Improving awareness of rabies and free-roaming dogs in schools of Guwahati, Assam, India: exploring the educators’ perspective

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Despite ongoing interventions in schools to increase awareness about rabies and free-roaming dogs (FRD), the incidence of dog bites and rabies cases among schoolchildren continues to rise. This study addresses the limitations of existing awareness programs by exploring educators' perspectives and proposing innovative, feasible, and cost-effective interventions in schools. Methods A three-day workshop involving 19 teachers from seven schools representing diverse socio-economic backgrounds followed a modified Delphi method to achieve consensus on interventions identified during the process. Results The workshop recommends (a) promoting awareness in morning assemblies, (b) starting a wall magazine on One Health, (c) distributing and displaying information, education, and communication (IEC) materials, (d) encouraging infographics, paintings, sketches, and reels, (e) integrating rabies-related topics in co-curricular activities, (f) initiating interdisciplinary projects focusing on rabies awareness (g) displaying in rabies awareness stalls during exhibitions/school functions, and (h) discussing in parent-teachers meets. Conclusions This study identifies sustainable and pedagogically sound interventions to raise awareness about rabies and FRD in schools, contributing to the broader goal of reducing rabies-related mortality among school children Rabies school children modified Delphi awareness One Health public health veterinary health pedagogical techniques Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Dog-mediated rabies is a neglected tropical disease and a serious health concern in endemic countries such as India, which accounts for one-third of the global human rabies mortality and significant economic losses annually ( 1 , 2 ). The ‘Zero by 30’ campaign, a tripartite initiative by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (WOAH), aims to eliminate human deaths from dog-mediated rabies by 2030 using One Health approach through a multi-sectoral collaboration including the education sector ( 3 ). Although post-exposure prophylaxis (PEP) can prevent human deaths, addressing the disease in dogs through vaccination and movement control is paramount to prevent and control human rabies ( 4 ). Additionally, enhancing awareness about the disease among vulnerable populations such as economically disadvantaged communities and schoolchildren is essential ( 3 , 5 ). Approximately 40% of rabies-related deaths comprise children below 15 years of age, indicating the necessity of rabies interventions in schools ( 6 ). Schoolchildren face an elevated risk of exposure to rabies because of their spontaneous amicable attitudes toward dogs ( 6 – 8 ). Smaller families and working parent’s children tend to seek the company of FRD to address their loneliness ( 9 ). The vulnerability of children to dog bites and potential rabies exposure is also attributable to shorter heights and physical weakness compared to adults ( 10 , 11 ). Due to short height, most bites are in proximity to the cranium which allows faster manifestation of the disease ( 12 , 13 ). The inability of children to recognise dog's behavioural cues ( 14 , 15 ) and provocative actions, such as stone pelting, increase the risk of dog bites ( 7 ). The limited understanding of rabies transmission and reluctance to communicate the exposures to parents or teachers, fearing admonition or ridicule from parents and peers often results in delayed or no reporting of potential rabies exposures ( 10 , 16 , 17 ). The fear of injections also discourages children from reporting exposure ( 11 , 18 ). The natural affectionate relationship between children and dogs requires appropriate and adequate education for children and adults to stymie the high mortality among children ( 7 , 16 ). Enhancing awareness about rabies and promoting responsible dog ownership reduces children's dog-bite-related rabies risk ( 19 ). Several government and non-governmental organisations (NGOs) engage schools to raise awareness about dog-mediated rabies ( 16 ), and awareness-enhancing measures in schools are an integral constituent of national rabies control plans ( 20 , 21 ). Such initiatives have been implemented in many countries such as the Communities Against Rabies Exposure (CARE) Project (Philippines), ‘Rabies Edutainment 4 Kids’ campaign (Sri Lanka), ‘BARK-Be Aware, Responsible, and Kind’ (USA), and programs in the Philippines supporting the inclusion of rabies education in school curricula ( 22 – 25 ). In India, education on rabies in schools featured prominently in the rabies control programs in Sikkim and Goa ( 20 , 26 , 27 ). There are significant limitations of the awareness interventions in schools as they are primarily sporadic and need sustainability in a vast country such as India ( 28 , 29 ). While results of direct interventions in schools are available, it is reported that such one-time efforts have a watered-down impact ( 23 ). Additionally, most knowledge, attitudes, and practices (KAP) assessment studies on rabies focus on adults ( 30 ), and the gaps in children’s understanding still need to be adequately addressed. The existing school interventions use conventional methods and need innovation to engage students effectively ( 31 ). The sporadicity of interventions often ignores the need to reinforce the information over time ( 24 ). In addition, direct school interventions tend to be resource-intensive requiring time and equipment commitment for adequate impact, limiting their applicability in economically constrained settings ( 32 ). As the awareness programs are unidirectional and instructional, the school’s involvement remains inactive lacking the element of inclusivity that is crucial for a meaningful engagement ( 33 ). The schools play only a marginal or inert role as external entities such as NGOs or other stakeholders run the awareness programs. The key influencers in the schools are the teachers, but they remain bystanders during such programs that undermines the sustainability of the awareness efforts ( 34 ). Moreover, studies recommended implementing regular awareness programs ideally on a quarterly or semi-annual basis as one-time external interventions may lose their impact over time ( 35 , 36 ). Therefore, innovative, continued, and sustainable interventions are required in schools for effective impact ( 31 , 37 ). A transition towards participatory and interactive interventions, where schoolteachers as pedagogical experts share the responsibility, can address this gap ( 38 ). Our hypothesis suggests that a participatory approach based on intervention tools developed by schoolteachers will lead to better knowledge acquisition by the students and seamless integration of rabies awareness into school activities. As professionals, schoolteachers are versed in pedagogical techniques, and interventions introduced and actively supported by schoolteachers (an indirect approach) are presumably more impactful than the existing one-time awareness measures (direct approach) by the external players. Before comparing the direct and indirect interventions, it's imperative to identify pedagogical tools that are impactful, sustainable, and aligned with the school’s existing resources. Here, we report workshop findings to identify consensus-based, resource-efficient pedagogical tools for diverse background schools to bridge existing gaps. The workshop aimed to develop easily actionable interventions for enhancing rabies awareness in schools without requiring significant economic or personnel investments. Methods 2.1 Study Design and workshop structure: A modified Delphi involving pedagogical experts (schoolteachers) in a workshop organised from 19th to 21st September 2023 was employed to build consensus to rank interventions that help improve awareness about dog-mediated rabies and FRD among schoolchildren. The schools were selected from ward number 5, 6, and 8 of Maligaon, Guwahati Municipal Corporation (GMC) (Fig. 1 ). The school authorities nominated participating schoolteachers as directed by the Inspector of Schools, Kamrup Metro District (Supplementary file 1). A ' discussion document' was shared with all teachers a week before the workshop to apprise the participants on the topic (Supplementary file 2). The participating teachers were asked to rate, (a) socio-economic standing; (b) level of infrastructure and resources, and (c) level of student-teacher interaction of their respective schools, on a scale from 1 to 10. 