A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City, Sri Lanka

<div><p>Background</p><p>One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management.</p><p>Methodology/Principal Findings</p><p>A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate.</p><p>Conclusions</p><p>The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control.</p></div

Costs (in 2011 US $) for dog rabies control activities in Colombo City for the years 2007–2011.

<p>Costs (in 2011 US $) for dog rabies control activities in Colombo City for the years 2007–2011.</p

Direct and indirect human health costs in Colombo City related to the treatment of one dog bite.

<p>Direct and indirect human health costs in Colombo City related to the treatment of one dog bite.</p

Overview of a conceptual integrated framework for the assessment of rabies control strategies.

<p>Overview of a conceptual integrated framework for the assessment of rabies control strategies.</p

Dog related problems listed in Colombo City, Sri Lanka.

<p>The number of focus groups (1 to 9) that listed specific dog related problems perceived for the years 2006 (blue line) and 2011 (red line) in Colombo City, Sri Lanka.</p

The difference in monetary human health costs (in 2011 US $) between the intervention and the baseline scenario when varying the inputs number of people bitten and seeking treatment in the baseline scenario (Input 1, row values) and the number of people bitten and seeking treatment in the intervention (Input 2, column values) between −30% and +30% from the base.

<p>The figures in italic reflect the input combinations that produce a net benefit in monetary human health costs.</p><p>The difference in monetary human health costs (in 2011 US $) between the intervention and the baseline scenario when varying the inputs number of people bitten and seeking treatment in the baseline scenario (Input 1, row values) and the number of people bitten and seeking treatment in the intervention (Input 2, column values) between −30% and +30% from the base.</p

Summary table for the dog acceptance scores of dog owners and non-dog owners for the baseline scenario and the intervention.

<p>Summary table for the dog acceptance scores of dog owners and non-dog owners for the baseline scenario and the intervention.</p

Scores for conditions and situations impacting on dog welfare in the rabies control baseline scenario.

<p>* The duration includes keeping the dogs in the animal control facility for a prolonged time period. Without that waiting phase, the duration would be a 3 (when compared to euthanasia with pentobarbitone that takes seconds).</p>†<p>Depending on carbon dioxide concentration and the tuning of the carburettor. With appropriate tuning, these could be 1 and 2, respectively.</p><p>Scores for conditions and situations impacting on dog welfare in the rabies control baseline scenario.</p

Scores for conditions and situations impacting on dog welfare in the rabies intervention.

<p>Scores for conditions and situations impacting on dog welfare in the rabies intervention.</p

Summary table of individuals' perceived number of roaming dogs in five wards in Colombo City before and after the implementation of the intervention activities reported by 61 focus group participants.

<p>Summary table of individuals' perceived number of roaming dogs in five wards in Colombo City before and after the implementation of the intervention activities reported by 61 focus group participants.</p