A l’occasion de la Jou n
é
e Mondiale con e la Rage, le 28 sep emb e, l’Ins i u Pas eu de
Madagasca (IPM) e le Cen e In e na ional de Reche che en Ag onomie pou le
D
é
eloppemen (CIRAD) o ganisen un symposium in i ul
é
« Rabies : sha ing in e na ional
expe ience o achie e “ Ze o by 30” objec i e »
les 8 e 9 oc ob e 2024
à
l’h
ô
el Radisson Blu
Wa e on , An anana i o.
Ce e encon e es o ganis
é
e pa le p oje CORAMAD «Con
ô
le de la age dans la Commune
U baine d’An anana i o», co-coo donn
é
pa l’IPM e le CIRAD e financ
é
pa l’Ambassade de
F ance
à
Madagasca . Le p oje es men
é
en pa ena ia a ec le Minis
è
e de la San
é
Publique
(DVSSER, DLMT), le Minis
è
e de l’Ag icul u e e de l’Ele age (DSV) e la Commune U baine
d’An anana i o (CUA).
A ec la pa icipa ion des esponsables du p oje CORAMAD, des ep
é
sen an s de ou es les
ins i u ions pa enai es e du bailleu , de che cheu s, d’ac eu s de la san
é
publique e de la
san
é
animale, d’
é
udian s, de esponsables na ionaux e de scien ifiques in e na ionaux
a aillan su la su eillance e la lu e con e la age, ce s
é
minai e ise
à
p
é
sen e les
di
é
en es ac i i
é
s
é
alis
é
es pa le p oje CORAMAD
à
An anana i o.
Du an deux jou s, en
é
unissan p
è
s d’une en aine de che cheu s in e na ionaux p o enan
d’ins i u ions scien ifiques en A ique, en Asie du Sud-Es e en Eu ope, le symposium es
é
galemen l’occasion d’o i un cad e d’
é
change scien ifique e de pa age de sa oi e
d’exp
é
ience su les moyens de lu e con e la age, u ilis
é
s dans le monde.
10/10/2025 20:48
Symposium « Rabies : sha ing in e na ional expe ience o achie e “ Ze o by 30” objec i e » - Ins i u Pas eu de Madagasca
h ps://www.pas eu .mg/symposium- abies-sha ing-in e na ional-expe ience- o-achie e-ze o-by-30-objec i e/
3/6
Dans une app oche «One Heal h», le p oje CORAMAD a pou objec i s (i) de p o
é
ge la
popula ion humaine pa le en o cemen de la su eillance de la age, (ii) d’am
é
lio e la
cou e u e accinale de la popula ion canine con e la age e (iii) de ou ni les connaissances
su la d
é
mog aphie canine de la CUA indispensables au con
ô
le de la age.
« La age ue enco e mais on peu l’
é
i e »
Voi l’ac uali
é
su
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e
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10/10/2025 20:48
Symposium « Rabies : sha ing in e na ional expe ience o achie e “ Ze o by 30” objec i e » - Ins i u Pas eu de Madagasca
h ps://www.pas eu .mg/symposium- abies-sha ing-in e na ional-expe ience- o-achie e-ze o-by-30-objec i e/
4/6
Mixed me hods o e alua e knowledge,
a i udes and p ac ices (KAP) owa ds
abies in cen al and emo e
communi ies o Mo amanga dis ic ,
Madagasca
▪C. Leblanc, D. Kassié, [ ... ],H. Guis
INTRODUCTION
Rabies o e iew:
•Rabies causes o e 59,000 dea hs yea ly in Asia
and A ica.
•99% o human cases om in ec ed dog bi es.
•100% p e en able wi h accines, bu a al a e symp oms appea .
Global & Madagasca con ex :
•Global inancial bu den: $124 billion/yea .
•Madagasca is abies-endemic wi h limi ed awa eness and access o ea men .
•960 es ima ed annual dea hs, PEP p e en s 800 mo e.
PEP access in Madagasca :
•32 ARTCs p o ide ee PEP na ionwide.
•Geog aphic ba ie s and poo in as uc u e limi access, especially in u al a eas.
•Inc eased abies dea hs in a eas a om ARTCs.
Dog owne ship and accina ion in Madagasca :
•Vaccina ion a es: Only 21.6% o dogs in An anana i o a e decla ed accina ed; 7.2% ha e
alid ce i ica es.
•Ru al co e age: Less han 5% o dogs accina ed.
•Mass campaigns: Spo adic, hinde ed by logis ical issues.
S udy con ex (1)
KAP s udies & knowledge gaps:
•Rabies knowledge: Limi ed unde s anding, especially o abies being incu able a e symp oms.
•T ansmission knowledge: 75.4% know abies sp eads ia bi es, bu only 19.1% unde s and i 's
a al a e symp oms.
•PEP awa eness: Many ic ims don' seek PEP due o mino wounds, una ailabili y, o lack o
awa eness.
