Issaka Tiembré^{1, 2,}, Coulibaly Adama³, Techi Sopi Mathilde², Djoman Christiane^{1, 2}, Taha Raymond⁴, John Tra⁵, Dagnan N'Cho Simplice¹

Since 2008, Côte d'Ivoire has recognized rabies as a notifiable disease and, in 2017, elevated it to one of the country's top five priority zoonoses. Despite the implementation of various measures and initiatives, the battle against rabies has been an ongoing struggle. This study aims to answer the question: What model, tailored to the unique characteristics of rabies and mortality determinants, can be recommended to expedite the progress towards its elimination in Côte d'Ivoire? The study introduces an integrated rabies control model specifically adapted to the disease's characteristics. The research was conducted through a mixed cross-sectional study spanning from January to September 2023. Data collection involved interviews, document reviews, and a narrative review of all rabies-related publications in Côte d'Ivoire from 2018 to 2023. Ethical guidelines were adhered to, including administrative approval, informed consent, and the preservation of confidentiality. The primary challenges identified in the fight against rabies in Côte d'Ivoire encompassed low dog vaccination rates, limited public awareness about the disease, and inadequate access to Post-Exposure Prophylaxis (PEP). A problem tree analysis elucidated the factors contributing to mortality, with a primary focus on insufficient dog vaccination coverage and inadequate public knowledge, leading to suboptimal PEP utilization. The proposed model to expedite rabies elimination in Côte d'Ivoire comprises a set of interventions designed to enhance PEP utilization while concurrently increasing dog vaccination coverage. Key elements of the model include bolstering geographical and financial accessibility, enhancing public knowledge, and instilling a sense of communal responsibility in the battle against rabies. In the absence of control over the disease's primary reservoir and vector, the integrated model of rabies control promotes the systematic implementation of PEP before any exposure to rabies, combined with extensive public awareness campaigns and improved PEP accessibility.

Problem tree, integrated model, rabies control, Côte d'Ivoire