2.2 Structure of the workshop: The three-day workshop included invitational talks on 'Introducing rabies', 'Rabies and Children', 'Dogs: historical, socio-cultural perspective', '21st-century skills for promoting rabies eradication', 'Introducing existing awareness tools (IEC)', narrating 'Individual experiences with FRD/rabies', and the discussions on, 'How are we fighting rabies in India?' by resource persons representing the different stakeholders such as academia, human health, veterinary, animal welfare organization, and the municipal corporation who were present throughout the workshop. The likely causes of children's vulnerability to dog bites, and rabies were discussed using case studies of human and animal rabies. A focus group discussion, individual rating of each intervention, followed by consensus building discussion among the experts was conducted. 2.3 Data Analysis: Key priorities were listed following (a) a literature search, (b) focus group discussion among experts, and (c) suggestions from the moderators during the workshop. The participants then identified two interventions to accomplish each priority. The proposed interventions were then ranked by a two-dimensional iterative process where each participant assessed the intervention on a scale of 10, plotting the impact of the proposed intervention against its feasibility. A consensus was ensured for final position of the plot by mutual agreement among participants. The flow chart elucidating the process is presented in Fig. 2 . The ranking of each intervention was established based on the relative distance or their proximity from the extreme top-right corner of the graph. Those plots that were farther from the top-right corner received lower rankings, while those closer received higher rankings. Finally, the participants reassessed the rankings, and a consensus among experts was reached by accommodating disagreements about the final rankings. The plots and the final ranking of the interventions are depicted in Fig. 3 . . 2.4 Ethical approval: Ethical approval was granted by the Institute Human Ethics Committee of IIT Guwahati (IITEC/2024/IIT/P/). A consent for willingness to participate was obtained from each participant. Results The workshop was attended by 19 teachers from seven schools of diverse socio-economic backgrounds. Descriptive details of the participants and schools are presented in Table 1. A majority of teachers were females (79%), taught languages and sciences (32% each), and came from public schools (68%). A high level of teacher-student interaction was reported with 15 (79%) of teachers scoring 7-10 on the scale of 10. The socio-economic backdrop of the schools was rated evenly with 10 (53%) teachers rating their school as low and 9 (47%) high socio-economic categories respectively. Table 1: Description of participating schools and schoolteachers in the workshop from 19 th to 21 st September 2023 for developing pedagogical tools to enhance awareness about dog-mediated rabies and free-roaming dogs among schoolchildren. Characteristics of participants and schools Number (%) Nature of participating school Public school 13 (68%) Private school 6 (32%) Subjects taught by participating schoolteachers Sciences (including Mathematics) 6 (32%) Humanities 4 (21%) Languages 6 (32%) Co-curricular subjects (Music, sports, Art) 3 (16%) Gender Male 4 (21%) Female 15 (79%) Students’ interaction with the participating teachers* 0-3 1 (5%) 4-6 3 (16%) 7-10 15 (79%) Socio-economic backdrop of the schools * Low 10 (53%) Middle 9 (47%) High 0 School infrastructure* 0-3 6 (32%) 4-6 11(58%) 7-10 2 (10%) *Ratings are based on the self-assessment by teachers scored on a scale of 0-10 A total of nine priorities and two corresponding interventions were identified, of which the ’One Health’ priority was introduced by the workshop moderators, while others evolved spontaneously by the teachers (Figure 4) . Supporting the use of IEC materials, one of the participants commented: "If we use IEC materials in the school, it will be informative for the students, and we can also discuss the topic in the morning assembly." The concerns about the availability of IEC were mitigated by another participant who suggested: "I think we can select the best paintings from painting competitions and good quality content from digital media projects to create IEC materials, it will also motivate and involve students effectively." The interdisciplinary projects were advocated by a participant who suggested: "We have been thinking about assigning projects where students can integrate the disciplines of social sciences, biology, and statistics in a combined way." Another participant suggested engaging students in educational exhibitions by saying: "Students are expected to put up stalls on various topics during science exhibitions, and they can be assigned to display on rabies ... that way other students could have easy learning and awareness on rabies." The participants were equivocal over the inclusion of the topic of rabies and e-learning modules in the academic curriculum as one of the experts remarked: "Adding the subject to the curriculum requires a long, complicated process that includes much paperwork at government, which I anticipate could potentially take much time for execution." The sentiment was supplemented by another participant who lamented resources and skills deficiency in schools: "Our school has no computer at all. How can we adopt an e-learning module? ... and there are no computer-literate teachers in the school." The top eight interventions according to the impact-feasibility ranking from the list of eighteen interventions are presented in Table 2 . Table 2: The top-eight interventions identified in the workshop organized on 19 th to 21 st September 2023 for developing pedagogical tools to enhance awareness about dog-mediated rabies and free-roaming dogs among schoolchildren. Sl. No. Top eight interventions 1 Promoting students' activities in morning assemblies. 2 Creating a dedicated wall magazine for One Health as the application to dog-mediated rabies. 3 Distributing and prominently displaying Information, Education, and Communication (IEC) materials. 4 Encouraging students to design paintings, infographics, and visual content related to rabies. 5 Semi-structured integration of rabies topics into co-curricular activities (Debate, storytelling, etc.). 6 Implementing interdisciplinary projects addressing rabies awareness. 7 Establishing informational corners during school functions focused on rabies. 8 Promoting discussions about rabies in parent-teacher meetings. Discussion This workshop highlights the interventions and implied priorities for enhanced awareness of rabies and FRD among schoolchildren in India, irrespective of the respective school’s socioeconomic standing. The listed interventions (Table 2) can be a game-changer in improving awareness of rabies and FRD among students and reducing mortality in children less than 15 years of age due to the disease. Unlike traditional Delphi, where the anonymity of the experts is paramount (39), a modified method that traded unanimity for anonymity was used that facilitated discussion among experts and encouraged them to express their opinions freely in an open forum as the Indian social fabric promotes free argumentation (40). The strategy ensured that the final rankings of the interventions were based on consensus and incidentally required minimal input for their implementation, contrary to existing ones(23). The initial sessions of the workshop comprised talks, presentations, group discussions, and experience-sharing on rabies and FRD to help overcome mutual inhibitions and allow open conversation among experts (41,42). It ensured all experts reached a levelled understanding of dog-mediated rabies and the importance of disease awareness among schoolchildren. Such a participatory approach involving experts as stakeholders helps to identify interventions that can have long-term impacts on students (31). Interestingly, consensus-driven priorities and corresponding interventions turned out to be low or no-cost activities that prevail upon the resource constraints and infrastructure deficiencies of schools. For example, incorporating talks and discussions on the topic of rabies, citing dog-related quotes in morning