Côte d’Ivoire: Community-led rabies education

Gbêkê is the third most populous region in Côte d'Ivoire (1). Rabies is endemic in the dog population. Communities are leading the way in the fight against this deadly disease, collaborating across human and animal health sectors to spread awareness and information to save lives.

The National Institute of Public Hygiene records an average of 14 000 dog bites and 20 rabies deaths per year with 48% of deaths affecting children aged under 15 years. Boys and men are disproportionately victims with over 66.2% of reported human rabies cases (2). However, human rabies surveillance data are not complete and all cases or even deaths are not captured due to difficulties with diagnosis, reporting and health-seeking behaviour (3).

In 2017, faced with risks to the community posed by rabid dogs in the Gbêkê region, a Local Committee for the Fight Against Rabies was established. The Committee was founded by Prefectoral Order (No. 40/P.BKE/SG2 of 20 November 2017) and includes representatives from both the animal and human health sectors as well as civil society groups, community leaders, local media organizations and nongovernmental organizations such as Breakthrough ACTION. As one communications specialist points out, community engagement, particularly the involvement of community leaders, is essential in raising awareness about rabies.

"We know that rabies awareness and education is lifesaving. We needed to get a diverse group of partners together to develop an educational programme which would reach all corners of our community. Indeed, some people only follow the instructions of their leader or guide."

William Beine, Senior Technical Advisor, Breakthrough ACTION.

Outreach awareness and education campaigns, developed in collaboration with teachers and educators, were organized in schools, from kindergarten through to higher education. Dog bite prevention was prioritized. Awareness of dog behaviour and body language can be transformative, particularly for children, who might refuse to tell their families if they feel they might be in trouble for playing around with dogs. Delays in seeking treatment cost lives.

"Crucially, we wanted children to understand that in the event of exposure, rabies is
preventable with timely action. Therefore, we taught children about the importance of thorough wound washing and post-exposure rabies vaccination. The school environment is a strategic target: firstly, it's home to a very large, easily accessible population; secondly, once pupils have been made aware, they will acquire good reflexes that they will adopt in life; and thirdly, they will be able to pass on this information to their respective families. This awareness and knowledge will save lives and prevent delays in visits to the health centre."
Lekouo Traoré, Spokesperson for the Union of Community Chiefs residing in Bouaké, President of the local rabies control committee, Gbêkê.

The programme has been rolled out to over 3200 students, and 83 teachers received online training to deliver the materials in their classrooms. However, the programme has not stopped at schools. The Local Committee for the Fight Against Rabies extended the reach of the programme to all corners of the community. Faith-based organizations, women's groups and traditional leaders are collaborating to share information about how to prevent bites and treat for rabies.

Whilst there is more that can be done to strengthen health systems and more accurately capture data on the number of suspected and confirmed rabies cases, community awareness and education is paramount to ensure that no one loses their life to this deadly disease. Community mobilization around rabies control is one of the key steps in achieving the Zero by 30 goal.

"We hope that the lessons learnt in the Gbêkê region will inspire other regions of Côte d'Ivoire to implement similar programmes in their communities. Together, we can achieve zero deaths from rabies by 2030."

Professor Isaac Tiembré, Sub-Director Vaccinology, National Institute of Public Hygiene, Abidjan.

^{Members of the CLLCR of GBÊKÊ (2017)}

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References

1. Résultats Globaux du 5ème Recensement Général de la Population et de l'Habitat (RGPH) 2021 [Overall results of the fifth general population and housing census, 2021]. Abidjan: Côte d'Ivoire Institut national de la statistique (INS); 2022 (https://www.ins.ci/RGPH2021/RGPH2021-RESULTATS%20GLOBAUX_VF.pdf; in French).
2. Issaka T, Malthide TS, Adama C, Djoman C, Simplice DN, Mireille D, et al. Epidemiological facies of human rabies deaths in Côte d'Ivoire from 2016 to 2022. Open J Epidemiol. 2023;13:373-384 (https://doi.org/10.4236/ojepi.2023.134027).
3. Zamina BYG, Tiembré I, Attoh-Touré H, N'Guessan KE, Tetchi SM, Benie BVJ. Factors associated with the abandonment of post-exposure prophylaxis at the Abidjan rabies centre, Côte d'Ivoire. Médecine et Santé Tropicales. 2018;28:212-218
   (https://pubmed.ncbi.nlm.nih.gov/29997083/).

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