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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 9  |  Page : 1281-1288

Knowledge and behaviors of veterinary students about rabies: A descriptive study from Turkey


Department of Public Health, Faculty of Medicine, Firat Üniversity, Elazig, Turkey

Date of Submission19-Feb-2019
Date of Acceptance11-Apr-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Dr. O Kurt
Faculty of Medicine, Public Health Department, Firat University, 23119 Elazig
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_108_19

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   Abstract 


Aims: This study aimed to obtain data on the knowledge, behavior, and immunization status of veterinary students about rabies. Methods and Materials: The population of this descriptive study consisted of all the 770 students of a veterinary faculty (response rate 85.7%; n = 660). A survey was conducted querying the knowledge and behaviors of the participants about rabies. Results: Of the surveyed students 28.6% (n = 189) stated that they were exposed to animal bites at least once, and 50.3% (n = 95) of these students stated that they were vaccinated following the exposure. Of the participants, 23.6% (n = 156) indicated that they received protective rabies treatment (prophylactic vaccination). About 32.9% (n = 217) of the students taking part in the study had pets at home. Around 70.7% (n = 153) of these students stated that their animals were vaccinated against rabies. A significant relationship was found between having a pet and being bitten by an animal (P < 0.001). 50.5% (n = 333) of the students who participated in the study were competent in knowledge, while 48.3% were competent in behavior. Students competent in knowledge or behavior were considerably more in the clinical classes compared to preclinical classes. A significant relationship in favor of men was found between the sexes concerning both knowledge and behavior levels. Conclusions: The study revealed deficiencies in the students' awareness levels regarding rabies. Ascertaining a sufficient amount of theory and practice courses on rabies in the veterinary faculty curriculum, starting from earlier classes will contribute to the knowledge and behaviors of the students.

Keywords: Behavior, knowledge, rabies, student, veterinary faculty


How to cite this article:
Pirincci E, Kurt O, Oguzoncul A F, Deveci S E. Knowledge and behaviors of veterinary students about rabies: A descriptive study from Turkey. Niger J Clin Pract 2020;23:1281-8

How to cite this URL:
Pirincci E, Kurt O, Oguzoncul A F, Deveci S E. Knowledge and behaviors of veterinary students about rabies: A descriptive study from Turkey. Niger J Clin Pract [serial online] 2020 [cited 2020 Sep 24];23:1281-8. Available from: http://www.njcponline.com/text.asp?2020/23/9/1281/294672




   Introduction Top


Despite the existence of well-established prevention and treatment protocols, rabies, one of the oldest diseases in human history, has remained a major public health problem. Rabies is a zoonotic viral disease that causes fatal encephalitis related to the genus Lyssavirus in the Rhabdoviridae family.[1],[2] All warm-blooded animals may be infected with the rabies virus, but their susceptibility to the virus is not the same. The risk of transmitting the virus after exposure also varies among animal species.[3] Foxes, wolves, jackals, skunk, and bats are the animals mostly transmitting the rabies virus. After exposure to wild animals, the virus passes on to domestic animals, and animals such as dogs, cats, horses, cattle, sheep, and pigs may get infected. Animal species which are the main reservoir of rabies virus vary in different parts of the world. In many parts of the world including Turkey, but especially in developing countries, the most important source of transmission of rabies are dogs; however, bats in the United States and foxes in Europe are the most common causes of rabies.[4],[5]

Rabies is encountered in more than 150 countries, and 59,000 people die of rabies per year. Among rabies-suspected contacts worldwide, dogs rank first with 91%, followed by cats with 2%, other pets with 3%, and bats with 2%. More than 95% of human deaths due to rabies result from the bite of an infected dog.[3]

Worldwide more than 15 million people receive postexposure prophylaxis every year. Although rabies is a 100% preventable disease if postexposure prophylaxis is performed, deaths continue to occur in many countries.[3],[6] The primary reason for mortality is interpreted as the fact that public health policies are not given due importance.[7] Turkey is still an endemic region regarding rabies; approximately 180,000 rabies-risk contact notifications and 1–2 cases of rabies are encountered per year. When animal species with rabies-suspected contact in Turkey are analyzed per official data, dogs rank first with 61%, followed by cats with 36.1%. As to a report by the Etlik Veterinary Control Central Research Institute covering 20 years, 93% of the animals with rabies are pets, and dogs rank first with 59%.[3]

Since rabies is a disease that results in death and does not have a specific treatment, preventive approaches could be life-saving. Therefore, people who often make contact with animals that have a risk of rabies should receive precontact prophylaxis, and those with rabies-risk contact should get postexposure prophylaxis.[3],[8] Since rabies is both a contagious and highly fatal disease without intervention, it is included in the group of notifiable diseases.[9],[10]

Students of the veterinary faculty make a lot of contact with animals during their education. They are at risk as they learn and apply the normal examinations, surgical interventions, and autopsies. Thus, they should be warned of these risks, taught about prevention, and informed about how to act in case of suspicious contact.

