| dc.description.abstract | Rabies can be eliminated if coverage of domestic dog vaccination is sustained above 40% all
year-round for five-seven consecutive years. Current approaches usually fail to achieve this
required vaccination coverage and an alternative, a community-based continuous mass dog
vaccination (CBC-MDV) approach, was designed and piloted in the Mara region of Tanzania.
This thesis used mixed, qualitative, quantitative and participatory methods to evaluate the
development and delivery of the CBC-MDV approach over two years to generate evidence to
inform the optimization of the design prior to its evaluation in a full-scale randomized control
trial. Specifically, it investigated the feasibility and fidelity of delivery and potential
effectiveness of the CBC-MDV strategies, drivers of innovations in the implementation
process, whether and how community engagement can be used to address barriers to
participation in mass dog vaccination (MDV) campaigns and what factors will determine the
normalization of CBC-MDV as the standard approach for delivering MDV in Tanzania.
Qualitative data were analyzed using thematic analysis, both inductive and deductive.
Quantitative data on delivery of CBC-MDV were analyzed descriptively. Regression analysis
was used to identify population-related factors that have implications for participation in MDV.
Two-proportion Z-tests and Mann-Whitney U test were used to assess whether the community
engagement strategies were effective and can address barriers to participation in MDV
campaigns. The findings showed that the development process of CBC-MDV was iterative and
involved cross-sectoral participation but without the direct involvement of communities. In
relation to feasibility, fidelity and potential effectiveness, CBC-MDV was delivered with 69%
fidelity and performed better in terms of sustaining high vaccination coverage compared to the
centralized approach. Design-, implementer- and context-related factors influenced delivery
and effectiveness of the CBC-MDV strategies. We found that the community engagement
activities positively influenced factors that underpin participation in MDV campaigns. In
relation to integrating and sustaining the new approach in practice, CBC-MDV was well
understood, accepted, operationalized with relative ease and positively appraised compared to
the centralized approach. We conclude that it was feasible to deliver CBC-MDV in the context
of Tanzania, it can be sustained in practice, and barriers to participation in mass dog vaccination
can be addressed through community engagement processes. However, community
participation in the design, delivery and evaluation of CBC-MDV is needed to foster ownership
and sustainability of the intervention. | en_US |
