Across different urban centres and rural parts in the country, stray dogs and cats are common sights, roaming around garbage sites, streets and some as pets. For generations, communities have domesticated these animals as pets, for hunting and for protecting homes. However, the same could be risky to your health, should they have rabies. Many people have been bitten by these animals kept as pets, with devastating effects.

Uganda has more than two million dogs kept at home with Western region having the highest number at 440,000 and the Karamoja region with the lowest number at 140,000, according to data from Ministry of Agriculture, Animal Industries and Fisheries and Uganda Bureau of Statistics, with almost a third of these free roaming which pose a high risk to the public.

The data indicates that at least more than 4000 dog bites are reported annually in Uganda, posing a huge risk to humans across the country. These figures do not include the unreported cases estimated to be in thousands also.

Rabies is a fatal viral zoonotic disease responsible for death of up to 59,000 humans each year globally. Statistics indicate that Rabies problem and impact are more felt in Africa and Asia where and up to 95% of annual cases are registered.

In Uganda, Dr Anna Rose Ademun Okurut, Commissioner Animal Health and the Chief Veterinary Officer Ministry of Agriculture, Animal Industry and Fisheries said rabies has persisted in animal population hence requiring routine surveillance and control mechanisms.

In March, 2017 rabies was selected among the seven priority zoonotic diseases in Uganda with emphasis on multi-sectoral approach for successful control. In the past, rabies control relied on mass vaccination of dogs and cats with significant success.

“Sustainable control of rabies can only be achieved if well planned, coordinated and aligned to the objectives of One Health Approach involving Ministry of Agriculture Animal Industry and Fisheries, Ministry of Health, Uganda Wildlife Authority and Ministry of Water and Environment,” she said.

She said to combat that, five year strategic plan was developed with objective to provide a framework for the detection, prevention, control and eventual elimination of the rabies disease in Uganda by 2030. The strategy, according to her targets control of dog‐ mediated human rabies disease as well as the protection and maintenance of a rabies-free country, mainly through risk based vaccination approach.

The 2020-2024 strategy for control and elimination of Rabies in the country says effective control of rabies in the country is still a challenge and that the true burden of the disease is not yet established due to under reporting.

Rabies ranked high among the top seven priority zoonotic diseases in Uganda, according to CDC, 2017 and significantly impacts on public health and wellbeing of many people and animals. Each year government spends an estimate of Shs7 billion (USD1.9m) for rabies management, mainly for procurement of vaccines, pre- and post-exposure prophylaxis (PEP).

A survey carried out by the Uganda Bureau of Statistics in 2008 indicates that the population of domestic dogs in Uganda was estimated at more than 1.6 million. Almost a third of these are free roaming and these pose a high risk to the public.

The strategy said the cost implications involved in rabies management are high with purchase of PEP estimated at $150 and that death can still occur. It is said due to lack of sufficient data, the true economic impact of rabies on the local communities associated with deaths in humans and animals cannot be accurately estimated.

“Efforts to control the disease as a country have been hampered by challenges such as lack of prevention and control strategy, poor inter-sectoral collaboration and financial constraints among others,” the document says.

Rabies was first confirmed in West Nile region in 1936 and has since then become endemic in the country. As of July 2018, more than 60% of the districts in Uganda were mapped as rabies high-risk areas or “hot spots “reporting more than five canine bite cases per year.

According to the latest statistics, 18 districts have been identified as hotspots for the rabies across the country. They include, Arua, Moyo, Koboko, Kitgum, Moroto, Lira, Luuka, Iganga, Busia and Buikwe. Also included on the list are Mukono, Kampala, Masaka, Mbarara, Isingiro, Kabale and Kasese.

Lt. Col (Rtd) Rwamirama Bright, minister of state for animal industry and veterinary affairs, said as Uganda joins the rest of the World to commemorate the world rabies day, focus must be on raising awareness about rabies, its prevention and to highlight the progress in defeating this horrifying disease.

He said rabies is a fatal viral disease that affects both humans and animals and that the most vulnerable ore children since they are commonly in touch with dogs and tend to provoke them.

He warned that the virus is transmitted through saliva of an infected animal, normally via a bite or an open wound on the mucous membrane in the mouth, nose or eyes. He also said since the virus is shed in the dogs’ and cats’ saliva several days before onset of clinic al signs hence humans may be exposed without their knowledge.

“Airborne transmission is also possible under special circumstances such as in laboratories and caves with an extremely high bat density. The wild carnivores such as foxes, jackals and wild dogs are reservoirs for the disease and can transmit the disease to domestic dogs,” he said.