This study aimed at obtaining data about the knowledge and behavior levels about rabies and the status of rabies immunization of the students in a veterinary faculty.


   Materials and Methods Top


This descriptive study was conducted between March and June 2018 at the Faculty of Veterinary at Fırat University, Turkey. Ethical approval (Number 050.01.04/249255, dated 30 January 2018) was obtained from the Fırat University Non-Invasive Research Ethics Committee and written administrative permission was received from the Dean's office of the veterinary faculty of the same university.

The population of the study consisted of the 1st, 2nd, 3rd, 4th and 5th-grade students of the Veterinary Faculty at Fırat University (N = 770). Efforts were made to reach the whole population without sampling. Of the 770 invited, 660 students agreed to participate (response rate of 85.71%).

Before starting the survey, the participants were informed that the information received would be kept confidential and used solely for research purposes. The questionnaire was self-applied by the volunteering individuals under direct observation, within the scope of the research.

The questions of the survey were prepared by the researchers using related literature.[3],[11],[12],[13],[14] Questions were asked about both knowledge and behavior. The highest possible score for knowledge and behavior were 11 and 8, respectively. Scores above the mean were categorized as “sufficient,” while participants with scores below the mean were considered as “insufficient.” The data obtained from the research was evaluated with a statistical package program. Findings were presented in the form of numbers, percentages, means, and standard deviations. The Chi-square test was used to compare categorical variables. A P value < 0.05 was considered as statistically significant. A logistic regression analysis was performed including variables with P < 0.05 in the Chi-square test. Both knowledge and behavior levels (sufficient: 0, insufficient: 1) were studied for affecting factors. The odds ratio (OR) and 95% confidence interval (CI) were calculated for each categorical variable.


   Results Top


The mean age of the students included in the study was 21.82 ± 2.78 years (min: 17, max: 46), 68.3% were males, 22.9% were in the first grade, and 43.2% had spent most of their lives in the city center. The sociodemographic characteristics of the students are shown in [Table 1].
Table 1: Sociodemographic characteristics of the students (n=660)

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Of the students, 58.6% mentioned that they were taught about rabies in the veterinary faculty. The percentage of students' knowledge of rabies is given in [Table 2].
Table 2: The distribution of student responses to knowledge questions about rabies

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Among the sources by which the students acquired rabies knowledge, school education ranked first, while social media ranked the last [Table 3].
Table 3: Students' information sources on rabies *

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Nearly 28.6% of the students mentioned that they were exposed to at least one animal bite, and 55.0% of these students indicated that they were vaccinated after contact [Table 4]. Only 9.6% of the vaccinated students stated that their antibody levels were checked. Furthermore, 82.7% of those who were vaccinated received all doses. Around 44.4% of the students who did not have all vaccine doses replied, “It was not required to take all doses.” However, 33.3% of the students responded, “I did not want to continue,” and 22.2% of students chose the option “Other” (no time, exams, etc.). Of those who got vaccinated, only 5.1% got their antibody levels measured after immunization.
Table 4: Students' exposure to rabies and distribution of their behaviors

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Responding to the question, “What would you do if you were bitten by a rabies-suspected animal&?” 37.9% of the students participating in the study answered, “I would wash with soap and water immediately.” While the rate of those choosing to go to the hospital was 61.4%, the proportion of students stating that they would do nothing was 0.7%.

Responding to the question, “What would you do to the animal if you were bitten by a rabies-suspected animal&?” 45.6% of the students answered, “I would observe the animal for at least 10 days.” While 20.8% of the students said, “I would try to find out whether the animal is vaccinated against rabies or not,” and 5.2% stated, “I'd kill the animal.” However, 21.2% said, “I'd take it to the vet to learn if it has rabies,” and 7.3% answered, “I do not know.”

About 23.6% of the participants stated that they received protective rabies treatment (precontact prophylactic vaccine), and 76.4% did not receive prophylactic vaccination. About 66.0% of those who received protective vaccination had all doses while 41.5% of the participants who did not have all doses said, “It was not necessary to take all doses.” Furthermore, 34.0% said, “I did not want to continue,” 11.3% said, “It was not in stock at the hospital,” while 13.2% had other reasons (I had exams, I was busy) for not having the required doses. Only 5.1% of those receiving protective vaccination indicated that they got their rabies antibody levels measured after vaccination.

To the question, “If you were bitten by an animal suspected of rabies, the rabies vaccine is not available in the health institution you applied, and you were directed to another institution, what would you do&?” 97.7% of the students responded, “I would go to the institution where the vaccine is available,” while 2.3% answered, “I would go home without doing anything.”

