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Rabies is an acute viral infection which causes horrifying neurological symptoms that inevitably result in death. Every year at least 59,000 people are estimated to die from rabies and more than 10 million are treated with post-exposure prophylaxis (PEP). Over 90% of human rabies deaths occur in Asia and Africa following bites from domestic dogs. Although human rabies deaths are 100% preventable through the delivery of prompt PEP to bite victims following a bite, PEP is not accessible to many poor rural victims, most of whom subsist on less than US$1.25/day. Empirical and theoretical evidence shows that mass dog vaccination that reaches 70% of susceptible dog population can interrupt the transmission cycle. Rabies has been eliminated from industrialized countries through mass dog vaccination, and the continent-wide elimination of canine rabies from the Americas is now within reach. In contrast, no effective large-scale control of dog rabies has been achieved in Africa and information is still needed to optimise and sustain dog vaccination programmes. The aim of this thesis was to evaluate the rabies control programme in Tanzania. This thesis is presented as a series of three standalone chapters (Chapters 2-4) that are introduced and then summarised by a general introduction (Chapter 1) and a general discussion (Chapter 5) respectively. Achieving high coverage is the most important aim of any vaccination programme; however, assessing the vaccination coverage achieved is often neglected in rabies endemic countries. In Chapter 2, I compare three methods of measuring vaccination coverage (post-vaccination transects, school-based surveys, and household surveys) across 28 districts in different settings in southeast Tanzania and Pemba island in order to determine which is most precise method. These approaches were explored in detail in a single district in northwest Tanzania (Serengeti), where their performance in producing precise estimates of coverage was compared with

Rabies is an acute viral infection which causes horrifying neurological symptoms that inevitably result in death. Every year at least 59,000 people are estimated to die from rabies and more than 10 million are treated with post-exposure prophylaxis (PEP). Over 90% of human rabies deaths occur in Asia and Africa following bites from domestic dogs. Although human rabies deaths are 100% preventable through the delivery of prompt PEP to bite victims following a bite, PEP is not accessible to many poor rural victims, most of whom subsist on less than US$1.25/day. Empirical and theoretical evidence shows that mass dog vaccination that reaches 70% of susceptible dog population can interrupt the transmission cycle. Rabies has been eliminated from industrialized countries through mass dog vaccination, and the continent-wide elimination of canine rabies from the Americas is now within reach. In contrast, no effective large-scale control of dog rabies has been achieved in Africa and information is still needed to optimise and sustain dog vaccination programmes. The aim of this thesis was to evaluate the rabies control programme in Tanzania. This thesis is presented as a series of three standalone chapters (Chapters 2-4) that are introduced and then summarised by a general introduction (Chapter 1) and a general discussion (Chapter 5) respectively. Achieving high coverage is the most important aim of any vaccination programme; however, assessing the vaccination coverage achieved is often neglected in rabies endemic countries. In Chapter 2, I compare three methods of measuring vaccination coverage (post-vaccination transects, school-based surveys, and household surveys) across 28 districts in different settings in southeast Tanzania and Pemba island in order to determine which is most precise method. These approaches were explored in detail in a single district in northwest Tanzania (Serengeti), where their performance in producing precise estimates of coverage was compared with

Rabies is an acute viral infection which causes horrifying neurological symptoms that inevitably result in death. Every year at least 59,000 people are estimated to die from rabies and more than 10 million are treated with post-exposure prophylaxis (PEP). Over 90% of human rabies deaths occur in Asia and Africa following bites from domestic dogs. Although human rabies deaths are 100% preventable through the delivery of prompt PEP to bite victims following a bite, PEP is not accessible to many poor rural victims, most of whom subsist on less than US$1.25/day. Empirical and theoretical evidence shows that mass dog vaccination that reaches 70% of susceptible dog population can interrupt the transmission cycle. Rabies has been eliminated from industrialized countries through mass dog vaccination, and the continent-wide elimination of canine rabies from the Americas is now within reach. In contrast, no effective large-scale control of dog rabies has been achieved in Africa and information is still needed to optimise and sustain dog vaccination programmes. The aim of this thesis was to evaluate the rabies control programme in Tanzania. This thesis is presented as a series of three standalone chapters (Chapters 2-4) that are introduced and then summarised by a general introduction (Chapter 1) and a general discussion (Chapter 5) respectively. Achieving high coverage is the most important aim of any vaccination programme; however, assessing the vaccination coverage achieved is often neglected in rabies endemic countries. In Chapter 2, I compare three methods of measuring vaccination coverage (post-vaccination transects, school-based surveys, and household surveys) across 28 districts in different settings in southeast Tanzania and Pemba island in order to determine which is most precise method. These approaches were explored in detail in a single district in northwest Tanzania (Serengeti), where their performance in producing precise estimates of coverage was compared with

