Translating one health research evidence into action: co-production of rabies control knowledge in Côte d’Ivoire

Abstract

Background

Translating research evidence into practice has become a priority for academics, funders and public institutions worldwide. However, many research projects still lack strategies and funds for policy-related research translation, innovation, dissemination and uptake activities. This study focuses on research evidence on rabies produced by Centre Suisse de Recherches Scientifiques en Côte d’Ivoire under GAVI’s project. It aims to (i) identify the mechanism used by researchers to share evidence with practitioners, policy makers and local communities and to (ii) identify what facilitates research uptake.

Methods

A qualitative method was used to gather data from the producers (researchers) and users (policy-makers and community) of research from both the human and animal health sectors, and local community leaders, using semistructured interview guide and observation. Fifteen informants were selected using the snowball sampling technique and purposive selection from the GAVI's project team. The knowledge brokering theory was used to explain the translation of rabies research evidence into practice by understanding what facilitate the research uptake in pratical way. Thematic content analysis was used for the interpretation of data.

Results

The main mechanisms mobilized to disseminate results were meeting platforms including workshops, trainings, and sensitizations during the annual WRD and written formats such as policy briefs, reports. The research findings lead to change or to have impact on actual practices, as some of the users associated with the research process hold high-ranking positions in human and animal health and this may facilitate research uptake in their sectors. Furthermore, sensitizations of local authorities and communities during the project cycle led to the creation of local intersectoral rabies committees that have had a direct impact on the increase of rabies reporting in the two regions with the highest prevalence of rabies in the country.

Conclusions

This paper highlights different strategies used to disseminate research evidence and shows the enabling factors of research evidence uptake at the policy-makers’ level and community level. To achieve the 0 rabies target by 2030, science needs to be more closely involved in policy, through dialogue with other stakeholders such as the media. In this way, stakeholders can make better use of health research evidence to co-construct strategies for improving the fight against rabies.

Background

Translational research (TR) arose within the medical community in the 90s, and since then has appeared in research programs, academic papers, journals and policy reports [1]. While TR has a variety of definitions, a single specific definition is still a matter of debate as TR joins aspects of both basic science and clinical research [2]. Despite different understandings of TR, the concept is relevant to almost every sector [3], across disciplines and geographies [4]. Often, TR refers to translating research into practice and, therefore, ensuring that new treatments and research reach those individuals for whom they were designed [3]. The importance of translating health research to stakeholders is to improve research utilization, reduce research waste and create a wider and more significant research impact [5]. TR deals with how scientific work is designed, moves into practice and benefits society. The Canadian Institutes for Health Research (CIHR) understands it as an interactive process between the creation of new knowledge and the implementation of public policies [6]. The term “translational research” has been used interchangeably with terms such as “bench-to-bedside research”, “translational science”, “knowledge translation”, “translating research” or “translational medicine” [1, 7]. Research funding agencies, industry, disease-related organizations and research institutes are making it a key priority around the world [8–12]. Moreover, for research funding agencies, and research institutes, translating research evidence into practice has become a priority [8, 13, 14].

Increasingly, the question of how to translate research into policy and practice has captured the attention of academia, particularly in the light of the United Nations’ (UN) Sustainable Development Goals (SDGs) [15, 16]. Many initiatives have been launched to strengthen TR. Among them is the creation of centres of TR by the National Institutes of Health (NIH) and the Clinical and Translational Science Award (CTSA) programme launched in 2006 in the United States [17, 18]. Australia has also invested in a research initiative at the National Health and Medical Research Council (NHMRC) [19] that promises to speed up the application of research results to actual healthcare. In addition, a pan-European network of institutes called the European Advanced Translational Research Infrastructure in Medicine (EATRIS) [20] was created in 2012, building on the partnerships that different countries have within Europe. TR has thus become a centrepiece of research agendas, funding agencies and research institutes in many parts of the world.

In Africa, the Evidence-Informed Policy Network (EVIPnet) was established by the WHO in 2005, and aimed to promote the systematic use of health research evidence in policy-making [21]. The WHO Africa Region has hence adopted a strategy for 2016–2025 which requests that member states set up a knowledge translation platform to facilitate African governments’ support for initiatives of this sort [22]. However, in its application, the African network has faced many challenges in promoting the uptake of health research. Despite the recognition of the importance of translating health research knowledge into policy and practice, its implementation remains an issue in Africa [23–25].

TR in sub-Saharan Africa (SSA) is limited owing to a lack of local researchers trained in TR, a lack of interest in TR, inadequate government support and a dearth of funding [20, 26–29]. Other barriers are limited capacity by policy-makers to use evidence, the inaccessibility of research evidence and a lack of high-quality usable evidence [24]. The resource-limited research environment of the continent also has an influence on translational health research. Nevertheless, TR is fundamental in improving and advancing clinical care, public health and policy-making in regions with a heavy disease burden, such as SSA [30, 31].

The increasing need for high quality of TR in SSA is exacerbated by the high disease burden, which includes both infectious and noncommunicable diseases, and a high exposure to zoonoses [32]. Infectious diseases account for at least 69% of deaths in SSA [33]. Thus, the absence of empirical evidence on the control, or established elimination models, of these diseases in Africa makes it difficult to improve this situation in the near future. For instance, research on onchocerciasis shows that its elimination is possible through ivermectin treatment, but it would require a therapeutic coverage of 80% for 15–20 years [34]. In addition, for malaria infection, two prevention methods are recommended: vector control (insecticide-treated bed nets and residual indoor spraying) and preventive therapy for at-risk groups (pregnant women and infants) [35]. In the case of rabies, evidence has shown that a dog vaccination coverage of 70% would eliminate the disease in the host and would maintain dog population immunity above critical levels (25–40%) [36–39]. The case of rabies is particularly urgent, as the science and strategy for eradication of the disease in the host animal was published over a decade ago [38]. Furthermore, unlike malaria and onchocerciasis, there are no readily available medications for rabies [40]. Post-exposure prophylaxis (PEP) with human rabies immunoglobulin is the only treatment for rabies in humans and is often unavailable in resource-limited settings [27]. Without PEP, rabies exposure is almost invariably fatal [41, 42]. In Côte d’Ivoire, despite notable research and knowledge acquired to control its transmission [43–48] and its prevention, rabies continues to kill approximately 20 people each year in the country [49]. This would suggest that Côte d’Ivoire, much as most other SSA countries, faces an issue of research translation [50–52], which needs to be urgently addressed.

Studies in the field of TR have focused on factors that affect the use of research evidence by policy-makers and clinicians, the prospects to improve the effectiveness of evidence by policy-makers [3, 31], knowledge translation strategies in public health such as the researcher-focused interventions, decision-maker-focused interventions [53] and interventions designed to create partnerships between researchers and decision-makers [54, 55]. Much has been done in this area, including a systematic review looking at facilitators and barriers in SSA countries [23–25, 55–68]. However, few studies to date have focused on knowledge translation strategies carried out within the context of rabies control. Thus, the current study uses the theoretical framework of knowledge brokering [69, 70] by assessing the transfer of rabies research evidence generated into practice in Côte d’Ivoire through GAVI's project. It addresses questions on the mechanism researchers used to share or negotiate evidence with practitioners, decision-makers and local communities. This theory allows us to explain what facilitates to the adoption of research uptake in rabies control in Côte d'Ivoire.

