campaign organized by Mad Dog Initiative (focused in the urban commune of Moramanga). Such levels are similar to previous findings in Moramanga [8] and in other rural areas in Africa [27,35,37,40,43] and in Asia [47,49]. These results are not surprising given the regular confirmation of human and animal rabies cases in the Moramanga area [14]. Yet, this question should be interpreted with caution as among the 27 respondents who said they did not have prior awareness of rabies, 23 (85%) correctly answered that rabies could be transmitted through a bite. Furthermore, out of the 27, 17 (63%) chose to answer the question if rabies could be transmitted by animals and only 10 (37%) answered that they did not know. Out of the 17 who answered the latter question, 16 (94%) answered that rabies could be transmitted by animals and only one (6%) that rabies could not be transmitted by animals suggesting that the proportion who really guessed what to answer was low. This question on prior awareness of rabies might have been biased because of a reinterpretation of the question, people who had prior awareness of rabies but were not sure of being able to talk of rabies in detail might have answered “no” to the question “are you aware of rabies?”. This may limit our understanding on how to reduce the proportion of people who say they don’t have prior awareness of rabies, a variable which was retained both the knowledge and practice score models (although the association was not statistically significant).

Here 21.0% of respondents (n = 70) in the study mentioned having benefited from rabies awareness campaign, with a larger proportion in the central area (30.0% vs. 11.6%, *p*<0.001). Although most of the respondents had benefited from the campaign recently in both areas (mean = 1.6 and 1.3 years, *p* = 0.5), having benefited from an awareness campaign was not significantly associated to better knowledge or practice scores. The qualitative survey showed that acquaintances were the principal source of information on what to do when someone has been bitten, in line with previous results in Moramanga [8] and with other studies in Africa [41,80].

Regarding knowledge on rabies, overall, many aspects of rabies were well-known such as the main species involved virus transmission, main transmission pathways (bites, scratches, contact with saliva on broken skin), main symptoms in animals (drool, aggressivity) and that rabies was fatal. Yet few people knew that ruminants could also transmit rabies (29.4%), as commonly observed in other settings [27,37,51]. Over 90% of respondents thought rabies was curable, but this could be due to an unclear wording of the question (interview bias) as it is not clear whether they were referring to rabies infection before or after symptom onset and if they were referring to PEP as the cure.

Lack of knowledge on the existence of ARTCs and the necessity to seek PEP as soon as possible are probably the knowledge gaps which have the most deleterious impact on the Zero by 30 goal. Indeed, the percentage of respondents who were aware of the existence of the ARTC was dramatically low (14.7%), even among those living less than 5 km away (18.2% vs. 11.0% in the remote area, *p* = 0.06). It is crucial to inform the population on the existence and location of ARTC, the availability of free-of-charge vaccine for exposed patients in ARTCs and that PEP should be sought as rapidly as possible as rabies is fatal after the onset of clinical signs. People also need to know that rabies can be transmitted even through superficial wounds and that all dogs can transmit rabies (not just feral ones).

A large majority of respondents (83.5%) thought that rabies could be transmitted by the ingestion of meat or milk from a rabid animal. This is much more than in Ethiopia for example where only 2% and 0.5% of respondents (n = 400) said that rabies could be transmitted through the ingestion of raw meat and raw milk respectively [37]. Raising awareness on the fact that people who have eaten meat from a rabid animal do not need to seek PEP would also be very useful, as this situation occurs regularly in Madagascar and leads to important groups of people visiting the ARTC to seek PEP (when a large number of people from a locality have eaten meat from a rabid zebu for example), and this wastage can lead to vaccine shortage. This
wastage is important: in Moramanga, 20% of patients reporting for PEP at the ARTC were classified as low-to-no risk contacts [14].

## Bite victims and bite management practices

The percentage of households in which a member had been bitten (7.5%) was similar to what was observed in Moramanga city in 2011 [8] but much lower than what was observed in Tanzania [27] where approximately the same percentage of households owned dogs, but where household size and the number of dogs per household were greater than what we observed here.

Bite incidence crude estimates were higher in the central area than in the remote area (0.53 vs. 0.22 per 100 person-years respectively) despite similar dog-to-human ratios. Reasons explaining this difference should be further explored. Are contacts with dogs more frequent in areas where urban fabric is denser? Are the types and contexts of contacts different? Bite incidence is multifactorial and varies greatly across countries, making it difficult to compare situations. Nevertheless, bite incidence in the central area was very similar to what was observed in Democratic Republic of Congo (5.2 per 1000 person-years) [25], despite a lower dog-to-human ratio (1:37.7) than in Moramanga. A more precise assessment of bite incidence and its spatial heterogeneity, as well as a more thorough understanding of factors driving bite incidence would be useful to better target prevention measures.

Concerning practices after a bite, only 45.5% of respondents considered the wound should be washed, similar to what was observed in Morocco [36]. Superficial wounds were more likely to be disregarded, as observed in other studies [8,76]. Overall, 87.7% would seek medical advice from a doctor or go to a medical center, but only 6.6% stated that the bitten person should seek PEP. The percentage of respondents who mentioned that bite victims should seek PEP was very low, as in Cameroon (Barbosa Costa 2018). The qualitative survey confirmed that PEP was not sought immediately. The care pathway comprised firstly a visit to the dog's owner to know if the dog was vaccinated and if the owner was willing to cover the costs, and only in a second stage the bite victim would eventually consult a health center, which in turn referred the patient to an ARTC. The willingness to avoid social conflicts within the community was strong: the bite victim usually did not want to confront the owner and create a conflict in the community if the owner did not accept to cover the care costs, in accordance with the Malagasy cultural concept of “fihavanana”, strong social links and moral obligations which entail to take care of others as kins and mutually help each other to guarantee social harmony and unity [81]. The whole process is likely to slow down PEP delivery, possibly reducing the chances of survival. Awareness campaigns should explain the importance of wound washing and of immediately seeking PEP after a bite. Population including dog owners should be aware that PEP is available and free in ARTCs.