Rabies is a fatal viral zoonotic infection caused by a Lyssavirus. Rabies exerts a major public health and economic burden; it is responsible for at least 55,000 deaths worldwide, predominantly in Africa and Asia. More than 90% of rabies deaths are caused by domestic dogs. Global expenditure on rabies prevention and control exceeds US$500 million per annum. Although human rabies is 100% preventable, through vaccination of animal reservoirs and post-exposure prophylaxis (PEP) of people exposed to bites, no effective large-scale control of rabies has been achieved in sub-Saharan Africa. Effective implementation of sustainable rabies control and prevention programs, involves full participation of individuals, veterinary and medical services. Veterinary services must control rabies transmission through mass dog vaccination campaigns because human deaths are caused by epidemics in domestic dogs, medical services must provide PEP to prevent disease in exposed individuals and exposed individuals must seek PEP and dog owners must take their dogs to be vaccinated. This thesis focuses on factors affecting individuals and medical services. This thesis examines challenges in the control and prevention of rabies in sub-Saharan Africa. Firstly, to address these challenges, we developed an analytical framework to portray the influence of individual and institutional factors within both the veterinary and medical services, in controlling and preventing rabies. The research carried out in chapters two and three investigate different aspects of this framework. Specifically in Chapter 2, we conducted a knowledge, attitude and practice (KAP) survey in seven districts covering southern, central and northern Tanzania. We used the collected data to investigate factors that influence knowledge of rabies and how knowledge of rabies influences attitudes and practice in control and prevention of rabies. Our findings show that knowledge about rabies in Tanzania is limited. However, we found an

Rabies is a fatal viral zoonotic infection caused by a Lyssavirus. Rabies exerts a major public health and economic burden; it is responsible for at least 55,000 deaths worldwide, predominantly in Africa and Asia. More than 90% of rabies deaths are caused by domestic dogs. Global expenditure on rabies prevention and control exceeds US$500 million per annum. Although human rabies is 100% preventable, through vaccination of animal reservoirs and post-exposure prophylaxis (PEP) of people exposed to bites, no effective large-scale control of rabies has been achieved in sub-Saharan Africa. Effective implementation of sustainable rabies control and prevention programs, involves full participation of individuals, veterinary and medical services. Veterinary services must control rabies transmission through mass dog vaccination campaigns because human deaths are caused by epidemics in domestic dogs, medical services must provide PEP to prevent disease in exposed individuals and exposed individuals must seek PEP and dog owners must take their dogs to be vaccinated. This thesis focuses on factors affecting individuals and medical services. This thesis examines challenges in the control and prevention of rabies in sub-Saharan Africa. Firstly, to address these challenges, we developed an analytical framework to portray the influence of individual and institutional factors within both the veterinary and medical services, in controlling and preventing rabies. The research carried out in chapters two and three investigate different aspects of this framework. Specifically in Chapter 2, we conducted a knowledge, attitude and practice (KAP) survey in seven districts covering southern, central and northern Tanzania. We used the collected data to investigate factors that influence knowledge of rabies and how knowledge of rabies influences attitudes and practice in control and prevention of rabies. Our findings show that knowledge about rabies in Tanzania is limited. However, we found an

Rabies is an acute viral infection which causes horrifying neurological symptoms that inevitably result in death. Every year at least 59,000 people are estimated to die from rabies and more than 10 million are treated with post-exposure prophylaxis (PEP). Over 90% of human rabies deaths occur in Asia and Africa following bites from domestic dogs. Although human rabies deaths are 100% preventable through the delivery of prompt PEP to bite victims following a bite, PEP is not accessible to many poor rural victims, most of whom subsist on less than US$1.25/day. Empirical and theoretical evidence shows that mass dog vaccination that reaches 70% of susceptible dog population can interrupt the transmission cycle. Rabies has been eliminated from industrialized countries through mass dog vaccination, and the continent-wide elimination of canine rabies from the Americas is now within reach. In contrast, no effective large-scale control of dog rabies has been achieved in Africa and information is still needed to optimise and sustain dog vaccination programmes. The aim of this thesis was to evaluate the rabies control programme in Tanzania. This thesis is presented as a series of three standalone chapters (Chapters 2-4) that are introduced and then summarised by a general introduction (Chapter 1) and a general discussion (Chapter 5) respectively. Achieving high coverage is the most important aim of any vaccination programme; however, assessing the vaccination coverage achieved is often neglected in rabies endemic countries. In Chapter 2, I compare three methods of measuring vaccination coverage (post-vaccination transects, school-based surveys, and household surveys) across 28 districts in different settings in southeast Tanzania and Pemba island in order to determine which is most precise method. These approaches were explored in detail in a single district in northwest Tanzania (Serengeti), where their performance in producing precise estimates of coverage was compared with