Awa eness campaigns:
•Limi ed each: No na ional abies awa eness campaigns in he pas decade, mos ly led by
NGOs.
•Wo ld Rabies Day: Ini ia i es es ic ed o a ew owns.
S udy objec i es
E alua e KAP owa d abies:
•Knowledge & P ac ices: Assess abies knowledge and p ac ices in households nea and a
om ARTC.
•A i udes: Explo e communi y a i udes owa d dogs, bi e managemen , and ca e-seeking a e
dog bi es.
S udy con ex (2)
METHODS
Loca ion o e iew:
•Mo amanga dis ic : Middle-eas e n Madagasca ,
pa o Alao a-Mango o egion.
•Popula ion: 350,724 (2018), 115 km om
An anana i o.
Rabies si ua ion:
•Endemic: Rabies p esen in bo h animals and
humans.
•ARTC: Loca ed in Mo amanga ci y.
S udy a ea:
•U ban: Mo amanga ci y.
•Ru al: Ambohiba y and Ampasimpo sy
communes.
KAP s udy ocus:
•Households nea (<5 km) and a (>15 km) om
ARTC.
S udy a ea
Knowledge and p ac ices : quan i a i e app oach(1)
S udy design and sampling
S udy design:
•Type: P ospec i e c oss-sec ional s udy (Oc 30 –Dec 22, 2018).
•Loca ion: Mo amanga ci y, Ambohiba y, and Ampasimpo sy.
Sample popula ion:
•318 households: 159 in Mo amanga ci y, 159 in emo e a eas (>15 km).
Randomiza ion me hod:
•GPS da a om he MHURAM p ojec o IPM, used o household egis a ion.
Eligibili y c i e ia:
•Households om Mo amanga dis ic ; no plans o mo e in 3 mon hs.
Da a collec ion Tool:
•S anda dized, p e- es ed ques ionnai e co e ing socio-economics, dog owne ship,
abies knowledge/p ac ices, and ARTC awa eness.
Fac o s in luencing abies knowledge
Knowledge sco e:
•Median sco e: 16.25 ( ange: 0-22), a e age: 15.8.
•Cen al a ea had highe sco es (16.41) han emo e a eas (15.21, p < 0.002).
Va iables in luencing knowledge:
•Highe sco es linked o:
•Highe socio-economic s a us (p = 0.001).
•Li ing in cen al a ea (p < 0.01).
•P io abies awa eness (p = 0.07).
•Awa eness o ARTC (p = 0.10).
•Dog owne ship in pas 5 yea s (p = 0.19).
S a is ical indings:
•Logis ic eg ession: Highe socio-economic s a us and cen al li ing signi ican o highe
sco es.
•Spa ial clus e ing o knowledge sco es de ec ed (p = 0.004). Bu no signi ican clus e ing wi hin
cen al o emo e a eas
Bi es incidence & p e en ion p ac ices
Bi e incidence:
•7.5% o households epo ed a bi e in he pas 5 yea s (2013-2018).
•C ude incidence: 0.53 pe 100 pe son-yea s in cen al a eas (p = 0.03), 0.22 in emo e a eas.
•61% o bi es we e unp o oked; 65% o ic ims sough ca e, 52% ecei ed PEP.
Bi e ic im cha ac e is ics:
•A e age age: 22 yea s; 13% we e child en unde 5.
•97% o ic ims we e heal hy pos -bi e; 1 dea h (3%).
P ac ice sco e:
•Median sco e: 12, a e age: 11.8.
•Lowe in emo e a eas (11.2) s. cen al a eas (12.3, p < 0.001).
Wound ca e p ac ices:
•45.5% would wash a wound (highe in cen al a eas, p = 0.011).
•87.7% would seek medical ca e (30% doc o , 60% medical cen e ).
•Highe in en ion o seek PEP and medical ca e in cen al a eas.
Uncon en ional p ac ices a e bi es
Uncon en ional p ac ices:
•13.5% o esponden s men ioned a leas one uncon en ional me hod o ea ing bi es, such as
applying oil
•73.1% belie ed in human abies accina ion, and 91.3% in dog accina ion o p e en abies
Dog managemen a e bi es:
•48.8% o esponden s would kill a dog ha bi a pe son (signi ican ly ewe in cen al a eas, p <
0.01)
•19.2% would consul a e e ina ian (highe in cen al a eas, p < 0.001)
•40% o esponden s in cen al a eas would consul a doc o ( s. 15% in emo e a eas, p <
0.001)
Fac o s a ec ing p ac ice sco es:
•Highe p ac ice sco es we e associa ed wi h:
•Li ing in he cen al a ea (p < 0.001)
•Highe socio-economic s a us (p = 0.06)
•P io awa eness o abies (p = 0.02)
•Awa eness o he ARTC (p = 0.002)
•Responden s wi h highe knowledge sco es had signi ican ly highe p ac ice sco es (p = 0.002)
S a is ical indings:
•P ac ice sco e model had accep able disc imina ion capaci y (AUC ROC = 0.73)
•Signi ican spa ial clus e ing o p ac ice sco es was obse ed ac oss he en i e s udy zone, bu
no clus e ing wi hin cen al o emo e a eas
RESULTS
Quali a i e app oach on a i udes
Fi e ca ego ies o dogs:
•Unowned ee- oaming dogs: in bo h u al and cen al a eas; seen as a h ea o
nuisance, including e al dogs.
