The determinants of rabies knowledge, attitudes and practices among dog owners in the North-Eastern Region of Peninsular Malaysia: a multivariable analysis

Abstract

Background

Rabies poses a significant public health threat worldwide, primarily transmitted through dog bites. Understanding community knowledge, attitudes, and practices (KAP) regarding rabies is crucial for effective prevention and control strategies. This study aimed to determine KAP levels and their determinants among dog owners in Kelantan, Malaysia.

Methods

A cross-sectional study was conducted in 2023 among 232 dog owners attending mass canine vaccination programs conducted by Kelantan State Department of Veterinary Services. A validated and structured questionnaire assessed knowledge, attitudes and practices of rabies. The determinants were analysed through multiple logistic regression analyses.

Results

Overall, 53.0% exhibited good knowledge, 26.7% had positive attitudes, and 40.0% demonstrated good practices concerning rabies. Higher education levels (AOR = 3.15,95%CI:1.07,9.26), attending rabies programs (AOR = 3.79,95%CI:1.37,10.43), and owning two dogs (AOR = 2.25,95%CI:1.09,4.61) were associated with good knowledge. Medium and long duration of dog ownership durations (AOR = 0.23,95%CI:0.10,0.53 and AOR = 0.40, 95%CI:0.16,0.98 respectively) has lower chances to have positive attitudes, while larger households (AOR = 1.49,95%CI:1.18,1.87) and higher knowledge scores (AOR = 2.80,95% CI:1.06,7.42) were associated to positive attitudes. Older age groups (AOR = 0.27,95%CI:0.12,0.6 and AOR = 0.22,95%CI:0.09,0.50) was associated with suboptimal practices, whereas higher knowledge scores (AOR = 1.29,95% CI:1.08,1.54) and acquiring dogs through formal channels (AOR = 4.79,95%CI:1.85,12.39) were associated with good practices.

Conclusion

The study identified critical knowledge gaps, misconceptions, and suboptimal practices among dog owners in Kelantan, highlighting the need for targeted interventions. Tailored educational programs, community engagement strategies, and a comprehensive One Health approach towards the high-risk groups of dog owner are recommended to enhance rabies prevention and control efforts, ultimately safeguarding human, and animal health.

Introduction

The historical relationship between humans and canine, dates back at least 14,000 years ago, indicating a longstanding bond between the two species [1]. However, alongside this enduring companionship, dog bites pose a significant public health challenge [2]. The consequences of a dog bite extend beyond physical injuries, encompassing mental and emotional trauma, as well as the risk of infectious diseases, particularly rabies [3].

Rabies is a viral zoonotic disease caused by the Rabies lyssavirus, primarily transmitted through the saliva of infected animals, poses a significant threat to public health worldwide [4]. Rabies ranks among the deadliest infectious diseases known to humankind, with a fatality rate that approaches 100% once symptoms manifest. Rabies primarily affects mammals, with domestic animals—especially dogs—serving as the main sources of transmission to humans [2, 4]. The persistence of dog-mediated rabies deaths raises pertinent questions despite being preventable through vaccination and prompt post-exposure prophylaxis [5, 6].

Malaysia recorded its first case of canine rabies in 1925 and has since experienced sporadic outbreaks, with the most recent canine rabies outbreaks reported since 2015. Dogs accounted for 89.35% of confirmed animal cases, with owned pets comprising 43.72% and stray dogs only 23.72%. The higher incidence of rabies among owned dogs is attributed to low vaccination rates [7, 8]. The most recent human rabies cases have been reported since 2017. There were 72 cases were reported up to 2023 with epidemiological investigations revealing that 51.3% were caused by bites from owned dogs. Similarly, a study in a Malaysian state with canine rabies reported that 58.4% of dog bite cases involved owned dogs. These findings highlight the significant role of owned dogs in rabies transmission dynamics [7, 9,10,11].

