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Any luck with rabies elimination in Ghana?

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Rabies is an acute, progressive, incurable but vaccine preventable zoonotic disease. The causative agents are neurotropic RNA viruses in the family Rhabdoviridae, genus Lyssavirus. Susceptible natural hosts include all mammals. Transmission of the virus occurs mainly via animal bite, and once the virus is deposited in peripheral wounds, centripetal passage occurs towards the central nervous system. After viral replication, there is centrifugal spread to major exit portals, the salivary glands.

 Although incubation periods average 1–3 months, disease occurrence in days or years after exposure has been documented.  Once the clinical symptoms appear, rabies is almost 100% fatal. Globally, the domestic dog remains the most significant species for viral transmission, responsible for millions of suspect human exposures and tens of thousands of fatalities through bites or scratches, usually through the saliva. Rabies should therefore be suspected in patients with a concomitant history of animal bite and traditional clinical presentation.

According to the WHO, rabies is endemic in more than 150 countries around the world. Even though the disease can be prevented, it kills an estimated 59 000 people each year, mostly in the world’s poorest and most vulnerable communities. About 40% of the victims are children younger than 15 years living in Asia and Africa. A staggering 99% of human cases are acquired via the bite of an infected dog, rather than through exposures to the many and varied wild animals that act as viral reservoirs on different continents.

Ghana’s Rabies Elimination Program

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Over the years, several countries have acted to improve rabies control measures by scaling up dog vaccination programmes, ensuring  post – exposure and pre – exposure prophylaxis more accessible to bite victims and persons at high risk such as veterinarians, veterinary technicians, wildlife workers, cavers, trappers etc. These global responses to rabies were fragmented and uncoordinated until the WHO, the UN Food and Agriculture Organization (FAO), the World Organisation for Animal Health (WOAH), and the Global Alliance for Rabies Control (GARC) joined forces to support countries to accelerate their actions towards the elimination of dog-mediated human rabies by 2030 by the creation of a the global strategic plan to end human deaths from dog-mediated rabies by 2030.

In Ghana, rabies is endemic and notifiable in both human and animal health sectors. The rabies virus has been isolated in dogs, cats, pigs, sheep, cattle, monkeys and goats with the domestic dog the principal vector, accounting for 99% of all reported human rabies cases. Previously, the country in its attempt to control rabies employed practices of dog vaccination and stray dog removal but these measures were intermittent and unsustainable. In 2018, Ghana accepted the challenge to eliminate rabies in humans by 2030 by adopting the Stepwise Approach towards Rabies Elimination (SARE), an assessment tool for planning, refining and monitoring rabies control programmes and development of a national rabies elimination programme, which attained the country a SARE score of 1.5.

The Zero by 30 global strategic plan which engages, empowers and enables countries to take the initiative in eradication efforts as they develop long-lasting institutional capacity and reach the global objective. The global strategic plan pursues three objectives which include, to reduce human rabies risk, provide guidance and data and harness multi-stakeholder engagement. Ghana’s performance in rabies elimination was assessed by these three key objectives.

Reducing human rabies risk which involves improving awareness and education on rabies, dog vaccinations, and increased access to healthcare, medicines and vaccines including post-exposure and pre-exposure prophylaxis. Analyzing data on rabies in Ghana between the years 2000 – 2012 shows a very low canine vaccination coverage of around 5% to 30% of the country’s dog population (Richard Dery Suu-ire et al, 2020). This is significantly low as compared to WHO recommended 70% dog vaccination coverage. This low coverage can be attributed to several factors but most importantly to the service charge per pet rabies vaccination that was introduced after the privatization of certain veterinary services in 1994. The veterinary division of the Ministry of Agriculture disclosed that an injection of anti-rabies vaccine can cost between $4-10 per dog, despite the fact that there is no documented uniform pricing for anti-rabies vaccination of dogs in Ghana. This poses a tremendous financial strain on dog owners, particularly in a nation where 23.4% of people make less than $1 each day (Ghana Statistical Service, Ghana Living Standard Surgery 2017).

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Providing guidance and data through ensuring reliable data to enable effective decision making, policies and governance is still a dream in Ghana as there is poor surveillance data on rabies and laboratory confirmed cases officially reported data only give a general idea and do not reflect the true prevalence of rabies. The main causes of inaccurate reporting of rabies cases include failure to present or report suspected cases, the absence of local district diagnostic facilities, inadequate packaging and transportation of specimens to diagnostic laboratories, and a general lack of public knowledge.

Harnessing multi-stakeholder engagement in Ghana requires the operationalization of a national working group on rabies control which seemed to have gained momentum through the development of a national rabies elimination strategy in 2018, where rabies was prioritized as the second of the top six prioritized zoonotic diseases in the country. However, rabies surveillance data on animals from the Veterinary Service Directorate is currently not being shared with other stakeholders as data is not in shareable format which limits the goal of this objective of monitoring and evaluation of effectiveness and sustainability. The Global Alliance for Rabies Control states that a SARE score of 1.5 out of 5 signifies a country where small-scale rabies control programs are in place and the country is working towards developing a national rabies control programme. Ghana’s SARE score for 2022 is 1.5 which indicates little to no improvement since the adoption of the zero human deaths from dog-mediated rabies by 2030 goal in 2018.

The way forward to significant progress in the country’s rabies elimination is by increasing awareness and education on rabies. This is evident in a study conducted by Awuni Baba et al, 2019 which found that residents from Bolgatanga municipality in the Upper East which recorded the highest literacy rate in the region according to the 2010 population and housing census were 7.89 times more likely to have good knowledge about rabies than those from Bawku Municipality. With more than half of the country’s population being youth, youthful organizations such as Animal Welfare League, Ghana which carries out education, free dog vaccinations and community engagement which are all key in reducing human rabies risk should be supported and collaborated by stakeholders and the international community to carry out nationwide activities.

Written by Jacob Ayang Achumboro and Daniel Abiliba

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Animal Welfare League, Kumasi-Ghana.

References

Richard Dery Suu-Ire et al. Socio-demography, and rabies situation in the Cape Coast and Ledzokuku-Krowor Municipalities of Ghana. PAMJ – One Health. 2020;1:6. [doi: 10.11604/pamj-oh.2020.1.6.21855]

World Health Organisation. WHO Expert Consultation on Rabies: second report. WHO technical report series. 2013;982:1-139.

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Lopes, P.H.; Akweongo, P.; Wurapa, F.; Afari, E.; Sackey, S.O.; Hansen, E.M.; Nyarko, K.M. Canine Rabies outbreaks, vaccination coverage, and transmission in humans: Greater Accra Region, Ghana-A retrospective study-2006–2011.

Ghana Statistical Service. Ghana-Ghana Living Standard Survey. 2017. Available online: http://www2. statsghana.gov.gh/nada/index.php/catalog/97/study-description

Awuni B, Tarkang E, Manu E, Amu H, Ayanore MA, Aku FYet al. Dog Owners´ Knowledge about Rabies and Other Factors That Influence Canine Anti-Rabies Vaccination in the Upper East Region of Ghana. Trop. Med. Infect. Dis. 2019;4(3)

Partners for Rabies Prevention. Blueprint for Rabies Prevention and Control. Global Alliance for Rabies Control. 2010

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