 My name is Christian Odinga and currently I'm undertaking my master's in veterinary epidemiology and economics at the University of Nairobi. So today I'm here to present to you on some work that you did as part of my MSc, that is to assess the importance of rabies vaccination campaign at influencing community knowledge and prevention of this disease. Rabies is a disease that affects both animals and humans. It has a domestic cycle and also a wild cycle. In the in the domestic cycle, the dog has been cited as the major source of infection in humans. But then the wild cycle is equally important because studies have shown that the disease as a potential of wiping out entire population, such as the African wild dog with the detrimental effects to the ecosystem. And so currently 59,000 people died of rabies in the world every year. And this is because of poor surveillance and also limited resources allocated for the control and prevention of this disease. And due to that, the World Health Organization set a target to eliminate human rabies by the year 2030. And these are seen increased collaborations across health sectors and the number of rabies vaccination campaigns have also increased. In Kenya, it accounts for about 2000 deaths per year. And I can say we are not in a bad place, because under the stewardship of the zoonotic disease unit, we have a strategy to eliminate this disease as per the World Health Organization target. And mass dog vaccination is the main part of these among other preventive efforts. So, while I keep you in like keep you, we have the like keep your rabies vaccination campaign, which was started in 2015 by the gentleman on the right of your slide. They've done this work actually they started it to increase vaccination coverage in past role and small holder settlements that dominate that region. And also, they also have a limited access to veterinary services. There's a photo of the paper that they developed from the work. If you want to know more about what they've done you can look into it. But then the map just below shows the, the polygons represents the communities that have been visited. Since this vaccination campaign was started in 2015. I'd just like to point out that the northern part of emotion control is predominantly made of pastoral communities, but the southern parts are made of agro pastoral settlements. So our objective for this study was to evaluate the impact of this vaccination campaign towards a mean improving community knowledge and also prevention practices on rabies. So how did you go about it. We conducted a cross sectional survey. For six months, we visited households in this in like keep your region, as shown on the map below. Those are the polygons represent the communities that have been visited by the vaccination campaign that we are assessing. And also on the light right, there's a region where they've never visited. So we also conducted a survey in that community and the right part of my part of my slide shows some of the questions that we are asking asking them on a mobile based device provided by the worldwide veterinary service and deposited to a common database. The image is just me conducting one of the questionnaires to a respondent. We were interested in three variables. That is the knowledge about the disease, the practices around it, and also the dog vaccination status. And for this, we scored the rabies knowledge based on a number of questions as shown on the block on the right side, mainly transmission of the disease and the species affected. But we also teased out the practices of these communities around this disease, based on the questions shown on the on the lower part, that is the health seeking behavior for humans, and also if they wash their wounds after dog bites. One of our key predictor variable among others was vaccination years. That is the years that this vaccination campaign covered in these communities that we visited. And we found that the range of the range of years that these communities have been visited by this vaccination campaign was from zero to six years with an average of five years. The graphics of our participants was that 59% of them were female, 26% of them had no formal education, while 34% had studied had studied from a secondary level and beyond. And their ages range from 13 years to 83 years with an average of 35 years of age. What did you find? We found that 60% of our respondents scored our work considered to have inadequate knowledge about this disease. And this was based on an aggregate score on the questions like how is rabies transmitted, the typical signs, and also whether it's fatal or not. So 75% of our respondents will be able to identify that this disease is fatal. 69% identified at least one typical sign in dogs. We are focusing on nervous signs, change of behavior, bites, hypersalivation, and 54% of our respondents stated that they knew this disease is transmitted by animal bites. On asking about the species that can be affected, the ones that knew that this disease can affect both humans and animals were 37%. 24% of our respondents that had adequate knowledge about this disease could identify the dog as the main reservoir, and 2.3% will identify other mammals that can be infected by this disease. And so, on further going deep into this analysis, we found that the number of years visited by this vaccination campaign was not significantly associated with or did not influence knowledge about rabies. But then, education of the dog owners actually influenced knowledge about rabies as shown on the plot there that shows that represents the odds ratios. The main source of information about rabies, as per our respondents, was informal word of mouth, either hearing about rabies from their neighbors or friends, or just any person that they meet. In the vaccination effort, mainly they like keep a rabies vaccination campaign accounted for 5% as the source of information. It's also important to note that about 17%, which is a good number, did not know about rabies at all. On further looking into the sources of information, we found that respondents who knew about this disease through informal word of mouth actually was called to have inadequate knowledge about rabies. But then, just to note, sources such as school and books provided adequate knowledge about this disease based on our aggregate score. On looking at the dog vaccination status, which was the main aim of this vaccination