KAP studies in Asia and Africa have shown that traditional treatments can be very frequent [28,36,51,82] and can act as barriers to seek medical treatment [41]. In our study, only 0.3% said they would seek traditional treatment after a bite, in line with the 4.5% of respondents who believed that traditional treatments were effective against rabies, much less than what was documented in Ethiopia [35], Morocco [36] or India [51]. As field investigators were clearly identified as linked to conventional medicine, a social desirability or courtesy bias could have impacted these results as suggested by the fact that more respondents reported using traditional treatments when questioned on their practices (11.4% (n = 38) of respondents answered they would treat the wound with oil) than when asked if they would seek traditional treatments in the event of a bite (0.3% reported they would seek this type of treatment). Use of oil was also frequently mentioned in the qualitative study, yet this did not seem to exclude seeking
wastage is important: in Moramanga, 20% of patients reporting for PEP at the ARTC were classified as low-to-no risk contacts [14].

## Bite victims and bite management practices

The percentage of households in which a member had been bitten (7.5%) was similar to what was observed in Moramanga city in 2011 [8] but much lower than what was observed in Tanzania [27] where approximately the same percentage of households owned dogs, but where household size and the number of dogs per household were greater than what we observed here.

Bite incidence crude estimates were higher in the central area than in the remote area (0.53 vs. 0.22 per 100 person-years respectively) despite similar dog-to-human ratios. Reasons explaining this difference should be further explored. Are contacts with dogs more frequent in areas where urban fabric is denser? Are the types and contexts of contacts different? Bite incidence is multifactorial and varies greatly across countries, making it difficult to compare situations. Nevertheless, bite incidence in the central area was very similar to what was observed in Democratic Republic of Congo (5.2 per 1000 person-years) [25], despite a lower dog-to-human ratio (1:37.7) than in Moramanga. A more precise assessment of bite incidence and its spatial heterogeneity, as well as a more thorough understanding of factors driving bite incidence would be useful to better target prevention measures.

Concerning practices after a bite, only 45.5% of respondents considered the wound should be washed, similar to what was observed in Morocco [36]. Superficial wounds were more likely to be disregarded, as observed in other studies [8,76]. Overall, 87.7% would seek medical advice from a doctor or go to a medical center, but only 6.6% stated that the bitten person should seek PEP. The percentage of respondents who mentioned that bite victims should seek PEP was very low, as in Cameroon (Barbosa Costa 2018). The qualitative survey confirmed that PEP was not sought immediately. The care pathway comprised firstly a visit to the dog's owner to know if the dog was vaccinated and if the owner was willing to cover the costs, and only in a second stage the bite victim would eventually consult a health center, which in turn referred the patient to an ARTC. The willingness to avoid social conflicts within the community was strong: the bite victim usually did not want to confront the owner and create a conflict in the community if the owner did not accept to cover the care costs, in accordance with the Malagasy cultural concept of “fihavanana”, strong social links and moral obligations which entail to take care of others as kins and mutually help each other to guarantee social harmony and unity [81]. The whole process is likely to slow down PEP delivery, possibly reducing the chances of survival. Awareness campaigns should explain the importance of wound washing and of immediately seeking PEP after a bite. Population including dog owners should be aware that PEP is available and free in ARTCs.

KAP studies in Asia and Africa have shown that traditional treatments can be very frequent [28,36,51,82] and can act as barriers to seek medical treatment [41]. In our study, only 0.3% said they would seek traditional treatment after a bite, in line with the 4.5% of respondents who believed that traditional treatments were effective against rabies, much less than what was documented in Ethiopia [35], Morocco [36] or India [51]. As field investigators were clearly identified as linked to conventional medicine, a social desirability or courtesy bias could have impacted these results as suggested by the fact that more respondents reported using traditional treatments when questioned on their practices (11.4% (n = 38) of respondents answered they would treat the wound with oil) than when asked if they would seek traditional treatments in the event of a bite (0.3% reported they would seek this type of treatment). Use of oil was also frequently mentioned in the qualitative study, yet this did not seem to exclude seeking
biomedical care in health centers and in the ARTC (since respondents of the qualitative survey were recruited through the ARTC). A malaria anthropology study conducted in Madagascar showed that traditional beliefs are very present in Madagascar but traditional beliefs and bio-medical explanations are not mutually exclusive [83]. Another study in Madagascar concluded that too much emphasis had been given to traditional practices and social norms as barriers to changing attitudes and behaviors towards health [84]. Although some cultural practices remained strong, in many cases, the obstacles were rather of the order of supply, distance and cost of services rather than cultural beliefs and traditions according to that study [84].

Concerning the fate of the biting dog, the consequences of a bite varied between two extremes: either nothing happened to the dog, either it was killed. When a person was bitten by a dog, 24.9% thought the dog should be killed, but if a known dog had bitten someone, then 48.8% would consider killing it. Similar results were found in the qualitative approach: the dog was killed mainly if the owner did it himself (as in four of the five cases where the dog was killed). Indeed, if the dog was known, the person could more easily decide to kill it in order to maintain social cohesion, but when the dog was not known, then they left the owners take their responsibilities and decide what to do with the dog. Thus, it showed the importance of social pressure not to disrupt relations in the community and also the weak attachment to dogs.

Only 5.7% mentioned that the dog should be restricted and placed under observation, and this finding was confirmed in the qualitative study. Awareness campaigns should aim to promote this practice, adapting it to the context, which, in poor and/or remote rural households might mean isolating the dog at home due to cost and low access to veterinarians. Alongside to awareness campaigns, increasing access to veterinarians and animal health workers would of course also contribute to improve practices, surveillance and animal health in general.

## Factors associated to knowledge and practices

Several factors impacting knowledge and practices towards rabies in the community of Mora-manga were identified. Respondents with high socio-economic status (OR = 2.08) and living in the central area within 5 km of the ARTC (OR = 1.91) were significantly likely to be more knowledgeable. Two further variables improved the model although their associations with the knowledge score were not statistically significant: having prior awareness of rabies (OR = 1.85) and having owned a dog in the previous 5 years (OR = 1.49). Respondents living in the central area (OR = 4.78) and who were aware of the ARTC's existence (OR = 2.29) were significantly more likely to have better practices. Prior awareness of rabies (OR = 2.21) and having a high socio-economic status (OR = 1.47) contributed to improve the model although their associations with the practice score were not statistically significant. Respondents with a higher knowledge score also had a significantly higher practice score. Overall, results show that prior awareness on rabies and the ARTC are key to increase appropriate health seeking practices and that remote rural areas and households with low socio-economic status need to be specifically targeted.