The Knowledge, Attitudes, and Practices (KAP) survey is a comprehensive tool designed to gather data on the understanding, beliefs, and behaviours of a targeted population regarding a specific subject. The KAP concept, grounded in Albert Bandura’s learning theory and Everett Rogers’ diffusion of innovation theory, emerged in the 1950s for family planning and population studies [12]. Surveys employing these frameworks have been widely utilized worldwide as a tool in studying health behaviour, and the field of rabies research is not an exception. Numerous prior studies have been conducted in regions with prevalent human rabies cases, focusing on households regardless of dog ownership status including the National Health and Morbidity Survey 2020 [13,14,15,16,17]. A previous study conducted in Malaysia focused on free-roaming dogs within the general population, differing from the present study, which specifically targets dog owners [18].

KAP surveys can shed light on knowledge gaps, cultural beliefs, and behavioural tendencies that can either facilitate or impede rabies control initiatives, besides providing valuable insights into prevalent attitudes and common health practices. KAP surveys are instrumental for planning, implementing, and evaluating public health interventions within local contexts. Moreover, this survey also assists in setting program priorities, estimating resource requirements, designing effective communication strategies, measuring intervention impact, and advocating for necessary resources especially while Malaysia to regain the rabies free country status [12, 19]. However, to the best of the researcher’s knowledge, there is limited published research available on community assessments among dog owners within Malaysia. Therefore, the current study aimed to determine the level and determinant of knowledge on rabies, attitudes towards the risk of rabies, and rabies preventive practices among dog owners in the Kelantan state of Malaysia. We hypothesize that there is a significant association between human, animal, and environmental factors with good knowledge, positive attitudes, and good practices on rabies preventive measures among dog owners in Kelantan. The findings aim to inform the development of a rabies prevention module specifically designed to address the needs of approximately 398 000 dog owners in Malaysia, as highlighted by the National Health and Morbidity Survey. This focus is critically important, as dog owners are the primary caregivers for domestic dogs and play an essential role in reducing rabies transmission by interrupting the rabies transmission chain [15, 20].

Methods

Study area

The study took place in Kelantan, situated in the northeastern part of Peninsular Malaysia. Kelantan is bordered by Narathiwat Province, Thailand to the north, Pahang state to the south, Terengganu state to the east, Perak state to the west, and the South China Sea to the northeast. Figure 1 illustrates the geographical arrangement of Kelantan and its adjacent regions. Kelantan state, with a human population of approximately 1.6 million residents, was chosen as the study area due to its proximity to Southern Thailand, which is endemic for rabies, and its shared land and maritime borders with them [21]. The hypothesis of rabies reintroduction in other Malaysian states via land movements and maritime routes underscores Kelantan’s susceptibility to the disease [8].

Fig. 1

a) Location of Kelantan in Peninsula Malaysia b) Administrative District of Kelantan State [22]

Study design

A cross-sectional study based on the community was conducted over a two-month period between 1st July to 31st August 2023. All dog owners in Kelantan represent the reference population, while those attending the mass canine vaccination program, organized by the Kelantan State Department of Veterinary Services (DVS), form the source population for this study. This annual program is a key part of the DVS’s strategic rabies prevention efforts, targeting all 10 districts in Kelantan. Each District Veterinary Service Office coordinates the event within its jurisdiction, ensuring statewide coverage. Typically, each vaccination event draws between 30 and 50 dog owners, with attendance varying based on geographic location and local dog ownership density. The study included dog-owner aged 18 and above who owned at least one dog. Dog-owner that had limitation in understanding Malay or English language were excluded from this study.

Sample size determination and sampling method

The sample size was determined using the odds ratio effect size method, z-test, and logistic regression power analysis in G*Power version 3.1.9.6 [23]. The minimum sample sizes required to achieve 80% power at a significance level of α = 0.05 were calculated to be 204, 211, and 176 for knowledge, attitude, and practice, respectively. These calculations were made based on assumed odds ratios of 2.22, 2.19, and 2.70 for each respective domain [17, 24]. Thus, the largest required sample size was chosen, and after incorporating a 10% non-response rate, the final sample size was determined to be 232 [11]. Convenience sampling was applied until the desired sample size is attained.

