific areas. For example, it is illegal to own unvaccinated dogs. Also, dogs are to be confined within buildings or other enclosed premises in all control areas.
The rabies situation in Kisumu
According to 2007 data from Kisumu District hospital, there were 1,270 cases of people bitten by dogs. Later, in 2009, 1,623 people were treated for suspected rabid dog bites at the district hospital. Reports suggest that 7 people (4 adults and 3 children) died from suspected rabid dog bites. After being bitten by dogs, people go to the public district hospital hoping to get treatment. However, rabies post-exposure vaccines are not routinely supplied by the Kenyan Government to public hospitals and oftentimes victims have to purchase them. Also, logistical constraints hinder laboratory diagnosis for suspected rabies cases involving dogs.
How the rabies prevention and control programme came about
In June 2009, given the high number of bites from unvaccinated roaming dogs, the city of Kisumu requested the district veterinary department to set up an intervention team to tackle the problem of dog bites and canine rabies. The district veterinary department appointed Mr. Peter Omemo to arrange and carry out veterinary public health duties in the affected areas. Mr. Omemo approached KEMRI/CDC to donate vaccines. He received 4,000 doses of animal rabies vaccine coming from Tanzania, in collaboration with national agencies in Nairobi. From the start, Mr. Omemo conducted basic research on animal bites and household surveys. The survey included information on the number of dogs per household, their sex, age, and vaccination status. His preliminary results indicated a dog population of almost 14 thousand; with 16% of dogs’ one-year-old and less. Only 7% of the owned-dog population had been vaccinated in the past 12 months against rabies. The average dog population density was 49 dogs per Km2. Mr. Omemo’s team do not count with a veterinarian who can treat, neuter, and spay dogs.
Implementation of the rabies prevention and control programme
The programme consists of two parts: prevention and control. Prevention is undertaken through awareness-raising of village elders and a radio talk show (donated airtime). Mr. Omemo and his team start by holding meetings with village elders to raise awareness on the consequences of irresponsible dog ownership, the risks associated with dog bites, rabies vaccinations, and their role in rabies disease control. The elders are kindly requested to add rabies on the agenda of village meetings, as well as to undertake community policing of roaming dogs. Rabies control consists of euthanizing rabid dogs.
A dog vaccination campaign was started in October 2010 in the most affected villages. This occurred with assistance of elders and village chiefs. The weekly meetings were used to request villagers to bring their dogs for vaccination. Dog owners are charged the equivalent of USD0.40 to vaccinate each dog. In most villages, it is important to combine livestock health activities with rabies vaccination for dogs. Many villagers are herders, and will bring their dogs along with cattle, thus giving Omemo’s team the opportunity to achieve higher results in the number of animals vaccinated. Vaccination is followed by registration and an explanation of why vaccinating dogs is essential in rabies prevention and control. The field vaccination programme is based on three factors: available dog population statistics, dog bite reports, and direct requests from village chiefs or elders. The programme has reached 47 villages and wants to cover all 158 villages, but more vaccines are needed. At times, awareness-raising and vaccination activities need to be rescheduled in areas that are more difficult to reach because of rugged terrains, bottlenecks, or logistics problems. Transportation is a major issue.
Mr. Omemo and his team are raising awareness on rabies in primary schools by talking to teachers and children. In the various school sessions, the team explains why there is a need to take good care of dogs and on the importance of dog vaccination. The team does not have educational materials for the children, so the rabies information sharing activity is limited to the time allotted to the team. One of the major obstacles with rabies prevention and control in rural Kenya is the belief that herbs can treat rabid dog bites and wounds. Omemo’s team continue to visit village schools in their vaccination trips.
The radio programme has been a great success. Mr. Omemo presents a radio show every Friday from 5.15 to 5.30 pm, in collaboration with the public health disease surveillance officer. The topics covered are varied and alternate between infectious diseases and environmental health. Due to the short time allocated, the radio show needs to be prepared in advance with an agreed outline to ensure that the theme(s) chosen are properly addressed. In the last minutes of the show, listeners call the station with questions regarding any issue affecting the general health status of their communities.
The establishment of District Disease Control Committees
The National Veterinary Department set up District Disease Control Committees (DDCCs). These are found in each district in Kenya and have been formed to review and evaluate strategies in place for zoonosis disease prevention and control. The DDCCs convene whenever there is a serious infectious disease outbreak in a district. The members of the DDCCs are composed of the District Public Health Officer, Municipal Public Health Officer and Medical Officer for Health, Private Veterinarians, and the District Veterinary Officer. Mr. Omemo and his colleagues are exploring the creation of working groups comprised of animal health and community health professionals from different districts to build awareness and help people understand that rabies is a problem requiring an integrated approach.
Omemo’s team already reports a drop in the number of people visiting hospitals with dog bites. Also, no rabies-related deaths have been reported since 2009. A large number of dogs have been vaccinated in villages visited by Mr. Omemo and his team. They report that responsible dog ownership has increased. Also, more poor people have been able to get medical treatment because the owners of unvaccinated dogs are often identified and compelled to pay hospital bills of victims.
Arbitration has been adopted as a conflict resolution option and to find an immediate solution for treating the injured person. Between January 2010 and April 2011, a total of 72 cases were successfully arbitrated and the owners of the dogs met the cost of treatments. Today, elders report roaming dogs and provide data to Omemo’s team on dog population, households whose dogs are not vaccinated, livestock attacked by dogs, and other details. The commendable work of Mr. Omemo in Kenya demonstrates the feasibility, viability, and added value of community-based approaches to disease prevention and control.