Nearly 32.9% of the participants had pets at home, of which 31.8% were cats, 30.4% were dogs, 14.3% were dogs and cats, 18.9% were birds, and 4.6% were other pets (rabbits, poultry, hamsters, iguana, etc.). About 76.6% of the pets were animals at risk of transmitting rabies. Consequently, 70.7% of the students who had animals with the risk of being a rabies-carrier stated that they had their animals vaccinated. While the proportion of having been bitten by an animal was 57.1% for students who had pets at home, this rate was 42.9% for students who did not have pets (P < 0.001, [Table 5]).
Table 5: The distribution of having a pet and being bitten by an animal

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Responding to the question, “What are your suggestions in order not to catch rabies&?” 70.8% of the students answered “to apply for an effective immunization program,” 14.5% responded “to stay away from animals,” 7.2% chose to neuter, 4.9% gave the response “to raise the awareness of the public,” and 2.6% answered, “to increase municipal work.”

While 50.5% of the students who participated in the study were sufficient in knowledge, 49.5% were found insufficient. Similarly, 48.3% of the students were sufficient in behavior, and 52.7% were insufficient. The distributions of knowledge and behavior levels about rabies according to various variables are given in [Table 6].
Table 6: The distribution of knowledge and behavior levels of students regarding various variables

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According to the logistic regression analysis, the results show that there is a statistically significant relationship between the students' grades and the level of knowledge/behavior; the students in the clinical class (4th and 5th grade) can be 6 times more successful in terms of knowledge level than the students in the preclinical classes (1st, 2nd, and 3rd grade) (OR-6.61, CI 4.58–9.54) and 4 times more successful (OR-4.43 CI 3.15–6.25) concerning behavior scores. In the same analysis, it was found that the students aged 23 and over were 10 times more successful than those in the 17–19 age group regarding knowledge (OR-10.57 CI 6.19–18.07) and 4 times more successful (OR-4.31 CI 2.68–6.96) concerning behavior.


   Discussion Top


Rabies has remained an important public health problem all over the world. Given the long time spent with dogs and cats in daily life, many people can be considered at risk. However, animals in the transmission of the rabies virus are not limited to dogs and cats. Knowing which animals are infected provides significant benefits regarding protection.

Studies about rabies disease and veterinary students are limited in the literature. In this study on emerging veterinarians, the majority of the students stated that dogs are the reasons for rabies infection. Besides, more than half of the students (64.5%) indicated that dogs are the main reservoir of rabies. This data is consistent with the literature.[12],[14],[15],[16],[17],[18] The majority (91.7%) of the students stated that rabies is a fatal disease if not properly treated. This proportion was 78.7% in the community-oriented study of Matibag et al.,[12] and 87.9% in the study conducted by Laishram et al.[15]

Because of the proximity to the central nervous system, the bites on the head, face, and neck are more dangerous. Around 80.3% of the students who participated in the study stated that these body parts carry a higher risk of mortality. In Singh and Choudhary's study, in an Indian rural community,[17] this rate was found to be 24.4%. This finding was attributed to the education of the students at the veterinary faculty.

While school education ranks first among the information sources of the students, this is followed by information from television, newspapers, and radio broadcasting. In the study of Muthunuwan et al.[19] on patients in a national hospital in Sri Lanka, more than half of the participants stated that they used television as a source of information. Such a difference can be attributed to the fact that university students attach more importance to education at school and television is not used as a source of information. Surprisingly, few of the students in our study indicated that they used “social media” as the source of information (ranking fifth). Considering the widespread use of social media among young people in the current era, the low ranking of social media among students may suggest that students do not use social media extensively for scientific knowledge accumulation.

Around 74.6% of the students who were exposed to any animal bites in their lives either immediately washed the exposed part with water and soap or rushed to the hospital. In the study conducted by Digafe et al. in Ethiopia,[20] this proportion was reported as 42.8%. This is indicating that veterinary medicine students are more informed about rabies. While the rate of receiving education about rabies at the veterinary faculty was 58.6% in our study, it was 12.6% in the study of Digafe et al.[20] Another important conclusion from our study is that education has a significant effect on displaying correct behaviors since there is a significant relationship between receiving education on rabies and washing the exposed body part with water and soap immediately after the animal bite, before going to the hospital (P = 0.021).

In this study, a relationship was found between the status of having a pet (dog, cat, etc.) and being bitten by an animal (P < 0.001). In the studies carried out in Bangladesh and China, it was found that there is a significant relationship between having a dog and being bitten by an animal.[21],[22]

More than half (55.0%) of the participants exposed to animal bites stated that they were vaccinated after the contact. In the study conducted by Ghosh et al.,[21] 28.5% of the participants were vaccinated.