Data collection and research tools

A structured KAP questionnaire was utilized in the study, originally developed in Malay and subsequently validated by technical experts, alongside cognitive testing with a diverse participant pool. The panel of technical experts encompassed program managers from the Ministry of Health and Veterinary Medicine Expert from Universiti Putra Malaysia. This process ensured the questionnaire’s feasibility, validity, and reliability, further corroborated by its previously employed in the National Health and Morbidity Survey 2020 [15, 25]. The questionnaire encompassed domains pertaining to knowledge of rabies diseases (9 statements), attitudes towards risk of rabies (7 statements), and rabies preventive practice following potential exposure to a rabid dog (10 questions). Besides that, a proforma was employed to collect sociodemographic information, details about participants’ dogs, and environmental factors.

The knowledge assessment statements employed a response format of “True,” “False,” or “Unsure,” with correct responses receiving one point whereas incorrect responses, including both false assertions and uncertainty, did not receive any points [15, 25]. Attitude assessment statements utilized a Likert scale method with a five-point scale, allowing participants to express their level of agreement with each statement. Each statement was scored on a scale of five points for “strongly agree,” gradually decreasing to one point for “strongly disagree”. Reverse scoring was applied to knowledge statement 4 and attitude statement 1. Practice assessment questions required a binary response of “Yes” or “No,” with one point awarded for each correct immediate action taken includes apply antiseptic, ointment or wound dressing and wash the wound using running water and soap for at least 15 min, seek treatment at the clinic or hospital immediately. Based on the Bloom cut-off point, where scores exceeding 80% of the total score were categorized as “Good Knowledge” and “Positive Attitude” whereas participants demonstrating practices scoring of 3 points were categorized as exhibiting “Good Practice” [15, 25]. Self-administered questionnaire distributed to consented eligible respondent at the mass canine vaccination program. The questionnaire has been reviewed to ensure that all responses have been fully documented.

Data management and statistical analysis

Data were entered, coded, and cleaned using Statistical Product and Service Solutions (SPSS) Version 27 for subsequent analysis. Descriptive analyses were conducted to examine the frequency distribution of participants’ sociodemographic characteristics, details regarding participants’ dogs, and environmental factors. Simple logistic regression was employed to estimate the crude odds ratio. Independent variables with a p-value less than 0.25 in the univariate analysis were selected as candidates for inclusion in the multivariable model. The backward elimination method in SPSS was used for variable selection in multiple logistic regression. Further details on this approach can be found in Chowdhury and Turin’s paper on clinical prediction modelling [26]. Collinearity among variables was assessed using variance inflation factors (VIF). The model’s fit and performance were evaluated through the Hosmer-Lemeshow test, a classification table, and the Receiver Operating Characteristic (ROC) curve. A p-value of less than 0.05 was considered statistically significant in the final model, identifying determinants that significantly associated with KAP outcomes.

Operational definition

The participant’s pet dog was identified as the dog that had been their pet for the longest period and served as the dog-related characteristics in this study. The duration of dog ownership was defined as the total length of time an individual had continuously owned a dog, encompassing both current and past pets. Ownership duration was categorized into three levels: “Short” for less than 5 years, “Medium” for 6 to 10 years, and “Long” for 11 years or more [27]. Confinement was defined as any method of restricting and segregating a dog. Fully confined dogs were continuously under their owner supervision, typically kept within the bounds of a home or a walled area and were walked on a leash or kept under control when beyond those boundaries. A partially confined dog spent some of its time restricted to a home or walled area but was also free to roam the neighborhood. A free-roaming dog was almost never confined to a residence or fenced-in area [28]. Dog age was categorized based on normative age-related stages. Dogs younger than 2 years were classified as young, a period encompassing both puppyhood and adolescence, during which cognitive and behavioural development continues. Middle-aged dogs, those between 2 and 7 years, represent a phase of maturity characterized by stable cognitive abilities and behaviour. Dogs aged 8 years and older were categorized as seniors, a stage marked by the potential onset of cognitive decline and notable behavioural changes associated with aging [29]. Household size was defined as the number of individuals, related and/or unrelated, who shared the same residence and had lived together for at least six months, making shared provisions for food and other living necessities [30]. Household size was classified into three categories: “Small,” referring to households with fewer than 3 members; “Medium,” for households with 4 to 6 members; and “Large,” for households with 7 or more members. Previous rabies awareness program attendance is defined as refers to participation in any organized event or program designed to increase awareness about rabies, covering both human and canine aspects. Qualifying programs include health talks, seminars, small group discussions, or online training sessions that provide structured information on rabies prevention, transmission risks, and control measures. Individual consultations, such as vaccinations at private clinics or dog neutering services without educational components, are excluded from this definition. Household dog bite experience refers to any incident in which a household member has been bitten by a dog, with the participant either witnessing or managing the event involving the affected household member.