assemblies, promoting paintings or story-telling during co-curricular activities, and introducing interdisciplinary projects can be ensured within the realms of existing resources (43,44). These interventions ensure the dissemination of information about the risks of rabies exposure with the active participation of students and teachers (33). Establishing dedicated rabies information stalls during school functions and distributing information, education, and communication (IEC) materials periodically is evidenced to improve understanding of the disease as demonstrated by educational interventions for HIV and filariasis in Egypt and India, respectively resulting in long-term compliance (45,46). In Sikkim, India, IEC materials played an important role in schools to effectively increase knowledge and awareness of rabies(27). Further, school-based educational programs on rabies proved to be effective in Sri Lanka and the Philippines to improve the knowledge of school children(23,47). Leveraging existing school resources and encouraging students to create IEC materials during painting competitions, or digital media projects is a viable option to mitigate the concerns over the lack of availability of the former as shown during the focused suicide prevention initiative for young adults that was developed based on input from college students in India (48). To involve students in creating informative and educational material through a wall magazine that focuses on the broader concept of 'One Health’ augurs well for dog-mediated rabies which warrants a comprehensive collaborative approach for its prevention, control, and elimination (49,50). Interestingly, although ‘One Health’ was introduced by moderators as a priority, the experts were unanimous on the interventions suggested to accomplish the One Health approach (initiate interdisciplinary projects). In fact, the sentiment of integrating One Health principles into education aligns with local religious and cultural beliefs, as one of the participants mentioned parallels with the symbolic representations of the bull, snake, and tiger belonging to the same family of a deity in India. The presence of such cultural acceptance makes it easy for the at-risk population to understand the framework of One Health to address zoonoses in general, including dog-mediated rabies (51). The intervention, 'discussing rabies and FRD in the parent-teacher meetings' underscores social involvement and sharing of responsibility to improve behaviour and attitude in children towards FRD thereby accelerating schoolchildren's learning by promoting discussion on health-related topics at home and fostering community involvement in health education initiatives (52). The proposed intervention of erecting stalls or booths during exhibitions and school functions to advocate positive attitudes towards FRD and spread awareness is novel, and despite initial scepticism among experts about its practicality, it found a place in the list of top eight interventions. The outcome of the workshop in the form of consensus-driven interventions reflects a pragmatic and contextually relevant approach to advancing knowledge about rabies and FRD as part of health education within school settings and requiring minimal external aid. Increased awareness can bring behavioural change in children resulting in a significant decrease in animal bite incidences as evidenced in the Philippines (24). Some seemingly important interventions failed to make it to the top eight after the consensus-building process lacked unanimity. Those worth the mention here included, ‘following a structured educational approach by incorporating the topic in the academic curriculum’, ‘involvement with animal welfare organisations’, ‘forming animal-friendly student communes or clubs’, and ‘promoting e-learning modules’. A structured educational intervention is effective in promoting sustained awareness by including the topic in the academic curriculum (32), the process involves long winding decision-making involving bureaucratic rigmaroles that delay implementation. On the contrary, a semi-structured approach can be implemented immediately using the existing school infrastructure and requires minimal approvals to ensure continuity in awareness efforts. Moreover, mere inclusion in the curricula may not be effective in the face of a shortage of resources and skills (24,53). Surprisingly, in this digital age, 'access to online information' as an intervention did not rank high. The non-availability of television screens in schools was the prime reason that renders activities requiring visual aids inefficient (54,55). The online e-learning modules were not ranked high as experts felt that creating them requires substantial investment, and require computer-literate teachers (56,57). The reluctance to prioritise e-learning highlights the computer literacy equity challenges in Indian schools, especially among economically disadvantaged ones. Despite its effectiveness (55,58), e-learning's feasibility is also hampered by insufficient technology infrastructure, including limited internet access and smartphone usage (59). These challenges are accentuated by lack of the pedagogues' computer or digital skills. There is a need for a context-specific and resource-appropriate approach to rabies awareness among children, as mentioned by Allensworth et al. regarding health education initiatives in the United States (60). The introduction of e-learning modules could be effective in schools of higher socio-economic status, and the reluctance of experts to rank it high could be because their respective schools were rated low or medium on infrastructure. The remote location of the schools presumably poses a challenge in identifying and inviting subject experts, particularly in specialised areas such as rabies (6,61). Further, activities mandated by the state education department take precedence over additional activities such as disease awareness to be taken up (62). Moreover, potential funding difficulties (29,63) in organising hands-on activities and logistical constraints of student visitations to animal welfare centres may limit the applicability of suggested interventions. Some approaches that appear theoretically logical, and their feasible implementation weigh heavily on existing resources, infrastructure, and logistical realities within school environments (64). The interventions must be evidence-based and contextually sensitive for students (65). As Murray et.al (34), emphasised, active engagement in learning is more important than limitations of socio-economic settings to derive maximum impact. The workshop successfully listed contextually relevant interventions for immediate implementation in schools, and it is only imperative that the gains of employing the interventions are assessed in future KAP studies. A limitation of the workshop is that despite a diverse panel of pedagogues, the involvement of critical stakeholders like the health and veterinary departments, policymakers, and politicians, who play vital roles in resource allocation and leading change in the education sector were not involved. Moreover, the outcomes represent observations from a single state in India, and their applicability to the rest of India needs further research. Finally, recruitment and response biases may have influenced the findings, highlighting the need for broader participation in future consensus-building exercises. Future studies should strive for greater engagement and geographic representation across diverse stakeholder groups to enhance the validity and applicability of the outcomes. Conclusions The workshop identified feasible interventions to address the existing gaps to improve rabies awareness in schools. These measures evolved based on their potential impact and applicability, through a collaborative approach to build consensus using the expertise of teachers from schools representing varied socioeconomic backgrounds. The identified interventions are economically feasible, ensure school and community engagement, and are immediately implementable. Declarations Ethics approval and consent to participate: Ethical approval was granted by the Institute Human Ethics Committee of IIT Guwahati (IITEC/2024/IIT/P/). A consent for willingness to participate was obtained from each participant. Consent for publication: Not applicable Availability of data and materials: The datasets analysed for the current study are available from the