Investigator(s)
| Submitter |
Tshewang Dorji Prince of Songkla University, Thailand Tshewang Dorji 
|
| Principal Investigator |
Tshewang Dorji Prince of Songkla University, Thailand Tshewang Dorji
|
| Co-Investigator(s) |
Tippawan Liabsuetrakul Prince of Songkla University, Thailand Tippawan Liabsuetrakul
|
Title(s) and abstract
| Scientific title | Associations of awareness and attitude with the intention to prevent dog-mediated human rabies among adult residents living along the Bhutan-Indian border |
| Public title | Associations of awareness and attitude with the intention to prevent dog-mediated human rabies among adult residents living along the Bhutan-Indian border |
| Background | Rabies is a deadly but entirely preventable viral disease, primarily spread through dog bites. It remains a serious public health threat in Asia and Africa, which account for over 99% of human cases and approximately 59,000 deaths each year. India alone contributes to one-third of global rabies fatalities. The disease disproportionately affects poor and marginalized populations with limited access to healthcare, vaccinations, and education on rabies prevention. Children under 15 are particularly at risk due to unreported bites and delayed medical care. Misconceptions, cultural beliefs, and reliance on traditional healers further hinder effective treatment. Rabies prevention involves pre-exposure prophylaxis (PrEP), immediate wound cleaning, and timely post-exposure prophylaxis (PEP), including vaccines and immunoglobulin. However, treatment failures are commonly due to inadequate wound care or improper vaccine administration, not vaccine ineffectiveness. High-risk areas face additional barriers such as poor adherence to treatment protocols. Dog vaccination is essential but often inconsistent, making human prophylaxis a crucial line of defense. In Bhutan, rabies remains prevalent, especially in southern districts bordering India. Between 2006 and 2024, the country reported 20 rabies deaths and 6,940 dog bite cases in 2024 alone. The government provides free PrEP and PEP and aims to eliminate dog-mediated human rabies deaths by 2030. Intra-dermal vaccine administration and proper cold chain management are promoted to cut costs and preserve vaccine efficacy. A comprehensive approach involving education, healthcare access, and timely medical response is vital to reducing rabies deaths globally. |
| Objectives | Objectives 1. To assess the awareness, attitude and practices on rabies prevention among adults aged 18 years or above living along the Bhutan-Indian border. 2. To identify the association of awareness and attitude with the intention of practices on rabies prevention. |
| Study Methods | A community-based cross-sectional study is planned from June 2025 to January 2026 in seven high-risk districts along the Bhutan-India border, where rabies prevention is overseen by 13 hospitals and 15 primary health centers. The study aims to assess rabies prevention awareness and behavioral intention in these communities. Sample size estimation is based on two study objectives. For Objective 1, the precision formula assumes a 50% proportion, 95% confidence interval, 5% margin of error, and a design effect of 1.5, with an anticipated 20% non-response rate. For Objective 2, the two-proportion difference formula is used, assuming a 40% intention rate among low-awareness individuals and 60% among those with high awareness. Factoring in a 20% data loss, the study will enroll 728 participants, ensuring at least 129 individuals in each awareness group for comparative analysis. Primary data will be collected using structured questionnaires, while secondary data will be obtained through self-reporting checklists from health facilities. Data will be gathered using the Kobo-Toolbox app and managed in Excel and R software. Cleaning will address missing values, outliers, and inconsistencies. Responses will be categorized, and variables will be scored for analysis. Descriptive statistics will summarize continuous variables using means with standard deviations or medians with interquartile ranges, and categorical data as frequencies and percentages. Inferential analysis will include bivariate and multivariate methods, adjusting for confounders such as age, sex, occupation, religion, education, income, past rabies exposure, and domestic animal ownership. |
| Expected outcomes and use of results | Rabies in Bhutan is mainly reported in southern districts bordering India, with occasional outbreaks in interior regions due to cross border disease spread. Bhutan has prioritized eliminating dog-mediated human rabies deaths by 2030. However, low awareness and negative community attitudes pose significant challenges to effective prevention and control. In low- and middle-income countries like Bhutan, where stray dog populations are common, largescale rabies elimination requires strong political commitment, financial investment, and a resilient health system. A community based cross-sectional study will be conducted in high-risk Bhutan-India border areas to identify critical gaps and barriers to rabies prevention. The study will focus on assessing community awareness, attitudes, practices, and the socio-cultural and economic factors influencing behavior. Its findings aim to inform evidence based strategies, improve public health planning, and strengthen Bhutan’s rabies response. By enhancing awareness and community engagement, the study supports proactive and targeted interventions to reduce rabies risks in vulnerable populations and move closer to Bhutan’s 2030 elimination goal. |
| Keywords | Rabies, Awareness, Attitude, Practice, Pre-exposure Prophylaxis, Wound management, Post Exposure Prophylaxis, Rabies Immunoglobulin and Rabies prevention. |
Research Details
| Student research | Yes |
| Institution: Prince of Songkla University, Thailand | |
| Academic degree: Master | |
| Supervisor of the student(s) | |
| Full Name and title: Professor Dr. Tippawan Liabsuetrakul | |
| Email: ltippawa@yahoo.com | |
| Start Date | 09-Jun-2025 |
| End Date | 31-Jan-2026 |
| Key Implementing Institution | THAILAND INTERNATIONAL COOPERATION AGENCY |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Infectious Disease |
| Involves human subjects | No |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | No |