兽研摘要
背景
犬狂犬病在乌干达米图马区仍然是地方性公共卫生威胁，传统的自上而下的公共卫生干预措施往往因社区参与有限和单向沟通而无法达到所需的70%大规模犬只疫苗接种覆盖率。
目的
本探索性研究评估了参与式沟通在米图马区人-犬-野生动物界面大规模犬只疫苗接种项目中增强社区参与的有效性，并识别了影响狂犬病控制的社会文化和生态因素。
方法
在米图马区基扬加副县有意选取的四个教区（Kiyanga、Kaburara、Iraramira和Kashasha）开展了四次性别分开的焦点小组讨论。数据采用主题框架分析法进行分析。
结果
关于麻痹型狂犬病、非咬伤传播途径和野生动物储存宿主方面仍存在关键认知空白，而互动式教育不足促使人们采用有害的传统伤口处理方法。此外，自上而下的疫苗接种不匹配和功利性犬只观念导致加强针不依从以及否认所有权以逃避医疗和法律责任。
结论
米图马区狂犬病的持续存在根本上是由双向社区参与和多部门协调的失败所驱动。从自上而下的公共卫生信息传达转向“同一健康”参与式沟通框架，对于建立可持续的社区共同所有权和打破传播循环是必要的。
关键词：人-犬-野生动物界面，大规模犬只疫苗接种，米图马区，同一健康，参与式沟通，狂犬病控制
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引言
狂犬病在乌干达仍然是重要的公共卫生威胁，该国的大规模犬只疫苗接种工作因社区参与有限和历史上对自上而下方法的依赖而受到阻碍。实施参与式沟通策略对于促进社区参与和实现世界卫生组织设定的70%疫苗接种覆盖率目标至关重要。本文填补了一项空白，报告了2024年3月在乌干达西部米图马区开展大规模犬只狂犬病疫苗接种项目期间进行的一项探索性研究的结果。作为一种致命的人兽共患病，其向人类的常见传播途径是通过感染动物未经处理的犬咬伤[1, 2]。乌干达宠物疫苗接种覆盖率不足10%，该国仍报告狂犬病高发病率，农村地区受影响尤为严重，凸显了该国严峻的免疫差距[3]。乌干达狂犬病高发病率可能归因于多种因素，包括地理气候季节性变化[4]以及大量绿地作为流浪犬的庇护所，但该国缺乏正式的狂犬病疫情监测机制[5]。为预防犬介导的狂犬病，乌干达政府在所有地区开展年度犬只疫苗接种和狂犬病监测项目。
农业、畜牧业和渔业部通过兽医司监督这些举措[6, 7]。然而，社区参与度低阻碍了项目有效性，使得难以达到世界卫生组织70%的疫苗覆盖率目标[8]，鉴于疫苗接种举措大多采用自上而下的方式，未能有效教育公众负责任地养犬或改变其将流浪犬和野生动物视为社区责任的观念[9]。为加强和提升这一举措，参与式沟通——一种已在多种健康情境中成功应用于增强社区参与的策略——被提倡用于启发、教育和改变行为，并最终有助于实现更公平和可持续的犬只大规模疫苗接种项目[10]，但其在人-犬-野生动物界面狂犬病控制中的应用研究不足，其在该情境中的有效性尚不清楚。这种疫苗可预防的疾病在许多国家呈地方性流行，家犬是狂犬病毒的主要储存宿主，占人类暴露和死亡的高达99%[1, 2]。
该病主要在资源匮乏地区高发，主要影响儿童和老年人[11]，且一旦出现临床症状几乎总是致命的[1, 2]。它通过接触咬伤伤口、开放性皮肤割伤以及来自唾液或其他感染性物质（如脑组织）的黏膜传播[12]。据估计，在全球所有狂犬病死亡病例中，95%被认为发生在亚洲和非洲的总和，其中仅非洲每年就有21,476例人死于犬介导的狂犬病[1, 13]。尽管非洲的犬只疫苗接种率已显著提高[14]，但仍存在资源动员以及操作和文化障碍方面的问题，需要在适当的背景下加以正确理解和处理[15, 16]。由于开展了众多公众意识宣传活动[17]，如今发展中国家的大多数人基本上都知道狂犬病的存在[18]，在某些地区，他们对疾病主要预防和暴露风险的认识有所提高[18, 19]。然而，关于犬咬伤预防技术及此类事件正确应对方式的重要信息缺口，仍然影响着狂犬病一般防控的态度和行为[20, 21]。
由于监测和实验室基础设施不足[22]、现场检测方案不完善以及误诊[23, 24]，狂犬病被严重漏报，它影响着世界最贫困地区的当地社区、公共卫生部门预算和畜牧业，估计每年造成86亿美元的经济损失[25]。通过广泛的犬只疫苗接种活动，发展中国家的人间和犬间狂犬病可以得到控制，有时甚至可以被消灭。消除狂犬病和实现“2030年前零死亡”战略取决于各国加强其犬只疫苗接种规划，达到70%覆盖率的目标，以此作为该承诺的关键直接可衡量指标[26]。作为目前可用的最经济的方法，最新的《全球战略计划》建议在数年内开展广泛的犬只疫苗接种活动，以到2030年阻止犬介导的人间狂犬病死亡[27]。预计在年度疫苗接种规划中，至少70%的犬只应接种疫苗以预防狂犬病[1]。了解犬只饲养的动态、人与犬之间的互动以及犬群生态学——所有这些都可能因地点而异或受社会文化因素影响[28]——通常有助于指导特定地区的长期狂犬病控制举措[29]。
有效的狂犬病管理努力需要认识到许多物种在多宿主病毒传播中所起的作用[13]。尽管所有哺乳动物都易感狂犬病，但某些物种比其他物种更可能感染并传播给其他动物[13, 30]。因此，如果我们全面掌握维持狂犬病病毒循环所必需的物种（维持宿主）[31]，狂犬病控制策略就可能有效。在整个非洲和亚洲，家犬被认为是狂犬病的主要维持宿主，犬咬伤导致超过99%的人间狂犬病死亡[13, 32]。尽管已反复证明家犬接种狂犬病疫苗在预防人间狂犬病方面既有效又经济，但在许多狂犬病流行国家，犬只疫苗接种规划仍未得到普遍采用[33, 34]。其主要原因是为犬只疫苗接种提供资金不足，尽管人们经常表达对野生动物可能助长疾病传播并使疫苗接种无效的担忧[35, 36]。然而，即使在野生动物病例比例相对较高的地区，家犬疫苗接种也降低了人类面临的风险[37, 38]。疫苗接种活动结束后犬间狂犬病病例的增加，体现了持续开展年度犬只疫苗接种规划的重要性[39]。
犬间狂犬病的这种增加以及随后野生动物狂犬病可能的上升，对公共卫生构成严重风险[40]。多年来，全球已尝试多种方法来消灭人间和犬间狂犬病[41]，例如大规模犬只安乐死[42]或使用常规方法处理咬伤伤口[43]。根据现有数据，在整合社区的同时维持犬只疫苗接种和管理犬群，是一种必须协同作用以避免人间狂犬病的策略[9]。有鉴于此，大多数现代狂犬病消灭计划遵循“同一健康”理念，采用社会文化策略，包括大规模犬只疫苗接种活动、公众宣传和教育运动、政府倡导以及人道犬群控制措施[44]。米图马区目前将其狂犬病消除策略重点放在疫苗接种和管理流浪犬群上，因为研究表明“未接种疫苗的有主犬、流浪犬或社区犬是全球狂犬病的主要储存宿主”[45]。鉴于犬咬伤几乎占所有人间狂犬病传播[46]，优化本地化沟通以推动规划参与仍然至关重要。