corresponding author upon request. Competing interests: The authors declare that there are no competing interests regarding the publication of this article. Funding: This work was supported by DBT Wellcome Trust India Alliance Intermediate Fellowship to Harish Kumar Tiwari (IA/CPH/21/1/505957) Authors' contributions: PM: data collection, curation, and analysis, original draft; SD: conceptualisation, review; SH: conceptualisation, review; AS: resource person, review; HKT: conceptualisation; data analysis, review, editing, supervision, funding acquisition. Acknowledgments: The Inspector of Schools, Kamrup Metro District; Principals of participating schools; Host school: Ms. Mitra Som Saha, Mr. Satirtha Saha; Resource persons: Dr. Nayanjeet Choudhury, Dr. Smriti Rekha Dutta, Dr. Prasanta Boro; Representatives of Guwahati Municipal Corporation (GMC); Team members: Ms. Sounika Karmakar, Mr. Dipankar Gogoi; Participants: Ms. Anamika Bose, Ms. Antara Chanda, Ms. Arpana Das, Ms. Ashma Khanam, Ms. Banti Bhattacharjee, Mr. Biswajit Goswami, Mr. Chittaranjan Mahanta, Ms. Dipali Medhi, Ms. Jutika Deka, Ms. Krishna Devi, Ms. Madhusmita Chaudhary, Ms. Mallika Das, Ms. Nazneen Begum, Ms. Parama Sharma, Ms. Pranita Devi, Ms. Priyanka Das, Ms. Parbeen Sultana, Mr. Shashadhar Kakati, Ms. Shatabdi Dey, Ms. Tapan Kumar Das. References Khairullah AR, Kurniawan SC, Hasib A, Silaen OSM, Widodo A, Effendi MH, et al. Tracking lethal threat: in-depth review of rabies. Open Vet J. 2023 Nov;13(11):1385–99. 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The workshop as a qualitative research approach: lessons learnt from a “critical thinking through writing” workshop. The Turkish Online Journal of Design, Art and Communication. 2018 Aug 22;September 2018(Special edition):1504–10. Kuan G, Abdullah N, Kueh YC, Ismail M, Shafei MN, Morris T. Co-Curricular Activities and Motives for Participating in Physical Activity among Health Sciences Students at Universiti Sains Malaysia, Malaysia. Malays J Med Sci. 2019 Jan;26(1):138–46. Kontak J, Macrae C, Caldwell H, Feicht B, Heath S, Friesen C, et al. The process of student engagement in school health promotion: A scoping review. 2023. Zython Paul T. Lachica. School Based Information and Education Campaign Program. 2021 [cited 2024 Apr 6]; Available from: https://www.scribd.com/document/616582630/School-Based-Information-and-Education-Campaign-Program Amer H, Nady S. School based educational intervention to raise awareness of students about HIV/AIDS disease. Journal of Nursing Education and Practice. 2019 Jul 15;9:67. Lachica ZP, Ang JD, Dy PD, Arrieta CY, Ong A, Mata MA, et al. School-based Information and Education Campaign (IEC) Program and Knowledge Gain of Student Participants on Rabies in a Private School in Davao City, Philippines. Philipp J Sci [Internet]. 2021 Jun 28 [cited 2024 Apr 11];150(5). Available from: https://philjournalsci.dost.gov.ph/publication/regular-issues/past-issues/108-vol-150-no-5-october-2021/1451-school-based-information-and-education-campaign-iec-program-and-knowledge-gain-of-student-participants-on-rabies-in-a-private-school-in-davao-city-philippines Dasgupta M, Meena KSM, Krishnamurthy L, Bhola P, Bordoloi S, Yadav C, et al. Development of an IEC resource (brochure) on suicide prevention for college students: A qualitative study in the Indian context. Journal of Education and Health Promotion [Internet]. 2023 [cited 2024 Apr 11];12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10670952/ Acharya KP, Subedi D, Wilson RT. Rabies control in South Asia requires a One Health approach. One Health. 2021 Jan 19;12:100215. Acharya KP, Acharya N, Phuyal S, Upadhyaya M, Lasee S. One-health approach: A best possible way to control rabies. One Health. 2020 Dec 1;10:100161. Weiss MG, Agashe M, Gupte MD. The concept of One Health: Cultural context, background & prospects in India. Indian J Med Res. 2021 Mar;153(3):333–7. Islam A. Parent–teacher meetings and student outcomes: Evidence from a developing country. European Economic Review. 2019 Jan 1;111:273–304. Gul R, Khilji G. Exploring the need for a responsive school curriculum to cope with the Covid-19 pandemic in Pakistan. Prospects (Paris). 2021;51(1–3):503–22. Kundu A. Barriers to Utilizing ICT in Education in India with a Special Focus on Rural Areas. 2018. Mhlongo S, Mbatha K, Ramatsetse B, Dlamini R. Challenges, opportunities, and prospects of adopting and using smart digital technologies in learning environments: An iterative review. Heliyon. 2023 Jun 1;9(6):e16348. Joshi P, Dewangan D. Impact And Development Of Online Education (E- Learning) In India. Journal of Contemporary Issues in Business and Government. 2021 Mar 27;27:2021. Ray P. Web based e-learning in india: the cumulative views of different aspects. Indian Journal of Computer Science and Engineering. 2010 Dec 1;1. Haleem A, Javaid M, Qadri MA, Suman R. Understanding the role of digital technologies in education: A review. Sustainable Operations and Computers. 2022 Jan 1;3:275–85. Jafar K, Ananthpur K, Venkatachalam L. Digital divide and access to online education: new evidence from Tamil Nadu, India. J Soc Econ Dev. 2023 Mar 20;1–21. Allensworth, Allensworth D, Lawson E, Nicholson L, Wyche J. Building the Infrastructure for Comprehensive School Health Programs. In: Schools & Health: Our Nation’s Investment [Internet]. National Academies Press (US); 1997 [cited 2024 Apr 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK232699/ Radhakrishnan S, Vanak AT, Nouvellet P, Donnelly CA. Rabies as a Public Health Concern in India—A Historical Perspective. Tropical Medicine and Infectious Disease. 2020 Dec;5(4):162. Koirikivi P, Kuusisto A, Kallioniemi A. Discussing school celebrations from an intercultural perspective - a study in the Finnish context. Intercultural Education. 2014 Jul 1;25:255–68. Jakasania A, Lahariya C, Pandya C, Raut A, Sharma R, K S, et al. School Health Services in India: Status, Challenges and the Way Forward. Indian Journal of Pediatrics. 2023 Sep 26;90. Storey KE, Montemurro G, Flynn J, Schwartz M, Wright E, Osler J, et al. Essential conditions for the implementation of comprehensive school health to achieve changes in school culture and improvements in health behaviours of students. BMC Public Health. 2016 Nov 2;16(1):1133. Pulimeno M, Piscitelli P, Colazzo S, Colao A, Miani A. School as ideal setting to promote health and wellbeing among young people. Health Promot Perspect. 2020 Nov 7;10(4):316–24. Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1.pdf Cite Share Download PDF Status: Published Journal Publication published 20 Feb, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 24 May, 2024 Submission checks completed at journal 23 May, 2024 Editor assigned by journal 23 May, 2024 First submitted to journal 19 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4445527","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306309526,"identity":"115ee762-adba-490e-9648-c5d96ecfbffd","order_by":0,"name":"Parimala Mohanty","email":"","orcid":"","institution":"Indian Institute of Technology Guwahati","correspondingAuthor":false,"prefix":"","firstName":"Parimala","middleName":"","lastName":"Mohanty","suffix":""},{"id":306309528,"identity":"30a29fdd-9faf-4b32-9cb0-a0078eb1e58a","order_by":1,"name":"Salome Durr","email":"","orcid":"","institution":"Veterinary Public Health Institute, University of Bern","correspondingAuthor":false,"prefix":"","firstName":"Salome","middleName":"","lastName":"Durr","suffix":""},{"id":306309530,"identity":"cb0bb2f8-59e1-4254-9d52-50a47ad9fd16","order_by":2,"name":"Samira Heydtmann","email":"","orcid":"","institution":"University of Zurich","correspondingAuthor":false,"prefix":"","firstName":"Samira","middleName":"","lastName":"Heydtmann","suffix":""},{"id":306309535,"identity":"f2d53b3d-6c7a-471f-8b0b-65e4d62a2c7a","order_by":3,"name":"Amrita Sarkar","email":"","orcid":"","institution":"Tomo Riba Institute of Health and Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Amrita","middleName":"","lastName":"Sarkar","suffix":""},{"id":306309540,"identity":"2dc914e8-db17-406f-87a3-b5cf03e6b4e0","order_by":4,"name":"Harish Kumar Tiwari","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACAwbGBiAlIQdmJxhAhRPwaWGDaDGGajEgRguETmwAaYFgAsBcvrlN4ucei/Tts5s3MDwo+GPXwH74AcPDHbi1WLYxtkn2PJPInXPnWAHIYckNPGkGDIln8DjsGGPbDZ4DErkzJHLAfklmYMgBurMNv5abfw5IpEvAtfC/IazlNtCWBJgWOwYJgrYktv+WOSBhOEMireBAgoFxApvEM4MDeLUcPv7Y8M2BOnkJieSND3/8kbPn509++PAnHi0o4AAD1EkHiNQAAfYkqR4Fo2AUjIIRAQDq3Uy2aj+VUQAAAABJRU5ErkJggg==","orcid":"","institution":"Indian Institute of Technology Guwahati","correspondingAuthor":true,"prefix":"","firstName":"Harish","middleName":"Kumar","lastName":"Tiwari","suffix":""}],"badges":[],"createdAt":"2024-05-19 19:55:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4445527/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4445527/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-21892-4","type":"published","date":"2025-02-20T15:57:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57943562,"identity":"da12c020-43ba-4f30-82a3-85e66352536e","added_by":"auto","created_at":"2024-06-07 19:06:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":194342,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLocations of the participating schools in the workshop organized in Kamrup, Assam, India from 19\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e to 21\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003est\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e September 2023 for developing pedagogical tools to enhance awareness about dog-mediated rabies and free-roaming dogs among schoolchildren.