Table 1. Economic and epidemiological context of countries included in this study.
| Country | Continent | Population (2020) | GDP (2020, US $/Bn) | HDI (2019) | Rabies elimination stage | Level of dog vaccination | Owned, free roaming dogs | Deaths per year | Policy on PEP (cost per course) | Bite incidence (per 100k) | Estimated HDR *** | Source |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Chad | Africa | 16,425,860 | 10.1 | 0.40 | Endemic | Not routine | >90% | 550 | Patient pays* (US$ 80100) | 480-570 | 1: 7.8 (1: 5.2-40) | (10, 22, 23, 24) |
| >90% | ||||||||||||
| Kenya | Africa | 53,771,300 | 98.8 | 0.60 | Endemic | Not routine | >90% | 2,200 | Patient pays* (US$ 85) | 290 | 1: 4-8 | (22, 25) |
| >90% | ||||||||||||
| Madagascar | Africa | 27,691,020 | 13.7 | 0.53 | Endemic | Not routine | >90% | 1,000 | Free | 190 | 1: 8-25 | (26, 27) |
| >90% | ||||||||||||
| Malawi | Africa | 19,129,955 | 12.0 | 0.48 | Endemic | Not routine | >90% | 900 | Free | 230 | 1: 23 (1: 14-31.8) | (22, 28) |
| >90% | ||||||||||||
| Tanzania | Africa | 59,734,210 | 62.4 | 0.53 | Endemic | Not routine | >90% | 650 | Patient pays (>US$ 80) | 12-120 | 1: 20.7 (1: 7-181.3) | (9, 22, 29) |
| >90% | ||||||||||||
| Brazil | Americas | 212,559,410 | 1,445.0 | 0.77 | Elimination* | Routine* | >90% | <10 | Free | 230-280 | 1: 4.2-7 | (30, 31) |
| <50% | ||||||||||||
| Guatemala | Americas | 16,858,330 | 77.6 | 0.66 | Endemic | Routine | >80% | 0-8 | Free | 150-280 | 1: 6.4 (1: 1-10) | (30, 33, 34) |
| >70% | ||||||||||||
| Haiti | Americas | 11,402,530 | 13.4 | 0.51 | Endemic | Routine | >90% | 350 | Free | 200 | 1: 5.2 | (22, 35) |
| >50% | ||||||||||||
| Peru | Americas | 32,971,850 | 202.0 | 0.78 | Emerging* | Routine | >80% | 0-10 | Free | 200-600 | 1: 3.8 | (30, 36, 37) |
| >40% | ||||||||||||
| India | Asia | 1,380,004,390 | 2,623.0 | 0.65 | Endemic *Goa State - elimination | Highly variable | >60% | >15,000 *Goa State: 0 since 2018 | Free | 1,300 | 1:11-36 | (22, 38, 39) |
| >40% | ||||||||||||
| Indonesia | Asia | 273,523,620 | 1,058.0 | 0.72 | Endemic* | Not routine | >90% | 3,300 | Free | 200 | 1: 8.3-360 | (22, 41, 42) |
| >70% | ||||||||||||
| Philippines | Asia | 109,581,090 | 361.5 | 0.72 | Endemic | Routine but variable | >80% | 200-300 | Free | 1,100 | 1:4-10 | (43, 44, 45) |
| >50% | ||||||||||||
| Vietnam | Asia | 97,338,580 | 271.2 | 0.70 | Endemic | Routine but variable | >80% | 500 | Patient pays (US$ 150) | 400 | 1: 10-38 | (22, 46, 47, 48) |
| >50% |
GDP, Gross Domestic Product, HDI, Human Development Index, PEP, post-exposure prophylaxis, HDR, Human to Dog Ratio. Population and GDP data from the World Bank OECD National Accounts data files, 2020 (https://data.worldbank.org). HDI data from the United Nations Development Programme 2020 Human Development Index Ranking (https://hdr.undp.org). Rabies elimination stage, level of rabies control, and policy on PEP were all reported from interviews. Deaths per year, annual bite patient incidence, and estimated human:dog ratios were from the literature.
Brazil is close to elimination, but rabies has continuously circulated in the state of Maranhao (47).
Peru is close to elimination, but rabies has continuously circulated in the border state of Puno and re-emerged in the city of Arequipa in 2015 (36). Canine rabies is endemic in India, but the State of Goa is now close to elimination and has not had a human rabies death since 2018 (47). Indonesia has endemic dog rabies in 26 provinces, while 8 provinces are rabies-free (39).
Dog vaccination is routine in 24/27 Brazilian states, but has been discontinued in 3 southern states: Parana', Santa Catarina and Rio Grande do Sul. There is considerable variability in the degree of routine dog vaccination reported in Asian countries.
Patients pay for PEP in Chad, but PEP was provided for free during the IBCM project (2016-2018).
Patients pay for PEP in most of Kenya, but PEP is free in a few counties (e.g., Makueni). Bite patient incidence (presentations to health facilities) is reported rather than cross-sectional surveys which typically are much higher.
Variability in HDRs relates to culture (with major differences between religions).