An assessment of knowledge, attitudes, and practices concerning rabies among communities with a high disease risk in Timor-Leste

Abstract

Timor-Leste reported its first rabies outbreak in March 2024, making it an emerging zoonotic health threat in the country. However, there was a lack of information about community knowledge, attitudes, and practices (KAP) regarding rabies which is crucial for informing disease response plans. This study investigated the KAP regarding rabies among communities in high-risk areas for rabies incursion and spread. Between July to September 2023, 660 heads of households were interviewed using structured questionnaires in municipalities bordering Indonesian West Timor, and Dili municipality. Dog ownership by households was high (65.3 %, 431/660) and almost all households that owned dogs allowed free-roaming of dogs (98.1 %, 423/431). A small proportion of participants (2.3 %; 15/660) imported dogs from Indonesia. Around half of the participants (52.3 %, 345/660) have heard of rabies, and the majority of these participants were knowledgeable about the disease (86.7 %, 299/345). Almost one-third (30.8 %, 203/660) of households reported dog bite events and only two-thirds of households that experienced dog bites in the last 12 months (67.0 %, 132/197) reported seeking professional medical assistance. Multivariable logistic regression showed that participants with higher education and from Dili municipality were more likely to have positive attitudes towards rabies prevention. This study found limited community awareness about rabies, but positive attitudes towards rabies prevention. Healthcare-seeking behaviour was poor following dog bite events. There is a need to enhance rabies risk communication and community engagement to improve dog rabies vaccination uptake, health-seeking behavior after dog bites, and prevention of unauthorized import and in-country movement of dogs.