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4445527/v1/43ee56f497110f9f7893f080.png"},{"id":57943563,"identity":"0095f314-ba2b-4d17-af29-d79caa834206","added_by":"auto","created_at":"2024-06-07 19:06:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":482890,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe three-stage modified Delphi was adopted to identify and rank interventions to enhance awareness about dog-mediated rabies and free-roaming dogs in schoolchildren, applied during the workshop organized in Kamrup, Assam, India from 19\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e to 21\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003est\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e September 2023.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4445527/v1/f6975719f0aab3cdcdd2dd84.png"},{"id":57943669,"identity":"fe6022bb-8c09-43c1-a23d-50c63dd57b9f","added_by":"auto","created_at":"2024-06-07 19:06:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":716913,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA depiction of the iterative process adopted for the modified Delphi ranking of the interventions based on impact (y-axis) and feasibility (x-axis) during the workshop in Kamrup, Assam, India 19\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e to 21\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003est\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e September 2023 for developing pedagogical tools to enhance awareness about dog-mediated rabies and free-roaming dogs among schoolchildren.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4445527/v1/dcb927149f72456942b2be00.png"},{"id":57943588,"identity":"2103a392-d937-45d4-9871-dc63c889a6e7","added_by":"auto","created_at":"2024-06-07 19:06:26","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":218438,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe priorities and interventions identified in the workshop organized on 19\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e to 21\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003est\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e September 2023 for developing pedagogical tools to enhance awareness about dog-mediated rabies and free-roaming dogs among schoolchildren. Eight top-ranked interventions were selected to be implemented in select schools.\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4445527/v1/a5419e25018a4ee1083bf134.png"},{"id":77058230,"identity":"b32ea026-3b4d-4a3b-849b-e0a12b5c8a85","added_by":"auto","created_at":"2025-02-24 16:55:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3059564,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4445527/v1/15c99a0a-f18f-476a-b6d9-eb4eebdd71cd.pdf"},{"id":57943667,"identity":"9efce879-75f4-4fca-b989-c9d348dd870f","added_by":"auto","created_at":"2024-06-07 19:06:38","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":443699,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4445527/v1/b501f5e32d625b389ce0a3f0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Improving awareness of rabies and free-roaming dogs in schools of Guwahati, Assam, India: exploring the educators’ perspective","fulltext":[{"header":"Background","content":"\u003cp\u003eDog-mediated rabies is a neglected tropical disease and a serious health concern in endemic countries such as India, which accounts for one-third of the global human rabies mortality and significant economic losses annually (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The \u0026lsquo;Zero by 30\u0026rsquo; campaign, a tripartite initiative by the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (WOAH), aims to eliminate human deaths from dog-mediated rabies by 2030 using One Health approach through a multi-sectoral collaboration including the education sector (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although post-exposure prophylaxis (PEP) can prevent human deaths, addressing the disease in dogs through vaccination and movement control is paramount to prevent and control human rabies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Additionally, enhancing awareness about the disease among vulnerable populations such as economically disadvantaged communities and schoolchildren is essential (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eApproximately 40% of rabies-related deaths comprise children below 15 years of age, indicating the necessity of rabies interventions in schools (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Schoolchildren face an elevated risk of exposure to rabies because of their spontaneous amicable attitudes toward dogs (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Smaller families and working parent\u0026rsquo;s children tend to seek the company of FRD to address their loneliness (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The vulnerability of children to dog bites and potential rabies exposure is also attributable to shorter heights and physical weakness compared to adults (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Due to short height, most bites are in proximity to the cranium which allows faster manifestation of the disease (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The inability of children to recognise dog's behavioural cues (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and provocative actions, such as stone pelting, increase the risk of dog bites (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The limited understanding of rabies transmission and reluctance to communicate the exposures to parents or teachers, fearing admonition or ridicule from parents and peers often results in delayed or no reporting of potential rabies exposures (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The fear of injections also discourages children from reporting exposure (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The natural affectionate relationship between children and dogs requires appropriate and adequate education for children and adults to stymie the high mortality among children (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEnhancing awareness about rabies and promoting responsible dog ownership reduces children's dog-bite-related rabies risk (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Several government and non-governmental organisations (NGOs) engage schools to raise awareness about dog-mediated rabies (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and awareness-enhancing measures in schools are an integral constituent of national rabies control plans (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Such initiatives have been implemented in many countries such as the Communities Against Rabies Exposure (CARE) Project (Philippines), \u0026lsquo;Rabies Edutainment 4 Kids\u0026rsquo; campaign (Sri Lanka), \u0026lsquo;BARK-Be Aware, Responsible, and Kind\u0026rsquo; (USA), and programs in the Philippines supporting the inclusion of rabies education in school curricula (\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In India, education on rabies in schools featured prominently in the rabies control programs in Sikkim and Goa (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are significant limitations of the awareness interventions in schools as they are