Duamor Christian Tetteh, Hampson Katie, Lankester Felix, Lugelo Ahmed, Changalucha Joel, Lushasi Kennedy Selestin, Czupryna Anna, Mpolya Emmanuel, Kreppel Katharina, Cleaveland Sarah, Wyke Sally
Department of Global Health and Biomedical Sciences, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania.
Environmental Health and Ecological Sciences Thematic Group, Ifakara Health Institute - Tanzania, Ifakara, Tanzania.
One Health. 2023 Jun 3;17:100575. doi: 10.1016/j.onehlt.2023.100575. eCollection 2023 Dec.
Sustained vaccination coverage of domestic dog populations can interrupt rabies transmission. However, challenges remain including low dog owner participation, high operational costs associated with current (centralized and annually delivered (pulse)) approaches and high dog population turnover. To address these challenges an alternative (community-based continuous mass dog vaccination (CBC-MDV)) approach was designed. We investigated the potential for successful normalization of CBC-MDV into routine practice within the context of local communities and the veterinary system of Tanzania.
In a process evaluation of a pilot implementation of CBC-MDV, we conducted in-depth interviews with implementers and community leaders ( = 24), focus group discussion with implementers and community members ( = 12), and non-participant observation ( = 157 h) of delivery of the intervention components. We analyzed these data thematically drawing on the normalization process theory, to assess factors affecting implementation and integration.
Implementers and community members clearly understood the values and benefits of the CBC-MDV, regarding it as an improvement over the pulse strategy. They had a clear understanding of what was required to enact CBC-MDV and considered their own involvement to be legitimate. The approach fitted well into routine schedules of implementers and the context (infrastructure, skill sets and policy). Implementers and community members positively appraised CBC-MDV in terms of its perceived impact on rabies and recommended its use across the country. Implementers and community members further believed that vaccinating dogs free of charge was critical and made community mobilization easier. However, providing feedback to communities and involving them in evaluating outcomes of vaccination campaigns were reported to have not been done. Local politics was cited as a barrier to collaboration between implementers and community leaders.
This work suggests that CBC-MDV has the potential to be integrated and sustained in the context of Tanzania. Involving communities in design, delivery and monitoring of CBC-MDV activities could contribute to improving and sustaining its outcomes.
维持家犬群体的疫苗接种覆盖率可阻断狂犬病传播。然而，挑战依然存在，包括犬主参与度低、当前（集中式且每年开展一次（脉冲式））方法相关的运营成本高以及犬只数量更替率高。为应对这些挑战，设计了一种替代方法（基于社区的持续大规模犬类疫苗接种（CBC - MDV））。我们在坦桑尼亚当地社区和兽医系统的背景下，调查了将CBC - MDV成功常态化纳入常规实践的可能性。
在对CBC - MDV试点实施的过程评估中，我们对实施者和社区领袖进行了深入访谈（n = 24），与实施者和社区成员进行了焦点小组讨论（n = 12），并对干预措施的实施进行了非参与式观察（157小时）。我们依据常态化过程理论对这些数据进行主题分析，以评估影响实施和整合的因素。
实施者和社区成员清楚地理解了CBC - MDV的价值和益处，认为它比脉冲式策略有所改进。他们清楚地知道实施CBC - MDV需要做什么，并认为自己的参与是合理的。该方法很好地融入了实施者的日常工作安排和环境（基础设施、技能组合及政策）。实施者和社区成员对CBC - MDV对狂犬病的感知影响给予了积极评价，并建议在全国推广使用。实施者和社区成员还认为免费为犬只接种疫苗至关重要，且使社区动员更容易。然而，据报告未向社区提供反馈，也未让社区参与评估疫苗接种活动的结果。地方政治被认为是实施者与社区领袖合作的障碍。
这项工作表明CBC - MDV有潜力在坦桑尼亚的背景下得到整合和持续开展。让社区参与CBC - MDV活动的设计、实施和监测，可能有助于改善并维持其效果。