Distance to the ARTC impacted both knowledge and practices despite testing only a limited range of distances as households from the remote area were all less than 30 km away from the ARTC. Knowing that 36% of the population are estimated to live at least 3 hours away from the closest ARTC [12] and that some households may be located 50 to 100 km from an ARTC question as to what are the KAP in households which are located further than 30 km from the closest ARTC. A KAP study targeting these very remote communities would help fill this important knowledge gap as these populations may be even less knowledgeable towards rabies prevention and at greater risk of not seeking PEP.
biomedical care in health centers and in the ARTC (since respondents of the qualitative survey were recruited through the ARTC). A malaria anthropology study conducted in Madagascar showed that traditional beliefs are very present in Madagascar but traditional beliefs and bio-medical explanations are not mutually exclusive [83]. Another study in Madagascar concluded that too much emphasis had been given to traditional practices and social norms as barriers to changing attitudes and behaviors towards health [84]. Although some cultural practices remained strong, in many cases, the obstacles were rather of the order of supply, distance and cost of services rather than cultural beliefs and traditions according to that study [84].

Concerning the fate of the biting dog, the consequences of a bite varied between two extremes: either nothing happened to the dog, either it was killed. When a person was bitten by a dog, 24.9% thought the dog should be killed, but if a known dog had bitten someone, then 48.8% would consider killing it. Similar results were found in the qualitative approach: the dog was killed mainly if the owner did it himself (as in four of the five cases where the dog was killed). Indeed, if the dog was known, the person could more easily decide to kill it in order to maintain social cohesion, but when the dog was not known, then they left the owners take their responsibilities and decide what to do with the dog. Thus, it showed the importance of social pressure not to disrupt relations in the community and also the weak attachment to dogs.

Only 5.7% mentioned that the dog should be restricted and placed under observation, and this finding was confirmed in the qualitative study. Awareness campaigns should aim to promote this practice, adapting it to the context, which, in poor and/or remote rural households might mean isolating the dog at home due to cost and low access to veterinarians. Alongside to awareness campaigns, increasing access to veterinarians and animal health workers would of course also contribute to improve practices, surveillance and animal health in general.

## Factors associated to knowledge and practices

Several factors impacting knowledge and practices towards rabies in the community of Mora-manga were identified. Respondents with high socio-economic status (OR = 2.08) and living in the central area within 5 km of the ARTC (OR = 1.91) were significantly likely to be more knowledgeable. Two further variables improved the model although their associations with the knowledge score were not statistically significant: having prior awareness of rabies (OR = 1.85) and having owned a dog in the previous 5 years (OR = 1.49). Respondents living in the central area (OR = 4.78) and who were aware of the ARTC's existence (OR = 2.29) were significantly more likely to have better practices. Prior awareness of rabies (OR = 2.21) and having a high socio-economic status (OR = 1.47) contributed to improve the model although their associations with the practice score were not statistically significant. Respondents with a higher knowledge score also had a significantly higher practice score. Overall, results show that prior awareness on rabies and the ARTC are key to increase appropriate health seeking practices and that remote rural areas and households with low socio-economic status need to be specifically targeted.

Distance to the ARTC impacted both knowledge and practices despite testing only a limited range of distances as households from the remote area were all less than 30 km away from the ARTC. Knowing that 36% of the population are estimated to live at least 3 hours away from the closest ARTC [12] and that some households may be located 50 to 100 km from an ARTC question as to what are the KAP in households which are located further than 30 km from the closest ARTC. A KAP study targeting these very remote communities would help fill this important knowledge gap as these populations may be even less knowledgeable towards rabies prevention and at greater risk of not seeking PEP.
The socio-economic status and level of education are well-known factors associated with better knowledge and practices in several KAP studies [26,33,51]. Our study confirms the association of socio-economic factors with the knowledge score but the association was not statistically significant with the practice score. This might partly be explained by the fact that PEP is free-of-charge for exposed patients in Madagascar. Unfortunately, individual information on the level of education was not collected in this study. The MHURAM project showed that in the urban commune of Moramanga, 2.4% of people never went to school, 31.6% had gone to primary school, 59.0% to middle school and 7.0% to high school or to a professional school whereas in the rural communes, 11% never went to school, 60.5% had gone to primary school, 27.7% to middle school and 0.8% to high school or professional school [63]. As level of education was lower in the rural communes, it would be important to disentangle the effects of the two to know whether part of the effect of living in the remote rural area on the decrease of knowledge and practice scores, observed in our models, is due to more limited access to education. Awareness on the disease and on PEP might in turn be associated with a higher level of education, whether they act as proxies of the latter remains yet to be fully explored.

## Conclusions and recommendations

This qualitative and quantitative community-based survey on knowledge, attitudes and practices on rabies in Moramanga community showed that the knowledge in the community was rather satisfying concerning the role of dogs in transmission but limited knowledge and unfavorable practices were found in terms of appropriate first aid measures, recourse to medical care and animal management. A key finding of this study was the negative impact of living in more rural communes further from the ARTC on both scores. This suggests that awareness campaigns should be particularly strengthened in remote rural areas and their coverage carefully monitored to make sure they reach the greatest number of households. Another key finding was that being aware of the ARTC's existence was associated with better practices, suggesting that awareness campaigns should clearly inform populations on the existence, location and availability of free-of-charge PEP in the ARTCs, alongside to the necessity to seek PEP when exposed. Finally, within both areas, households with lower socio-economic status should be targeted to improve knowledge on rabies.

This survey also collected some key figures for rabies control such as the percentage of households owning dogs, dog-to-human ratios, the percentage of vaccinated dogs and bite incidence which are important when designing mass dog vaccination campaigns. It also showed that several factors impacted the steps of the care pathway: the severity of the wound, how the biting dog was perceived and to which category it belonged, whether its owner said it was vaccinated (whether he had a vaccination certificate or not) and whether the owner agreed to cover costs.