Results

Sociodemographic characteristic of participants, dogs and environment

The sociodemographic characteristics of dog owners, their pets’ dogs, and environment were analysed in this study, encompass 232 participants. The age distribution of dog owners showed a relatively even spread across different age groups, with a slight male majority (56.0%). A substantial proportion having completed secondary education (45.7%) and married (77.6%) while self-employment emerged as a prevalent employment status (50.9%). The duration of ownership showed a balanced distribution, with a notable percentage falling into the medium-term ownership category (56.1%), while personal experiences of being bitten by dogs were reported by only a small fraction of participants (5.2%). Table 1 shows the detailed descriptive statistics for all the participants.

Table 1 Sociodemographic of the dog owner participants from all 10 districts in Kelantan (n = 232)

The characteristics of the dogs were often acquired from family (59.5%) and mostly were kept as partial confinement (38.4%), followed closely by free roaming (30.1%). Household compositions were diverse, with over half of households including children (51.7%). Despite high rates of dog ownership and diverse household compositions, reported instances of household bites were relatively low (7.8%), with even fewer reporting multiple bite incidents (3.0%). Table 2 shows the detailed descriptive statistics for participant’s characteristics dogs and environmental factors.

Table 2 The demographic characteristics of dogs owned by participants and environmental factors in Kelantan (n = 232)

Participants’ knowledge on rabies

Table 3 illustrate nine key statements on rabies knowledge, along with the responses from the participants. There is generally a good level of knowledge regarding the transmission of rabies from dogs to humans, with 72.4% correctly recognizing the risks associated with rabid dogs. The majority (71.1%) also correctly identified the clinical sign of rabid dog. A significant proportion (72.0%) recognized the risk of rabies transmission through bites from rabid dogs. However, there are significant knowledge gaps concerning other transmission routes, exemplified by the fact that only 22.8% correctly identified dog scratches and 58.6% recognized exposure to a rabid dog’s saliva as the potential source of rabies transmission. Despite these misconceptions, there is widespread understanding of the importance of prompt treatment after a dog bite, with 95.2% recognizing this necessity. Moreover, 77.2% correctly identified that a tetanus booster shot is one of the treatments given for dog bites, and 93.1% understand that vaccination for dogs serves as protection from disease transmission.

Table 3 Participants’ responses to knowledge statement on rabies (n = 232)

Participants’ attitude towards rabies

Table 4 illustrate seven key statements regarding attitudes related to rabies, along with the responses from the participants. A significant portion (42.2%) strongly agreed that dogs can spread diseases, while only a small percentage (2.6%) strongly agreed that there is no need for first aid treatment after a dog bite. participants commonly expressed concerns about disease transmission to family members and children playing with dogs, with 50.4% and 56.0% respectively agreeing. Most participants recognized the importance of annual vaccination for pet dogs (78.5%) and vaccinating dogs in areas with rabies cases (79.7%). Only a minority (10.8%) disagreed regarding the necessity of receiving a rabies vaccination after being bitten by a dog.

Table 4 Participants’ responses to attitude on rabies risk (n = 232)

Participants’ practices on rabies prevention

Table 5 provides insights into participants’ practices following potential rabies exposure. Most participants (78.9%) reported not seeking traditional treatment, with an even larger proportion (91.8%) endorsing the practice of preventing dogs from licking wounds. Additionally, 84.9% of participants adhered to recommended wound care practices by applying antiseptic, ointment, or dressing. Many participants (86.7%) sought immediate treatment after being bitten, crucial for potential rabies exposure. Furthermore, slightly over half (54.3%) reported washing the wound with water and soap for at least 15 min. However, a concerning 23.7% indicated they would wash with water and soap for less than the recommended duration.