Overview of rabies in Côte d’Ivoire

Rabies is endemic in Côte d’Ivoire. It was identified in January 2017 as one of the five priority zoonoses in the country [71]. It is transmitted in Côte d’Ivoire mainly by dogs [43, 72]. The estimated dog population is around 1.5 million, and vaccination coverage is only currently about 10%. The Ministry of Animal Health records an average of ten cases of animal rabies annually [73, 74]. In addition, the country’s National Institute of Public Hygiene (INHP) registers over 12,000 cases of human rabies exposure each year, and records an average of 18 human rabies exposure-related deaths per year [75]. However, based on a recent estimate, there are 48,000 animal bites per year, which suggests that rabies exposure in humans may be underestimated. The same study also estimated that there are around 637 undetected human cases per year (95% confidence interval [CI] 442–849)[73]. The majority of deaths (50%) occur in children under the age of 15 years, and the majority (60%) occur in rural settings in the country’s southwestern and northern regions [76]. The INHP has 27 Anti-Rabies Centres, which serve as reference centres for the care of exposed people, communicates with, and educates, communities on avoiding and responding to exposures, and oversees epidemiological surveillance of human rabies nationally [77]. From data collected at human rabies vaccination centres, we know that almost half of those who begin prophylactic treatment do not complete it [76, 78]. In view of these mortality rates, attempts are made annually to raise national awareness through World Rabies Day [79]. Nevertheless, the institution in charge of animal rabies control is the Directorate of Veterinary Services (DSV) through the veterinary Anti-Rabies Centre. Throughout the country, there are 19 regional centres of DSV with the main tasks of surveillance over biting animals and the analysis of the information related to animal rabies cases. Two laboratories support these two centres: the Central Pathology Laboratory of Bingerville (LCVB) for diagnosis and detection in animals and the Institute Pasteur of Côte d’Ivoire (IPCI) for diagnosis and detection in humans [77]. 

Overview of the GAVI-project in Côte d'Ivoire 

In order to establish the data situation on rabies in Africa and Asia, the Global Alliance for Vaccines and Immunization (GAVI) learning agenda and the WHO have committed to support different specific research activities [80]. The Swiss Tropical and Public Health Institute (Swiss TPH), alongside local partner institutions, carried out an essential part of the GAVI learning agenda in three West and Central African countries [76, 77, 80]. The project aimed to gather empirical field data on the frequency of animal bites, the percentage of exposure cases receiving PEP currently in place and the potential health effects of PEP in selected urban and rural study areas in Mali, Chad and Côte d’Ivoire [81]. In Côte d’Ivoire, the project activities were carried out by the Centre Suisse de Recherches Scientifiques (CSRS) and implemented by an interdisciplinary committee with representatives from the Program for Improvement of Animal Health (HPV DSV/PASA), the Ministry of Livestock and Fisheries (MIRAH), the INHP, the Laboratory for the Support of Agricultural Development (LANADA) and the University Alassane Ouattara (sociology laboratory) [81] from 2016 to 2018. The research was conducted in two cities (Bouaké and San-Pedro) with a high incidence of rabies exposure cases in humans [43, 46, 78]. The project made use of a transdisciplinary approach in which all stakeholders participated from the outset in the design through to the dissemination and action. Stakeholders from different disciplines worked together to create a new conceptual, theoretical, methodological framework and a new way to translate research that integrates and goes beyond disciplinary boundaries to address rabies as a common problem. Concurrently, the project aimed at strengthening rabies control capacities in both veterinary and human health sectors and raising public awareness about the disease. In addition, the project team sought to foster mutual learning and capacity building among all cooperating parties. Data were collected through their collaboration by using the One Health approach, an approach that increases collaboration between veterinary and human health services that yield mutual benefits and increased value for both fields [82]. Thus, the two ministries involved, the Ministry of Public Health and the Ministry of Agriculture (in charge of animal health) have an established collaboration in the fight against rabies through the approach. The outcomes from this project show the success of the project implementation and were briefly presented at different levels: household level, human and animal health level, and national level [81]. All the activities led to the development of knowledge based on a transdisciplinary approach.

Knowledge produced was shared through 20 publications in peer-reviewed journals, presentations at international conferences and expert meetings. In addition, it was shared with the Rabies Modelling Consortium [81]. Furthermore, research articles were compiled in a special issue entitled: ‘Towards the elimination of dog rabies in West and Central Africa” in the Acta Tropica journal. The results influenced the GAVI investment agenda through two major publications of [83] and the advantage of applying ID post-exposure prophylaxis (ID PEP) scheme [84]. One of the principal outcomes of the project was the generation of knowledge, which facilitated the inclusion of human rabies vaccination and PEP to be included in the GAVI investment strategy for 2021 [85]. Moreover, at the international policy level, this project helped shape the new WHO recommendations for rabies immunization published in April 2018 and the WHO manual for rabies diagnosis (laboratory procedures) in the same year [81].

At the national level, to guarantee the control efforts beyond the duration of the project, local stakeholders were encouraged to establish a One Health committee during a research feedback meeting. This led to the creation of local intersectoral committees (rabies champions) in Bouaké and San Pedro with the support of the project team. The local intersectoral committees comprised the leading representatives in the animal and human health sectors, the staff of anti-rabies centres, a journalist (communication team), a sociologist and a teacher. In addition, the committee members’ responsibilities and roles within the state were clearly outlined and defined during a training session. Their main goal was to strengthen collaborative efforts against rabies at the local level. As part of World Rabies Day (WRD) in September 2016, public health education and information dissemination to teachers from primary schools, pupils and leaders of rabies community association was carried out in Bouaké and San Pédro [78].

Furthermore, an assessment on the national rabies strategy, conducted in May 2018, concluded that the GAVI funded project qualified Côte d’Ivoire to move from 1 to 2 levels using the Stepwise Approach to Rabies Elimination (SARE) [86]. SARE is a tool to guide, develop and refine rabies control programs. This tool promotes self-assessment and provides measurable steps and guides to progress from stage 0 (where little or no data are available for rabies) to stage 5 (where a country is declared free from dog-transmitted rabies) (Fig. 1: Adapted from the SARE assessment from the Global Alliance for Rabies Control). This assessment shows that the research project has had a direct impact on the national strategy.

Fig. 1.

Adapted from the SARE assessment from the Global Alliance for Rabies Control

Methodology

Study design

This study used a qualitative approach by drawing on a case-study methodology. This approach was used to describe the phenomena of the transfer of rabies research evidence generated into practice in Côte d’Ivoire. It was seen as the most suitable approach with which to acquire pertinent information since “qualitative research only makes sense if it shows and analyses the intentions, discourses, actions and interactions of actors, from their point of view and from the researcher’s point of view” (p. 12–13) [87].

