Barriers to dog bite case management and dog rabies vaccination in Soroti district, Uganda.

Introduction: Rabies, a neglected tropical disease, causes about 59,000 annual human fatalities globally, the majority of which result from dog bites. Although rabies is preventable by vaccinating dogs and providing post-exposure prophylaxis (PEP) to humans, dog vaccination coverage in Uganda remains low at approximately 10% and not all human dog bite cases receive PEP. This study sought to understand barriers to dog bite case management and dog rabies vaccination. Methods: This study, conducted between September 2022 and March 2023, involved 10 focus group discussions (FGDs) with dog owners and eight key informant interviews (KIIs) with opinion leaders, veterinary and health professionals. Participants were purposively selected based on their experience with dog vaccination and bite case management. Data was collected from Soroti Municipality (peri-urban) and Kamuda sub-county (rural) using structured interview guides premised on the socio-ecological model. Transcripts were coded and analyzed thematically using NVivo software (version 12.0). Results: At the individual level, limited first aid knowledge, few available PEP doses and high PEP costs were major barriers to proper dog bite case management. Community level barriers included poor management of roaming dogs and insufficient knowledge on managing biting dogs. Organizational barriers included frequent PEP stock-outs, improper cold-chain system in health facilities and poor communication between relevant health sectors. Regarding dog rabies vaccination, individual level barriers were, uncertainty about vaccination frequency, high vaccine costs and irresponsible dog ownership. Community level barriers centered on inadequate communication about dog vaccination campaigns and poor communication between the dog owners and veterinary officers, while organizational barriers included inaccurate data on dog population, inadequate staffing and logistical constraints. Discussion: The study's findings revealed that effective rabies prevention is constrained by interrelated individual, community and systemic factors. To address these gaps, district health authorities should provide continuous community education on dog bite first aid and timely seeking of care, ensure consistent availability of PEP through improved supply chain management, and implement subsidized or free mass dog vaccination campaigns. In addition, local governments should improve dog registration systems and enforce responsible dog ownership, while strengthening coordination between human and animal health sectors through One Health approaches.