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材料与方法
这项探索性、定性描述性案例研究于2024年3月在乌干达西南部米托马区基扬加副县四个教区（伊拉拉米拉、卡布拉拉、基扬加和卡沙沙）开展——该地区毗邻伊丽莎白女王保护区内马拉马甘博森林保护区（图1）。该研究环境为评估本地化狂犬病大规模疫苗接种（MDV）工作提供了具有代表性的生态和社会人口学背景。本研究通过焦点小组讨论（FGD）、非正式访谈和实地观察，评估了一项大规模犬只疫苗接种规划中的参与式沟通策略。
[图：乌干达地图，显示米托马区和基扬加副县的位置。]
采用非概率抽样策略。在助理畜牧官员协助下，所有四个组成教区均被选为主要疫苗接种点。根据既往狂犬病流行情况和活动时间安排，采用目的抽样选择行政利益相关者和目标村庄；而在疫苗接种活动点，采用便利抽样招募犬主。为减少选择偏倚，数据收集团队在多个地理集群中轮换上午和下午班次，以覆盖更广泛的人口范围。
以当地语言（鲁尼亚基塔拉语）开展了四组性别同质的焦点小组讨论，共44名参与者（25名男性，19名女性；表1）。每组焦点小组讨论（8–13名参与者，约40分钟）遵循半结构化指南，涵盖四个主题领域：狂犬病知识素养、管理与控制措施、风险行为以及犬只的社会角色。为补充并三角验证这些数据，研究者与地方委员会领导人、村民、学校教师、临床护士和兽医进行了有针对性的非正式讨论和沉浸式参与观察（图2），直至达到理论数据饱和。
TABLE 1. Features of the focus group discussions (FGDs) by parish, group type, and dog ownership.
| Parish | Group type | Participants ( n ) | Dog owners | Non‐dog owners |
|---|---|---|---|---|
| Kiyanga | Men (FGD 1) | 13 | 11 | 2 |
| Iraramira | Women (FGD 2) | 8 | 5 | 3 |
| Kaburara | Men (FGD 3) | 12 | 9 | 3 |
| Kashasha | Women (FGD 4) | 11 | 7 | 4 |
| Total | 4 | 44 | 32 | 12 |
[图：一名研究者在疫苗接种点开展有针对性的非正式讨论和参与观察。]
焦点小组讨论和访谈的录音被逐字转录、翻译成英文，并按照Braun和Clarke的框架通过归纳主题分析进行分析。两名独立研究者对一部分转录稿进行编码，以建立统一的编码簿，并通过共识解决分歧。随后将反复出现的编码汇总为关于参与式沟通促进因素和障碍的总体主题。通过广泛的实地笔记进行三角验证，并与选定的地方领导人进行成员核查，以保持严谨性和可信度。
本研究作为机构项目评估开展，评估由米托马区地方政府兽医部门管理和监督的常规大规模犬只狂犬病疫苗接种活动；该部门授予了行政许可、机构同意和定性数据收集的正式伦理授权。学术和科学监督严格按照首席研究者于坎帕拉国际大学的博士研究方案进行。由于这项探索性研究完全依赖涉及人类参与者（焦点小组讨论和非正式访谈）的定性方法，研究公共卫生沟通渠道，不涉及对活体动物的实验操作、保定、生物采样或临床干预；因此未触发侵入性兽医研究的正式动物福利委员会方案。在数据收集之前，所有参与者均以鲁尼亚基塔拉语充分了解研究目标、数据保密性和参与的自愿性质。所有犬主和社区利益相关者在参与前均提供了知情口头同意。
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结果
米托马区社区对狂犬病的认知呈现出深刻的悖论：尽管对该疾病致死性和经咬伤传播的基线认识普遍存在，但公众的深度健康素养因历史上依赖自上而下、单向沟通渠道而受到严重制约。实地数据显示，社区对狂犬病的整体识别严重偏向典型的“狂躁型”临床表现，在亚临床或其他表现形式方面存在显著脆弱性。在男性队列（FGD-M1、FGD-M2）中，参与者能够轻易识别攻击性狂犬病行为，但完全不熟悉麻痹型或“哑型”狂犬病。相反，女性参与者（FGD-W1、FGD-W2）经常指出，她们不知道病毒可通过轻微抓伤或感染性唾液与破损皮肤接触传播。受这些结构性知识空白以及与兽医专业人员就检疫方案完全缺乏双向对话的驱动，局部焦虑常常最终导致对疑似动物的立即、不协调扑杀。这一反应性动态被基扬加教区的一位参与者描述为：
我们只知道疯狗会到处乱跑咬人。如果一只狗只是安静、虚弱、躲在厨房角落里，我们就把它当作普通疾病来对待。区里从来没有人坐下来跟我们解释过，安静的狗也可能患有狂犬病。（参与者3，FGD‐M1）
这种互动式健康沟通的断裂直接延伸到理论医学认知与家庭应急反应之间的关键脱节。在县以下地区，犬类暴露的一线处理仍然严重以传统的本地化做法为主，而非循证干预。Kashasha的女性（FGD‐W2）指出，咬伤后的即时优先事项集中在控制出血和用可获取的强腐蚀性物质“拔出毒素”，如电池酸液、辣椒粉和当地草药。至关重要的是，立即用肥皂和流动水冲洗伤口15分钟这一至关重要的公共卫生做法在社区叙述中完全缺失。此外，当寻求临床暴露后预防（PEP）时，结构和经济障碍系统性地削弱了依从性。来自Iraramira等边缘地区的参与者（FGD‐W1）面临高昂的摩托车交通费用以及公共卫生机构疫苗的长期缺货，使就医行为变成一种不确定的经济风险：
在Iraramira这里，当孩子被咬伤时，我们用家里有的东西——比如烟草或灰烬——来封住伤口。我们从未收到过关于使用基本肥皂和水的明确指导。前往主要卫生中心是一场经济赌博，因为他们通常告诉我们狂犬病疫苗反正缺货。（参与者7，FGD‐W1）
