Children zoonoses and ill-health perceptions: lessons for rabies in Bhutan

Abstract BackgroundThe perception of illness and health seeking behaviors differs from one culture to another including rabies. Depending on the cultural setting of the society in which people live, definition for causal factors of illness may ranges from modern biological causes to supernational causes which greatly influence subsequent health seeking behavior. To ensure best health practices and planning effective health intervention strategies including rabies, we explored how school children and adult health and education professionals perceive the causes of illness and their associated health seeking behaviors in southern Bhutan.MethodsWe collected quantitative data related to causes of illness and health seeking practices of the school children using questionnaire survey. Qualitative data were collected through focus group discussions and key informant interviews from the education and health communities that closely associated with school children. Descriptive analysis was performed for the qualitative data collected from school children and thematic analysis were performed for the qualitative data collected from community members that closely interact with students.Results School children associated the causes of illness with microorganisms (n=526, 75%), bad karmic actions n=118, 16.8%), spirits (n=67, 9.6%) and black magic practices (n=64, 9.1%). They further indicated that these illnesses can be treated through medical intervention by visiting hospitals (n=687, 98%), performing rituals (n=414, 59.1%), and seeking traditional treatments practices (n=131, 18.8%). Similarly, the education and health professional surveyed in the study associated illnesses with bio-physical causes (e.g. microorganisms), supernatural or religious related causes (e.g. spirits, deities) and social causes (e.g. taboos, family problems). In addition to the allopathic medicines, most of the participants indicated the importance of performing religious healing practices to cure the illness. However, most respondents were well aware of the need for allopathic treatments for rabies, such as washing of the bite wound with soap and water and anti-rabies vaccine injection. Conclusion There is need for the consideration of socio-cultural context in the planning and implementation of health-related policies, including rabies prevention program in Bhutan, associating traditional healers and religious entities with “One Health” public health sectors.