Community awareness, perception, and preventive practices towards rabies in Ethiopia: A systematic review and meta-analysis.

Background: Rabies is a major global public health problem, with case fatality rate approaching 100% once clinical symptoms appear, causing severe neurological complications and significant social and economic burdens. Ethiopia bears a high burden of rabies, with the disease remaining endemic and contributing to considerable vaccine-preventable deaths, largely due to low community awareness, inadequate preventive practices, and limited access to timely post-exposure prophylaxis. Although studies have examined community knowledge, attitudes, and preventive practices regarding rabies in Ethiopia; however, the reported findings vary across studies. Objectives: This review was conducted to estimate the pooled prevalence and identify associated factors of community knowledge, attitudes, and preventive practices related to rabies prevention in Ethiopia. Design: Systematic review and meta-analysis. Data Sources and Methods: A comprehensive and systematic literature search was conducted in PubMed/MEDLINE, EMBASE, ScienceDirect, Semantic Scholar, Google Scholar, the Cochrane Library, and the National Institute for Health and Care Excellence (NICE), together with relevant grey literature to identify studies reporting on community knowledge, attitudes, and preventive practices regarding rabies in Ethiopia. Data on prevalence estimates and associated determinants were extracted using Microsoft Excel and subsequently analyzed using Stata version 17.0. A random-effects model was applied to estimate the pooled prevalence, and subgroup analyses were performed to explore potential sources of heterogeneity among the included studies. Publication bias was assessed through visual inspection of funnel plots and Egger's regression test. The methodological quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist. Results: A total of 27 studies involving 11,964 participants were included in the final analysis. The pooled estimates of good knowledge, favorable attitudes, and good preventive practices toward rabies were 60.36%, 58.56%, and 54.62%, respectively. Individuals living in urban areas, formal education and previous exposure to rabies were positively associated with good knowledge of rabies prevention. Conclusions: Community awareness, attitudes, and preventive behaviors toward rabies in Ethiopia remain suboptimal, with disparities among rural populations and individuals with lower educational status. The findings highlight the need for focused education intervention, improved availability of vaccination and post-exposure services, and enhanced collaboration through the One Health approach. Future efforts should focus on scaling up community awareness and preventive behaviors to support rabies control. Registration: Not registered.