这些系统性沟通障碍直接塑造了社区成员对机构干预的认知和参与方式。当前政府主导的MDV项目被广泛描述为自上而下、零散和被动反应式的，完全缺乏双向规划或社区动员。Kaburara的受访者（FGD‐M2）强调，疫苗接种活动通常是在该区发生高关注度人狂犬病死亡事件后作为事后紧急措施部署的。由于地方领导和居民被排除在运营规划之外，时间安排通知来得晚，中心分发点设置不当，迫使畜主将未约束的工作犬跨越教区边界长距离运输，路途危险。为解决这一结构性摩擦，在疫苗接种点引入了一种替代方法，采用新型视觉信号技术对已接种疫苗的犬只进行颜色标记（图3）。这一参与式工具展示了透明、面向社区的沟通如何赋能村民独立识别未接种疫苗的动物，培养本地化自主意识并推动活动参与率。一位来自Kaburara的参与者描述了时间安排不协调的历史挑战：
[图：一名研究人员在大规模疫苗接种点为一只狗施加临时颜色标记。]
区官员不征求我们关于何时何地举办疫苗接种的意见。他们只是在已经到达县总部时通过口头传播或扩音器发出通知。等你把狗从Kaburara的偏远角落带过来时，官员们已经离开了。（参与者2，FGD‐M2）
Mitooma区独特的生态景观进一步放大了这些公共卫生挑战，在Maramagambo森林保护区和当地森林碎片的边缘形成了一个未受监测的人—犬—野生动物交界面。在Kiyanga教区（FGD‐M1），参与者详细描述了家养猎犬或护卫犬与野生食肉动物（如豺和狐狸）之间的定期互动和领地冲突。这一森林交界面作为持续、未受监测的病毒再感染储库运作，但在区兽医外展工作中完全未被涉及。在县内更城市化的区域，这种生态压力因缺乏结构化、人道的流浪犬种群管理而加剧。不断扩大的自由 roaming 犬群由管理不善的社区垃圾堆维持。在缺乏机构动物福利支持或兽医指导的情况下，社区经常诉诸使用农用杀虫剂进行危险、不协调的毒杀行动：
我们的狗深入灌木丛进行狩猎和安保，它们经常与野生狐狸和豺搏斗。野生动物和我们的狗之间存在持续的疾病循环，但区兽医办公室从不与我们讨论这一交界面或帮助我们管理它。（参与者5，FGD‐M1）
这些生态动态与日常行为风险相互作用，加剧了社区对亚临床传播的脆弱性。在所有研究地点，人们普遍随意地接近自由 roaming 的犬只，尤其是儿童经常与友好、看似健康的社区犬互动（FGD‐W1）。这种暴露风险因长期疫苗不依从而严重加剧。尽管社区成员经常为幼犬寻求初始疫苗接种，但由于私人兽医费用以及约束和牵引大型未训练工作犬前往远处集中诊所的巨大身体挑战，年度加强针依从性几乎不存在：
儿童在病理上信任院子里任何摇尾巴的狗。他们每天与狗玩耍，而我们这些母亲只有在狗改变叫声或开始咬东西时才会产生怀疑。（参与者1，FGD‐W1）
这种保护性基础设施和程序指导的系统性缺失最终破坏了关键的咬伤后管理方案。对于咬人动物进行10天隔离观察的标准公共卫生和兽医实践完全缺失。在恐慌驱使下，社区几乎总是立即杀死可疑动物，消除了任何诊断追踪或流行病学验证的机会。此外，即使患者成功启动了PEP，临床依从性仍然严重不足。Kaburara的参与者（FGD‐M2）指出，一旦即刻的咬伤伤口愈合且局部疼痛消退，多剂次依从性便急剧下降，因为患者通常将可见皮肤创伤的愈合误解为完全治愈：
当皮肤闭合、疼痛消失后，人们就不再前往卫生中心了。很难说服一个人为一种他们无法再在你皮肤上看到的疾病花钱打额外的针。（参与者6，FGD‐M2）
至关重要的是，这些行为模式和公共卫生依从性差距深深植根于社区内狗的社会文化定位和功利价值。狗不被视为伴侣动物，而几乎仅因其资产安全和森林边界生计狩猎的价值而受到重视。这种功能导向建立了决定运动参与的明显性别差异。由于这些动物被饲养得凶猛以用于安全目的，男性在文化上被指定为其主要饲养者和处理者。Kashasha的女性（FGD‐W2）解释说，她们及其子女在体力上感到无力将这些大型、具有攻击性的实用动物约束并带到集中疫苗接种点。因此，如果男性户主在运动期间外出，狗就被简单地关在宅基地内，在社区群体免疫中造成显著的局部缺口：
这个村庄养狗是为了干活——要么看守房屋防贼，要么驱赶野生动物远离我们的庄稼。因为它们被养得凶猛，处理它们被认为是男人的责任。如果疫苗团队到达那天父亲不在家，家庭就会直接把狗锁在院子里，因为妇女和儿童无法把一只野性十足、沉重的大狗拖到路上。（参与者11，FGD‐W2）
[内容请查看原文]
讨论
本研究表明，地方性社区认知、社会文化信仰和传统医学实践对Mitooma地区有效的狂犬病暴露后管理构成了深远的、高度情境化的障碍。具体而言，我们的实地数据分离出两个关键行为风险。其中包括利用家犬进行被禁止的野生动物狩猎，这加剧了森林-城乡交界面的传播，以及依赖危险的传统急救方法，如将烟叶、电池酸或辣椒粉敷于咬伤伤口。这一特定焦点——即对临床狂犬病行为的地方性模糊认知直接驱动非正式的、非临床干预——得到了乌干达西部Buyaga地区区域文献[47]的大力印证。尽管Kankya等人证实这种模糊性延迟了就医行为，但我们的研究通过记录乌干达西南部使用的确切家庭疗法扩展了这一研究方向。在全球范围内，这一结构性瓶颈进一步得到南非农村[48]和坦桑尼亚Tanga地区转诊医院[49]研究的验证，两者均将传统伤口护理实践确定为立即生物医学干预的主要障碍。因此，这些综合发现表明，狂犬病根除不能依赖自上而下的沟通。相反，公共卫生框架必须转向参与式健康促进，与地方领导者共同设计教育信息，以系统性地破除这些特定的、高度地方化的迷思。
我们探究的第二个关键焦点是社区对跨物种传播途径的认知严重不足，这直接损害了群体免疫所需的70% MDV阈值。我们的研究结果强调，当公共卫生运动将社区视为同质实体、忽视当地生态如何塑造认知时，这些运动便会失败。生态界面与文化特征之间的这一特定交汇点，反映了印度研究人员提出的更广泛的系统性论点[50]，他们证明，在人类—犬—野生动物界面忽视社会文化细微差异和公众认知障碍，必然使大规模动员努力注定失败。此外，在乌干达开展的一项全国范围综述[51]明确指出，社区层面缺乏“同一健康”框架的可操作化是当前研究的一大盲点，并指出历史性研究、纯描述性研究或仅针对人类的研究留下了巨大空白。我们的研究直接填补了这一实证空白。通过部署参与式视觉信号技术对已接种疫苗的犬只进行颜色编码，我们的实地数据提供了一种弥合这一知识鸿沟的实用机制，这与海地狂犬病流行地区大规模疫苗接种活动中记录的操作成功经验相呼应[52]。在该背景下，互动式、社区主导的沟通策略成功地将抽象的流行病学目标转化为可操作的本地知识，直接推动了达到群体免疫目标所需的集体依从性。