primarily sporadic and need sustainability in a vast country such as India (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). While results of direct interventions in schools are available, it is reported that such one-time efforts have a watered-down impact (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Additionally, most knowledge, attitudes, and practices (KAP) assessment studies on rabies focus on adults (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), and the gaps in children\u0026rsquo;s understanding still need to be adequately addressed. The existing school interventions use conventional methods and need innovation to engage students effectively (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The sporadicity of interventions often ignores the need to reinforce the information over time (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In addition, direct school interventions tend to be resource-intensive requiring time and equipment commitment for adequate impact, limiting their applicability in economically constrained settings (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). As the awareness programs are unidirectional and instructional, the school\u0026rsquo;s involvement remains inactive lacking the element of inclusivity that is crucial for a meaningful engagement (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The schools play only a marginal or inert role as external entities such as NGOs or other stakeholders run the awareness programs. The key influencers in the schools are the teachers, but they remain bystanders during such programs that undermines the sustainability of the awareness efforts (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Moreover, studies recommended implementing regular awareness programs ideally on a quarterly or semi-annual basis as one-time external interventions may lose their impact over time (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Therefore, innovative, continued, and sustainable interventions are required in schools for effective impact (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). A transition towards participatory and interactive interventions, where schoolteachers as pedagogical experts share the responsibility, can address this gap (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Our hypothesis suggests that a participatory approach based on intervention tools developed by schoolteachers will lead to better knowledge acquisition by the students and seamless integration of rabies awareness into school activities. As professionals, schoolteachers are versed in pedagogical techniques, and interventions introduced and actively supported by schoolteachers (an indirect approach) are presumably more impactful than the existing one-time awareness measures (direct approach) by the external players. Before comparing the direct and indirect interventions, it's imperative to identify pedagogical tools that are impactful, sustainable, and aligned with the school\u0026rsquo;s existing resources. Here, we report workshop findings to identify consensus-based, resource-efficient pedagogical tools for diverse background schools to bridge existing gaps. The workshop aimed to develop easily actionable interventions for enhancing rabies awareness in schools without requiring significant economic or personnel investments.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and workshop structure:\u003c/h2\u003e \u003cp\u003eA modified Delphi involving pedagogical experts (schoolteachers) in a workshop organised from 19th to 21st September 2023 was employed to build consensus to rank interventions that help improve awareness about dog-mediated rabies and FRD among schoolchildren. The schools were selected from ward number 5, 6, and 8 of Maligaon, Guwahati Municipal Corporation (GMC) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The school authorities nominated participating schoolteachers as directed by the Inspector of Schools, Kamrup Metro District (Supplementary file 1). A \u003cem\u003e'\u003c/em\u003ediscussion document' was shared with all teachers a week before the workshop to apprise the participants on the topic (Supplementary file 2). The participating teachers were asked to rate, (a) socio-economic standing; (b) level of infrastructure and resources, and (c) level of student-teacher interaction of their respective schools, on a scale from 1 to 10.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Structure of the workshop:\u003c/h2\u003e \u003cp\u003eThe three-day workshop included invitational talks on 'Introducing rabies', 'Rabies and Children', 'Dogs: historical, socio-cultural perspective', '21st-century skills for promoting rabies eradication', 'Introducing existing awareness tools (IEC)', narrating 'Individual experiences with FRD/rabies', and the discussions on, 'How are we fighting rabies in India?' by resource persons representing the different stakeholders such as academia, human health, veterinary, animal welfare organization, and the municipal corporation who were present throughout the workshop. The likely causes of children's vulnerability to dog bites, and rabies were discussed using case studies of human and animal rabies. A focus group discussion, individual rating of each intervention, followed by consensus building discussion among the experts was conducted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data Analysis:\u003c/h2\u003e \u003cp\u003eKey priorities were listed following (a) a literature search, (b) focus group discussion among experts, and (c) suggestions from the moderators during the workshop. The participants then identified two interventions to accomplish each priority. The proposed interventions were then ranked by a two-dimensional iterative process where each participant assessed the intervention on a scale of 10, plotting the impact of the proposed intervention against its feasibility. A consensus was ensured for final position of the plot by mutual agreement among participants. The flow chart elucidating the process is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe ranking of each intervention was established based on the relative distance or their proximity from the extreme top-right corner of the graph. Those plots that were farther from the top-right corner received lower rankings, while those closer received higher rankings. Finally, the participants reassessed the rankings, and a consensus among experts was reached by accommodating disagreements about the final rankings. The plots and the final ranking of the interventions are depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003e2.4 Ethical approval:\u003c/strong\u003e Ethical approval was granted by the Institute Human Ethics Committee of IIT Guwahati (IITEC/2024/IIT/P/). A consent for willingness to participate was obtained from each participant.\u0026nbsp;\u003c/p\u003e\n"},{"header":"Results","content":"\u003cp\u003eThe workshop was attended by 19 teachers from seven schools of diverse socio-economic backgrounds. Descriptive details of the participants and schools are presented in Table 1. \u0026nbsp;A majority of teachers were females (79%), taught languages and sciences (32% each), and came from public schools (68%). \u0026nbsp;A high level of teacher-student interaction was reported with 15 (79%) of teachers scoring 7-10 on the scale of 10. The socio-economic backdrop of the schools was rated evenly with 10 (53%) teachers rating their school as low and 9 (47%) high socio-economic categories respectively. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Description of participating schools and schoolteachers in the workshop from 19\u003csup\u003eth\u003c/sup\u003e to 21\u003csup\u003est\u003c/sup\u003e September 2023 for developing pedagogical tools to enhance awareness about dog-mediated rabies and free-roaming dogs among schoolchildren. \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"590\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Characteristics of participants and schools\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNature of participating school\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003ePublic school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e13 (68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003ePrivate school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e6 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubjects taught by participating schoolteachers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eSciences (including Mathematics)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e6 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eHumanities\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e4 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eLanguages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e6 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eCo-curricular subjects (Music, sports, Art)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e3 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e4 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e15 (79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudents\u0026rsquo; interaction with the participating teachers*\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003e0-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e1 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003e4-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e3 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003e7-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e15 (79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-economic backdrop of the schools *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e10 (53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eMiddle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e9 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool infrastructure*\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003e0-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e6 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003e4-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e11(58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"71.35593220338983%\" valign=\"top\"\u003e\n \u003cp\u003e7-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.64406779661017%\" valign=\"top\"\u003e\n \u003cp\u003e2 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e*Ratings are based on the self-assessment by teachers scored on a scale of 0-10\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of nine\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003epriorities and two corresponding interventions were identified, of which the \u0026rsquo;One Health\u0026rsquo; priority was introduced by the workshop moderators, while others evolved spontaneously by the teachers \u003cstrong\u003e(Figure 4)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eSupporting the use of IEC materials, one of the participants commented: \u003cem\u003e\u0026quot;If we use IEC materials in the school, it will be informative for the students, and we can also discuss the topic in the morning assembly.\u0026quot;\u0026nbsp;\u003c/em\u003e The concerns about the availability of IEC were mitigated by another participant who suggested: \u003cem\u003e\u0026quot;I think we can select the best paintings from painting competitions and good quality content from digital media projects to create IEC materials, it will also motivate and involve students effectively.\u0026quot;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe interdisciplinary projects were advocated by a participant who suggested: \u003cem\u003e\u0026quot;We have been thinking about assigning projects where students can integrate the disciplines of social sciences, biology, and statistics in a combined way.\u0026quot;\u003c/em\u003e Another participant suggested engaging students in educational exhibitions by saying: \u003cem\u003e\u0026quot;Students are expected to put up stalls on various topics during science exhibitions, and they can be assigned to display on rabies ... that way other students could have easy learning and awareness on rabies.\u0026quot;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe participants were equivocal over the inclusion of the topic of rabies and e-learning modules \u0026nbsp; in \u0026nbsp; the academic curriculum as one of the experts remarked: \u003cem\u003e\u0026quot;Adding the subject to the curriculum requires a long, complicated process that includes much paperwork at government, which I anticipate could potentially take much time for execution.\u0026quot;\u003c/em\u003e\u0026nbsp; The sentiment was supplemented by another participant who lamented resources and skills deficiency in schools: \u003cem\u003e\u0026quot;Our school has no computer at all. How can we adopt an e-learning module? ... and there are no computer-literate teachers in the school.\u0026quot;\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe top eight interventions according to the impact-feasibility ranking from the list of eighteen interventions are presented in \u003cstrong\u003eTable 2\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: The top-eight interventions identified in the workshop organized\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eon 19\u003csup\u003eth\u003c/sup\u003e to 21\u003csup\u003est\u003c/sup\u003e September 2023 for developing pedagogical tools to enhance awareness about dog-mediated rabies and free-roaming dogs among schoolchildren. \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"674\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSl. No.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTop eight interventions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003ePromoting students\u0026apos; activities in morning assemblies.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003eCreating a dedicated wall magazine for One Health as the application to dog-mediated rabies.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003eDistributing and prominently displaying Information, Education, and Communication (IEC) materials.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003eEncouraging students to design paintings, infographics, and visual content related to rabies.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003eSemi-structured integration of rabies topics into co-curricular activities (Debate, storytelling, etc.).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003eImplementing interdisciplinary projects addressing rabies awareness.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003eEstablishing informational corners during school functions focused on rabies.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.6053412462908%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"91.3946587537092%\" valign=\"top\"\u003e\n \u003cp\u003ePromoting discussions about rabies in parent-teacher meetings.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eThis workshop highlights the interventions and implied priorities for enhanced awareness of rabies and FRD among schoolchildren in India, irrespective of the respective school\u0026rsquo;s socioeconomic standing. The listed interventions (Table 2) can be a game-changer in improving awareness of rabies and FRD among students and reducing mortality in children less than 15 years of age due to the disease. \u0026nbsp;Unlike traditional Delphi, where the anonymity of the experts is paramount\u0026nbsp;(39), a modified method that traded unanimity for anonymity was used that facilitated discussion among experts and encouraged them to express their opinions freely in an open forum as the Indian social fabric promotes free argumentation\u0026nbsp;(40). The strategy ensured that the final rankings of the interventions were based on consensus and incidentally required minimal input for their implementation, contrary to existing ones(23). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe initial sessions of the workshop comprised talks, presentations, group discussions, and experience-sharing on rabies and FRD to help overcome mutual inhibitions and allow open conversation among experts\u0026nbsp;(41,42). It ensured all experts reached a levelled understanding of dog-mediated rabies and the importance of disease awareness among schoolchildren. Such a participatory approach involving experts as stakeholders helps to identify interventions that can have long-term impacts on students\u0026nbsp;(31).