Table 5 Participants’ responses to rabies preventive practice (n = 232)

Level of knowledge, attitude, and practice on rabies

The mean knowledge score among dog owners was calculated as 6.19 (Standard Deviation [SD] = 1.79). A significant proportion, comprising 53.0% (95% Confidence Interval [CI]: 46.5, 59.5), of the participants exhibited a good level of knowledge regarding rabies. Furthermore, 26.7% (95% CI: 21.0, 32.5) of the participants demonstrated a positive attitude, with a mean attitude score of 25.38 (SD = 4.72). 40.0% (95% CI: 33.7, 46.4) of participants displayed good health seeking practice pertaining to rabies, with a mean practice score of 2.26 (SD = 0.72).

The determinants of good knowledge on rabies

The final multiple logistic regression model, as shown in Table 6, revealed significant associations between certain factors and good rabies knowledge. Specifically, dog owners who had completed secondary education (Adjusted Odds Ratio [AOR]: 3.15, 95% CI: 1.07,9.26) exhibited approximately three times higher odds of possessing good knowledge compared to those with no formal education. Moreover, attending rabies programs was statistically significant, indicating that dog owners who had participated in such programs previously were more likely having a good knowledge (AOR = 3.79, 95% CI: 1.37,10.43). Dog owners with exactly two dogs had significantly higher odds (AOR = 2.25, 95% CI: 1.09,4.61) of having good knowledge compared to those with a single dog, after controlling for other variables. Furthermore, household characteristics also played a significant role, with medium-sized households exhibiting lower odds (AOR = 0.27, 95% CI: 0.11,0.66) of possessing good knowledge on rabies compared to small-sized households.

Table 6 Factor Associated with rabies knowledge among Kelantan Dog Owners (n = 232)

The determinants of positive attitude towards rabies

Dog owners with medium and long durations of ownership were less likely to have positive attitudes toward rabies prevention compared to those with shorter durations (AOR = 0.23, 95% CI: 0.10,0.53; AOR = 0.40, 95% CI: 0.16,0.98 respectively). Higher knowledge scores were statistically significant associated having positive rabies prevention attitudes (AOR = 1.49, 95% CI: 1.18,1.87). Moreover, dog owners from larger households showed a significantly higher likelihood of having positive attitudes toward rabies prevention compared to those from smaller households (AOR = 2.80, 95% CI: 1.06, 7.42), whereas it is not statistically significant for medium-sized households as shown in Table 7.

Table 7 Factors associated with rabies prevention attitude among dog owners (n = 232)

The determinants of good practice on rabies prevention

The analysis demonstrates owners aged 50 to 59 and those over 60 years old showed a statistically significant decreased odds of engaging in rabies preventive practice compared to those under 39 years old (AOR = 0.27, 95% CI: 0.12,0.61; AOR = 0.22, 95% CI: 0.09,0.50, respectively). Higher knowledge scores were associated with increased odds of practicing rabies preventive practice (AOR = 1.29, 95% CI: 1.08,1.54). Moreover, dog owners who acquired pet dogs through others means include purchasing from breeder or obtaining them from shelters were significantly more chance to engage in rabies preventive practice as compared to those who adopt the stray dog as their pets (AOR = 4.79, 95% CI: 1.85, 12.39). All the findings were illustrated by the Table 8.

Table 8 Factors Associated with Health-seeking practices after Dog bites among Kelantan Dog Owners (n = 232)