•F ee- oaming gua d dogs: Owned dogs, mos ly in u al a eas; pe cei ed as a h ea
despi e amilia i y wi h humans.
•Res ained gua d dogs: Con ined o owne 's p ope y, wi h minimal con ac wi h humans.
•F ee- oaming hun ing dogs: Found only in emo e u al a eas, used o hun ing.
•Pe dogs: Exclusi e o u ban a eas, conside ed amily membe s, well ca ed o , bu a
small mino i y.
•Unowned & gua d dogs: Common in u al a eas, seen as h ea s.
•Pe dogs: Found mainly in u ban a eas, well ca ed o bu a e.
Dog owne ship T ends:
•Mos owned dogs se e as gua d dogs.
•Pe dogs a e a e and mos ly u ban.
Dog accina ion p ac ices:
•Few dogs accina ed despi e ecogni ion o i s impo ance.
•Ba ie s: Pe cei ed ha mlessness, inancial cons ain s, cul u al belie s.
•Vaccina ion seen as a luxu y in u al a eas.
Social p essu e & Rabies:
•Dog owne s ace social p essu e o co e heal h cos s a e bi es.
•Rabies accina ion alued o p e en inancial and social dis up ion.
Human-dog in e ac ions
P ac ices conce ning bi e managemen
Bi e inciden s & dog ypes:
•28 bi e cases: 19 by ee- oaming dogs, 7 by gua d dogs, 2 by pe dogs.
•No bi es by e al dogs, despi e pe cei ed h ea .
Rabies cases in bi ing dogs:
•Rabies con i med in 7 dogs: 3 bi en by o he s' dogs, 4 by hei own.
•Rabid dogs showed agg essi e beha io , bi ing mul iple people.
Bi e ic im ca e pa hway:
•Vic ims sough ca e a local cen e s o ARTC in Mo amanga.
•5 abid dogs bi mul iple people he same day.
•Rabies con i med pos -mo em in dogs.
Wound ea men p ac ices:
•Mos washed bi es wi h soap; supe icial bi es o en un ea ed o ea ed wi h oil/zebu a .
•F ee- oaming dog bi es led o heal h cen e isi s.
Dog Owne s’ ole and ac o s in luencing ca e seeking
Dog owne s’ ole:
•Bi e ic ims o en sough he dog owne o accina ion con i ma ion and ea men cos
assis ance.
•Few dogs we e killed a e a bi e; only 5 esponden s men ioned doing so, usually hei own
dog.
Rabies su eillance:
•Moni o ing bi ing dogs o abies was a e; only 2 o 28 cases in ol ed ying he dog o
obse a ion.
Fac o s in luencing medical ca e seeking:
•Communi y ad ice: Encou aged ca e, especially when abies was known locally.
•Cos co e age: Ca e was sough i he dog owne ag eed o co e cos s.
•Rabies pe cep ion: Signs o abies (d ooling, "mad eyes") p omp ed as e medical ac ion.
DISCUSSION & CONCLUSION
Discussion
S udy objec i e:
•Assess KAP owa d abies in Mo amanga dis ic .
•Quan i a i e: Focus on dis ance o ARTC and i s impac on knowledge and p ac ices.
•Quali a i e: Explo e a i udes owa d dogs, bi es, accina ion, and ca e-seeking beha io .
KAP me hodology:
•Quan i a i e: Desc ip i e bu lacks beha io al con ex .
•Quali a i e: In-dep h insigh s, limi ed by small samples.
•Combina ion: Cla i ies esul s and con ex .
•Sa is ac o y knowledge o abies ansmission, limi ed unde s anding o i s aid and medical
ca e.
Conclusion
Geog aphic impac :
•Lowe KAP sco es in u al a eas a he om ARTC, highligh ing he need o ocused
awa eness.
Awa eness o ARTC:
•Awa eness o ARTC linked o be e p ac ices.
Socio-economic ac o s:
•Lowe socio-economic households had less abies knowledge, needing a ge ed ou each.
Key da a o abies con ol:
•Collec ed da a on dog owne ship, dog- o-human a ios, accina ion a es, and bi e incidence o
guide u u e campaigns.
•Ca e-seeking in luenced by wound se e i y, dog owne ship, accina ion s a us, and owne 's
willingness o co e cos s.
Challenges in u al a eas:
•Poo abies knowledge, low accina ion a es, and inadequa e p ac ices in emo e a eas.
•Campaigns should p io i ize emo e u al popula ions.
