Factors associated with perceived barriers to canine rabies vaccination among owners of unvaccinated dogs in Sierra Leone

Dog vaccination is the most effective method for preventing rabies virus transmission and human deaths. However, in Sierra Leone, vaccination rates remain low, and the reasons for non-vaccination are not well understood. We analysed 2023 household survey data using a hierarchical Bayesian multinomial regression to provide insight into perceived barriers to canine rabies vaccination among owners of unvaccinated dogs. Our results indicated that of the 2558 dog-owning households interviewed, only 14 % (358) reported having fully vaccinated their dogs. Of the 2200 respondents with unvaccinated dogs, most (71.6 %) didn't know how to access rabies vaccination services, 17.6 % cited cost, and 10.8 % believed it was unimportant. Posterior distribution of our model showed that urban residents had 91 % lower odds of believing rabies vaccination was unimportant compared to rural residents (OR = 0.11, 95 % CrI: 0.02-0.34). Similarly, individuals with tertiary education had 28 % lower odds of believing rabies vaccination was unimportant (OR = 0.72, 95 % CrI: 0.31-1.59), though this effect is uncertain despite an 80 % probability of being protective. Respondents in areas without veterinary services were more likely to cite cost as a barrier. Students were significantly less likely than civil servants to consider rabies vaccination unimportant (OR = 0.41, 95 % CrI: 0.17-0.95). In contrast, owners of free-roaming dogs were significantly twice as likely to believe that rabies vaccination was unimportant (OR = 2.41, 95 % CrI: 1.15-5.59). Those with partially confined dogs were significantly more likely to report not knowing how to access rabies vaccination services (OR = 1.99, 95 % CrI: 1.39-2.86). Compared to households citing cost, those in the Eastern Province were significantly less likely to report that the vaccine is unimportant. Respondents in the Western Area were significantly less likely to report cost as a barrier. In contrast, households in the Eastern were more likely to report cost as a barrier. These findings suggest that barriers to dog vaccination in Sierra Leone are shaped by a combination of informational, socioeconomic, and geographic factors. Improving public awareness, especially in rural areas, and expanding access to veterinary services could help address key obstacles. Tailored outreach strategies that consider education levels, occupation types, and local infrastructure are recommended to enhance vaccination uptake and support rabies prevention efforts.