Evaluation of a One Health mass dog rabies vaccination campaign in a resource-limited urban setting: Evidence from Techiman, Ghana

This study evaluates a One Health mass dog rabies vaccination campaign in Techiman, Ghana, finding that while coordinated municipal efforts successfully achieved the target 74% coverage and increased public awareness in a resource-limited urban setting, logistical challenges and the exclusion of free-roaming dogs highlight the need for improved monitoring and inclusive strategies to ensure effective rabies elimination.

The Gist

Imagine a city as a giant, bustling neighborhood where humans and dogs live side-by-side. Now, imagine a invisible, deadly thief called Rabies that sneaks into this neighborhood. Once this thief gets into a person's brain, it's almost impossible to catch it, and it's usually fatal. But here's the good news: we have a shield called a vaccine that can stop the thief before it ever enters.

The problem is, the thief is very good at hiding. In many places, including the city of Techiman, Ghana, there are thousands of dogs. Some are owned by families, but many are "free-roaming" (they wander the streets without an owner). To stop the thief, you need to put the shield on 70% of all the dogs. If you miss even a few, the thief can still jump from dog to dog and eventually to people.

This paper is like a report card on a big "Shield Day" event that happened in Techiman in September 2024. Here is what they found, explained simply:

1. The Big Plan: "All Hands on Deck"

Instead of just the dog doctors (vets) showing up, the city used a "One Health" approach. Think of this like a neighborhood block party where the vet, the health nurse, the police, and the community leaders all work together.

• The Vets brought the vaccines and the needles.
• The Health Workers told people, "If you get bitten, come here immediately!"
• The Community Leaders acted like the hype-men, telling everyone, "Don't miss this free event!"

2. The Results: Did They Hit the Target?

The organizers were thrilled with the numbers they saw on their clipboards.

• The Clipboard Count: They vaccinated about 5,600 dogs. Based on their best guess of how many dogs live there, this looked like they hit the 74% target. They thought, "We did it! The thief is stopped!"
• The Reality Check (The Household Survey): The researchers went door-to-door and asked 200 dog owners, "Did you bring your dog?"
  • Good News: Over half the owners said, "Yes, we brought at least one dog!"
  • The Catch: Many families have more than one dog. If a family has three dogs, they might have only brought one to get vaccinated. It's like showing up to a buffet with a plate but only filling half of it.
  • The Missing Dogs: The biggest gap? The free-roaming dogs. These are the dogs that sleep on the street and don't have an owner to bring them to the clinic. The campaign didn't have a plan to catch and vaccinate these wanderers.

3. The Hiccups: What Went Wrong?

Even though the event was a success, it wasn't perfect. The researchers interviewed the team and found some bumps in the road:

• The Delivery Truck was Late: The vaccines arrived a bit late, which made people wait in long, hot lines. Some people got tired and went home without their dogs.
• The Ice Box Problem: Vaccines need to stay cold, like ice cream. The city didn't have enough "ice boxes" (cold chain) to keep everything fresh for everyone.
• The "Too Far" Problem: People living on the edge of the city (peri-urban areas) had to travel too far to get to the vaccination spot. It's like having a free pizza party, but you only set it up in the center of town, so people on the outskirts can't get there.

4. The Bright Side: People Learned a Lot

Before the event, only about 45% of people knew that rabies is deadly, and 40% knew it could be prevented.
After the event, those numbers jumped to 75% and 70%.
Think of this like a fire drill. Before the drill, people didn't know where the exits were. After the drill, everyone knows exactly what to do. The campaign didn't just vaccinate dogs; it woke up the whole community.

The Bottom Line

This study tells us that Teamwork works. When vets, health workers, and neighbors join forces, they can vaccinate a huge number of dogs in a short time.

However, there is a warning:
If you only vaccinate the dogs that have owners, but ignore the stray dogs wandering the streets, the "deadly thief" can still hide in the shadows. To truly win the game, the city needs to:

1. Find the strays: Create a special team to catch, vaccinate, and release the free-roaming dogs.
2. Fix the logistics: Make sure vaccines arrive on time and are easy to get for everyone, even those living far away.
3. Keep the momentum: Don't just do this once a year; keep the conversation going so people never forget.

In short: Techiman took a giant step forward, but to truly eliminate rabies, they need to make sure no dog is left behind.

Technical Summary

1. Problem Statement

Dog-mediated rabies remains endemic in sub-Saharan Africa, causing approximately 59,000 human deaths annually. While the World Health Organization (WHO) and the "Zero by 30" framework recommend vaccinating at least 70% of the dog population annually to interrupt transmission, achieving this in low- and middle-income countries (LMICs) is challenging.