Discussion

This study highlights notable gaps that necessitate prioritization in public health interventions. The majority (72%) of participant were aware of rabies transmission through dog bites, while a significant proportion lacked understanding of transmission through licking wounds and scratches, consistent with a study conducted in Ethiopia and Haiti [31, 32]. While awareness of rabies transmission through dog bites is relatively high, there is a need to improve understanding of other modes of transmission to prevent the spread of rabies. This study underscores the negative perception of children playing with dogs (65.5%), which may increase the risk of severe dog bites. Research has shown that such negative perceptions can render children more vulnerable to such incidents. Children’s behaviour, such as unpredictable and active actions, can induce stress in dogs, potentially eliciting aggressive responses, particularly when children lack the cognitive abilities to recognize and respond appropriately to dogs [33, 34]. Therefore, comprehending the dynamics of children’s interactions with dogs is pivotal in averting adverse incidents. Consequently, educating parents and adult dog owners on minimizing the risk of dog bites is imperative to interrupt rabies transmission. While 97.5% of participants expressed a preference for seeking treatment at varying intervals to healthcare facilities, yet approximately 21% also resorted to traditional remedies. The use of herbal treatments, rooted in non-scientific diagnostic methods from sacred texts, signifies poor health-seeking practice, potentially leading to delayed presentation at healthcare facilities for rabies vaccination, as observed in fatal human rabies cases in Ethiopia [32]. Although the rate of seeking traditional healers in Kelantan exceeds that in the Philippines (2–8%) and Cambodia (5.3%), it is considerably lower than in countries like Ghana (65%) and Bangladesh (90%) [35]. Besides that, this study also reveal dissimilarity between the 86.7% of dog bite victims who sought immediate treatment at a clinic or hospital and the 54.3% who reported washing the wound with soap and water for at least 15 min. While many participants were prompt in seeking professional medical assessment, they may not have been fully informed about the importance of initial wound care—particularly the practice of thoroughly washing the wound to reduce the risk of rabies infection [6]. This highlights the importance of addressing misconceptions and promoting evidence-based practices for rabies prevention and treatment to mitigate the morbidity and mortality associated with this preventable disease.

The study revealed that nearly half (53.0%) of dog owners in Kelantan exhibited a good level of rabies knowledge. This proportion surpassed that observed in surveys among the general population and dog owners during the NHMS, where 46.4% and 45.2% displayed good knowledge, respectively [15]. It is essential to note the substantial variation observed across different regions. The proportion of good rabies knowledge among dog owners in Kelantan was comparable to findings from Kigali City, Rwanda and West Hararghe, Ethiopia, where 53.3% and 52.1% exhibited good knowledge [24, 27]. In Tanzania, for example, the prevalence of good rabies knowledge was strikingly high at almost perfect levels (98.6%) [36]. Both studies were conducted in regions endemic for rabies, whereas the focus of this study is an area where no cases of rabies have ever been reported. The prevalence was still considered acceptable when compared to other Southeast Asian Countries include Indonesia (36.0%), Cambodia (9.7%), and Thailand (20.8%) [37,38,39]. Conversely, the rate of good rabies knowledge among dog owners in Kelantan was slightly lower than the pooled prevalence observed in Ethiopian studies (62.2%). It is expected as the studies included in the systematic review were predominantly conducted in urban settings, whereas this study encompassed both urban and rural areas within Kelantan. Participants in urban settings may have had better access to information and communication channels [40].

The comparison between attitude levels revealed intriguing insights. The study indicated that 26.7% of participants demonstrated a positive attitude towards rabies. Surprisingly, this finding aligned closely with the population-level data from the NHMS 2020, where 55.9% of participants displayed positive attitudes towards risk factors for contracting dog-related diseases. However, the positive perception level among dog owners in the NHMS 2020 was notably lower at 24.6% [15]. Comparing these figures to other studies adds further depth to the discussion. For instance, research conducted in Rwanda reported a mere 17% displaying positive attitudes towards rabies, while in Tanzania, a striking 81.8% exhibited positive attitudes [27, 36]. Moreover, a pooled analysis of Ethiopian studies revealed that only 56.73% displayed favourable attitudes towards dog-mediated human rabies [40]. This discrepancy of this study findings and other studies across different regions underscores the influence public health campaigns or community-based interventions, which may not be as prevalent in Tanzania where rabies is endemic [41].

This study unveils that 40.0% of participants demonstrated good rabies preventive practice concerning rabies. Comparatively, the NHMS 2020 indicated that 38.5% of the general population and 39.7% of dog owners displayed or were perceived to have good rabies preventive practice [15]. In a study conducted in Kigali, 66% of dog owners adopted adequate practices, while in Tanzania, only a small proportion (23.22%) exhibited good practices [27, 36]. The pooled prevalence of good practices related to dog-mediated rabies prevention and control in Ethiopian studies up to 2023 was only 56.73%. This comparison highlights the diversity in rabies preventive practice among dog owners in various regions probably due to the different in accessibility of suitable healthcare facilities, cultural tendencies favouring traditional healers, and the financial constraints between countries [35, 40].