Rabies is an acute viral infection which causes horrifying neurological symptoms that inevitably result in death. Every year at least 59,000 people are estimated to die from rabies and more than 10 million are treated with post-exposure prophylaxis (PEP). Over 90% of human rabies deaths occur in Asia and Africa following bites from domestic dogs. Although human rabies deaths are 100% preventable through the delivery of prompt PEP to bite victims following a bite, PEP is not accessible to many poor rural victims, most of whom subsist on less than US$1.25/day. Empirical and theoretical evidence shows that mass dog vaccination that reaches 70% of susceptible dog population can interrupt the transmission cycle. Rabies has been eliminated from industrialized countries through mass dog vaccination, and the continent-wide elimination of canine rabies from the Americas is now within reach. In contrast, no effective large-scale control of dog rabies has been achieved in Africa and information is still needed to optimise and sustain dog vaccination programmes. The aim of this thesis was to evaluate the rabies control programme in Tanzania. This thesis is presented as a series of three standalone chapters (Chapters 2-4) that are introduced and then summarised by a general introduction (Chapter 1) and a general discussion (Chapter 5) respectively. Achieving high coverage is the most important aim of any vaccination programme; however, assessing the vaccination coverage achieved is often neglected in rabies endemic countries. In Chapter 2, I compare three methods of measuring vaccination coverage (post-vaccination transects, school-based surveys, and household surveys) across 28 districts in different settings in southeast Tanzania and Pemba island in order to determine which is most precise method. These approaches were explored in detail in a single district in northwest Tanzania (Serengeti), where their performance in producing precise estimates of coverage was compared with

Rabies is a fatal viral zoonotic infection caused by a Lyssavirus. Rabies exerts a major public health and economic burden; it is responsible for at least 55,000 deaths worldwide, predominantly in Africa and Asia. More than 90% of rabies deaths are caused by domestic dogs. Global expenditure on rabies prevention and control exceeds US$500 million per annum. Although human rabies is 100% preventable, through vaccination of animal reservoirs and post-exposure prophylaxis (PEP) of people exposed to bites, no effective large-scale control of rabies has been achieved in sub-Saharan Africa. Effective implementation of sustainable rabies control and prevention programs, involves full participation of individuals, veterinary and medical services. Veterinary services must control rabies transmission through mass dog vaccination campaigns because human deaths are caused by epidemics in domestic dogs, medical services must provide PEP to prevent disease in exposed individuals and exposed individuals must seek PEP and dog owners must take their dogs to be vaccinated. This thesis focuses on factors affecting individuals and medical services. This thesis examines challenges in the control and prevention of rabies in sub-Saharan Africa. Firstly, to address these challenges, we developed an analytical framework to portray the influence of individual and institutional factors within both the veterinary and medical services, in controlling and preventing rabies. The research carried out in chapters two and three investigate different aspects of this framework. Specifically in Chapter 2, we conducted a knowledge, attitude and practice (KAP) survey in seven districts covering southern, central and northern Tanzania. We used the collected data to investigate factors that influence knowledge of rabies and how knowledge of rabies influences attitudes and practice in control and prevention of rabies. Our findings show that knowledge about rabies in Tanzania is limited. However, we found an

Rabies is a fatal viral zoonotic infection caused by a Lyssavirus. Rabies exerts a major public health and economic burden; it is responsible for at least 55,000 deaths worldwide, predominantly in Africa and Asia. More than 90% of rabies deaths are caused by domestic dogs. Global expenditure on rabies prevention and control exceeds US$500 million per annum. Although human rabies is 100% preventable, through vaccination of animal reservoirs and post-exposure prophylaxis (PEP) of people exposed to bites, no effective large-scale control of rabies has been achieved in sub-Saharan Africa. Effective implementation of sustainable rabies control and prevention programs, involves full participation of individuals, veterinary and medical services. Veterinary services must control rabies transmission through mass dog vaccination campaigns because human deaths are caused by epidemics in domestic dogs, medical services must provide PEP to prevent disease in exposed individuals and exposed individuals must seek PEP and dog owners must take their dogs to be vaccinated. This thesis focuses on factors affecting individuals and medical services. This thesis examines challenges in the control and prevention of rabies in sub-Saharan Africa. Firstly, to address these challenges, we developed an analytical framework to portray the influence of individual and institutional factors within both the veterinary and medical services, in controlling and preventing rabies. The research carried out in chapters two and three investigate different aspects of this framework. Specifically in Chapter 2, we conducted a knowledge, attitude and practice (KAP) survey in seven districts covering southern, central and northern Tanzania. We used the collected data to investigate factors that influence knowledge of rabies and how knowledge of rabies influences attitudes and practice in control and prevention of rabies. Our findings show that knowledge about rabies in Tanzania is limited. However, we found an