Introduction

Rabies is a fatal zoonotic disease caused by a single stranded RNA virus from the rhabdoviridae family. Animal bites, commonly dog bites, are a major public health issue for the possibility of contracting rabies (Kamble et al., 2016). India contributes to more than 36% of deaths globally every year, most of which are due to bite by free-roaming dogs (Tiwari, Vanak, O’Dea, & Robertson, 2018). Rabies is a 100% fatal disease that can be prevented through timely intervention (Jain & Jain, 2014; Tripathy, Satapathy, & Karmee, 2017).

Mortality can be prevented through prompt washing of bite wounds with soap and water along with timely administration of rabies immunoglobulins (RIG) and anti- rabies vaccines (Singh & Choudhary, 2005). Despite the availability of vaccines with near hundred percent protections against rabies, it continues to be a major public health problem in developing countries like India (Kamble et al., 2016). India is the largest contributor to rabies mortality in the world (Ichhpujani et al., 2006; Ntampaka, Nyaga, Niragire, Gathumbi, & Tukei, 2019).

This is due to the misapprehension about the attitude towards dog bite wounds, its first aid, management and vaccination. There are many false beliefs and myths regarding dog bite wound management like application of oils, red chilli powder, turmeric powder on the wound (Singh et al., 2005). People in the rural areas have more faith in the indigenous methods that have an unproven efficacy. They have poor knowledge regarding the availability of rabies vaccines, their efficacy and vaccination of dogs.

Most of the deaths are due to ignorance and lack of access to affordable services (Kamble et al., 2016). The only way to avoid deaths due to rabies is by early intervention, vaccination, post exposure prophylaxis and vaccination of dogs. This can be achieved by propagating the awareness about the need for early consultation that can reduce the risk of contracting rabies and by bringing to their knowledge the vulnerability of the disease. The availability of vaccines and their almost hundred percent efficacies should be brought to their knowledge. This study is aimed to bring to light the knowledge of people about rabies and their attitude and practice towards dog bites and its management.

Materials and Methods

A descriptive cross sectional study was conducted among the residents of an urban area in Tamil Nadu (Thirumazhisai ), selected by simple random sampling method. In a study done by (Kamble et al., 2016) 75.2% had heard about rabies. L (relative precision) = 8% of P using the formula: Z²pq/L². The sample size was calculated to be 206; with 5% refusal rate, the sample size was calculated to be 215. The study was conducted after obtaining approval from the institutional ethical committee.

Written informed consent was obtained from all the study participants before collecting the required data. The duration taken for the study was 3 months. The subjects were evaluated based on a pre-tested validated structured questionnaire for socio demographic details and questions related with their awareness regarding rabies, knowledge about dog bites, first aid measures adopted by them, knowledge regarding anti-rabies vaccines. The questionnaire contains a total of thirty four questions, which includes sixteen knowledge based questions, eleven attitude based questions and seven practice based questions.

Data management and analysis was done by using Microsoft Excel and SPSS software. Chi square was used to test the significance and p value <0.05 was considered significant.

Results and Discussion

Socio - Demographic details

Out of 205 subjects studied, 116(56.6%) were males and 89(43.4%) were females. Maximum were between 21-40 years of age 121(59.0%). Most of them, 74(36.1%) were undergraduates. 36(17.6%) subjects had pets at home, out of which men were 29(14.1%).

Knowledge, attitude and behaviour

52(25.3%) subjects had heard of rabies and knew that it could be spread by animal bite. Regarding the animals that could spread rabies, 52(25.3%) subjects reported dogs to be the most common source, the second commonest response being cats 24(11.7%) subjects. An association is made between age and knowledge, attitude and behaviour on dog bites and its management among study participants. Out of 205 participants, 52 (25.3%) knew what rabies is. Among them, majority (53.8%) belonged to the age group of 21-40 years. Following a dog bite, 195 (95.1%) participants agreed to take the patient to the hospital and 10 (4.8%) participants claimed that hospital intervention was not required.

When questioned about home remedies being sufficient to treat a dog bite, 131 (63.9%) disagreed to it, 24 (11.7%) said home remedies are sufficient, out of which 45.8% belonged to the age group of 21-40 years. 75 (36.58%) believed turmeric powder can be used as first aid before taking the patient to the hospital. Only 58(28.3%) knew that vaccines were available for rabies, out of which 55.2% belonged to the age group of 21-40 years shown in (Table 1).

An association is made between educational qualification and knowledge, attitude and behaviour on dog-bites and its management among the study participants. 52 (25.3) knew what rabies is, majority being undergraduates 28 (53.8%). 37 (18.04%) participants knew rabies is a fatal disease. 164 (80%) participants said that 18 injections should be given following a dog bite, out of which 55 (33.5%) were undergraduates.

When asked about taking a patient to the hospital following a dog bite, 10 (4.8%) participants said it was unnecessary, out of which 6 (60%) were illiterates. 24 (11.7%) participants said that home remedies were sufficient to treat a dog bite out, of which 8 (33.3%) were illiterates and 8 (33.3%) were undergraduates. 75 (36.5%) participants said turmeric order could be used as a first aid before taking the

patient to the hospital. 58 (28.3%) participants knew about rabies vaccine, out of which 30 (51.7%) were undergraduates as shown in (Table 2).

In a Knowledge, Attitude, Behaviour and Practice Study on Dog-Bites and Its Management in the Context of Prevention of Rabies in a Rural Community of Gujarat (Sambo et al., 2014; Singh et al., 2005) all the individuals knew about rabies and 98.6% knew about its transmission through dog bites. In comparison to our study, only 25.3% knew what rabies is and its transmission through dog bites.

This difference in knowledge could be due to the lack of educational intervention regarding rabies and its fatality. Even though the number of illiterates in our study is only 15.6%, there is a great influence of myths and indigenous methods among the educated people. Out of the 164 (80%) participants who said 18 doses are required for a dog bite case, which is a myth, 33.5% were undergraduates and 23.8% had completed higher secondary education.

In the study conducted by (Singh et al., 2005), 36.4% of the participants would like to visit a doctor in case of a dog bite. In comparison to our study, 195 (95.1%) of participants agreed to take them to the hospital. This difference shows the easy accessibility and trust that has been established between the hospitals and the public. In the same study conducted by U S Singh et al., 86.6% knew about anti rabies vaccine. In our study, only 28.2% were aware about anti rabies vaccine. In the study conducted by (Singh et al., 2005; Sor, Higuchi, Sarker, & Hamajima, 2018) 24.4% knew that pet dogs should be vaccinated against rabies.

In our study, only 40 (19.5%) knew that pet dogs should be vaccinated against rabies. This difference in knowledge is of high significance that awareness should be brought among the people regarding rabies, anti-rabies vaccine, and mode of transmission, vaccination of dogs and fatality of rabies, which is also stated in a study conducted in Maharashtra (Valekar et al., 2014).

Conclusion

Knowledge, attitude and behaviour study suggests that there is need to create awareness amongst the masses regarding epidemiology of the disease and merits of prompt and appropriate post exposure treatment.

Acknowledgement

We thank all the residents who participated in-the study.