通过将狂犬病管理置于社会人类学背景中，本研究直面东非人兽共患病研究中的一种方法论偏倚，即传统上偏向临床、兽医或定量参数，而忽视决定规划执行的人类行为现实。我们对社区能动性的关注挑战了乌干达国家人兽共患病卫生政策评估中所批评的自上而下模式[53]。这些国家政策认为，消除策略持续受挫，是因为它们将农村人口视为兽医服务的被动接受者，而非积极的利益相关者。Mitooma实地数据为这一批评提供了实证依据，表明若无积极的社区伙伴关系，兽医—医学干预在结构上是有限的。这使我们的工作与津巴布韦发展出的社会人类学框架相一致[54]，该框架主张，可持续的人兽共患病控制需要深入理解社区结构，以识别隐藏的阻力点，并将居民转变为疾病监测的积极伙伴。
对本研究的最终分析强调，MDV覆盖率不仅仅是疫苗供应的后勤函数，还受到历史、社会、政治、经济和生态背景因素交织矩阵的严重制约。我们对操作摩擦的关注，特别是公告延迟、分发几何布局不佳以及约束大型工作犬的物理挑战，得到了乌干达Kyegegwa区实证证据的有力支持[55]。Kyegegwa此前的发现将地理地形、根深蒂固的社区动态、严重的经济制约以及兽医人员的系统性短缺列为运动优化的复合障碍。坦桑尼亚也记录了类似的多因素脆弱性[56]，证实孤立的疫苗投递是不够的，解决这些重叠的脆弱性需要摆脱不协调的干预措施。我们的研究通过将参与式沟通作为这些障碍的直接操作解决方案，推进了这一讨论。让地方领导人参与运动后勤，使社区能够围绕农事安排和地理障碍共同绘制疫苗接种边界，将负责任的养犬行为从抽象的本地需求转变为系统性支持的现实。
改善地方参与需要对负责任养犬行为在社区和系统层面的概念化和支持方式进行全面的改革。负责任的养犬行为，包括犬只圈养、充足营养和常规疫苗接种，如果系统性制度支持仍然缺位，仅靠局部信息传递是无法维持的。这种对地方问责和系统基础设施的双重要求与先前研究表明参与式沟通培养互补的双重意识相一致[57]。在地方层面，它使社区对犬只的看法从松散的功利性资产转变为受保护的伴侣动物；在系统层面，它利用社区生成的数据来倡导一致的兽医基础设施，确保社区的意愿得到机构能力的有效匹配。由于结构性疫苗依从性与犬咬伤发生率动态且高度相关[58]，利用参与式沟通优化局部免疫基础设施是实现世界卫生组织到2030年消除犬介导的人类狂犬病死亡全球战略计划（WHO“Zero by 30”）的直接、实际前提。
[内容请查看原文]
结论与建议
本探索性研究表明，米图马地区本土狂犬病的持续存在不仅仅是疫苗短缺的结果，更是社区参与和参与式沟通根本性失败的体现。历史上对自上而下、说教式公共卫生模式的依赖，造成了严重的公众知识素养缺失，维持了危险的传统伤口处理做法，并导致MDV运动碎片化、覆盖率低下。此外，在Kiyanga教区等生态热点地区，未经监测的人、家犬和野生动物界面形成了持续的流行病学威胁，标准的、被动反应式的公共卫生策略无法遏制。实现可持续的人兽共患病消除，要求米图马地区地方政府实施一个由参与式沟通驱动的功能性“同一健康”框架，从文本上转变当地社区，使其从被动、恐惧的旁观者转变为积极、负责任的公共卫生和动物健康共同管理者。
为将这些实证见解转化为可操作的干预措施，米图马地区地方政府必须立即正式成立一个联合多部门工作组，整合地区卫生官员、地区兽医官员、环境主管部门以及乌干达野生动物管理局的代表。该跨部门机构每季度召开会议，可同步人兽疾病监测、共同预算大规模犬类疫苗接种运动，并降低森林和农业前沿的溢出风险。同时，地区兽医主管部门必须放弃自上而下的行政排程模式，直接与当地教区发展委员会和LC I主席合作，共同选择分散式疫苗接种站点，建立与社区农耕日历相一致的最佳季节性时机，并利用当地信息路径以最大化社区参与率。地方当局还应转变狂犬病沟通方式，培训乡村卫生团队开展互动式社区对话会议，而非依赖被动的印刷媒体。这些教育活动必须摆脱高度恐惧的图像，聚焦于可操作的知识，包括识别狂犬病的哑型瘫痪形式、实践正确的15分钟肥皂和水伤口清洗，以及强调完整多剂次PEP依从性的救命必要性。
最后，长期稳定要求副县和地区议会起草、刊登公报并积极执行地方性动物控制附例。这些法规必须强制要求家犬登记，对遗弃或拒绝在夜间圈养役用犬的饲养者设定明确处罚，并建立法律机制使饲养者对牲畜损害或人咬伤医疗费用承担经济责任。为补充这些法律护栏，地区应培训当地猎人、农民和学校教师担任社区监测联络点。利用简单的移动端报告系统或专门的本地沟通渠道，这些人可以直接向“同一健康”工作组报告动物咬伤、流浪犬群或异常野生动物遭遇，从而在人类暴露发生之前实现快速、预防性的现场干预。通过这种综合方法，该地区可以弥合眼前的运营差距，并积极为实现全球疾病消除目标作出贡献。
作者贡献
Augustino Ngabirano：概念化、调查、写作——原始草稿、方法学、写作——审阅与编辑、项目管理、数据管理、资源。Matthew Chibunna Igwe：方法学、验证、形式分析、监督、数据管理、写作——审阅与编辑。Charles Idehen：数据管理、监督、形式分析、方法学、验证、写作——审阅与编辑。所有作者阅读并批准了最终稿件。
资助
作者无内容需报告。
伦理声明
本研究经米图马地区地方政府批准为机构项目评估，并在首席研究员的坎帕拉国际大学博士研究方案下开展。
知情同意
已获得参与本探索性研究的所有参与者的知情同意。
利益冲突
作者声明无利益冲突。
致谢
作者感谢米图马地区兽医部门和社区参与者在大规模犬类疫苗接种评估期间分别给予的监督与合作。
数据可用性声明
支持本研究发现的定性和空间数据可在合理请求下从通讯作者处获取。
参考文献
[内容请查看原文]
关联数据
数据可用性声明
支持本研究发现的定性和空间数据可在合理请求下从通讯作者处获取。
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ABSTRACT
Background
Canine rabies remains an endemic public health threat in Mitooma District, Uganda, where traditional, top–down public health interventions frequently fail to achieve the required 70% mass dog vaccination (MDV) coverage due to limited community engagement and one‐way communication.
