Study area
The study was conducted in Mekelle city, Tigray Region, Northern Ethiopia. Mekelle city is the capital city of Tigray Region and it is found about 783 km far from Addis Ababa. According to the projected census of 2007 Ethiopian Fiscal Year, the city had a total population of 340,589. The city is divided into seven administrative sub cities namely: Hawelti, Hadnet, Ayder, Semen, Kedamay weyane, Adihaki, and Quiha.
Study design and study period
A community based cross-sectional study was conducted from October 3, 2016 to November 29, 2016.
Sample size determination
The sample size was calculated using single population proportion formula. Assuming the proportion of knowledge level 83%, attitude level 52.3%, and practice level 67% [8] with 5% margin of error, 95% confidence level, and 1.5 design effect, the calculated sample size for knowledge, attitude and practice were 217, 383 and 340 respectively.
Therefore, the larger sample size among the knowledge, attitude and practice is taken as appropriate which is 383. Then, the sample size 383 is multiplied by 1.5 design effect (385*1.5=575) and 10% none response rate was added to 575. Finally, the final sample size was determined to be 633.
Sampling procedure
Mekelle city has seven sub cities namely Hawelti, Hadnet, Ayder, Semen, Kedamay weyane, Adihaki, and Quiha. Among the seven sub cities, two were selected using the simple random sampling technique (lottery method), namely Kedamay weyane (with four kebelles) and Ayder (with five kebelles). Two kebelles for each sub city (total four kebelles) were selected for the study by lottery method (Figure 1).
The selected kebelles were Harya and Walita from Kedamay weyane sub city and Gunibet 20 and Seritse from Ayder sub city. Therefore, the total sample size was proportionally allocated to the four kebelles based on six months living in the kebelles (Figure 1). Therefore, the study participants were household heads. List of the households or each kebelles were found from the respective sub city administrative. The first household was selected randomly between 1-13 using lottery method, then the first household to be included in the sample was the fifth household, then every 13th households was selected. In case, a selected household's head was not found at home, a second visit was made by appointment.
Data collection procedure
A pretested structured questionnaire (Additional file 1) was used. The questionnaire was initially prepared in English and translated in to local language (Tigrigna) and again retranslated back to English to check for any inconsistencies or distortions in the meaning of words and concepts. Face to face interview was the technique of data collection. For administering the interview, four diploma nurses as data collectors and one health officer as supervisor were recruited.
Twenty three questions (eight knowledge, seven attitude and eight practice) were asked for each participant regarding cause, sources and mode of transmissions, attitude, practice and prevention and control measures about rabies. The questions to assess knowledge and practice were in type of a response of either “Yes” or “No” for each question. Whereas for attitude questions, the likert scale method with a five points scale (strongly agree, agree, no opinion, disagree, strongly disagree) responses were used to allow the study participants to express how much they agree or disagree with a particular statement. Responses with strongly agree and agree had got one mark, while responses with disagree and strongly disagree had got zero mark. For a participant with a response of “no opinion”, we exclude the question from the summing of the overall score for the participant.
Participant’s response for the knowledge, attitude and practice questions were counted and scored separately. This score was then pooled together and the mean score was computed to determine knowledge, attitude and practice of respondents.
Respondents who score greater than or equal to the mean value (Mean=5.5, SD=1.96) grouped to good knowledge and less than the mean value poor knowledge level, respondents who score greater than or equal to the mean value (Mean=4.6, SD=1.36) grouped to positive attitude and less than the mean value negative attitude level, respondents who score greater than or equal to the mean value (Mean=1.9, SD=1.6) grouped to good practice and less than the mean value poor practice level.
Data quality control
A structured questionnaire was pretested on 5% sample size outside of the study area, in Enderta District, for consistent understanding of the survey. Close supervision was undertaken during data collection. Questionnaire was checked for completeness and consistency before data entry by the principal investigator.
Data management and Analysis
All collected data were entered to EPI-info version 3.5.4 and exported to SPSS version 20 statistical software for analysis. Data were coded and cleaned for completeness and consistency. Descriptive and Bivariate analyses were computed to see the frequency distribution and to test whether there was association between dependent and independent variables respectively. Binary logistic regression model was used for analysis. The factors associated with knowledge, attitude and practice of rabies at bivariate binary logistic regression analysis were identified and variables with p-value of 0.20 and less were fit to logistic model for multivariable analysis to determine relative prediction level of independent variables to the outcome variable. P-value less than 0.05 were considered as statistically significant and hence adjusted odds ratio were reported to show strength of association.
Ethical consideration
Ethical clearance was obtained from the Ethical Review Board of Institute of Public Health, College of Medicine and Health Science, University of Gondar with a reference number of IPH/2284/09/2016. Official permission was obtained from Tigray Regional Health Bureau, Mekelle Zone, Kedamay weyane and Ayder sub cities. All study participants were adult and verbal consent was obtained from each study participant to confirm willingness for participation after explaining the objective of the study. Confidentiality of the information was maintained throughout by excluding names and keeping their privacy during the interview, by interviewing them alone. Participants had the right to withdraw at any time from the interview.
Operational definition
Good knowledge: respondents who scored points at mean and above for the knowledge questions prepared were referred to be having good knowledge otherwise not.
Positive attitude: respondents who scored points at mean and above for the attitude questions were referred to be having a positive attitude otherwise not.
Good practice: respondents who scored points at mean and above for the practice questions were referred to be having a good practice otherwise not.
Kebelle: is the smallest administrative unit of Ethiopia.