Overall, awareness campaigns should focus on (i) the necessity to wash the wound with soap and seek PEP as soon as possible after a bite, and (ii) the availability of free-of-charge PEP for exposed patients in ARTCs and their locations. They should encourage seeking care after the bite of any category of dog, and even if the wound is superficial. They should also encourage owners of biting dogs to confine (or attach) and monitor the health and behavior of biting dogs at home if they are unable to seek the services of animal health care workers. Although bite incidence was lower, remote areas had more limited knowledge, poorer practices on rabies and extremely low dog vaccination coverage, so awareness and vaccination campaigns should be carefully designed so as to make sure more remote rural populations are reached.

Finally, if awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, contributing to the Zero by 30 goal, their impact on dog vaccination seems more
The socio-economic status and level of education are well-known factors associated with better knowledge and practices in several KAP studies [26,33,51]. Our study confirms the association of socio-economic factors with the knowledge score but the association was not statistically significant with the practice score. This might partly be explained by the fact that PEP is free-of-charge for exposed patients in Madagascar. Unfortunately, individual information on the level of education was not collected in this study. The MHURAM project showed that in the urban commune of Moramanga, 2.4% of people never went to school, 31.6% had gone to primary school, 59.0% to middle school and 7.0% to high school or to a professional school whereas in the rural communes, 11% never went to school, 60.5% had gone to primary school, 27.7% to middle school and 0.8% to high school or professional school [63]. As level of education was lower in the rural communes, it would be important to disentangle the effects of the two to know whether part of the effect of living in the remote rural area on the decrease of knowledge and practice scores, observed in our models, is due to more limited access to education. Awareness on the disease and on PEP might in turn be associated with a higher level of education, whether they act as proxies of the latter remains yet to be fully explored.

## Conclusions and recommendations

This qualitative and quantitative community-based survey on knowledge, attitudes and practices on rabies in Moramanga community showed that the knowledge in the community was rather satisfying concerning the role of dogs in transmission but limited knowledge and unfavorable practices were found in terms of appropriate first aid measures, recourse to medical care and animal management. A key finding of this study was the negative impact of living in more rural communes further from the ARTC on both scores. This suggests that awareness campaigns should be particularly strengthened in remote rural areas and their coverage carefully monitored to make sure they reach the greatest number of households. Another key finding was that being aware of the ARTC's existence was associated with better practices, suggesting that awareness campaigns should clearly inform populations on the existence, location and availability of free-of-charge PEP in the ARTCs, alongside to the necessity to seek PEP when exposed. Finally, within both areas, households with lower socio-economic status should be targeted to improve knowledge on rabies.

This survey also collected some key figures for rabies control such as the percentage of households owning dogs, dog-to-human ratios, the percentage of vaccinated dogs and bite incidence which are important when designing mass dog vaccination campaigns. It also showed that several factors impacted the steps of the care pathway: the severity of the wound, how the biting dog was perceived and to which category it belonged, whether its owner said it was vaccinated (whether he had a vaccination certificate or not) and whether the owner agreed to cover costs.

Overall, awareness campaigns should focus on (i) the necessity to wash the wound with soap and seek PEP as soon as possible after a bite, and (ii) the availability of free-of-charge PEP for exposed patients in ARTCs and their locations. They should encourage seeking care after the bite of any category of dog, and even if the wound is superficial. They should also encourage owners of biting dogs to confine (or attach) and monitor the health and behavior of biting dogs at home if they are unable to seek the services of animal health care workers. Although bite incidence was lower, remote areas had more limited knowledge, poorer practices on rabies and extremely low dog vaccination coverage, so awareness and vaccination campaigns should be carefully designed so as to make sure more remote rural populations are reached.

Finally, if awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, contributing to the Zero by 30 goal, their impact on dog vaccination seems more
uncertain because vaccination costs and low access to animal health practitioners are impor-
tant barriers in rural communities. Therefore, to reach dog vaccination coverage goals
enabling rabies elimination, we strongly recommend combining awareness campaigns with
free-of-charge mass dog vaccination with high spatial outreach.

**Supporting information**

S1 Table. Socio-economic score assessment in the remote and central areas.
(XLSX)

S2 Table. Reasons for not vaccinating dogs.
(XLSX)

S3 Table. Comparison of knowledge on rabies in the remote and central areas.
(XLSX)

S4 Table. Variables associated to the knowledge score in the bivariate analysis.
(XLSX)

S5 Table. Knowledge score model selection.
(XLSX)

S6 Table. Spatial autocorrelation of the knowledge and practice scores and of the residues of the knowledge and practice models.
(DOCX)

S7 Table. Characteristics and practices of bitten individuals.
(XLSX)

S8 Table. Comparison of practices towards rabies in the remote and central areas.
(XLSX)

S9 Table. Comparison of practices carried out by a bitten member of the household to practices that the respondent thought should be carried out in the event of a bite.
(XLSX)

S10 Table. Variables associated to the practice score in the bivariate analysis.
(XLSX)

S11 Table. Practice score model selection.
(XLSX)

S12 Table. Dataset.
(XLSX)

**Acknowledgments**

The authors thank Charles Ramarokoto and Malavika Rajeev for helping design the protocol.
The authors greatly thank the people of the MHURAM cohort and the people interviewed dur-
ing the qualitative survey for participating in the study as well as Moramanga ARTC for its
help in recruiting bitten patients. We also thank Moramanga district and city authorities for
helping us organise the work in the field. Finally, the authors thank the two anonymous
reviewers who greatly contributed improving the manuscript.
uncertain because vaccination costs and low access to animal health practitioners are impor-
tant barriers in rural communities. Therefore, to reach dog vaccination coverage goals
enabling rabies elimination, we strongly recommend combining awareness campaigns with
free-of-charge mass dog vaccination with high spatial outreach.