Objectives
This exploratory study evaluated the effectiveness of participatory communication in enhancing community engagement in MDV programs at the human–dog–wildlife interface in Mitooma District and identified the sociocultural and ecological factors influencing rabies control.
Methods
Four gender‐segregated focus group discussions were conducted across four purposively selected parishes (Kiyanga, Kaburara, Iraramira, and Kashasha) in Kiyanga sub‐county, Mitooma District. Data were analyzed using thematic framework analysis.
Results
Critical gaps persist regarding paralytic rabies, non‐bite transmission pathways, and wildlife reservoirs, whereas inadequate interactive education drives the adoption of harmful traditional wound care. Furthermore, top–down vaccination mismatches and utilitarian canine views trigger booster noncompliance and ownership denial to evade medical and legal liabilities.
Conclusion
Rabies persistence in Mitooma District is fundamentally driven by a failure of bidirectional community engagement and multi‐sectoral coordination. Shifting from top–down public health messaging to a One Health participatory communication framework is necessary to establish sustainable community co‐ownership and break the transmission cycle.
Keywords: human–dog–wildlife interface, mass dog vaccination, Mitooma District, One Health, participatory communication, rabies control
[内容请查看原文]
Introduction
Rabies remains a significant public health threat in Uganda, where mass dog vaccination (MDV) efforts are hindered by limited community participation and a historical reliance on top–down approaches. Implementing participatory communication strategies is essential to foster community engagement and achieve the World Health Organization's targeted 70% vaccination coverage. This article fills a gap by giving results from an exploratory study conducted during a mass dog rabies vaccination program in Mitooma District, western Uganda, in March 2024. As a fatal zoonotic disease, its common route of transmission to humans is through untreated dog bites from infected animals [1, 2]. With less than 10% vaccination coverage of Uganda's pets, the country still reports a high incidence of rabies with rural areas disproportionately affected, highlighting the country's stark immunization gaps [3]. The high incidence of rabies in Uganda may be attributed to a number of factors, including the geo‐climatic seasonal variations [4] and a high amount of greenery that serves as a haven for stray dogs, yet a formalized mechanism for monitoring the rabies epidemic is absent in the country [5]. To prevent canine‐mediated rabies, the Ugandan government conducts yearly dog vaccination and rabies monitoring programs throughout all districts.
The Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) oversees these initiatives through the Veterinary Department [6, 7]. However, low community engagement and participation hinder program effectiveness, making it difficult to reach the World Health Organization's 70% vaccine coverage target [8] given that the vaccination initiatives have mostly taken a top–down approach, and not effectively educating the public about responsible dog ownership or changing their perception to take stray dogs and wildlife as a community obligation [9]. To enhance and heighten this initiative, participatory communication, a strategy that has been successfully applied in various health contexts to enhance community involvement, has been advocated seeking to enlighten, educate, and modify behavior and ultimately contributing to more equitable and sustainable mass vaccination program for the dogs [10], but its application in rabies control at the human–dog–wildlife interface is understudied, and its effectiveness in this context is unknown. This vaccine‐preventable disease is endemic in many countries where domestic dogs serve as the principal reservoir for the rabies virus that accounts for as high as 99% of human exposures and fatalities [1, 2].
The disease is predominantly high in low‐resource settings, majorly affecting children and the elderly [11], and the disease is nearly always lethal once clinical symptoms appear [1, 2]. It spreads through contact with bite wounds, open skin cuts, and mucous membranes from saliva or other infectious materials like brain tissue [12]. It is estimated that of all rabies deaths globally, 95% are thought to occur in Asia and Africa combined, whereby 21,476 human deaths from dog‐mediated rabies occur in Africa alone annually [1, 13]. Despite the fact that vaccination rates for dogs have significantly increased in Africa [14], there are still issues with resource mobilization as well as operational and cultural hurdles that need to be properly understood and dealt with in the appropriate context [15, 16]. Consequent to the numerous public awareness campaigns [17], these days, the majority of people living in developing nations are largely aware that rabies exists [18], and in certain areas, their knowledge of the disease's major preventative and exposure risks has improved [18, 19]. Nonetheless, attitudes and behaviors of general rabies control are still impacted by significant information gaps about dog bite prevention techniques and the proper way to respond to such incidents [20, 21].
Significantly underreported as a result of inadequate surveillance and laboratory infrastructure [22], inadequate field‐based testing protocols as well as misdiagnosis [23, 24], rabies affects local communities, public health sector budgets, and livestock industries in the world's poorest regions, with an estimated $8.6 billion in economic losses each year [25]. Through widespread dog vaccination campaigns, rabies in both humans and dogs can be managed and occasionally eradicated in developing nations. Rabies elimination and attaining the zero‐by‐30 strategy rely on countries stepping up their dog vaccination programs to the target of 70% coverage as the critical directly measurable indicator on this commitment [26]. As the most economical approach now available, the latest Global Strategy Plan to halt human mortality from dog‐mediated rabies by 2030 recommends widespread dog vaccination campaigns spread over several years [27]. It is expected that during yearly vaccination programs, at least 70% of dogs should receive vaccinations to prevent rabies [1]. An understanding of the dynamics of dog ownership, the interaction between humans and dogs, and the ecology of the dog population—all of which might differ depending on the location or be influenced by sociocultural factors [28] is generally helpful in directing long‐term rabies control initiatives in particular areas [29].
Effective rabies management efforts require an awareness of the roles that many species play in the transmission of multi‐host viruses [13]. Although all mammals are rabies‐prone, some species are more likely than others to contract and transmit it to others [13, 30]. Therefore, rabies control strategies could be effective if we have a comprehensive grasp of the species that are necessary to keep the rabies virus circulating (the maintenance hosts) [31]. Across Africa and Asia, domestic dogs are thought to be the principal maintenance hosts for rabies, and dog bites cause more than 99% of human rabies fatalities [13, 32]. Even though it has been repeatedly shown that rabies vaccinations for domestic dogs are both effective and affordable in preventing human rabies, dog vaccination programs are still not generally adopted in many countries where rabies is endemic [33, 34]. The main cause of this is a lack of funding for canine vaccinations, although worries that wildlife could contribute to the spread of the disease and make vaccinations ineffective are frequently voiced [35, 36]. Nevertheless, domestic dog vaccination decreased the risk to humans even in locations with a comparatively high percentage of wildlife cases [37, 38]. The significance of continuing annual dog vaccination programs is observed in the rise of canine rabies cases after vaccination campaigns have ended [39].
