Community perspectives on canine-mediated rabies risk in the Klang Valley, Malaysia: implications for outbreak preparedness

Despite being declared rabies-free in 2012, Malaysia has experienced a resurgence of canine-mediated rabies since 2015, with the Klang Valley, a densely populated urban hub, facing an increasing threat. The success of elimination efforts hinges on community engagement. Yet, baseline data on public knowledge, attitudes, and practices (KAP) in this critical region are limited. This study aimed to assess the cognitive (knowledge), affective (attitude), and behavioural (practice) domains of the Klang Valley community regarding canine-mediated rabies to inform targeted public health interventions and outbreak preparedness strategies. A cross-sectional questionnaire survey was conducted from September 2022 to March 2023 to assess community knowledge, attitudes, and behaviours regarding rabies risk factors. Knowledge was evaluated using true/false/unsure options, perceptions were measured with a Likert scale, and practices were recorded via yes/no responses. Understanding levels were quantified using Bloom’s scoring system, categorised as high (80–100%), moderate (60–79%), or low (below 60%). Perceived knowledge scores were similarly classified as positive, neutral, or negative based on these percentage ranges. Univariate binary logistic regression was used to examine the association between socio-demographic factors and the likelihood of having a non-positive Cognitive-Affective-Behavioural (CAB) score, a proxy for increased rabies risk, with data analysed using Microsoft Excel and SPSS version 20. The study achieved a high response rate of 73.44%, with respondents predominantly female (60.99%) and aged 18–25 (48.40%). The majority were Malaysian citizens of Malay descent (45.57%), single (59.04%), and possessed tertiary education (62.06%). The overall mean CAB score was 61.61% (± 2.30%), with 38.39% (± 2.29%) of respondents exhibiting a non-positive score. While 74.70% (95% CI: 71.11–78.29) demonstrated general knowledge of rabies, only 31.25% (95% CI: 27.42–35.08) reported the positive practice of immediate wound washing after a dog bite. Univariate logistic regression revealed that gender and age were significant predictors of a non-positive CAB score. Males had 34% lower odds of a non-positive CAB score compared to females (OR = 0.66, 95% CI [0.47, 0.95], p = 0.024). Furthermore, participants aged 26–33 years had 45% lower odds of a non-positive CAB score compared to the youngest group (18–25 years) (OR = 0.55, 95% CI [0.33, 0.92], p = 0.022). The study highlights significant gaps in rabies-related practices and identifies vulnerable demographic groups (females, the youngest, and the oldest age cohorts) in the Klang Valley. The low adherence to immediate post-exposure prophylaxis practices poses a critical public health risk. Hence, Public health campaigns must be urgently implemented in the Klang Valley, focusing on improving correct post-exposure wound care practices and specifically targeting vulnerable groups identified by this study to enhance rabies outbreak preparedness and support the ‘Zero by 30’ global goal.