The results of this study indicate a significant association between higher education levels and good knowledge regarding rabies. This finding was unsurprising, completion of secondary education entails six years of primary education followed by an additional five years of secondary education, which is mandatory in Malaysia to ensure individuals are proficient in reading and understanding provided information [42]. This finding aligns with research conducted in Tanzania and Cambodia, which similarly found that participants with secondary education exhibited better knowledge of rabies [38, 43]. Individuals with higher educational backgrounds are likely to find it easier to comprehend and retain information about rabies through various channels as compared to those who receive no formal education. Besides that, this study also highlights that participants who attending any rabies program were associated with good levels of knowledge. The findings of this study could serve as reflection on the success delivery of rabies programs conducted in improving rabies knowledge among community including the dog owners. This finding was in agreements with the study that being conducted towards household head in Mekelle, Ethiopia and schoolchildren in South Bhutan [13, 17]. Although the awareness programs in South Bhutan, such as street walks and educational initiatives in schools, were prompted by frequent reports of rabies outbreaks, implementing similar programs within dog owner communities in high-risk areas like Kelantan could serve as proactive measures to sustain the state’s rabies-free status and prepare for potential reintroduction of the disease [13]. The association between participation in rabies education initiatives and increased chances to have a good knowledge highlights the importance of targeted interventions in disseminating information about the disease. Moreover, the consistency of this finding across different geographic regions underscores its generalizability and relevance in diverse settings. Besides that, the analysis reveals that dog owners who had two dogs demonstrate to have good knowledge. One plausible explanation is that owners of multiple dogs tend to have better knowledge of rabies, potentially due to a stronger commitment to dog welfare that drives them to seek out more information on the disease and its prevention. This is further supported by the likelihood of these owners engaging more frequently with veterinarians, thus having more opportunities to engage about rabies.

Dog owners residing in medium-sized households are less likely to possess comprehensive knowledge about rabies, a finding consistent with research conducted in India [44]. This phenomenon may be linked to the diffusion of responsibility within such households, where dog care tasks are often shared among multiple members, leading individuals to feel less individually responsible for acquiring in-depth knowledge about rabies, which is perceived as a collective responsibility [45]. Conversely, larger households demonstrate a significantly higher odds of harbouring positive attitudes towards the risk of rabies. This observation aligns with similar findings from a study conducted among household heads in Mekelle City and may be attributed to the concept of collective efficacy. Larger households may benefit from stronger communal ties and enhanced information exchange, which fosters positive attitudes towards rabies risk [17]. However, this positive shift in attitude does not necessarily translate into practice, as this study found no significant association between household size and good practice practices, like findings on community activism [46]. This contrast in findings underscores the complex interplay between household dynamics and health practices, with medium-sized households potentially facing challenges due to diffusion of responsibility, while larger households leverage collective efficacy to promote positive health attitudes.

One noteworthy finding is that individuals with medium and long durations of dog ownership exhibited less favourable attitudes compared to newer dog owners. This unexpected result may be attributed to a phenomenon termed complacency bias, wherein long-term dog owners become desensitized to the risks associated with rabies, potentially due to a lack of recent or direct encounters with the disease. This complacency can result in a reduced perception of the risk of contracting the infection and underestimation of its severity, akin to what has been reported in the context of HIV and AIDS [47]. The statistically significant association between higher knowledge scores and positive attitudes towards rabies risk as well as preventive practice is consistent with findings from a study conducted among household members in, also Southeast Asian country, Philippines [48]. This relationship is well-documented in health practice literature, where knowledge not only serves as the basis for forming attitudes but also acts as a catalyst for behaviour change. According to the Health Belief Model, a widely used theoretical framework for understanding health behaviours, knowledge about a health threat and its prevention is fundamental in shaping an individual’s perception of the threat and their subsequent engagement in preventive practices [49]. However, inconsistent findings within studies conducted in various regions of Ethiopia did not consistently find statistically significant associations between knowledge and attitudes or between knowledge and practices [16, 17, 24].