Rwamirama said that many facts  about the disease are  overshadowed  by myths, misinformation and or falsehoods and fear among communities that have lost animals and their dear ones. He said this makes rabies prevention and control efforts less effective and thus the disease has remained one of the least attended to yet it’s fatal and causes significant economic losses to the country attributed to loss of productivity and pre-mature deaths annually.

“There is need for all stakeholders to collaborate and support efforts towards rabies prevention and control. This is to call upon all the stakeholders to support government efforts in ending this deadly disease through; Awareness creation on rabies control through print media and radio talk shows; Investing in robust surveillance systems for both animal and public health to get real time data that can inform decisions on the control of the rabies disease,” he said.

Global perspective

Data from global rabies control organisations indicate that each year at least 59,000 people die from rabies worldwide and more than 10 million people are treated for post exposure to the rabies virus in Asia and Africa.

“The risk and burden of rabies is mainly among the vulnerable sectors of society especially the children due to highest risk of dog bites and injuries, more so those living in the resource limited settings
with limited access to human rabies vaccine,” the report says.

It is estimated that global annual expenditure due to rabies control and prevention is estimated to be more than $500 million and that the high cost of post-exposure prophylaxis (PEP) is a burden for governments in developing countries. Additionally, different reports say livestock losses due to rabies infection can be substantial for subsistence communities.

Back in Uganda, data from Ministry of Agriculture, Animals Industries and Fisheries says the burden of rabies has over the years increased to due several factors including population growth. The ministry says frequent vaccine shortages in nearby health units implies that bite-victims must often travel long distances seeking for PEP, which is extremely costly in terms of transport and medical bills, and this can increase delays to treatment and therefore the risks of developing rabies infection is high.

The strategy says while the quantitative socio-economic impact of rabies in Uganda is generally scanty, qualitative impacts of rabies in animals and humans are related to, death in humans, death of animals,
psychological trauma, and loss of income to treatment costs, loss of labor and loss of food.

According to the strategy to control and eliminate rabies, while Uganda practices both mass pet vaccination in animals and post exposure prophylaxis (PEP) in humans, in many instances the coverage is very low and irregular due to financial constraints and lack of a clear guiding program.

Dr Willington Bessong, the country team leader for Emergency Centre for Transboundary Animal Diseases said rabies is a disease that must not be ignored. He said while the disease originates from animals,
its impact on human life is catastrophic and that a lot needs to be done to both prevent and eliminate the disease in the country.

He said irresponsible domestication of animals for pets and poor handling mechanisms are some of the major causes of transfer of rabies from animals to human beings.

“People need to engage in responsible pet management and make sure that they are kept safe, vaccinated and properly fed to avoid cases of straying out where they can come into contact with wild animals that can bite and infect them with rabies,” he said.

Arua district has remained a hotspot for rabies in the country with over 270 cases registered so far this year. Ms Roselin Sandra Ewachabo, the assistant Chief Administrative Officer, Arua attributed the crisis to stray dogws, which she said have become a real problem. She said already in 2021, the district so far has registered over 270 cases and six deaths.

According to her, of the registered cases this year, 135 are males, 48 females and 89 are children under 14 years. She also said last year, there 182 males, 149 females and 160 children under the age of 14 were
registered, with 9 deaths in the district. 

Dr. Robert Mwebe, a senior veterinary officer at ministry of agriculture, animal industries and fisheries said that rabies is one of the notifiable diseases which has to be reported to the authority as soon as it is
suspected. According to him, records from the ministry of health show that between 2015 and 2016, over 16,000 human dog bites were recorded.

He called for joined efforts from all different stakeholders to bring one health approach which brings almost everyone.

“As a ministry, we are committed to working with all the stakeholders involved in the control. Annually the ministry procure the vaccines and make sure all the districts use this vaccines properly to control the disease,” he said.

Utility
Key facts about the rabies diseases;

• Rabies is a deadly disease that affects both animals and humans.

• 99% of all human cases are due to bites from infected dogs.

• Rabies causes 100% death in humans and animals once signs and symptoms of the disease begin to manifest.

• Human rabies is 100% preventable through effective annual vaccination of animals at risk especially dogs and cats.

•  4000 dog bites reported annually in Uganda.

•  Cost of treatment is $150 (Shs526169)

• Uganda spends Shs7billion annually to procure vaccines/medicines to combat rabies.

• 59,000 people killed globally annually by rabies

• $500m spent annually globally to treat rabies and vaccination