Study site

The study was conducted in Côte d’Ivoire, a lower-middle-income country (LMIC) in Western Africa with a total population estimated at 29 million inhabitants. The study was carried out specifically in Abidjan and Bouaké, respectively, the largest and the second largest cities within the country [88]. Furthermore, Abidjan is the economic capital of Côte d’Ivoire and is the site of many of the country’s national and international institutions. Institutions visited where from human and animal health sectors in four communes in Abidjan (Fig. 2). These are Plateau, Treichville, Cocody, and Bingerville. It is important to know that Abidjan hosted the institution conducted the GAVI-project in Côte d’Ivoire.

Fig. 2.

Study Site 1 (Abidjan)

Bouaké, is one of the study sites of the GAVI -project in Côte d’Ivoire, and is also of particular interest as it has the highest rabies burden in the country [43, 46, 78] (Fig. 3). It is also an endemic area where many stray dogs are left on the streets with the most cases of animal rabies in 2015 [43, 78, 89]. Additionally, the local community members in place are located in Bouaké for local activities.

Fig. 3.

Study Site 2 (Bouaké)

Study population

The study covered three types of stakeholders: researchers, community members and practitioners in the human and animal health sectors. Practitioners are here defined as those who practice a profession, especially veterinarians or physicians. The first category of people were scientists from a multidisciplinary background (health sciences, social sciences). People in the second category were the local committee members for rabies control. People in the third category were composed of personnel from the INHP, the DSV, the veterinary Anti-Rabies Centre, the anti-rabies centres, and the laboratory for the support of agricultural development (LANADA). All research participants where involved in the GAVI-project from the outset during the proposal writing phase of the project and preceding the implementation in 2016. Thus, the study involved actors engaged in the fight against rabies within the country, the project team members (researchers, veterinarians, physicians, policymakers) and the rabies local committee members. The informants provided insights in questions about the research findings, the evidence sharing process with different stakeholders, policy makers and local communities, the enabling factors of the uptake and the outcome or impact of TR in practice.

Sampling technique

Purposive sampling or selection of research participants was based on their participation in the GAVI-project at their two study sites, Abidjan and Bouaké. The snowball sampling method [90] was applied after purposive interview of respondents from GAVI’s project team sequentially.

Data collection and analysis

In this case study, data were collected through semi-structured interviews and non-participatory observation in sequential periods in September 2019, December 2020, and from January to June 2021. A total of 15 interviews were conducted. We interviewed stakeholders who participated to the GAVI-project from human and animal health and local commitees. The key informants were the producers of knowledge or researchers. This comprised eight people in total from a multidisciplinary background (health sciences and social sciences). Moreover, policy-makers and community representatives were also interviewed. This comprised seven people in total from the ministries of human health and animal health, and community leaders.

The interviews were conducted in the relevant human and animal health institutions, which are based in four communes in Abidjan. In Bouaké, the interviews were conducted with the intersectoral committee members on rabies who were also part of the GAVI funded project implemented in the country. A range of different interview guides were used, according to the status of the participants (policymaker, researcher, veterinarians, physicians, local committee member).The interviews lasted about one hour with the respondents after they had given their consent. The interviews were carried out in French. Furthermore, the interviews were audio recorded, transcribed in Microsoft word, and then uploaded to NVivo 12 pro software for analysis. Thematic content analysis was used for the interpretation of the data [91]. The data was coded into themes and sub-themes and presented as narratives supported by verbatim quotations from interviews. Observations were carried out using a guide during knowledge sharing meetings – either workshops or conferences – where different key informants from institutions made oral presentations. Handwritten notes were taken during the observation which were transcribed to text files immediately after. Observations and informal conversations provided data which were linked to formal interviews conducted. We used observation to see how users were involed in activities and how producers and users interacted during meetings. The notes from the observations were transcribed and integrated into the analysis.

Theoretical framework

The knowledge brokering theory is used in the study to explain the translation of rabies research evidence into practice by understanding the knowledge brokers who facilitate the research uptake in a practical way [70]. By applying this theory, we observe the various roles and functions of knowledge brokers and their interactions within the network, from the knowledge creation phase to knowledge uptake. Knowledge brokers are people positioned at the interface between the worlds of researchers and decision-makers; they are seen as the human force behind knowledge transfer, assessing and interpreting evidence, facilitating interaction and identifying emerging research questions [92]. The theory presents three frameworks for thinking about knowledge brokering within the public sector [69, 70, 92] – the knowledge system framework, the transactional framework and the social change framework. The brokers are viewed as knowledge managers, linkage agents and capacity builders.

The knowledge management model is the most recognized or best known and widely used aspect of knowledge brokering, developed to address difficulties associated with navigating, managing and sharing a large body of research and other evidence. In our context, which is translating rabies research evidence into practice, knowledge management involves collecting, synthesizing and disseminating research findings on rabies. These elements of knowledge management are accessed by practitioners, policy-makers and other stakeholders.

The linkage and exchange model focuses on the development of positive relationships between researchers and decision-makers. In this study, the linkage and exchange refer to the interactions and collaborations between researchers and practitioners. This involves stakeholders in organizing conferences, workshops and seminars where researchers present their findings to animal and healthcare professionals, and policy-makers (ministries). It also includes the established networks and partnerships that enable continuous communication and feedback between those who generate knowledge and those who apply it. The stakeholders’ involvement in the research process is the best predictor of successful knowledge utilization.

The capacity-building model focuses on enhancing the ability of practitioners and policy-makers to understand and use research evidence [69, 70]. In the case of rabies, this includes training programs for healthcare workers on the latest rabies prevention and treatment protocols, developing educational materials for policy-makers on the implications of new research findings and supporting the development of institutional capacities to incorporate evidence-based practices. In addition, this also includes training programs for animal health workers on how to recognize rabies in dogs, etc.

Results

Three key themes emerged from the interviews carried out in the present study. These are presented below under the following subtitles:

Knowledge dissemination mechanism with end users

As is standard practice within academia, researchers in this study have all engaged in sharing data and results from projects through the traditional dissemination channels to the wider research community during conferences, seminars and workshops, and through peer-reviewed scientific articles, or book publications, as well as training events. With regards to strategies used to share findings on rabies, researchers reported two main strategies namely meeting platforms (workshops, conferences, feedback to communities) and written material (policy briefs, reports, or flyers). Meeting platforms in this context were invitation only events, where different stakeholders exchanged information on a predefined topic.

