Owned dog population profile, dog ownership and bite risk determinants: Key steps to rabies control in Antananarivo, Madagascar

Rabies remains a significant public health threat in Madagascar, with dog-mediated transmission causing approximately 1,000 human deaths annually. In Antananarivo, the capital city, control efforts are hindered by limited up to date knowledge on the dog population. This study aims to provide updated estimates of the owned dog population characteristics, identify determinants of ownership, and assess dog bite incidence and risk factors to guide effective vaccination and prevention strategies. Between 2023 and 2025, a longitudinal door‑to‑door household survey was conducted across 21 fokontany (administrative units) in Antananarivo. Of 2,518 surveyed households, 30.5% reported dog ownership, with 1,273 dogs recorded, yielding an estimated dog‑to‑human ratio of 1:9. The owned dog population was predominantly male (63.6%), with a median age of three years. Survival analysis in the selected study site indicated a median lifespan of 4.4 years and an annual mortality hazard of 16%. Vaccination coverage was low: 64.2% of owned dogs had never been vaccinated, primarily due to owners' time constraints, lack of awareness about the need for dog rabies vaccination, and financial barriers. Ownership was positively associated with household location and size, household head's age, education and income. No significant difference in bite risk was observed between dog‑owning and non‑dog‑owning households, whereas households with children under 15 years experienced a significantly higher risk. Rabies elimination among the owned dog population in Antananarivo requires sustained, context‑adapted interventions that address high population turnover. Annual city‑wide dog vaccination campaigns combining door‑to‑door strategies with fixed‑point sites are suggested to increase the chances of reaching a larger share of the owned dog population. Public health efforts must also prioritize paediatric bite prevention and expand access to post‑exposure prophylaxis to contribute to the global goal of eliminating dog‑mediated human rabies by 2030.