**Supporting information**

S1 Table. Socio-economic score assessment in the remote and central areas.
(XLSX)

S2 Table. Reasons for not vaccinating dogs.
(XLSX)

S3 Table. Comparison of knowledge on rabies in the remote and central areas.
(XLSX)

S4 Table. Variables associated to the knowledge score in the bivariate analysis.
(XLSX)

S5 Table. Knowledge score model selection.
(XLSX)

S6 Table. Spatial autocorrelation of the knowledge and practice scores and of the residues of the knowledge and practice models.
(DOCX)

S7 Table. Characteristics and practices of bitten individuals.
(XLSX)

S8 Table. Comparison of practices towards rabies in the remote and central areas.
(XLSX)

S9 Table. Comparison of practices carried out by a bitten member of the household to practices that the respondent thought should be carried out in the event of a bite.
(XLSX)

S10 Table. Variables associated to the practice score in the bivariate analysis.
(XLSX)

S11 Table. Practice score model selection.
(XLSX)

S12 Table. Dataset.
(XLSX)

**Acknowledgments**

The authors thank Charles Ramarokoto and Malavika Rajeev for helping design the protocol.
The authors greatly thank the people of the MHURAM cohort and the people interviewed dur-
ing the qualitative survey for participating in the study as well as Moramanga ARTC for its
help in recruiting bitten patients. We also thank Moramanga district and city authorities for
helping us organise the work in the field. Finally, the authors thank the two anonymous
reviewers who greatly contributed improving the manuscript.
## Author Contributions

**Conceptualization:** Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Anjasoa Randrianarijaona, Ravo Ramiandrasoa, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Data curation:** Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson.

**Formal analysis:** Claire Leblanc, Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Chiarella Mattern, Hélène Guis.

**Funding acquisition:** Daouda Kassié, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Investigation:** Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Ravo Ramiandrasoa, Alphonse José Nely, Nivohanitra Perle Razafindraibe, Soa Fy Andriamandimby, Dany Bakoly Ranoaritiana, Virginie Rajaonarivony, Laurence Randrianasolo, Rila Ratovoson.

**Methodology:** Claire Leblanc, Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson.

**Project administration:** Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Resources:** Laurence Baril, Chiarella Mattern, Rila Ratovoson.

**Software:** Reziky Tiandraza Mangahasimbola, Anjasoa Randrianarijaona.

**Supervision:** Daouda Kassié, Elliot Fara Nandrasana Rakotomanana, Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Validation:** Daouda Kassié, Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Visualization:** Daouda Kassié.

**Writing – original draft:** Claire Leblanc, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Chiarella Mattern, Hélène Guis.

**Writing – review & editing:** Claire Leblanc, Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Reziky Tiandraza Mangahasimbola, Anjasoa Randrianarijaona, Ravo Ramiandrasoa, Alphonse José Nely, Nivohanitra Perle Razafindraibe, Soa Fy Andriamandimby, Dany Bakoly Ranoaritiana, Virginie Rajaonarivony, Laurence Randrianasolo, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

## References

1. Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, et al. Estimating the global burden of endemic canine rabies. PLoS neglected tropical diseases. 2015; 9(4):e0003709. https://doi.org/10.1371/journal.pntd.0003709 PMID: 25881058.

2. WHO, FAO, OIE, GARC. Zero by 30: the global strategic plan to end human deaths from dog-mediated rabies by 20. Geneva: 2018.

3. World Health Organization. WHO Expert Consultation on Rabies, third report. Geneva, Switzerland 2018. 185 p.
**Author Contributions**

**Conceptualization:** Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Anjasoa Randrianarijaona, Ravo Ramiandrasoa, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Data curation:** Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson.

**Formal analysis:** Claire Leblanc, Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Chiarella Mattern, Hélène Guis.

**Funding acquisition:** Daouda Kassié, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Investigation:** Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Ravo Ramiandrasoa, Alphonse José Nely, Nivohanitra Perle Razafindraibe, Soa Fy Andriamandimby, Dany Bakoly Ranoaritiana, Virginie Rajaonarivony, Laurence Randrianasolo, Rila Ratovoson.

**Methodology:** Claire Leblanc, Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson.

**Project administration:** Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Resources:** Laurence Baril, Chiarella Mattern, Rila Ratovoson.

**Software:** Reziky Tiandraza Mangahasimbola, Anjasoa Randrianarijaona.

**Supervision:** Daouda Kassié, Elliot Fara Nandrasana Rakotomanana, Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Validation:** Daouda Kassié, Reziky Tiandraza Mangahasimbola, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

**Visualization:** Daouda Kassié.

**Writing – original draft:** Claire Leblanc, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Chiarella Mattern, Hélène Guis.

**Writing – review & editing:** Claire Leblanc, Daouda Kassié, Mendrika Ranaivoharimina, Elliot Fara Nandrasana Rakotomanana, Reziky Tiandraza Mangahasimbola, Anjasoa Randrianarijaona, Ravo Ramiandrasoa, Alphonse José Nely, Nivohanitra Perle Razafindraibe, Soa Fy Andriamandimby, Dany Bakoly Ranoaritiana, Virginie Rajaonarivony, Laurence Randrianasolo, Laurence Baril, Chiarella Mattern, Rila Ratovoson, Hélène Guis.

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19. Evans MV, Andreambeloson T, Randriamihaja M, Ihantamalala F, Cordier L, Cowley G, et al. Geo- graphic barriers to care persist at the community healthcare level: Evidence from rural Madagascar. PLOS Glob Public Health. 2022; 2(12):e0001028. https://doi.org/10.1371/journal.pgph.0001028 PMID: 36962826.

20. World Health Organization. Rabies vaccines: WHO position paper, April 2018—Recommendations. WHO Wkly Epidemiol Rec. 2018; 93(16):201–2019. https://doi.org/10.1016/j.vaccine.2018.06.061 PMID: 30107991

21. Dechambre E. Origine des animaux domestiques de Madagascar. La terre et la vie. 1951; 4:187-96.

22. Ardalan A, Oskarsson MCR, van Asch B, Rabakonandriania E, Savolainen P. African origin for Mada- gascan dogs revealed by mtDNA analysis. Royal Society Open Science. 2015; 2(140552). https://doi. org/10.1098/rsos.140552 PMID: 26064658

23. Kshirsagar AR, Applebaum JW, Randriana Z, Rajaonarivelo T, Rafaliarison RR, Farris ZJ, et al. Human-Dog Relationships across Communities Surrounding Ranomafana and Andasibe-Mantadia
4. Fooks AR, Shipley R, Markotter W, Tordo N, Freuling CM, Muller T, et al. Renewed Public Health Threat from Emerging Lyssaviruses. Viruses. 2021; 13(9). https://doi.org/10.3390/v13091769 PMID: 34578350.