This analysis uncovers pivotal age-related disparities in the adoption of rabies preventive measures, demonstrating that individuals aged more than 50 years old were significantly less likely to engage in rabies prevention compared to their younger counterparts indicating a potential generational gap. This finding aligns with a study among bite victims in China but are contradictory to results from studies conducted in Africa. It is conceivable that senior dog owners may not have been adequately informed about contemporary rabies prevention practices, thereby perpetuating the misconception that treatment entails the administration of multiple injections into the abdomen with a long needle. As result, the owners could potentially delay their seeking care at healthcare facilities and lead them to prefer traditional healers [35, 50]. Besides that, the study also found that dog owners who obtained their pets through formal channels, such as purchasing from breeders or adopting from shelters, were significantly more inclined to engage in rabies preventive practices compared to those who adopted stray dogs. This is a noteworthy finding that has not been previously reported. This may be attributed to the higher motivation for pet care among dog owners who acquire their pets through formal adoption processes, indirectly leading to greater adherence to preventive measures against rabies infection [51].

The study demonstrates several strengths that bolster the scientific rigor and validity of its findings. This study utilises a feasible, valid, and reliable instrument in assessing the Malaysian general population’s knowledge on rabies, attitude towards risk of rabies and rabies preventive practices. These strengths contribute to the robustness and scientific soundness of the study, yielding meaningful insights for rabies prevention strategies in the study area. Moreover, the study’s robustness is underscored by its adoption of an inclusive One Health approach. The investigation delves into the determinants of good knowledge, positive attitudes, and good rabies prevention practices by integrating considerations of human, animal, and environmental factors. This comprehensive framework not only enriches the depth of analysis but also acknowledges the intricate interplay between these domains, thereby enhancing the study’s relevance and applicability to real-world contexts.

The study encountered several limitations that warrant consideration. The study is susceptible to selection bias due to its reliance on a population attending mass vaccination campaigns primarily held on weekdays. This approach may inadvertently exclude individuals who do not participate in these campaigns, potentially skewing the sample towards those with greater accessibility or motivation to participate. While this method was chosen for its feasibility in data collection, the findings may not accurately reflect the perspectives of all dog owners in the region, limiting the generalizability of the study. Despite attempts to mitigate information bias by including only participants fluent in English or Malay, potential misunderstandings or discrepancies in responses may arise given the diverse linguistic backgrounds of Malaysian dog owners, predominantly comprising Siamese, Chinese, and Indians. These limitations underscore the importance of exercising caution when interpreting the study findings and highlight the need for future research to adopt more inclusive sampling methods while addressing the language-related barriers more comprehensively.

Conclusions

This study offers critical insights into the knowledge, attitudes, and practices related to rabies among dog owners in Kelantan, Malaysia, while acknowledging the limitations imposed by the use of convenience sampling, which constrains the generalizability of these findings. Key determinants influencing knowledge were identified as education level, participation in rabies awareness programs, and number of dogs, while attitudes were influenced by the duration of ownership, knowledge score, and household size. Preventive practices were significantly associated with age group, method of dog acquisition, and knowledge score.

The results underscore the necessity of targeted educational interventions to enhance understanding of safe human-dog interactions, clarify transmission routes beyond dog bites, and reinforce the importance of rabies vaccination. Effective rabies prevention efforts should incorporate inter-ministerial collaboration, tailored community interventions, and strategic partnerships with traditional healers and community leaders to maximize outreach, particularly among high-risk groups such as dog owners with lower educational attainment, older individuals, and those who have acquired dogs through informal channels.

Future research should focus on the cultural and social determinants influencing delayed healthcare-seeking behaviours and reliance on traditional remedies, with special emphasis on understanding risk factors in human-dog interactions, particularly among children. Addressing these gaps and misconceptions will allow public health initiatives to enhance community preparedness, foster adherence to recommended preventive practices, and contribute to Malaysia’s goal of achieving rabies-free status through a comprehensive One Health approach.