Knowledge, attitudes, and referral practices regarding animal bites and prevention of human rabies among traditional health practitioners in Ethekwini district in Kwazulu-Natal province, South Africa, 2022

Background: Despite the availability of effective post-exposure prophylaxis (PEP), South Africa records about 10 human rabies deaths each year. Many animal bite victims initially seek help from Traditional Health Practitioners (THPs) before considering conventional healthcare facilities. Prompt referral of animal bite victims for PEP initiation by THPs can be lifesaving. Our study aimed to assess the knowledge, attitudes, and referral practices regarding human rabies and the associated factors among THPs in eThekwini District, KwaZulu-Natal. Methods: We conducted a cross-sectional study among registered THPs consulting patients in the eThekwini District. We used a structured standardized questionnaire to collect data. The questionnaire was administered through physical and telephonic interviews. We described socio-demographic characteristics using summary statistics. Multivariable logistic regression was used to analyze factors associated with knowledge, attitudes, and referral practices of human rabies. Odds ratios (OR) were used with a 95% confidence interval, and a probability (p)-value of ≤0.05 was considered statistically significant. Results: We interviewed 204 THPs, and 74% (150/204) were female. The median age was 43 years (inter-quartile range: 22-75 years) and 31% (64/204) had over 10 years of experience. The majority of THPs had inadequate knowledge (80%, 163/204), and poor referral practices (73%, 149/204). However, 91% (186/204) had positive attitudes toward human rabies prevention. Having more experience was associated with adequate knowledge (p<0.01), and positive attitudes (p=0.02). THPs who had adequate knowledge (aOR:2.30 95% CI: 1.12-4.75) and positive attitudes (aOR:1.21 95% CI: 0.37-3.89), had higher odds of having good referral practices. Conclusion: Despite THPs in eThekwini District having positive attitudes towards rabies prevention, gaps exist in their knowledge and referral practices. The study highlights that improving their knowledge and attitudes might lead to better referral practices of animal bite victims for PEP initiation. A multidisciplinary approach that includes THPs is recommended to decrease human rabies deaths in eThekwini District.
A research report submitted in partial fulfilment of the requirement for the degree of Master of Science in Epidemiology to the Faculty of Health Sciences, University of the Witwatersrand, School of Public Health, Johannesburg, 2023
Human rabies, Post-exposure prophylaxis, Traditional health practitioners, KwaZulu-Natal