Very few of the students who participated in the study (5.2%) stated that they would choose to kill the animal. In the study by Fenelon et al. conducted on public individuals and healthcare staff in Haiti,[14] nearly half of the public persons (46.5%) stated that they would kill the animal, while only a few (1.9%) of the healthcare professionals stated that they would kill the animal. Likewise, in the study of Sambo et al. in Tanzania,[23] the percentage of the public people who indicated that they would kill the animal was 79.0%, and in the study of Mucher et al. in Kenya,[24] this proportion was 47.0%.

The World Health Organization (WHO) recommends precontact prophylactic rabies vaccination programs to the risk groups such as veterinary surgeons, animal breeders, rabies laboratory staff, and the people who travel to areas where rabies is highly prevalent, or there is no appropriate medical treatment in case of rabies-risk contact.[25] Veterinary students are a risky group concerning their professional life as well as internship courses. However, only 23.6% of the students participating in the study stated that they received precontact rabies treatment. In the study carried out by Piyaphanee et al. on a traveler group,[16] the rate of the people having precontact immunization (29.1%) was close to that in our study. However, in the study conducted by Trevejo on veterinarians,[13] the percentage of those who received precontact rabies vaccination was found very high (29.1%). Such a difference can be explained by the fact that veterinarians have more practical experience, and thus, are more sensitive about precontact immunization, whereas students do not have this experience.

Rabies antibodies are monitored biyearly in the people at high-risk such as working in rabies research or vaccine production laboratories. On the other hand, in the other risk groups, antibodies are measured every 2 years. Vaccination is not required for those who have adequate antibody levels, but booster vaccination is suggested to those whose antibody levels are lower than the reference values.[3] Very few (5.1%) of the students who received precontact preventive treatment stated that they had their rabies antibodies measured after vaccination. This low percentage may be explained by the fact that there is only one institution in Turkey, which is capable of checking the level of rabies antibodies in humans.

Of the students participating in the study, 97.7% indicated of being bitten by a rabies-suspected animal, they would go to another institution if there was no vaccination in the institution they went first, which suggests that the students are willing to get immunized.

At least 70% of the total population of rabies-carrying animals (especially dogs) should be vaccinated to prevent the transmission of rabies virus.[26],[27],[28] In our study, 70.7% of those who had pets at home stated that they had their animals vaccinated. However, in a study in India, the proportion of those who vaccinated their pets was very low (1%). This result may demonstrate that the veterinary faculty students are sensitive about this subject.

The World Health Organization emphasizes the importance of mass vaccination on all occasions to fight against rabies and protect the whole society.[29] In our study, 70.8% of the students reported that vaccination is necessary for protection from rabies. In the study of Sambo et al. in Tanzania,[23] the majority of the participants similarly indicated that vaccination would be effective in struggling with rabies. In the study by Prakash et al.,[30] more than half of the participants stated that vaccination would be effective.

In this study, it was found that 50.5% of the students had sufficient knowledge, and 48.3% were sufficient concerning behavior. In the study conducted by Tripathy et al.,[31] the proportion of people successful in knowledge, attitude, and behaviors about rabies was found to be 34.25%. The status of students' being sufficient in both knowledge and behavior is significantly higher in the clinical classes than in the preclinical phases. It was confirmed from the literature that the level of the knowledge and behavior increases parallel to the educational levels of the individuals.[15],[32],[33]

A significant difference was found in the students' knowledge and behavior levels between the two sexes in favor of men. Similarly, in the study carried out by Tripathy et al.,[31] the knowledge, attitude, and behavior levels of men were found to be significantly higher. However, there are also studies in the literature, in which there is no significant difference between the genders.[15],[32],[33] More extensive studies are needed to document whether the level of knowledge and practice differs between males and females.

In our study, as the age increased, the level of knowledge and behavior also increased significantly, which was confirmed by several studies.[15],[31]

A significant relationship was found between the students' level of knowledge and behavior and the status of receiving education on rabies. This emphasizes the importance of education at the school in raising the students' level of awareness.

While there was no significant relationship between having a pet and rabies knowledge, a significant relationship was found between having a pet and correct rabies-related behaviors. In the study conducted by Sambo et al. in Tanzania,[23] a significant relationship was found between animal ownership and knowledge and behaviors.


   Conclusion Top


Veterinary faculty students are in the risk group for rabies disease during both their university education and professional lives. Hence, veterinary students are expected to have more awareness about this issue than other members of society. In this study, some deficiencies in students' awareness levels were observed. Further inclusion of this serious disease in the veterinary faculty curriculum will be an important step in the prevention of rabies.

Arranging pre-exposure vaccination campaigns for risk groups like veterinary faculty students could be useful in terms of prevention. Economic benefits can be obtained if it can be possible to monitor antibody levels following vaccination. Therefore, increasing the number of institutions measuring antibody levels in the country and the development of rapid and inexpensive antibody measurement methods should be achieved.

Acknowledgments

The authors would like to thank the participants in our study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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