Knowledge, attitudes and prevention practices related to dog-mediated rabies in Ethiopia: a systematic review and meta-analysis of observational epidemiological studies from inception to 2023

Abstract

Background: Rabies is a horrific and neglected zoonotic disease that kills thousands of people worldwide each year and continues to pose threats to public health. Prevention and control of dog-transmitted rabies require mapping the level of understanding, perception, and existing practices to minimize its impacts on health. Therefore, we undertook this systematic review and meta-analysis to pool evidence from available data on knowledge, attitudes, and prevention practices regarding the disease from studies conducted in various areas of Ethiopia.

Methods: Articles were searched in electronic bibliographic medical databases such as the Excerpta Medica database, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We used Microsoft Excel spreadsheets and STATA software version 16 for the data excerption and analysis, respectively. The variability among studies was evaluated via Higgins and Thompson's I² statistics and the x² test (significant at p ≤ 0.1). The Dersimonian and Laird random-effect meta-analysis model was used to estimate the pooled effect at a 95% uncertainty interval (UI). Visual inspection and Egger's test (significant at p ≤ 0.05) were used to identify the presence of small-study effects.

Results: The search identified 1,249 electronic records. Of them, 27 studies involving 11,150 participants met the inclusion criteria. The pooled prevalence of a good level of knowledge was 62.24% (95% UI: 48.56, 75.92). Furthermore, the pooled prevalence of a favorable level of attitudes towards rabies and a good level of rabies prevention practices was only 56.73% (95% UI: 47.16, 66.29) and 52.73% (95% UI: 43.32, 62.15), respectively.

Conclusion: The study revealed credible gaps in attitudes and prevention practices, though some level of knowledge about dog-mediated rabies was demonstrated. Therefore, we call for country-wide cross-sectoral collaboration to allow for the realization of a global elimination strategy for dog-mediated human rabies.

Keywords: Ethiopia; attitudes; knowledge; practices; rabies; systematic review.

Figure 1

PRISMA flow diagram for identification and selection of articles included in this review.

Figure 2

The forest plot displays the meta-analysis result on the prevalence of a good level of knowledge about dog-mediated rabies under the random-effects model (overall).

Figure 3

The forest plot displays the meta-analysis result on the prevalence of a favorable level of attitude towards dog-mediated rabies under the random-effects model (overall).

Figure 4

The forest plot displays the meta-analysis result on the prevalence of a good level of dog-mediated rabies prevention practices under the random-effects model (overall).

Figure 5

Illustration of sensitivity meta-analysis. (A) A good level of knowledge. (B) A favorable attitudes. (C) A good prevention practices related dog mediated human rabies.

Figure 6

Funnel plots of publication biases. (A) A good level of knowledge about dog-mediated human rabies. (B) A favorable level of attitudes towards dog-mediated human rabies. (C) A good level of dog-mediated human rabies prevention practices. The x-axis shows the effect size (i.e., prevalence), and the standard errors of the effect sizes were plotted on the y-axis. The dashed lines represent the 95% confidence interval. The dots show the distribution of individual studies. Studies with smaller sample sizes are scattered at the bottom of the funnel, and vice versa.