5. Abela-Ridder B. Rabies: 100 per cent fatal, 100 per cent preventable. Vet Rec. 2015; 177(6):148-9. https://doi.org/10.1136/vr.h4196 PMID: 26251539.

6. Anderson A, Shwiff SA. The Cost of Canine Rabies on Four Continents. Transboundary and emerging diseases. 2015; 62(4):446-52. https://doi.org/10.1111/tbed.12168 PMID: 24112194.

7. Nel LH. Discrepancies in data reporting for rabies, Africa. Emerg Infect Dis. 2013; 19(4):529-33. https://doi.org/10.3201/eid1904.120185 PMID: 23628197.

8. Rakotonirainy N. Dog ecology and knowledge about rabies by the population of Moramanga district. Veterinary Thesis: University of Antananarivo, Madagascar. 2012. http://biblio.univ-antananarivo.mg/pdfs/rakotonirainyNorofaliana_MED_VET_12.pdf.

9. Andriamandimby SF, Heraud JM, Ramiandrasoa R, Ratsitorahina M, Rasambainarivo JH, Dacheux L, et al. Surveillance and control of rabies in La Reunion, Mayotte, and Madagascar. Veterinary research. 2013; 44:77. https://doi.org/10.1186/1297-9716-44-77 PMID: 24016204.

10. Andriamandimby SF, Volasoa MH, Razafindraibe NP, Ranoaritiana DB, Razafindramparany MH, Rafisandratantsoa T, et al. Rabies surveillance in Madagascar from 2011 to 2021: can we reach the target? Frontiers in veterinary science. 2023; 10. https://doi.org/10.3389/fvets.2023.1270532 PMID: 37901098

11. Dreyfus A, Volasoa MH, Guis H, Razafindraibe NP, Razafindramparany MH, Arivony Nomenjanahary L, et al. Challenges of rabies surveillance in Madagascar based on a mixed method survey amongst veterinary health officers. Frontiers in veterinary science. 2024; 11. https://doi.org/10.3389/fvets.2024.1270547 PMID: 38487708

12. Rajeev M, Guis H, Edosoa GT, Hanitriniaina C, Randrianarijaona A, Mangahasimbola RT, et al. How geographic access to care shapes disease burden: The current impact of post-exposure prophylaxis and potential for expanded access to prevent human rabies deaths in Madagascar. PLoS neglected tropical diseases. 2021; 15(4):e0008821. https://doi.org/10.1371/journal.pntd.0008821 PMID: 33901194.

13. Rasolonjatovo FS, Guis H, Rajeev M, Dacheux L, Arivony Nomenjanahary L, Razafitrimo G, et al. Enabling animal rabies diagnostic in low-access areas: Sensitivity and specificity of a molecular diagnostic test from cerebral tissue dried on filter paper. PLoS neglected tropical diseases. 2020; 14(3): e0008116. https://doi.org/10.1371/journal.pntd.0008116 PMID: 32142519.

14. Rajeev M, Edosoa G, Hanitriniaina C, Andriamandimby SF, Guis H, Ramiandrasoa R, et al. Healthcare utilization, provisioning of post-exposure prophylaxis, and estimation of human rabies burden in Madagascar. Vaccine. 2019; 37 Suppl 1:A35–A44. https://doi.org/10.1016/j.vaccine.2018.11.011 PMID: 30509692.

15. Leblanc C. Rabies in Madagascar: a three-pronged survey of knowledge and practices among health care providers from anti-rabies treatment centers, veterinarians and the community of Moramanga. Paris: Conservatoire National des Arts et Métiers (CNAM) Master thesis: Paris, France. 2019.

16. Rasolonjatovo F. Evaluation of filter paper for molecular diagnosis of rabic virus infection. Veterinary The sis: University of Antananarivo, Madagascar. 2017.

17. Sreenivasan N, Li A, Shiferaw M, Tran CH, Wallace R, Blanton J, et al. Overview of rabies post-expo- sure prophylaxis access, procurement and distribution in selected countries in Asia and Africa, 2017– 2018. Vaccine. 2019; 37 Suppl 1:A6–A13. https://doi.org/10.1016/j.vaccine.2019.04.024 PMID: 31471150.

18. World Bank. How are roads changing lives in Madagascar? 2023 [cited 2023 25/09/2023]. https://www. worldbank.org/en/results/2023/02/10/how-are-roads-changing-lives-in-madagascar.

19. Evans MV, Andreambeloson T, Randriamihaja M, Ihantamalala F, Cordier L, Cowley G, et al. Geo- graphic barriers to care persist at the community healthcare level: Evidence from rural Madagascar. PLOS Glob Public Health. 2022; 2(12):e0001028. https://doi.org/10.1371/journal.pgph.0001028 PMID: 36962826.

20. World Health Organization. Rabies vaccines: WHO position paper, April 2018—Recommendations. WHO Wkly Epidemiol Rec. 2018; 93(16):201–2019. https://doi.org/10.1016/j.vaccine.2018.06.061 PMID: 30107991

21. Dechambre E. Origine des animaux domestiques de Madagascar. La terre et la vie. 1951; 4:187-96.

22. Ardalan A, Oskarsson MCR, van Asch B, Rabakonandriania E, Savolainen P. African origin for Mada- gascan dogs revealed by mtDNA analysis. Royal Society Open Science. 2015; 2(140552). https://doi. org/10.1098/rsos.140552 PMID: 26064658

23. Kshirsagar AR, Applebaum JW, Randriana Z, Rajaonarivelo T, Rafaliarison RR, Farris ZJ, et al. Human-Dog Relationships across Communities Surrounding Ranomafana and Andasibe-Mantadia
National Parks, Madagascar. Journal of Ethnobiology. 2020; 40(4):483-98. https://doi.org/10.2993/0278-0771-40.4.483

24. Valenta K, Gettinger-Larson JA, Chapman CA, Farris ZJ. Barking up the right tree: Understanding local attitudes towards dogs in villages surrounding Ranomafana National Park, Madagascar can benefit applied conservation. Madagascar Conservation & Development 2016; 11(2):87-90. https://doi.org/10.4314/mcd.v11i2

25. Mbilo C, Kabongo JB, Pyana PP, Nlonda L, Nzita RW, Luntadila B, et al. Dog Ecology, Bite Incidence, and Disease Awareness: A Cross-Sectional Survey among a Rabies-Affected Community in the Democratic Republic of the Congo. Vaccines. 2019; 7(3). https://doi.org/10.3390/vaccines7030098 PMID: 31454908.