This increase in dog rabies and the probable subsequent rise in wildlife rabies pose a serious risk to the public health [40]. Over the years, numerous methods have been tried globally to eradicate rabies in both humans and canines [41], such as mass dog euthanasia [42] or using conventional treatment to treat bite wounds [43]. According to available data, maintaining dog vaccination and managing the dog population while integrating the community is one strategy that must work in tandem to avoid rabies in people [9]. In light of this, the majority of modern rabies extermination plans adhere to the “One Health” concept, which adopts a sociocultural strategy that includes MDV campaigns, public outreach and education campaigns, government advocacy, and humane dog population control measures [44]. Mitooma District is presently focusing its rabies elimination tactics on vaccination and managing stray dog populations because research indicates that “unvaccinated owned, stray or community dogs are the major reservoirs of rabies worldwide” [45]. In light of the fact that dog bites account [46] for almost all human rabies transmissions, optimizing localized communication to drive program uptake remains vital.
[内容请查看原文]
Materials and Methods
This exploratory, qualitative descriptive case study was conducted in March 2024 across four parishes (Iraramira, Kaburara, Kiyanga, and Kashasha) in Kiyanga sub‐county, Mitooma District, southwestern Uganda—a region bordering the Maramagambo Forest Reserve within the Queen Elizabeth Conservation Area (Figure 1). This setting provides a representative ecological and sociodemographic context for evaluating localized MDV efforts. The study assessed participatory communication strategies during a large‐scale dog vaccination program using focus group discussions (FGDs), informal interviews, and field observations.
[图：Map of Uganda showing the location of Mitooma District and Kiyanga sub‐county.]
A non‐probability sampling strategy was utilized. All four constituent parishes were selected as primary vaccination sites with the assistance of the assistant animal husbandry officer. Purposive sampling was applied to select administrative stakeholders and target villages based on past rabies prevalence and campaign timing, whereas convenience sampling was used to recruit dog owners at active vaccination sites. To mitigate selection bias, data collection teams rotated morning and afternoon shifts across multiple geographic clusters to capture a broader demographic range.
Four gender‐homogeneous FGDs were conducted in the native language (Runyakitara), involving 44 participants (25 men, 19 women; Table 1). Each FGD (8–13 participants, taking approximately 40 min) followed a semi‐structured guide addressing four thematic domains: rabies literacy, management/control measures, risk behaviors, and canine societal roles. To complement and triangulate these data, the researcher conducted targeted informal discussions and immersive participant observations (Figure 2) with local council leaders, villagers, school teachers, clinical nurses, and veterinarians until theoretical data saturation was achieved.
TABLE 1. Features of the focus group discussions (FGDs) by parish, group type, and dog ownership.
| Parish | Group type | Participants ( n ) | Dog owners | Non‐dog owners |
|---|---|---|---|---|
| Kiyanga | Men (FGD 1) | 13 | 11 | 2 |
| Iraramira | Women (FGD 2) | 8 | 5 | 3 |
| Kaburara | Men (FGD 3) | 12 | 9 | 3 |
| Kashasha | Women (FGD 4) | 11 | 7 | 4 |
| Total | 4 | 44 | 32 | 12 |
[图：A researcher conducting targeted informal discussions and participant observations at the vaccination site.]
Audio recordings from FGDs and interviews were transcribed verbatim, translated into English, and analyzed via inductive thematic analysis following Braun and Clarke's framework. Two independent researchers coded a subset of transcripts to establish a uniform codebook, resolving discrepancies through consensus. Recurrent codes were then aggregated into overarching themes regarding participatory communication facilitators and hurdles. Rigor and trustworthiness were maintained through extensive field notes for triangulation and member‐checking with selected local leaders.
This study was conducted as an institutional program evaluation of a routine mass dog rabies vaccination campaign managed and overseen by the Mitooma District Local Government Veterinary Department, which granted administrative clearance, institutional consent, and formal ethical authorization for qualitative data collection. Academic and scientific oversights were maintained in strict accordance with the lead investigator's doctoral research protocols at Kampala International University. Because this exploratory study relied entirely on qualitative methodology involving human participants (FGDs and informal interviews) regarding public health communication channels and did not involve experimental manipulations, handling, restraint, biological sampling, or clinical interventions on live animals; formal animal welfare committee protocols for invasive veterinary research were not triggered. Prior to data collection, all participants were thoroughly informed in Runyakitara about the study's objectives, data confidentiality, and the voluntary nature of their participation. All dog owners and community stakeholders provided informed verbal consent before participating.
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Results
Community perceptions of rabies across Mitooma District are characterized by a profound paradox: Although a baseline awareness of the disease's fatal nature and transmission through bites is universal, deep public health literacy is severely constrained by historical reliance on top–down, one‐way communication channels. Field data reveal that community‐wide recognition of rabies is heavily biased toward the classic “furious” clinical presentation, leaving significant vulnerabilities regarding subclinical or alternative manifestations. In the men's cohorts (FGD‐M1, FGD‐M2), participants readily identified aggressive rabid behaviors but demonstrated complete unfamiliarity with paralytic or “dumb” rabies. Conversely, women participants (FGD‐W1, FGD‐W2) frequently noted an unawareness that the virus could be transmitted via minor scratches or contact between infected saliva and broken skin. Driven by these structural knowledge gaps and a total lack of bidirectional dialogue with veterinary professionals regarding quarantine protocols, localized anxiety frequently culminates in the immediate, uncoordinated culling of suspected animals. This reactive dynamic is captured by a participant from Kiyanga Parish:
We only know about the mad dog that runs around biting people. If a dog is just quiet, weak, and hiding in the kitchen corner, we treat it as a normal sickness. Nobody from the district has ever sat down with us to explain that a quiet dog can also have the madness. (Participant 3, FGD‐M1)
This breakdown in interactive health communication extends directly into critical disconnects between theoretical medical awareness and household emergency responses. First‐line treatments for canine exposure within the sub‐county remain heavily dominated by traditional, localized practices rather than evidence‐based interventions. Women in Kashasha (FGD‐W2) noted that immediate post‐bite priorities focus on hemorrhage control and “drawing out the poison” using accessible, highly caustic substances like battery acid, chili powder, and local herbs. Crucially, the vital public health practice of immediately flushing the wound with soap and running water for 15 min was entirely absent from community narratives. Furthermore, when clinical post‐exposure prophylaxis (PEP) is sought, structural and financial barriers systematically undermine compliance. Participants from peripheral areas like Iraramira (FGD‐W1) face prohibitive motorcycle transport fares alongside chronic vaccine stockouts at public health facilities, transforming healthcare‐seeking behaviors into an uncertain economic risk:
When a child is bitten here in Iraramira, we use what we have at home—like tobacco or ash—to seal the wound. We have never received explicit instruction on using basic soap and water. Traveling to the main health center is a financial gamble because they often tell us the rabies vaccine is out of stock anyway. (Participant 7, FGD‐W1)
These systemic communication barriers directly shape how community members perceive and engage with institutional interventions. Current government‐led MDV programs are widely characterized as top–down, sporadic, and reactive, operating entirely without bidirectional planning or community mobilization. Informants in Kaburara (FGD‐M2) highlighted that vaccination campaigns are typically deployed as post hoc emergency measures following a high‐profile human rabies death in the district. Because local leaders and residents are excluded from operational planning, scheduling announcements arrive late and central distribution points are poorly placed, forcing owners to transport unrestrained, working dogs over long, hazardous distances across parish borders. To address this structural friction, an alternative approach was introduced at the vaccination site, where a novel visual signaling technique was deployed to color‐code vaccinated dogs (Figure 3). This participatory tool demonstrated how transparent, community‐facing communication can empower villagers to independently identify unvaccinated animals, fostering localized ownership and driving campaign attendance. The historical challenges of uncoordinated scheduling are illustrated by a participant from Kaburara:
[图：A researcher applying a temporary color marking to a dog at a mass vaccination site.]