When considering strategies for dissemination to local communities, researchers made use of inperson meetings, which were either open to all members of the community who wished to attend or closed by invitation. More specific, it took the form of feedback workshops, trainings for community relays and the WRD annual event. During these meetings, public health education and information dissemination activities were carried out to promote widespread dissemination of research results generated from the study. This aspect was illustrated by a researcher who explained the sharing of data to stakeholders in this way: “Knowledge about rabies is shared, like how to avoid rabies, what are the dangers of rabies, etc. This knowledge has helped raise awareness, especially among associations, NGOs, and the general public, and has led them to understand the importance of vaccination. Even data on mortality, for example, when you tell them that their city (either San Pedro or Bouaké) is more affected, that every year one person dies of rabies. Since we invited them when you give them this information, they really feel concerned about the issue and don't want to be the last to know about rabies, whether they are chiefs or mayors etc. When you tell them that there is no cure for rabies, many people don’t know that.” (Veterinarian-researcher).

Sharing knowledge with practitioners and policy-makers

The main mechanisms reported by interviewees for disseminating knowledge to practitioners and policy-makers were of two types: meetings plateforms including workshops, trainings, and sensitizations during the annual WRD, and written formats such as scientific publications, policy briefs and reports. According to the interviewees, sharing the findings in meetings or workshops aimed at decision makers provided a space where different actors were able to come together, engage and share knowledge or experiences. It was a mechanism used to share findings at different scales: local, national and regional. This aspect was illustrated by a veterinarian–researcher who described their meetings with policy-makers, and how they included evidence in their work: 

For the GAVI-Rage project, we first held a feedback workshop at the local level in San Pedro and Bouaké. At the national level we called on the FAO and donors, etc. we held the national planning workshop for rabies control (…) At regional level, we presented our findings at the 3rd meeting of the GARC, [Global Alliance for Rabies Control], a pan-African meeting in South Africa. And later in Johannesburg (veterinarian–researcher).

As mentioned by the interviewee, meetings were held at different levels with different stakeholders to share research findings. The majority of the participants were explicitly stated and were excited about the fact that for the very first time, research had produced an estimate of the dog population in Côte d’Ivoire, and this was shared with the policy-makers and practitioners from both the human and animal health sectors. The intention was that all stakeholders would work jointly to achieve zero rabies by 2030. The following quotes effectively illustrate that:

This project highlights for the first time the dog population in Côte d’Ivoire and shows a clear estimate of dog population which is around 1,500,000. (…) Before that, in the DSV we talked about 100,000 dogs. If you set up a strategy around 100,000 dogs, you have only vaccinated 10% of the population. You have not done anything. To eliminate rabies, you must vaccinate 70% of the population. Therefore, you cannot formulate a strategy without first knowing the number of dogs to vaccinate. This is the first thing that we tell decision-makers so that they will know the basis of working on all the logistics and resources involved in a vaccination campaign for the dog population (veterinarian).

This statement illustrates the importance of research results (estimation of the dog population) and reveals a clear logic strategy for animal health sector to better plan an appropriate for intervention with the resources required. In another way, it highlights the link between reliable data and effective decision-making.

In the human health sector, policy-makers were provided an overview of the burden of rabies through the total number of people exposed per year. This allowed decision-makers to better estimate the number of doses of post-exposure prophylaxis to have on stock, and to ensure that shortages are avoided. The importance of sharing study results with the two ministries working together guided them in handling both human and animal rabies. One participant noted:

Research allows us to know approximately how many people are bitten by dogs each year in Côte d’Ivoire. Because to protect them, it is necessary to foresee the number of doses of anti-rabies vaccines for humans to avoid vaccine shortage (…) (medical stakeholder).

The feedback from researchers increased the knowledge of public health services on the estimated number of people exposed or bitten per year and aided their calculation of the estimated number of doses of PEP needed. This improved preparedness and resource allocation to safeguard the public from rabies.

Observations made during a rabies workshop showed that the scientific knowledge shared with policy-makers and practitioners led to increased collaboration between the human and animal health sectors. In this workshop, all team members of the GAVI project met to launch a new project called BlockRabies. Participants of this new project comprised the researchers previously involved in the GAVI project, veterinarians, physicians, international and regional partners, representatives of research institutions, international funders, the administrative authorities and local community members. The observation activities of the new project aimed to assess how actors meet and interact, and how researchers share their scientific knowledge with stakeholders in that meeting. The following was noted:

During the meeting, the authors observed that participants were gathered to launch a new research project on rabies. A collaborative meeting between national and international institutions, local committee members and the media was held to share knowledge and experiences about the GAVI- project. High-level representatives from animal and human health sectors each gave a speech while other stakeholders also gave contributions such as comments and presentations. The members of the local committee shared testimonies of bite victims and field activities, and researchers presented their findings. Stakeholders’ interactions were seen even beyond the meeting place. These observations indicate that the meeting platform was used to emphasize on the disease, the participant engagement; and the cross-institutional interaction (workshop to launch a research project on rabies, notes, 2020).

Furthermore, the presence of decision-makers and authorities from human and animal health sectors in such the meetings meant that information was presented to them, as they are involved in implementing health policy. The presentations during the meeting emphasized the importance of sharing updated knowledge. Policy makers were informed of the findings, and their attendance at these meetings allowed them to engage with researchers and the results, providing an opportunity to consider how the results may be incorporated into policy. These stakeholders were subsequently involved in the WRD activities, which were jointly organized for awareness raising on the disease. This was captured by one informant:

Talking about World Rabies Day, when we organise it, we invite the ministers and when they arrive, they give messages to the population to let them know that this decision to fight rabies has been taken from the highest level. In fact, people take it seriously. When you carry out an activity and the authorities are not involved, it cannot lead anywhere. [Their presence] guarantees advocacy (medical researcher).

This highlights the role of ministers and authorities during WRD awareness. The quote also points out the perceived necessity of authorities’ involvement in the activity. Furthermore, their participation is seen as a guarantee of visibility and credibility for rabies control efforts. Despite these successes, authorities may still face challenges such as reaching all segments of the population and vaccinating both owned and un-owned animals.

Additionally, practitioners from the animal health sector expressed satisfaction about the ways in which researchers shared findings, as it opened their eyes to what was happening in the world of research. One of the interviewees expressed how scientific knowledge can be used to guide intervention strategies in the following terms:

From the vaccination [coverage] rate of the dog population, it was found that less than 15% of the population is vaccinated. And the urban area has up to 30% vaccination coverage, but the rural area has less than 5%. So, we know in terms of vaccination priorities, where it is really necessary to vaccinate, and we also know that the rural area does not have the money to pay the 3000 CFA per dog vaccinated. And we also know that studies have shown that from INHP data, more than 50% of victims come from rural areas (…) We also realized that among the rabies deaths there were more children (…) Scientific knowledge helps to develop a good strategy. (policymaker, animal health).

This statement thus illustrates that knowledge generated from the project guides intervention strategies.