26. Barbosa Costa G, Gilbert A, Monroe B, Blanton J, Ngam Ngam S, Recuenco S, et al. The influence of poverty and rabies knowledge on healthcare seeking behaviors and dog ownership, Cameroon. PloS one. 2018; 13(6):e0197330. https://doi.org/10.1371/journal.pone.0197330 PMID: 29927935.

27. Sambo M, Lembo T, Cleaveland S, Ferguson HM, Sikana L, Simon C, et al. Knowledge, attitudes and practices (KAP) about rabies prevention and control: a community survey in Tanzania. PLoS neglected tropical diseases. 2014; 8(12):e3310. https://doi.org/10.1371/journal.pntd.0003310 PMID: 25473834.

28. Hagos WG, Muchie KF, Gebru GG, Mezgebe GG, Reda KA, Dachew BA. Assessment of knowledge, attitude and practice towards rabies and associated factors among household heads in Mekelle city, Ethiopia. BMC public health. 2020; 20(1):57. https://doi.org/10.1186/s12889-020-8145-7 PMID: 31937297.

29. Tschopp R, Bekele S, Aseffa A. Dog Demography, Animal Bite Management and Rabies Knowledge-Attitude and Practices in the Awash Basin, Eastern Ethiopia. PLoS neglected tropical diseases. 2016; 10(2):e0004471. https://doi.org/10.1371/journal.pntd.0004471 PMID: 26900855.

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31. Ratsitorahina M, Rasambainarivo JH, Raharimanana S, Rakotonandrasana H, Andriamiarisoa MP, Rakalomanana FA, et al. Dog ecology and demography in Antananarivo, 2007. BMC veterinary research. 2009; 5:21. https://doi.org/10.1186/1746-6148-5-21 PMID: 19486516.

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33. Awuni B, Tarkang E, Manu E, Amu H, Ayanore MA, Aku FY, et al. Dog Owners' Knowledge about Rabies and Other Factors That Influence Canine Anti-Rabies Vaccination in the Upper East Region of Ghana. Tropical medicine and infectious disease. 2019; 4(3). https://doi.org/10.3390/tropicalmed4030115 PMID: 31426558.

34. Beyene TJ, Mindaye B, Leta S, Cernicchiaro N, Revie CW. Understanding Factors Influencing Dog Owners' Intention to Vaccinate Against Rabies Evaluated Using Health Belief Model Constructs. Fron tiers in veterinary science. 2018; 5:159. https://doi.org/10.3389/fvets.2018.00159 PMID: 30050912.

35. Bihon A, Meresa D, Tesfaw A. Rabies: Knowledge, Attitude and Practices in and Around South Gondar, North West Ethiopia. Diseases. 2020; 8(1). https://doi.org/10.3390/diseases8010005 PMID: 32102458.

36. Bouaddi K, Bitar A, Bouslikhane M, Ferssiwi A, Fitani A, Mshelbwala PP. Knowledge, Attitudes, and Practices Regarding Rabies in El Jadida Region, Morocco. Veterinary sciences. 2020; 7(1). https://doi.org/10.3390/vetsci7010029 PMID: 32121594.

37. Digafe RT, Kifelew LG, Mechesso AF. Knowledge, attitudes and practices towards rabies: question-naire survey in rural household heads of Gondar Zuria District, Ethiopia. BMC research notes. 2015; 8:400. https://doi.org/10.1186/s13104-015-1357-8 PMID: 26328612.

38. Ebuy Y, Alemayehu T, Reda M, M B, Bsrat A. Community Knowledge, Attitude and Practice on Rabies, Incidence in Humans and Animals and Risk Factors to Rabies in Selected Districts of Tigray Region, Ethiopia. Nigerian Veterinary Journal. 2019; 40(2):147-63. https://doi.org/10.4314/nvj.v40i2.7

39. Edukugho AA, Umoh JU, Diem M, Ajani O, Uba B, Okeke L, et al. Knowledge, attitudes and practices towards rabies prevention among residents of Abuja municipal area council, Federal Capital Territory, Nigeria. Pan African Medical Journal 2018; 31(21). https://doi.org/10.11604/pamj.2018.31.21.15120 PMID: 30918548

40. Guadu T, Shite A, Chanie M, Bogale B, Fentahun T. Assessment of Knowledge, Attitude and Practices about Rabies and Associated Factors: In the Case of Bahir Dar Town. Global Veterinaria. 2014; 13 (3):348-54. https://doi.org/10.5829/idosi.gv.2014.13.03.8579

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24. Valenta K, Gettinger-Larson JA, Chapman CA, Farris ZJ. Barking up the right tree: Understanding local attitudes towards dogs in villages surrounding Ranomafana National Park, Madagascar can benefit applied conservation. Madagascar Conservation & Development 2016; 11(2):87-90. https://doi.org/10.4314/mcd.v11i2

25. Mbilo C, Kabongo JB, Pyana PP, Nlonda L, Nzita RW, Luntadila B, et al. Dog Ecology, Bite Incidence, and Disease Awareness: A Cross-Sectional Survey among a Rabies-Affected Community in the Democratic Republic of the Congo. Vaccines. 2019; 7(3). https://doi.org/10.3390/vaccines7030098 PMID: 31454908.

