Dog-Mediated Rabies Exposure to Humans in Ethiopia: A Systematic Review and Meta-analysis

Abstract

Background: Dog-mediated rabies is a global public health agenda, especially in developing countries like in Asia and Africa. More than 95% of rabies incidence can be reduced by dog vaccination coverage of 70 %. In Ethiopia, a review of facility-based studies indicated around 32 % of dog-mediated human rabies exposure cases, which seems low compared to the global estimate. Given this finding, assessing comprehensive level of human exposure to dog-mediated rabies in Ethiopia becomes a crucial first step toward addressing the issue. Therefore, this review aimed to pool the prevalence of dog-mediated rabies exposure to humans using both community and facility-level studies.

Methods: We prepared a review protocol per Joanna Briggs Institute (JBI) manual for evidence synthesis and conducted a comprehensive search of PubMed, Cochrane, Google Scholar, and African Index Medicus databases and grey literature from 17 December 2023 to 06 April 2024. The pooled prevalence of dog-mediated rabies exposure to humans was computed using R v 4.3.1 software. Subgroup analysis was done on sample size, geographical location, and year of publication. Publication bias was assessed using a funnel plot.

Results: Based on 21 studies and 9,261 participants, the pooled prevalence of dog-mediated rabies exposure to humans was 90% (95% CI: 83-94) for the random effects model with I2 = 97% and p < 0.01. Sub-group analysis was done to investigate the source of heterogeneity, including sample size, study area, and year of publication. All the above-listed variables were not significant sources of statistical heterogeneity.

Conclusion and recommendations: This finding showed that the prevalence of dog mediated rabies exposure to humans is high. Therefore, the Ethiopian ministry of health, in collaboration with animal health, through a one-health approach, should target dog management including vaccination to preventive coverage (70%) to prevent the risk of rabies by dogs.