Sharing knowledge with communities

With regard to researchers’ strategies to translate research results to the local level, the study found that the main techniques utilized were meanly meetings platforms which also included a feedback workshop, and sensitization and trainings during WRD. The feedback workshop is here defined as a meeting by invitation used by the researchers to disseminate the study’s final findings to all stakeholders. It serves as a forum to share knowledge with specific segments of the general population which the researchers have identified as key stakeholders. The inclusion of question-and-answer sessions within the meetings served as a vehicle to allow invited participants to deepen their understanding of the research findings. During one of the research feedback meetings, the idea to establish a committee was raised, to guarantee the national control efforts beyond the duration of the project. This led to the creation of two local intersectoral committees, one in Bouaké and one in San Pedro, with the support of the project team.

The role of these rabies local committee members, or so-called rabies champions is to continuously raise awareness and educate the population about the disease. Thus, they were considered as playing a role in relaying to the wider population both knowledge received on rabies from veterinarians and physicians and new knowledge shared by researchers. Thus, they serve as knowledge brokers at the community level. There are, at the time of writing, up to 15 people from different entities of local committee members that have been trained to conduct engagement activities at schools and in communities once they had received official approval to begin their work sensitizing their local community. In the field of public health, sensitization is a form of sharing knowledge with actors who are generally unaware of health risks.

A representative of Bouaké’s local committee explained how the committee was created and the work they do within the population as follows:

It was after a workshop that the committee was formed. The committee has been trained and is responsible for sensitizing the population and for directing the population to the human and animal health centres. We have been trained on what rabies is and so on (…) (a committee member).

Sensitization was the most frequently mentioned knowledge-dissemination technique used at the community level (14 out of the 15 research participants interviewed for this study). The sensitizations have brought researchers, health workers and veterinarians together to raise community awareness. Sensitizations are mainly carried out during WRD each year, on 28 September, to sensitize the population, with a particular focus on especially at-risk groups, such as children. Research contributes to updating knowledge on rabies and training veterinarians, medical personnel, local committee members and teachers on advanced knowledge. This is illustrated in the quote from a local committee member as follows:

Every year when we celebrate World Rabies Day, the human and animal health sectors take the opportunity to train teachers, vets, and medical staff. Because you can be a nurse, but you don’t know anything about rabies (…) On World Rabies Day, we brought in 100 people, including women leaders, youth leaders, directors and heads of department, and community leaders. We did a sketch. We addressed everyone (a local committee member).

The sensitization is also noted from the perspectives of medical researchers and veterinarians, for whom WRD is an opportunity to raise awareness and offer training, not only to the medical assistants and veterinarians but also to teachers. Respondents describe this meeting platform as follows:

At the human health level, we perform capacity building, by training on the ground, and awareness raising through the World Rabies Days. The awareness raising in schools allows to communicate with teachers and students. Online training with the Global Alliance for Rabies Control website, is also open to any teacher, health worker, anyone in the field (medical researcher).

Above all, these statements underline the awareness raised and training offered during WRD, where DSV makes computers available and supplies internet for medical assistants, veterinarians and teachers to access the online course from the Global Alliance for Rabies Control (GARC) website. The training can be considered as one of the best dissemination strategies for bridging the two sectors (animal and human health), as well as including teachers in the process. It should also be reiterated here, that the main victims of rabies are children; thus, by training one teacher from elementary school, information may reach more than 40 pupils. This is why teachers are important knowledge brokers and encouraged to become trained in rabies control and sensitization efforts to disseminate the knowledge at schools. Stakeholders from human and animal health, as well as from the local communities, agreed on this point. These actors from different sectors work together as a team in the field, in data reporting and in conducting awareness campaigns to fight against rabies.

Furthermore, participants reported that, during the vaccination campaigns, which are combined with awareness raising efforts, women and children are more likely to bring their dogs for vaccination. Respondents explained that this is because of the locations where the sensitizations had taken place. They were conducted at schools, in women’s association meetings, during market days and via house-to-house visits, as well as in churches and mosques. According to our research participants, the local rabies committees’ support to encourage people to come to the vaccination sites have been a real success when considering the high number of women and children now bringing their dogs for vaccination. Therefore, veterinarians adjusted their strategy and began to set up their campaigns in places where women and children had easy access, which serves to increase the success of their campaign.

Recognizing and addressing this gender aspect in relation to the vaccination campaign is crucial for its success. It ensures that communication efforts are directed to the key stakeholders who play a significant role in caring for, and thus, bringing in dogs for vaccination. According to this researcher:

The last point I noticed is that 70% of the people who sent their dogs for vaccination [in the chosen place by the mayor and the chief villagers for the event] were women and children. What does this mean? (…) This means that (…) they are the ones who bring their dogs with the children to be vaccinated. The men were less than 25%. To succeed in the vaccination campaign, we have to consider the gender aspect (veterinarian–researcher).

As is evident from these remarks, research outcomes were successfully translated into the strategy of vaccination campaigns, which has had a positive effect on the number of dogs reached in the campaign.

In addition, local committee members’ activities include indoor sensitization activities, and educational animations at schools. One of the rabies champions shared his experience of how they conduct their work in communities as follows:

We move from community to community for real awareness raising. How does it happen? We ask the immigrant community leaders, for example, when you will have your monthly meetings? Where do you meet? And as soon as it’s fixed, we go there. And we do community sensitization from community to community. Often, we even show films to show exactly what is happening [in case of bite]. And we are now going to schools. It’s not in the form of a lecture. From kindergarten onwards, we go from class to class. Ten minutes per class and we do educational animations (a local committee member).

Before starting the activities, the local committee rabies champions requested verbal authorization from the village chief, the heads of local authorities from each locality and the head of schools. Regarding other local officials, such as district-level administrative officials, and local city/town mayors, these officials were informed of the campaign’s activities through letters. The local committee that conducted the awareness activities comprised:

(…) member of human health, animal health, a representative of the mayor’s office, a representative of the regional council, a representative of the youth leaders, a representative of the red cross, a representative of the religious guides (…) (a respondent from a local committee).

In addition, the rabies champions who are trained for this purpose use a direct communication strategy tailored to the respective places or areas they visit. They also share with each other on certain online and social media platforms, such as WhatsApp^® groups, when and where there are cases of rabies in dogs, ensuring that the message reaches everyone. The specific tools most often used in sensitization efforts are sketches, flyers, T-shirts, door-to-door sensitization visits, and mass sensitization to inform children, women and the general population at large. The committee itself is an entity based in the local community, which spontaneously arose during the research cycle, and was consolidated with the result feedback workshop.

The intersectoral committee was created to reinforce joint efforts and training on rabies; however, in addition, teachers from different schools also received online training via the GARC website. Furthermore, the public sensitization strategy, including the conception and the distribution of information materials, the celebration of the WRD during the project and the establishment of local rabies committees have had a direct impact on the reporting of bite victims in two major regions (Bouaké and San Pédro) of the country. For example, in the city of Bouaké, the polyvalent role of the president of the local intersectoral committee facilitates the immersion of this committee in the different communities for their intervention at different levels of the local populations.