26. Barbosa Costa G, Gilbert A, Monroe B, Blanton J, Ngam Ngam S, Recuenco S, et al. The influence of poverty and rabies knowledge on healthcare seeking behaviors and dog ownership, Cameroon. PloS one. 2018; 13(6):e0197330. https://doi.org/10.1371/journal.pone.0197330 PMID: 29927935.

27. Sambo M, Lembo T, Cleaveland S, Ferguson HM, Sikana L, Simon C, et al. Knowledge, attitudes and practices (KAP) about rabies prevention and control: a community survey in Tanzania. PLoS neglected tropical diseases. 2014; 8(12):e3310. https://doi.org/10.1371/journal.pntd.0003310 PMID: 25473834.

28. Hagos WG, Muchie KF, Gebru GG, Mezgebe GG, Reda KA, Dachew BA. Assessment of knowledge, attitude and practice towards rabies and associated factors among household heads in Mekelle city, Ethiopia. BMC public health. 2020; 20(1):57. https://doi.org/10.1186/s12889-020-8145-7 PMID: 31937297.

29. Tschopp R, Bekele S, Aseffa A. Dog Demography, Animal Bite Management and Rabies Knowledge-Attitude and Practices in the Awash Basin, Eastern Ethiopia. PLoS neglected tropical diseases. 2016; 10(2):e0004471. https://doi.org/10.1371/journal.pntd.0004471 PMID: 26900855.

30. Rakotonandrasana H. Dogs and risks of rabies in 1st and 6th Arrondissement of C.U.A. Veterinary The sis: University of Antananarivo, Madagascar. 2008.

31. Ratsitorahina M, Rasambainarivo JH, Raharimanana S, Rakotonandrasana H, Andriamiarisoa MP, Rakalomanana FA, et al. Dog ecology and demography in Antananarivo, 2007. BMC veterinary research. 2009; 5:21. https://doi.org/10.1186/1746-6148-5-21 PMID: 19486516.

32. Filla C, Rajeev M, Randriana Z, Hanitriniana C, Rafaliarison RR, Edosoa GT, et al. Lessons Learned and Paths Forward for Rabies Dog Vaccination in Madagascar: A Case Study of Pilot Vaccination Cam paigns in Moramanga District. Tropical medicine and infectious disease. 2021; 6(2):48. https://doi.org/10.3390/tropicalmed6020048 PMID: 33921499

33. Awuni B, Tarkang E, Manu E, Amu H, Ayanore MA, Aku FY, et al. Dog Owners' Knowledge about Rabies and Other Factors That Influence Canine Anti-Rabies Vaccination in the Upper East Region of Ghana. Tropical medicine and infectious disease. 2019; 4(3). https://doi.org/10.3390/tropicalmed4030115 PMID: 31426558.

34. Beyene TJ, Mindaye B, Leta S, Cernicchiaro N, Revie CW. Understanding Factors Influencing Dog Owners' Intention to Vaccinate Against Rabies Evaluated Using Health Belief Model Constructs. Fron tiers in veterinary science. 2018; 5:159. https://doi.org/10.3389/fvets.2018.00159 PMID: 30050912.

35. Bihon A, Meresa D, Tesfaw A. Rabies: Knowledge, Attitude and Practices in and Around South Gondar, North West Ethiopia. Diseases. 2020; 8(1). https://doi.org/10.3390/diseases8010005 PMID: 32102458.

36. Bouaddi K, Bitar A, Bouslikhane M, Ferssiwi A, Fitani A, Mshelbwala PP. Knowledge, Attitudes, and Practices Regarding Rabies in El Jadida Region, Morocco. Veterinary sciences. 2020; 7(1). https://doi.org/10.3390/vetsci7010029 PMID: 32121594.

37. Digafe RT, Kifelew LG, Mechesso AF. Knowledge, attitudes and practices towards rabies: question-naire survey in rural household heads of Gondar Zuria District, Ethiopia. BMC research notes. 2015; 8:400. https://doi.org/10.1186/s13104-015-1357-8 PMID: 26328612.

38. Ebuy Y, Alemayehu T, Reda M, M B, Bsrat A. Community Knowledge, Attitude and Practice on Rabies, Incidence in Humans and Animals and Risk Factors to Rabies in Selected Districts of Tigray Region, Ethiopia. Nigerian Veterinary Journal. 2019; 40(2):147-63. https://doi.org/10.4314/nvj.v40i2.7

39. Edukugho AA, Umoh JU, Diem M, Ajani O, Uba B, Okeke L, et al. Knowledge, attitudes and practices towards rabies prevention among residents of Abuja municipal area council, Federal Capital Territory, Nigeria. Pan African Medical Journal 2018; 31(21). https://doi.org/10.11604/pamj.2018.31.21.15120 PMID: 30918548

40. Guadu T, Shite A, Chanie M, Bogale B, Fentahun T. Assessment of Knowledge, Attitude and Practices about Rabies and Associated Factors: In the Case of Bahir Dar Town. Global Veterinaria. 2014; 13 (3):348-54. https://doi.org/10.5829/idosi.gv.2014.13.03.8579

41. Kabeta T, Deresa B, Tigre W, Ward MP, Mor SM. Knowledge, Attitudes and Practices of Animal Bite Victims Attending an Anti-rabies Health Center in Jimma Town, Ethiopia. PLoS neglected tropical dis eases. 2015; 9(6):e0003867. https://doi.org/10.1371/journal.pntd.0003867 PMID: 26114573.
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51. Tiwari HK, Robertson ID, O'Dea M, Vanak AT. Knowledge, attitudes and practices (KAP) towards rabies and free roaming dogs (FRD) in Panchkula district of north India: A cross-sectional study of urban residents. PLoS neglected tropical diseases. 2019; 13(4):e0007384. https://doi.org/10.1371/journal.pntd.0007384 PMID: 31034474.

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74. Chevalier V, Davun H, Sorn S, Ly P, Pov V, Ly S. Large scale dog population demography, dog management and bite risk factors analysis: A crucial step towards rabies control in Cambodia. PloS one. 2021; 16(7):e0254192. https://doi.org/10.1371/journal.pone.0254192 PMID: 34237103.

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