Socio-economic factors associated with voluntary rabies control measures in Vietnam.

Rabies is a fatal zoonosis, and in Vietnam, it remains problematic despite the availability of dog rabies vaccination. The purpose of this study was to clarify the socio-economic factors associated with voluntary rabies control measures among the general population using a "Knowledge, Attitudes, and Practice" framework to provide health and veterinary authorities in Vietnam with baseline information for better planning of policy supports. A questionnaire survey with interviews was conducted in 495 households (64 mountainous and 431 plain-area households) in Thai Nguyen Province in September 2016. After the survey, uni- and multivariable analyses were performed to detect factors associated with the practices of dog rabies vaccination and tethering dogs. Structural equation modelling (SEM) was performed to understand the structures associated with practice decisions. Contingent valuation was performed to calculate willingness-to-pay for vaccination. Vaccination coverage was 77.4% (724/935 dogs), and was significantly lower in mountainous areas dominated by ethnic minorities (63.8%, 67/105) than in plains (79.2%, 657/830, x = 11.7, df = 1, p <  0.001). Mean estimation of willingness-to-pay for a vaccination was 2.30 USD (51,959 Vietnamese dong), which was more than double the current price. The willingness-to-pay in mountainous areas was 2.16 USD, while that in plain areas was 2.32 USD. The proportion that never confined dogs was significantly higher in mountainous areas (65.6%, 42/64 households) than in plain areas (26.5%, 114/430, x = 37.7, df = 1, p < 0.001). Despite the low proportion of households tethering dogs, the majority answered that they would confine (479/489, 98.0%) or leash while walking (482/491, 98.2%) if such orders were enforced. SEM result showed that higher social status promoted better knowledge (β, the coefficient, = 0.75, se = 0.05, p <  0.001), better knowledge positive attitudes (β = 1.0, se = 0.0, p value not calculated), and positive attitudes better practices of confinement (β = 0.4, se = 0.05, p <  0.001), vaccination (β = 0.52, se = 0.06, p <  0.001), and sterilization (β = 0.11, se = 0.04, p <  0.001). Our study suggested that rabies education targeted to mountainous areas using local languages for ethnic minority groups as well as the national language, and higher subsidies on dog rabies vaccination for poor households may improve vaccination coverage. Dog management may be improved by promotion campaigns.