Sharing knowledge with the media

Knowledge was also disseminated in the form of a training offered to journalists following the results workshop. The aim of the training was to raise awareness and train journalists on rabies; its transmission, symptoms, prevention and treatment; and the strategies in place to control the disease. A veterinarian–researcher reported that based on the training, journalists were encouraged to write and publish an article in their respective newspapers about rabies, with the best articles receiving a prize. This activity of sharing knowledge with the media has facilitated improving the knowledge of people working in the media who can thus reach a broader audience with their articles. The role of the media in this regard is to disseminate information and, in particular, raise awareness via different channels. It also promotes rabies vaccination programs for domestic animals through advertisements and broadcasting, and by directly engaging with the public.

Enabling factors for knowledge uptake

As discussed above, knowledge brokers facilitate research uptake. The enabling factors for research uptake identified in our case study were mainly that (a) the project employed researchers that simultaneously hold positions in the human and animal health sectors and (b) the project’s transdisciplinary approach involved stakeholders from the start.

Practitioners as researchers facilitate knowledge uptake

Practitioners as researchers have a particular position that can be described as knowledge brokering. They played a central role in facilitating knowledge sharing not only among the research community but also among policy-makers and practitioners through stakeholder workshops, as well as the general population, through sensitisation campaigns. As knowledge brokers anchored in the animal and/or human health sectors, they helped translate knowledge from the research outcomes to subject experts in the different ministries. Owing to their double-role standing between practice and research, they were able to accurately transmit both the research results and the current practice. Having both scientific and practical knowledge was particularly advantageous, as they were able to develop ideas for how to make use of the new knowledge and then demonstrated ways in which to improve current practice to reach better health outcomes. As one of our interviewees explained in the following terms: “For some time now, with the support of the researcher, who is a veterinarian in this animal sector and who trained, guided, and mentored us, we have been very involved in the fight. Thanks to this knowledge from the GAVI rabies project and our actions, we have been able to save lives through the awareness-raising work we do in the field. As researcher, they have conducted effective research and shared them, which we use as inspiration to better raise awareness among the population” (Veterinarian). This statement highlights that, with the role of veterinarian researcher in guidance and mentorship, the team of veterinarians have been actively participating in efforts to combat rabies. Also, it shows the researcher’s dual role as both veterinarian and knowledge broker.

The project’s transdisciplinary approach

The transdisciplinary approach, which engaged all stakeholders (policy-makers, practitioners in various sectors, and communities) from the research project’s design up to results’ validation and feedback, has played an important role in research uptake. This approach led to the creation of, and later the involvement of, the intersectoral rabies committees in the research process. The familiarity which was created by regular and shared common activities facilitated a One Health research uptake. The following two statements highlight this:

It is mainly meetings, setting up projects together, achieving objectives together, transparency, and as time goes by, animal and human health actors start to know each other and to move in the same direction. And that is fundamental (professional, animal health).

We medical personnel, we work with DSV in our daily activity. If there is a case our workers are always with animal health workers in the field. We work on One Health. (…) We write the research project together and implement it together on animals and humans (physician, human health).

These statements demonstrate the importance of close collaboration by using a One Health approach and communication between the public health providers and animal health authorities. The local committee’s members also played an important role as knowledge brokers as they relay the health information to the population.

Impact of transforming research evidence on rabies into practice

The outcome of efforts to share research knowledge to different actors has contributed in transforming the picture of rabies control in Côte d’Ivoire at a range of different levels from the policy-makers to practitioners, and local communities’ perspectives. As one of the researchers in veterinary sciences put it, awareness-raising events lead to a change of perceptions:

For example, in San Pedro, the mayor gave us 10 tarpaulins at the vaccination sites. Each point had tarpaulins that had been installed free of charge by the mayor’s office. The prefect allowed the radio announcements to be made free of charge in the community radios. The local actors, whether they are local decision-makers, community leaders or NGO associations, are involved in the campaign to be a success (veterinarian–researcher).

There were also some specific benefits observed for researchers when conducting sensitizations directly with the population during the course of the project. One particular benefit was that there was an increase in the involvement of local authorities and improved trust and rapport between the empowered local community members, as a result of the trainings received, and an increase in initiatives by the population for further sensitizations. This suggests that the targeting of local authorities in dissemination activities served a direct and tangible benefit, even during the short term, indicating the effectiveness of the approach.

A practising veterinarian also stated that, following awareness campaigns, the committees that had been created, continued with sensitizations, which had a remarkable impact:

There has been an impact which shows an increase in the number of vaccinations of dogs. There are departments where the case of mortality is high but after the awareness campaign people started vaccinating their pets (public veterinarian, anti-rabies centre).

Research participants perceived the impact of awareness campaigns at the community level through positive results such as an increase in dog vaccination coverage, an increase in the number of dogs put under surveillance by the veterinarians in the new dog kennel in Bouaké and San Pédro, higher health centre attendance rates, higher numbers of reported dog bite cases through local rabies committees, ongoing continued awareness-raising efforts by campaigners, enhanced community surveillance and increased rabies control measures in areas with high case registrations. Moreover, thorough preparation within the community lays the foundation for a successful vaccination campaign. This was described by one of the stakeholders in the animal health sector in this way:

People are starting to take the situation seriously. Last year we had 10 reported bite cases, but now if we do the statistics, we’re around 15. People are started to report as they go along (professional, animal health).

Furthermore, the GAVI research project has repeatedly had a positive impact on actual rabies control strategy at government level. The veterinarians, physicians and laboratory technicians in their respective departments updated their knowledge through the research project. One of the stakeholders who has a position in the government, but also continues to work in research, was the ideal broker to influence the uptake in decision-making. Thus, a policy-maker from animal health said that gaining more knowledge on the rabies burden situation helped them to revise the rabies control strategy of the country and to establish a programme for the key stakeholders:

The strategic plan for rabies elimination was adopted by all stakeholders including the politicians. Both Ministers in charge of public health and livestock signed the strategic plan, and it was translated into a national rabies control programme. This has enabled Côte d’Ivoire to set up a training programme for the main actors (policymaker, animal health).

The national rabies control programme has also involved other sectors, such as the Ministry of Environment, the Ministry of Communication through the media and the Ministry of Education, to name but a few. Furthermore, there was a change in rabies regimen by WHO, who recommended four-dose for Thai Red Cross intradermal (ID) PEP schedule different to the Intramuscular (IM) regiments (Essen 5 dose & Zagreb 3 dose) used prior to the project in all study countries. One of the physicians explained the change in rabies regimen in this way: “We changed the approach in Bouaké and San Pedro because previously, victims were treated with intramuscular injections. So we were able to test the intradermal route on site. (...) This saved on doses. One vial can treat five people. The reduction in the cost of the disease itself has shown that it is feasible, that people who have been treated using the new method have not died of rabies and have been able to avoid the disease. We followed them for at least six months. This reassured them about the new approach and reduced their doubts” (Physician, human health). In addition, the GAVI rabies roll-out program is using ID route as the best solutions to improve the PEP compliance in the country Côte d’Ivoire and has been introduced to many countries in Asia and Africa. Also, through the GAVI’s project, the country passed from 1 to 2 levels on SARE assessment which shown the direct impact of the research project in the national strategy for the integrated control of rabies in Côte d’Ivoire.

