Rabies is a devastating yet preventable disease that causes around 59,000 human deaths annually. Almost all human rabies cases are caused by bites from rabies-infected dogs. A large proportion of these cases occur in Sub Saharan Africa (SSA). Annual vaccination of at least 70% of the dog population is recommended by the World Health Organisation in order to eliminate rabies. However, achieving such high vaccination coverage has proven challenging, especially in low resource settings. Despite being logistically and economically more feasible than door-to-door approaches, static point (SP) vaccination campaigns often suffer from low attendance and therefore result in low vaccination coverage. Here, we investigated the barriers to attendance at SP offering free rabies vaccinations for dogs in Blantyre, Malawi. We analysed data for 22,924 dogs from a city-wide vaccination campaign in combination with GIS and household questionnaire data using multivariable logistic regression and distance estimation techniques. We found that distance plays a crucial role in SP attendance (i.e. for every km closer the odds of attending a SP point are 3.3 times higher) and that very few people are willing to travel more than 1.5 km to bring their dog for vaccination. Additionally, we found that dogs from areas with higher proportions of people living in poverty are more likely to be presented for vaccination (ORs 1.58-2.22). Furthermore, puppies (OR 0.26), pregnant or lactating female dogs (OR 0.60) are less likely to be presented for vaccination. Owners also reported that they did not attend an SP because they were not aware of the campaign (27%) or they could not handle their dog (19%). Our findings will inform the design of future rabies vaccination programmes in SSA which may lead to improved vaccination coverage achieved by SP alone.

狂犬病是一种毁灭性但可预防的疾病，每年导致约 59,000 人死亡。几乎所有人类狂犬病病例都是由感染狂犬病的狗咬伤引起的。其中很大一部分病例发生在撒哈拉以南非洲 (SSA)。世界卫生组织建议每年至少对 70% 的狗进行疫苗接种，以消除狂犬病。然而，事实证明，实现如此高的疫苗接种覆盖率具有挑战性，特别是在资源匮乏的环境中。尽管在后勤和经济上比挨家挨户的方法更可行，但静态点 (SP) 疫苗接种活动往往因出席率低而导致疫苗接种覆盖率低。在这里，我们调查了马拉维布兰太尔 SP 为狗提供免费狂犬病疫苗接种的障碍。我们使用多变量逻辑回归和距离估计技术，结合 GIS 和家庭问卷数据，分析了全市疫苗接种活动中 22,924 只狗的数据。我们发现，距离对于 SP 出勤率起着至关重要的作用（即，距离每近一公里，前往 SP 点的几率就会增加 3.3 倍），并且很少有人愿意携带狗前往超过 1.5 公里的地方进行疫苗接种。此外，我们发现来自贫困人口比例较高地区的狗更有可能接受疫苗接种（OR 1.58-2.22）。此外，小狗（OR 0.26）、怀孕或哺乳期的母犬（OR 0.60）不太可能接受疫苗接种。业主还表示，他们没有参加 SP 活动，因为他们不知道这项活动 (27%) 或他们无法照顾自己的狗 (19%)。我们的研究结果将为 SSA 未来狂犬病疫苗接种计划的设计提供信息，这可能会导致仅通过 SP 就能提高疫苗接种覆盖率。