campaign, 63% of our respondents had their dogs vaccinated against rabies. But then, 87% of the respondents that had their dogs vaccinated were up to date with their vaccination. That is, they had vaccinated their dogs, not more than one year before we conducted our study. And again, there was no significant association between the number of years covered by the vaccination campaign and the probability of the owners to vaccinate their dogs. There was no influence in the number of years to dog vaccination by the owners. But then, on the other hand, only education and knowledge about rabies actually influenced the vaccination status. When we looked at some of the reasons, and this is just preliminary because when we looked at some of the reasons that the owner, the dog owners presented for not vaccinating their dogs, 14% of the respondents say that they did not believe their dogs needed to be vaccinated. Also, it's important to note that a good percentage say that they didn't know that their dogs should be vaccinated and another good percentage did not know where to get the vaccines for rabies for their dogs. Looking at health-seeking behavior, 95% of our respondents said that they will visit the hospital after a dog bite. But then we all know that it's not enough to visit the hospital. There are other practices that determine the outcome of a dog bite. So for example, we have practices such as wound hygiene, agency of going to the hospital and also knowing that you need to get vaccinated or post-exposure treatment. And 4% of our respondents that said they will go to the hospital stated that they will practice wound hygiene. 5% showed agency in going to the hospital by using terms such as going there immediately before 24 hours elapses or the same day. And 2% of them knew exactly what they were going to get in the hospitals that is anti-rabies vaccine. So what can we conclude so far from what we have? The number of vaccination years by this vaccination campaign was not a significant predictor of rabies knowledge and dog vaccination. But then, education of the dog owners was, and we can also say that more efforts are needed to improve on the human health-seeking behavior as a key practice in preventing human rabies. So what are our recommendations? We recommend that the Likipi Arabi's vaccination campaign should incorporate more education efforts in tandem with their vaccination. And they can do this by involving local elders during the planning process so that people know, you know, conducting focus group discussions to educate the locals about the importance of vaccinating their dogs so that they don't just bring their dogs closer to have them vaccinated for free while they don't know the importance of having their dogs vaccinated. And this has been shown by a previous experience where we had a kind of distemper outbreak just after the 2017 vaccination, which led to detrimental effects. I mean, the communities were, again, doubting the relevance of vaccinating their dogs. The other recommendation is that the vaccination campaign needs to train local representatives so that they can act as a quick response team to constantly monitor the situation of this disease and also other welfare practices in the dogs and the humans. So what are the next steps? We plan to educate the communities by conducting, you know, educating local representatives and also looking at the ethnic differences so that we can determine if we need to carry out more education efforts in other communities compared to others. And also we plan to estimate the burden of rabies by conducting intensive bite care management. And all these steps will be working towards improving the one health aspects of this vaccination campaign, as I can quote Henry Ford, if everyone else is moving forward together then success takes care of itself. And finally, I'd like to acknowledge all the study participants. Andrew Lesurma, who was my field assistant, and my university's providers, and also all the other organizations that made this work possible in one way or the other. Thank you. Thank you very much, Dr. for keeping it short and brief and to the point. There are several questions that are coming through which you might need to look at the chat and discuss or respond to, but the interesting ones which I think I'd like to throw out there is a question by a you. I don't know whether that's African Union but they call themselves a you is elimination of rabies achievable. I think something that we need to be thinking through one from a good friend of mine says dealing with stray dogs do we need a dog protection policy. And then maybe for Dr. Christian, did you use any, was there the use of local language. That's one and then which other species Dr. Queer of KWS is asking which other species or animals were affected, or did you look at maybe you can answer those two then you can proceed to the next one. So first I'll ask I'll answer the question the first one was about. Sorry. The first one was, do you want to deal with is elimination of rabies achievable. I can say elimination of human rabies is achievable. Okay. Then the second one, and that is based on the current trajectory. Okay, but then also for for the other cycles it's also achievable. All right, if you can do a good vaccination coverage. So it's about policy and implementing it because the strategy is in place is just ensuring the right actors are put in place and drives that process for us. Yes. Okay, then the last two which are critical and important is in your discussion you one of the things you said is use of local representatives. Somebody asked whether the engagement was in local language or it was in English or the international other languages. And then we want to know whether there were any other species of animals affected by the rabies other than dogs. Yes. So first of all about the language we had a field assistant, who is a local, and he assisted in translating the questionnaires and also formulating the questionnaires. And then about other species, I can say we have, I mean, what we've seen from literature is that rabies has been incriminated in almost wiping out the entire African wild dog population in certain settings. Okay. Yes. Thank you, Dr. I think you can engage the rest on the chat box. I want to and my good friend but as I will be picking up whether we need to have a dog protection policy or whether it's something that we can look at at another level.