The district officials do not consult us on when or where to hold the vaccinations. They just send an announcement via word‐of‐mouth or a loudspeaker when they are already at the sub‐county headquarters. By the time you walk your dogs from the far corners of Kaburara, the officers have already left. (Participant 2, FGD‐M2)
The unique ecological landscape of Mitooma District further amplifies these public health challenges, establishing an unmonitored human–dog–wildlife interface along the edges of the Maramagambo Forest Reserve and local forest fragments. In Kiyanga Parish (FGD‐M1), participants detailed regular interactions and territorial conflicts between domestic hunting or guard dogs and wild carnivores, such as jackals and foxes. This sylvatic interface operates as a continuous, unmonitored viral reservoir for reinfection, yet it remains completely unaddressed in district veterinary outreach. In more urbanized pockets of the sub‐county, this ecological pressure is compounded by the absence of structured, humane stray dog population management. Expanding populations of free‐roaming dogs are sustained by poorly managed community garbage heaps. Deprived of institutional animal welfare support or veterinary guidance, communities frequently resort to dangerous, uncoordinated poisoning campaigns using agricultural pesticides:
Our dogs go deep into the bush for hunting and security, and they regularly fight with wild foxes and jackals. There is a continuous loop of sickness between the wild animals and our dogs, but the district veterinary office never discusses this interface with us or helps us manage it. (Participant 5, FGD‐M1)
These ecological dynamics interact with daily behavioral risks that elevate community vulnerability to subclinical transmission. Across all study sites, there is a pervasive, casual proximity to free‐roaming canines, particularly among children who regularly interact with friendly, seemingly healthy community dogs (FGD‐W1). This exposure risk is severely exacerbated by long‐term vaccine noncompliance. Although community members frequently seek initial vaccinations for puppies, annual booster compliance is virtually nonexistent due to private veterinary fees and the intense physical challenges of restraining and walking large, untrained working dogs to distant, centralized clinics:
Children pathologically trust any dog that wags its tail in the compound. They play with them daily, and we mothers only become suspicious if the dog changes its voice or starts biting objects. (Participant 1, FGD‐W1)
This systemic lack of protective infrastructure and procedural guidance ultimately disrupts critical post‐bite management protocols. The standard public health and veterinary practice of a 10‐day confinement and observation period for a biting animal is entirely absent. Driven by panic, communities almost always kill the suspected animal immediately, eliminating any opportunity for diagnostic tracking or epidemiological verification. Furthermore, even when patients successfully initiate PEP, clinical adherence remains critically deficient. Participants in Kaburara (FGD‐M2) noted that multidose compliance drops sharply once the immediate bite wound heals and localized pain subsides, as patients routinely misinterpret the resolution of visible skin trauma as a complete cure:
When the skin closes up and the pain goes away, people stop traveling to the health center. It is hard to convince someone to spend money on additional injections for an illness they can no longer see on your skin. (Participant 6, FGD‐M2)
Crucially, these behavioral patterns and public health compliance gaps are deeply anchored in the sociocultural positioning and utilitarian value of dogs within the community. Rather than being treated as companion animals, dogs are valued almost exclusively for asset security and subsistence hunting along forest borders. This functional orientation establishes distinct gender disparities that dictate campaign participation. Because these animals are raised to be fierce for security purposes, men are culturally designated as their primary owners and handlers. Women in Kashasha (FGD‐W2) explained that they and their children feel physically unempowered to restrain and walk these large, aggressive utility animals to centralized vaccination booths. Consequently, if male household heads are away during campaign hours, dogs are simply confined within the homestead, creating significant, localized gaps in community herd immunity:
A dog in this village is kept to work—either to guard the house from thieves or to chase wild animals away from our crops. Because they are raised to be fierce, it is considered the man's responsibility to handle them. If the father is not home on the day the vaccine team arrives, the family will simply lock the dog inside the compound because the women and children cannot drag a wild, heavy dog down the road. (Participant 11, FGD‐W2)
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Discussion
This study demonstrates that localized community perceptions, sociocultural beliefs, and traditional medical practices present profound, deeply contextual obstacles to effective rabies post‐exposure management in Mitooma District. Specifically, our field data isolate two critical behavioral risks. These include the utilization of domestic dogs for prohibited wildlife hunting, which intensifies transmission at the sylvatic interface, and the reliance on dangerous traditional first aid, such as applying tobacco leaves, battery acid, or chili powder to bite wounds. This specific focus point, where localized ambiguity regarding clinical rabies behavior directly drives informal, nonclinical interventions, is heavily corroborated by regional literature in the Buyaga region of western Uganda [47]. Although Kankya et al. established that such ambiguity delays clinical seeking behaviors, our study extends this line of inquiry by documenting the exact home remedies used in southwestern Uganda. Globally, this structural bottleneck is further validated by studies in rural South Africa [48] and the Tanga Regional Referral Hospital in Tanzania [49], which both pinpoint traditional wound care practices as a primary barrier to immediate biomedical intervention. Consequently, these collective findings argue that rabies eradication cannot rely on top–down communication. Instead, public health frameworks must shift toward participatory health promotion that codesigns educational messages with local leaders to systematically dismantle these specific, highly localized myths.
A second critical focus point of our inquiry is the severe deficiency in community literacy regarding cross‐species transmission pathways, which directly compromises the 70% MDV threshold required for herd immunity. Our findings highlight that public health campaigns fail when they treat communities as uniform entities, ignoring how local ecology shapes awareness. This specific intersection between the ecological interface and cultural characteristics reflects broader systemic arguments raised by researchers in India [50], who demonstrated that ignoring sociocultural nuances and public awareness hurdles at the human–dog–wildlife interface inevitably dooms mass mobilization efforts. Furthermore, a national scoping review conducted across Uganda [51] explicitly pointed to the lack of community‐level operationalization of the One Health framework as a major blind spot in current research, noting that historical, purely descriptive, or human‐only studies leave substantial gaps. Our study directly addresses this empirical gap. By deploying a participatory visual signaling technique to color‐code vaccinated dogs, our field data offer a practical mechanism to bridge this knowledge divide, echoing operational successes documented during mass vaccination campaigns in rabies‐endemic regions of Haiti [52]. In that context, interactive, community‐led communication strategies successfully translated abstract epidemiological targets into actionable local knowledge, directly driving the collective compliance required to reach herd immunity targets.
