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Awareness of animal bite and rabies among agricultural workers in rural Dharwad, Karnataka, India

Rabies is an enzootic and epizootic disease of worldwide importance. In India, rabies is a zoonotic problem of considerable magnitude. Annual mortality more than 30,000 cases reported by national authorities may not be a complete picture because; since 1985 India continues to report the same number of cases every year. It is estimated that number of deaths due to rabies may be 10 times more than those reported. Every year approximately 1.1 to 1.5 million people are receiving post exposure prophylactic treatment. Although 2 million animal bites occur each year in India, out of which more than 95% of cases are bitten by dogs 1 . Rabies in India has been a disease of low public health priority in the medical sector.


INTRODUCTION
Rabies is an enzootic and epizootic disease of worldwide importance. In India, rabies is a zoonotic problem of considerable magnitude. Annual mortality more than 30,000 cases reported by national authorities may not be a complete picture because; since 1985 India continues to report the same number of cases every year. It is estimated that number of deaths due to rabies may be 10 times more than those reported. Every year approximately 1.1 to 1.5 million people are receiving post exposure prophylactic treatment. Although 2 million animal bites occur each year in India, out of which more than 95% of cases are bitten by dogs 1 . Rabies in India has been a disease of low public health priority in the medical sector. This is very unfortunate as almost 65,000 people across the globe and 20,000 people in India die of rabies every year, making it the country with the highest rabies fatalities in Asia and the second highest in the world. 2 Most of the deaths are due to ignorance and lack of access to affordable services. The owned dog population is estimated to be over 25 million in India. 1 There are many myths and false beliefs associated with animal bite wound management. These include application of oils, herbs, and red chillies on the wounds. People have more faith in indigenous medicines that are of unproven efficacy. Not washing the wound properly because of fear that it would get infected is one of the prevailing myths. 3 Earlier many studies have been done on medical students, health care professionals, veterinary personals, and animal bite victims. However, not many studies have been done on general population.
Hence the present study was under taken to study the knowledge, attitude and practice regarding animal bite and rabies, among agricultural workers and to create awareness regarding animal bite and rabies.

METHODS
A cross sectional study was done in rural field practice area of SDM College of Medical Sciences and Hospital, Dharwad in the month of September and October 2015. Data was collected after taking informed consent from agricultural workers who were working in fields at the time of data collection.
Sample size was calculated by assuming awareness to be 50% and considering an absolute precision of 5%. The sample came out to be 400.
Data was collected using a semi structured interview schedule. The schedule consisted of questions regarding knowledge, attitude and practice of animal bite and rabies, as well as about basic socio demographic characteristics like age, sex, religion, socio economic status etc.

Statistical analysis
Data was entered using Epidata v3.1 and analysis was done using SPSS v20.0. Descriptive statistics like percentages, frequencies, mean and standard deviation was used. Chi square test was applied to test association between categorical variables. KAP (knowledge, attitude and practice) scores were calculated as below.

KAP scoring
For every correct answer a score of 1 was given and a score of 0 for every incorrect answer and the mean scores and standard deviation was calculated for knowledge, attitude and practice (KAP).
The participants who had KAP score more than the mean were considered as good and less than mean score were considered poor. 4

RESULTS
Data was collected from 400 agricultural workers. Average age of study participants was 34.95±13.49 years. The age ranged from 18 years to 68 years. Males were 340 (85%) and 60 females (15%). Age categories, education, religion, socio economic status (according to modified B.G. Prasad classification) is given in Table 1.

Attitude of study participants about animal bite and rabies
Seven questions were asked to each of the study participants to assess the attitude regarding the reaction, first aid, health seeking behaviour, vaccination of pets. 16 (4%) of people answered that, lime should be applied to the animal bite wound. Table 3 shows attitude of study participants about animal bite and rabies.

Practice of study participants about animal bite and rabies
Five questions were asked to assess the practice of study participants following supposed animal bite. The questions were related to first aid, watching the animal which bit, health seeking behaviour. Table 4 shows practice of participants about animal bite and rabies.

DISCUSSION
In our present study 51% of study participants had good knowledge and attitude scores, where as 45% of study participants had good practice scores. Socio economic status was significantly associated with knowledge, attitude and practice scores. Education was statistically associated with attitude and practice scores. Religion was only associated with practice scores.
After extensive literature search we could not find any study done on awareness about animal bite and rabies among agricultural workers. So we have compared our findings with studies done on general population.
In the present study 86% belonged to Hindu religion and 14% to Muslim religion. 85% of study population were male and 15% were females. Age ranged from 18 to 68 years. Considering education 11.75% were illiterates, 34.5% had completed primary education, 43.75% had completed high school, 8% up to PUC (12 th standard) and only 2% had completed their graduation.
In a study conducted by Guadu  In the present study 89% of study participants had heard the word rabies. Among those who had heard about rabies most of them heard from health workers (38.2%), followed by from hospital staff (19.11%), radio (17.98%) and other sources.85% of study participants were aware that rabies is transmitted by bite of rabid animals. Most of the study participants answered mad dog bite as the commonest cause of rabies. 67% of the study participants had heard that there is some vaccination for animal bite. In present study 73% of the study participants informed that they will wash suspected animal bite wound with water and soap immediately, rest had traditional or house hold belief of applying lime, mud, turmeric, coffee powder to the suspected animal bite wound. 81% were of the opinion that pet animals should be vaccinated. 77% were willing to consult a doctor following suspected animal bite.
In a study conducted in Gujarat by Singh  In the present study 51% of the study participants informed that they will practice washing of animal bite wound with soap and water. 77% informed that following suspected animal bite to self, family or friends they would consult a doctor. In Ethiopia study by Ali A et al 70.8% of respondents said that they would wash wound with soap and water after suspected animal bite and 50.4% would seek health care following suspected animal bite.
In present study knowledge score was statistically significantly associated with age and socio economic status. Attitude score was significantly associated with age, education and socio economic status.
Practice score was significantly associated with age, education, religion and socio economic status. In a study from Bahir Dar town by Guadu et al KAP scores were significantly associated with sex and educational status. 4 In another study by Ali A et al from Ethiopia knowledge score was significantly associated with sex and education level. Attitude score was significantly associated with age and education level. Practice scores were significantly associated with sex and education levels. 5

CONCLUSION
In present study the agricultural workers had fair awareness about animal bite and rabies. Still there are lots of gaps in knowledge about cause of rabies, most importantly about prevention and treatment of rabies/ dog bite. Creating awareness through periodic health education is required among the agricultural workers.