Discussion

This study has facilitated an improved understanding of the process of scientific knowledge translation on rabies control into practice to end users in Côte d’Ivoire. This was undertaken through a diverse range of mechanisms based on the specific stakeholders targeted. In general, research findings are not always targeted to the end users, as the costs of TR are often not included in the research proposals. However, here, in the case study presented in this paper, the project took a unique approach, including stakeholders and end users from the project proposal stage right through to the project end. This has allowed the co-production of knowledge with specific attention paid to researchers, practitioners from human and animal health, and the local committee members. Stakeholders are not excluded but rather seen as integral parts of the research process, both contributing to and benefiting from the study.

It has been suggested that science should be separated from people who have direct interests in the research outcomes. Although we do partially agree with this critique, particularly in the case where there may be financial gain involved leading to a potential conflict of interest, we do not believe that this critique should apply in every case. There are a wide range of research applications where it is critical that stakeholders and end users are engaged from the start. This is particularly true in the case of developing intervention strategies for disease control and elimination, as is the case in the current study. Thus, end users may evaluate a new tool more critically, taking practical issues into consideration, in addition to administrative constraints, which are, furthermore, an even more important concern in resource-limited settings. Therefore, including a mix of both researchers and research-cum-practitioners to conduct research is especially beneficial and valuable when this facilitates the translation of outcomes into improvements in local health systems. As noted by Hickey et al., the co-production of a research project is an approach in which researchers, practitioners and the public work together, sharing power and responsibility from the start to the end of the project, including the generation of knowledge [93, 94]. This collaborative between scientists and end users from the outset of the research process optimizes research co-production and improves health service performance [95] and increases research uptake. This, therefore, serves to drive the co-creation of solutions to health problems, directly facilitating improved uptake and understanding of intervention measures. This can be seen directly in the outcomes of the project discussed herein, in particular, the increase in resources allocated by local authorities to sensitization campaigns as the project progressed (Section “Impact of transforming research evidence on rabies into practice” above).

This often runs contrary to established practices observed in knowledge production, use or circulation in global health [96]. These practices lead to epistemic wrongs or injustices, as some people (local experts) are recognised as credible, and others (marginalised groups) are attributed a lower credibility. Contrary to practices associated with that position, which often excludes local experts, and marginalised groups, from the scientific aspects of research, our findings indicate that actors from human and animal health and community members (rabies committees) being actively involved in the scientific research project lead to a range of beneficial outcomes [96]. These actors are therefore recognised as credible knowledge producers in the research process. In addition, the human and animal health practitioners, and local communities, are seen as the intended audience of the research findings owing to their active role in the health system. Moreover, the content and format of research dissemination workshops are tailored to suit practitioners and communities.

Findings from our study provide insights into the knowledge dissemination mechanisms employed to connect research results with end users (practitioners, policy-makers, community and the media). The knowledge producers (researchers) share new knowledge or research findings with policy-makers through written form (scientific publications, policy briefs, reports), and through meeting platforms (workshops, conferences, meetings and trainings). These findings are in line with the general strategies used in knowledge-dissemination interventions in health research, which are normally grouped into written, electronic and visual materials, along with interpersonal communication activities [97, 98]. In the case of interpersonal communication activities, sketches or theatre were best employed by the local rabies champions in our work and facilitated connection with the general public.

Researchers from different disciplines and sectors in this study were able to target policy-makers effectively, as they understood the relevance of the project at a deeper level, which aided in their implementation of control measures, as policy-makers were involved in all stages of the project from the proposal stage. This allowed the project to be conceived with implementation of specific measures in mind from the outset. Researchers further engaged with policy makers outside the project directly through research partnerships with government in the ministries in charges of rabies control. Area where a number of the policy makers could also be described as knowledge brokers, as they fulfilled a dual role as both researchers, and held a policy making on influencing position in either in the human or animal health sector. This explains how the researcher embodies both roles: knowledge producer and embedded practitioner/policy maker, bridging the gap between science and practice. Knowledge brokers (as individuals or organizations) act as intermediaries who speak the languages of both evidence producers and users, link various knowledge transfer partners, and facilitate the use of research evidence [99]. Haynes et al. described this dual role of researchers as facilitating the instrumental use of their research by providing scientifically rigorous papers, in addition to formal advice to policy-makers in Australia [100]. In the same vein, Khatri et al noted that the engagement of these three key groups (evidence producers, users, and brokers ensures the effective translation of research into practice [101]. Furthermore, our research echoes observations from a recent global health project, also carried out in Côte d’Ivoire. This study also made extensive use of similar methods of dissemination, including workshops, awareness campaigns and a pamphlet [102].

However, the model employed for disseminating research depends on the target audience or end users, and follows what Shannon and Weaver call the “source, message, audience, and channel” [103]. The sources, in this case, are the researchers who generate the results. The message contains relevant information sent by the researchers on a policy topic such as a disease-elimination policy. The audience includes those receiving the message via different channels. The channel is how the message gets from the source to the audience [104]. The channel mobilises communication tools and methods. In our study, we sought to expand on this model by effectively harnessing multiple components of the model and incorporating them directly into the dissemination approach used herein. For example, projects often separate the source, and the audience; however, in our case, as stakeholders were included at all stages of the project, effectively, our project contained both source and (a partial) audience from the outset. This greatly facilitated dissemination approaches, as we were able to draw on both source and audience understanding of the different channels available, and their value for targeting different audiences.

Workshops have long been recognised as an important tool to directly inform key actors of research results that increase the chances of knowledge uptake [105]. At the community level, the meetings, during which we were able to highlight findings (feedback workshops, sensitizations), training sessions, and WRD served as the main platforms we made use of and served as the main channels used to disseminate project results.

Knowledge transfer strategies also naturally depend on the knowledge to be transferred, the objectives to be achieved and the audiences to be reached or targeted. Facilitators that encourage sharing and use of findings include rabies champions or organized local committees in dissemination activities, ongoing collaboration, and researchers’ position in the ministries (knowledge brokers) by developing context-specific knowledge-sharing strategies. Our case study shows the importance of knowledge brokers in bridging the science community with the policy-makers and supporting knowledge transfer. This is in line with Davison's study on knowledge translation, wherein the author noted that successful knowledge translation relies on the engagement with the target audience [106]. Furthermore, knowledge sharing relies on a good level of interaction between team members and communication opportunities [107].