• Specific Context: Techiman South Metropolitan, Ghana, is a rapidly urbanizing commercial hub with high human-dog contact rates, recurrent dog bites, and confirmed human rabies cases.
• Operational Gaps: Existing campaigns often rely on administrative data that may overestimate coverage by failing to account for unregistered or free-roaming dogs. There is a lack of operational evidence regarding the effectiveness of One Health-coordinated campaigns in resource-constrained, peri-urban settings.

2. Methodology

The study employed a mixed-methods, cross-sectional post-campaign evaluation conducted two weeks after a free mass dog rabies vaccination campaign held in September 2024.

• Study Design:
  • Quantitative: A household survey of 200 dog-owning households (purposive and snowball sampling). Data included demographics, dog ownership, vaccination status, and pre/post-campaign rabies knowledge.
  • Qualitative: 10 Key Informant Interviews (KIIs) with veterinary officers, public health officials, environmental health officers, and community leaders to assess implementation barriers and facilitators.
  • Administrative Data: Review of vaccination records from the Veterinary Services Directorate to estimate total dogs vaccinated.
• Data Analysis:
  • Quantitative data were analyzed using descriptive statistics (frequencies/percentages) in SPSS.
  • Qualitative data underwent thematic analysis (Braun & Clarke framework).
  • Coverage Estimation: Calculated by dividing the number of vaccinated dogs (5,600) by the projected dog population (derived from municipal reports and a 5:1 human-to-dog ratio).
• Ethical Considerations: No formal IRB approval was obtained (as no medical intervention occurred), but administrative permissions were secured from regional and municipal health/veterinary directors. Informed consent was obtained from all participants.

3. Key Contributions

• Operational Evidence: Provides rare empirical data on the implementation of a One Health rabies campaign in a rapidly urbanizing Ghanaian municipality.
• Triangulation of Data: Demonstrates the necessity of combining administrative records with household surveys to get a realistic picture of campaign performance, highlighting discrepancies between reported and perceived coverage.
• One Health Validation: Offers evidence that multisectoral collaboration (Veterinary, Public Health, and Community) is operationally feasible and effective for mobilization in resource-limited settings.
• Identification of Critical Gaps: Specifically highlights the "blind spot" regarding free-roaming dogs and the limitations of relying solely on projected denominators for coverage calculations.

4. Key Results

A. Vaccination Coverage

• Administrative Records: Approximately 5,600 dogs were vaccinated.
• Estimated Coverage: Based on projected population figures, this yielded an estimated 74% coverage, meeting the WHO threshold for transmission interruption.
• Household Participation: Among the 200 surveyed households, only 51.5% reported vaccinating at least one dog.
  • 59.5% of households owned more than one dog.
  • Households with multiple dogs often vaccinated only some of their animals, leading to partial household coverage.

B. Knowledge and Awareness

Significant improvements in community awareness were observed post-campaign:

• Rabies is Fatal: Increased from 45% (pre-campaign recall) to 75%.
• Rabies is Preventable: Increased from 40% to 70%.
• Campaign Awareness: 95% of respondents had heard of the campaign.
• Information Sources: Radio/TV (35%), Health Workers (28%), and Peer Networks (37%) were the primary sources.

C. Qualitative Findings (Themes)

Four major themes emerged from stakeholder interviews:

1. Mobilization: World Rabies Day (WRD) branding significantly boosted community trust and participation.
2. Operational Challenges: Vaccine supply delays, long queues, and limited cold-chain capacity discouraged some participants.
3. Access Inequity: Peri-urban and rural communities faced barriers due to lack of transportation and distant vaccination sites.
4. Stray Dog Gap: The absence of Catch-Vaccinate-Release (CVR) teams meant free-roaming dogs were not systematically vaccinated, threatening herd immunity.

5. Significance and Conclusions

• Feasibility: The study confirms that short-duration, One Health-coordinated campaigns can achieve high vaccination numbers (meeting the 70% target) even in resource-limited urban settings.
• The "Coverage Paradox": While administrative data suggests the 70% target was met, the exclusion of free-roaming dogs and reliance on projected population denominators likely overestimates true population immunity. The discrepancy between the 74% administrative estimate and the 51.5% household participation rate underscores the risk of relying solely on administrative data.
• Strategic Recommendations:
  • Future campaigns must integrate structured strategies for free-roaming dogs (e.g., CVR teams) to ensure epidemiological impact.
  • Decentralization of vaccination sites is required to improve access for peri-urban communities.
  • Monitoring systems must be strengthened to move beyond simple headcounts to accurate, geospatially disaggregated coverage data.
  • Sustained multisectoral coordination is essential for moving from episodic campaigns to sustainable rabies elimination.

In summary, while the Techiman campaign was a successful mobilization effort that improved knowledge and reached high administrative targets, the study warns that without addressing free-roaming dog populations and logistical barriers, the epidemiological goal of interrupting rabies transmission may not be fully achieved.