By framing rabies management within a socio‐anthropological context, this study confronts a methodological bias in East African zoonotic research, which traditionally favors clinical, veterinary, or quantitative parameters while ignoring the human behavioral realities that dictate program execution. Our focus on community agency challenges the top–down models criticized in evaluations of national zoonotic health policies in Uganda [53]. These national policies argue that elimination strategies consistently falter because they treat rural populations as passive recipients of veterinary services rather than active stakeholders. The Mitooma field data provide empirical proof for this critique, demonstrating that veterinary–medical interventions are structurally limited without active community partnerships. This positions our work alongside socio‐anthropological frameworks developed in Zimbabwe [54], which assert that sustainable zoonotic disease control requires a deep understanding of community structures to identify hidden points of resistance and transform residents into active partners in disease surveillance.
Final analysis of our study underscores that MDV coverage is not merely a logistical function of vaccine supply but is heavily constrained by an intersecting matrix of historical, social, political, economic, and ecological contextual factors. Our focus on operational friction, specifically late announcements, poor distribution geometry, and the physical challenges of restraining large working dogs, is strongly supported by empirical evidence from Kyegegwa District, Uganda [55]. Prior findings in Kyegegwa isolated geographic terrain, deep‐seated community dynamics, severe economic constraints, and systemic shortages of veterinary personnel as compounding barriers to campaign optimization. Similar multi‐factorial vulnerabilities were documented in Tanzania [56], confirming that isolated vaccine drops are insufficient and that addressing these overlapping vulnerabilities requires moving away from uncoordinated interventions. Our study advances this discussion by presenting participatory communication as a direct operational solution to these barriers. Involving local leaders in campaign logistics allows communities to co‐map vaccination boundaries around farming schedules and geographical hurdles, transforming responsible dog ownership from an abstract local demand into a systemically supported reality.
Improving local participation requires a comprehensive overhaul of how responsible dog ownership is conceptualized and supported both at the community and systemic levels. Responsible ownership, encompassing canine confinement, adequate nutrition, and routine vaccination, cannot be sustained through localized messaging alone if systemic institutional support remains absent. This dual requirement for local accountability and systemic infrastructure aligns with prior research demonstrating that participatory communication fosters a complementary dual awareness [57]. Locally, it shifts community perceptions of dogs from loose, utilitarian assets to protected domestic animals; systemically, it leverages community‐generated data to advocate for consistent veterinary infrastructure, ensuring that community willingness is effectively matched by institutional capacity. Because structural vaccine compliance and dog bite incidences are dynamically and heavily correlated [58], utilizing participatory communication to optimize localized immunization infrastructure serves as an immediate, practical prerequisite to achieving the World Health Organization global strategic plan to eliminate dog‐mediated human rabies deaths by 2030 (WHO “Zero by 30”).
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Conclusion and Recommendation
This exploratory study demonstrates that the persistence of domestic rabies in Mitooma District is not merely a consequence of vaccine scarcity, but rather a fundamental failure of community engagement and participatory communication. Historical reliance on top–down, instructional public health models has left deep public literacy deficits, sustained hazardous traditional wound care practices, and resulted in fragmented, low‐coverage MDV campaigns. Furthermore, the unmonitored human, domestic dog, and wildlife interface in ecological hotspots like Kiyanga Parish creates a continuous epidemiological threat that standard, reactive public health tactics cannot contain. Achieving sustainable zoonotic disease elimination requires that the Mitooma District Local Government operationalize a functional One Health framework driven by participatory communication, textually transforming local communities from passive, fearful onlookers into active, accountable co‐managers of public and animal health.
To translate these empirical insights into actionable interventions, the Mitooma District Local Government must immediately formalize a joint multi‐sectoral taskforce integrating the District Health Officer, the District Veterinary Officer, environmental authorities, and representatives from the Uganda Wildlife Authority. Meeting quarterly, this intersectoral body can synchronize human and animal disease surveillance, co‐budget mass canine vaccination campaigns, and mitigate spillover risks at the forest and agriculture frontier. Concurrently, district veterinary authorities must abandon top–down administrative scheduling models and work directly with local Parish Development Committees and Local Council I chairpersons to co‐select decentralized vaccination stations, establish optimal seasonal timing aligned with community farming calendars, and leverage local information paths to maximize community turnout. Local authorities should also transform rabies communication by training Village Health Teams to deliver interactive, community dialogue sessions rather than relying on passive print media. These educational campaigns must move away from high‐fear imagery and focus on actionable knowledge, including recognizing the dumb paralytic form of rabies, practicing proper 15 min soap and water wound washing, and emphasizing the lifesaving necessity of complete multidose PEP compliance.
Finally, long‐term stabilization requires sub‐county and district councils to draft, gazette, and actively enforce localized animal control bylaws. These regulations must mandate the registration of domestic canines, establish clear penalties for owners who abandon or refuse to confine utility dogs at night, and formalize legal mechanisms to hold owners financially liable for livestock damage or human bite medical costs. To complement these legal guardrails, the district should train local hunters, farmers, and school teachers to serve as community surveillance focal points. Utilizing simple, mobile‐based reporting systems or dedicated local communication channels, these individuals can report animal bites, stray packs, or unusual wildlife encounters directly to the One Health taskforce, enabling rapid, preventive field interventions before human exposures occur. Through this integrated approach, the district can bridge immediate operational gaps and actively contribute toward the realization of global disease elimination targets.
Author Contributions
Augustino Ngabirano: conceptualization, investigation, writing – original draft, methodology, writing – review and editing, project administration, data curation, resources. Matthew Chibunna Igwe: methodology, validation, formal analysis, supervision, data curation, writing – review and editing. Charles Idehen: data curation, supervision, formal analysis, methodology, validation, writing – review and editing. All authors read and approved the final manuscript.
Funding
The authors have nothing to report.
Ethics Statement
This study was approved as an institutional program evaluation by the Mitooma District Local Government and conducted under the lead investigator's Kampala International University doctoral research protocols.
Consent
Informed consent was obtained from all participants involved in the exploratory study.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgments
The authors would like to thank the Veterinary Department and community participants of Mitooma District for their supervision and cooperation respectively during the mass dog vaccination assessment.
Data Availability Statement
The qualitative and spatial data supporting the findings of this study are available from the corresponding author upon reasonable request.
References
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Associated Data
Data Availability Statement
The qualitative and spatial data supporting the findings of this study are available from the corresponding author upon reasonable request.