Rabies mortality and morbidity associated with animal bites in Africa: A case for Integrated Rabies Diseases Surveillance, Prevention and Control - A Scoping review
Authors: Nyasulu Peter , Weyer Jacqueline , Tschopp Rea , Mihret Adane , Aseffa Abraham , Nuvor Samuel Victor , Balogun Tolulope , Tamuzi Jacques Lukenze , Nyakarahuka Luke , Helegbe Gideon Kofi , Ntinginya Nyanda Elias , Gebreyesus Melaku Tefera , Doumbia Seydou , Blumberg Lucille , Busse Reinhard , Drosten Christian 
Published: August 2020

AbstractBackgroundRabies a neglected tropical disease, mostly affecting poor and vulnerable populations living in remote rural areas in developing countries. The disease continues to pose a significant public health a threat with an estimated 59,000 dog-transmitted human deaths, of which an estimated 21,476 human deaths occur in Africa each year. The global strategy has been set by the quartite World Health Organization (WHO), the World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and the Global Alliance for Rabies Control (GARC), aiming for “zero human deaths associated with dog transmitted rabies by 2030”. African countries, however, face several challenges and there are still gaps in controlling rabies. The aim of this study review is to determine rabies prevalence, mortality and associated risk factors in both human population and animal population and to evaluate the presence or absence of integrated one health surveillance response in African nations.Methods and analysisWe will conduct an electronic literature searches on PubMed, CINAHL, (Cumulative Index of Nursing and Allied Health Literature), Scopus, and Web of Science and other relevant databases. Reference lists from identified published articles or reviews and conference abstracts will also be searched for relevant articles. Published and unpublished literatures (grey) will be included in the search. The findings will be presented graphically in terms of mortality, morbidity, interventions for rabies control in Africa, research gaps identified, available research evidence, rabies surveillance, prevention and control and adverse events.ConclusionThis review will contribute to the coordination of interventions for surveillance, prevention, and control with African countries as country-based gaps and challenges and opportunities will be highlighted. In addition, the scaling up of post-exposure prophylaxis (PEP rabies will be evaluated in African countries and the projection to achieve the target of “zero deaths of human rabies by 2030” in Africa.Ethics and disseminationSince this is a scoping review, there is no institutional requirement to obtain ethical clearance from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University. Data used will be from open source and publicly available accessed on different databases as described in the methods. Ethical conduct of scientific investigator regarding publication of the work arising from this protocol will be adhered to by the research team. The findings will be disseminated in clinical seminars, scientific forums and conferences targeting infectiology for human and veterinary clinician, public health scientists, virologists, immunologists, vaccinologists and policy makers among others.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercialStrengths and limitations of the studyThis is the first scoping review to synthesize new and old evidences on rabies and weight those evidence to achieve global target of “zero human rabies deaths by 2030” in Africa.The review will include published and non-published literature (i.e. peer reviewed and non-peer reviewed) in different African countries. So called grey literature is key in a review of this topic as surveillance data and other related findings are often not reported in peer-reviewed scientific journals.Mapping outcomes are designed as evidence-based practices that may play key role in African countries rabies public health policy.As with most scope reviews, this scope review does not assess the quality of evidence and the risk of bias in various studies. In addition, the review will include a large number of studies (both published and unpublished), which will require considerable time to complete the study.