In general, knowledge-transfer strategies are varied but are grouped into two main categories [108]. There are data-dissemination strategies, and the appropriation strategies, both of which aim to facilitate the integration and the use of knowledge in a given context. In the context of public health, it has been shown that knowledge transfer and sharing making use of only a single strategy is unlikely to reach the entire target audience, and thus, it is recommended to make use of diverse strategies for dissemination [109]. In this sense, knowledge transfer cannot be limited to a one-way dissemination from researchers to stakeholders. It should be a continuous process of exchange and interaction [110], followed by a two-way flow between the researchers and the users of research data [111]. For this reason, we have sought in this project to engage in a co-creation approach, ensuring that we have an open and constant exchange and interaction between researchers and stakeholders throughout the project. The strategy of appropriation of research consists of making the research findings, knowledge and skills usable or marketable by bringing together the research and socioeconomic worlds. Also, the positive relationships between researchers and decision makers foster continuous communication, which in turn facilitate the uptake of the research.

In Canada, the lack of interaction between researchers and decision-makers has been reported as one of the main reasons for the low uptake and use of research results [109]. In Africa, there is a growing interest in the dialogue between the media, policy and society. The coronavirus disease 2019 (COVID-19) pandemic has shown how important knowledge exchange is. However, to date, most African countries, through their policy-makers, have not invested much in research, arguing that scientists keep findings hidden away. To enhance research funding in Africa, researchers should improve their knowledge exchange with the users, and current funders could intensify resource allocation for TR activities, especially for stakeholders’ seminars within the project cycles. The results of this project offer a path to rectifying this issue. Owing to the close involvement of policy-makers and a diverse array of stakeholders throughout the project, we were able to demonstrate concrete improvements in the implementation of a range of important rabies control measures. As such, this project represents cause for optimism in improving disease control and eradication efforts in SSA through stakeholder driven co-creation with the research community.

From our results, a rabies stakeholder platform at the national level could be set up to create an interactive process between scientists, decision-makers and communities for knowledge exchange, dialogue and impact. In parallel, programmes with an appropriate dissemination mechanism through research institutions should be developed, with all potential users being able to access new knowledge co-produced on rabies. This rabies stakeholder platform could be a technical working group of the national One Health coordination mechanism or platform and contribute to the achievement of zero human rabies deaths by 2030.

Strengths and limitations

There are some strengths and limitations worth highlighting with regard to this study. First, this study included researchers, local authorities, and human and veterinary stakeholders who were engaged right at the inception of the research project until the project completion. This shows an example of a co-produced study in Côte d’Ivoire, which takes specific account of the identified public health needs of the country (in this case, rabies control), and which is directly translated within the project, with tangible impacts at policy and community levels. The close involvement of researchers who hold positions in the human and animal health sectors allowed us to capture their role in facilitating communication from the bottom to the top, leading to an applied One Health approach. However, one limitation is that the study was conducted in only two cites. This was unfortunately due to resource limitations, although we attempted to mitigate this limitation by engaging the city with the highest rabies burden in the country (Bouaké), and the economic capital (Abidjan). Thus, we were able to capture a snapshot of major coastal and interior population centres. In the future, it would be of great value to further focus on the north of the country and more rural settings. Nonetheless, this study represents an important step and a potential blueprint for stakeholder co-creation, moving towards improving rabies control throughout SSA.

Conclusions

The results of the project provide a successful first-of-its-kind knowledge co-production study, leading to tangible impacts at both policy and community levels regarding rabies control, and understanding of its burden, in Côte d’Ivoire. The mechanisms that were used by researchers in our study to share knowledge with policy-makers and local communities were key enabling factors in the uptake of project results in Côte d’Ivoire. In modern public health, the translational process is now of utmost importance. It is now more than ever critically important to involve a wide range of stakeholders, as disease eradication and control efforts depend on effective implementation that requires their engagement across all sectors. It is only through improved engagement that we can move closer to disease eradication and ensure sustainable impact. Our project sets a path for this, as we were able to increase access to research evidence, as we involved researchers as knowledge brokers, straddling the divide between the policy-making and research worlds. The interactive platform between scientists, decision-makers and communities at each scale of the project cycle was particularly innovative. The current study further demonstrates the value of a transdisciplinary process within the field of One Health, with knowledge sharing identified as a key factor in the success of the collaborations undertaken herein. Engaging practitioners as researchers and communities as facilitators has the power for knowledge transformation in the process of disease control and elimination.

To achieve the “Zero by 30” rabies target set by the WHO, science needs to be more closely involved in policy, and engage in dialogue with other stakeholders, such as the media. In this way, stakeholders can make better use of health research evidence to co-construct strategies for improving the fight against rabies.

Abbreviations

TR

Translational research

WHO

World Health Organization

CIHR

Canadian Institutes for Health Research

NIH

National Institutes of Health

EATRIS

European Advanced Translational Research Infra Structure in Medicine

EVIPnet

Evidence-Informed Policy Network

SSA

Sub-Saharan Africa

DSV

Directorate of Veterinary Services

INHP

National Institute of Public Hygiene

LCVB

Central Pathology Laboratory of Bingerville

CSRS

Centre Suisse de Recherches Scientifiques en Côte d’Ivoire

ANT

Actor–network theory

IPCI

Institute Pasteur Côte d’Ivoire

MIRAH

Ministry of Livestock and Fisheries

LANADA

Laboratory for the Support of Agricultural Development

PEP

Post-exposure prophylaxis

IM

Intramuscular

ID PEP

Intradermal post-exposure prophylaxis

GARC

Global Alliance for Rabies Control

SARE

Stepwise Approach towards Rabies Elimination

GAVI

Global Alliance for Vaccines and Immunization

WRD

World Rabies Day

Author contributions

ASK (sociologist): carried out the study and the general writing of the document. KH-T (social anthropologist): contributed to all stages of the project from conception to finalization. BB (veterinary-epidemiologist and specialist in rabies control in Africa): the principal investigator, who contributed to all stages of the project. FA (professor of sociology): contributed to the academic supervision of the work and to all stages of the project. All authors reviewed the manuscript.

Funding

The research for this article was conducted under the DELTAS Africa Initiative (Africa One-ASPIRE/DEL-15-008). Africa One-ASPIRE is funded by a consortium of donors, including the African Academy of Sciences (AAS), the Alliance for Accelerating Scientific Excellence in Africa (AESA), the New Partnership for Africa’s Development (NEPAD) Planning and Coordinating Agency, the Wellcome Trust (107753/A/15/Z) and the British Government.

Data availability

Data generated in this study are available from the corresponding author without undue reservation.

Declarations

Ethics approval and consent to participate

This study was covered by the ethical approval of the GAVI Project: ethical approval (N/Ref: 072/MSHP/CNER-kp) from the National Ethics Committee of Côte d’Ivoire. In addition, ethical approval was granted by the Ethics Committee of North Western and Central Switzerland (EKNZ) (Basec 2016–00,220). At the research site, we sought survey authorization from the Ministry of Higher Education and Scientific Research, the INHP, the Directorate of Veterinary Services, the regional prefect and the subprefects. During the study, we presented these authorizations and provided an oral explanation of the purpose of our presence before the start of the interviews to obtain the participants’ informed oral consent. Thus, only those who agreed were interviewed.

Consent for publication

All authors provided consent for this study to be published.

Competing interests

The authors declare no competing interests.