\u003c/p\u003e\n\u003cp\u003eInterestingly, consensus-driven priorities and corresponding interventions turned out to be low or no-cost activities that prevail upon the resource constraints and infrastructure deficiencies of schools. For example, incorporating talks and discussions on the topic of rabies, citing dog-related quotes in morning assemblies, promoting paintings or story-telling during co-curricular activities, and introducing interdisciplinary projects can be ensured within the realms of existing resources\u0026nbsp;(43,44). These interventions ensure the dissemination of information about the risks of rabies exposure with the active participation of students and teachers\u0026nbsp;(33). Establishing dedicated rabies information stalls during school functions and distributing information, education, and communication (IEC) materials periodically is evidenced to improve understanding of the disease as demonstrated by educational interventions for HIV and filariasis in Egypt and India, respectively resulting in long-term compliance\u0026nbsp;(45,46). In Sikkim, India, IEC materials played an important role in schools to effectively increase knowledge and awareness of rabies(27). Further, school-based educational programs on rabies proved to be effective in Sri Lanka and the Philippines to improve the knowledge of school children(23,47). Leveraging existing school resources and encouraging students to create IEC materials during painting competitions, or digital media projects is a viable option to mitigate the concerns over the lack of availability of the former as shown during the focused suicide prevention initiative for young adults that was developed based on input from college students in India\u0026nbsp;(48). To involve students in creating informative and educational material through a wall magazine that focuses on the broader concept of \u0026apos;One Health\u0026rsquo; augurs well for dog-mediated rabies which warrants a comprehensive collaborative approach for its prevention, control, and elimination\u0026nbsp;(49,50). Interestingly, although \u0026lsquo;One Health\u0026rsquo; was introduced by moderators as a priority, the experts were unanimous on the interventions suggested to accomplish the One Health approach (initiate interdisciplinary projects). In fact, the sentiment of integrating One Health principles into education aligns with local religious and cultural beliefs, as one of the participants mentioned parallels with the symbolic representations of the bull, snake, and tiger belonging to the same family of a deity in India. The presence of such cultural acceptance makes it easy for the at-risk population to understand the framework of One Health to address zoonoses in general, including dog-mediated rabies\u0026nbsp;(51).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The intervention, \u0026apos;discussing rabies and FRD in the parent-teacher meetings\u0026apos; underscores social involvement and sharing of responsibility to improve behaviour and attitude in children towards FRD thereby accelerating schoolchildren\u0026apos;s learning by promoting discussion on health-related topics at home and fostering community involvement in health education initiatives\u0026nbsp;(52). The proposed intervention of erecting stalls or booths during exhibitions and school functions to advocate positive attitudes towards FRD and spread awareness is novel, and despite initial scepticism among experts about its practicality, it found a place in the list of top eight interventions. The outcome of the workshop in the form of consensus-driven interventions reflects a pragmatic and contextually relevant approach to advancing knowledge about rabies and FRD as part of health education within school settings and requiring minimal external aid. Increased awareness can bring behavioural change in children resulting in a significant decrease in animal bite incidences as evidenced in the Philippines\u0026nbsp;(24).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome seemingly important interventions failed to make it to the top eight after the consensus-building process lacked unanimity. Those worth the mention here included, \u0026lsquo;following a structured educational approach by incorporating the topic in the academic curriculum\u0026rsquo;, \u0026lsquo;involvement with animal welfare organisations\u0026rsquo;, \u0026lsquo;forming animal-friendly student communes or clubs\u0026rsquo;, and \u0026lsquo;promoting e-learning modules\u0026rsquo;. A structured educational intervention is effective in promoting sustained awareness by including the topic in the academic curriculum\u0026nbsp;(32), the process involves long winding decision-making involving bureaucratic rigmaroles that delay implementation. On the contrary, a semi-structured approach can be implemented immediately using the existing school infrastructure and requires minimal approvals to ensure continuity in awareness efforts. Moreover, mere inclusion in the curricula may not be effective in the face of a shortage of resources and skills\u0026nbsp;(24,53). Surprisingly, in this digital age, \u0026apos;access to online information\u0026apos; as an intervention did not rank high. The non-availability of television screens in schools was the prime reason that renders activities requiring visual aids inefficient\u0026nbsp;(54,55). The online e-learning modules were not ranked high as experts felt that creating them requires substantial investment, and require computer-literate teachers\u0026nbsp;(56,57). The reluctance to prioritise e-learning highlights the computer literacy equity challenges in Indian schools, especially among economically disadvantaged ones. Despite its effectiveness\u0026nbsp;(55,58), e-learning\u0026apos;s feasibility is also hampered by insufficient technology infrastructure, including limited internet access and smartphone usage\u0026nbsp;(59). These challenges are accentuated by lack of the pedagogues\u0026apos; computer or digital skills. There is a need for a context-specific and resource-appropriate approach to rabies awareness among children, as mentioned by Allensworth et al. regarding health education initiatives in the United States\u0026nbsp;(60). \u0026nbsp;The introduction of e-learning modules could be effective in\u0026nbsp;schools of higher socio-economic status, and the reluctance of experts to rank it high could be because their respective schools were rated low or medium on infrastructure. The remote location of the schools presumably poses a challenge in identifying and inviting subject experts, particularly in specialised areas such as rabies (6,61). Further, activities mandated by the state education department take precedence over additional activities such as disease awareness to be taken up (62). Moreover, potential funding difficulties (29,63) in organising hands-on activities and logistical constraints of student visitations to animal welfare centres may limit the applicability of suggested interventions. Some approaches that appear theoretically logical, and their feasible implementation weigh heavily on existing resources, infrastructure, and logistical realities within school environments (64). The interventions must be evidence-based and contextually sensitive for students (65). As Murray et.al (34), emphasised, active engagement in learning is more important than limitations of socio-economic settings to derive maximum impact.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe workshop successfully listed contextually relevant interventions for immediate implementation in schools, and it is only imperative that the gains of employing the interventions are assessed in future KAP studies. \u0026nbsp;A limitation of the workshop is that despite a diverse panel of pedagogues, the involvement of critical stakeholders like the health and veterinary departments, policymakers, and politicians, who play vital roles in resource allocation and leading change in the education sector were not involved. Moreover, the outcomes represent observations from a single state in India, and their applicability to the rest of India needs further research. Finally, recruitment and response biases may have influenced the findings, highlighting the need for broader participation in future consensus-building exercises. Future studies should strive for greater engagement and geographic representation across diverse stakeholder groups to enhance the validity and applicability of the outcomes.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe workshop identified feasible interventions to address the existing gaps to improve rabies awareness in schools. These measures evolved based on their potential impact and applicability, through a collaborative approach to build consensus using the expertise of teachers from schools representing varied socioeconomic backgrounds. \u0026nbsp;The identified interventions are economically feasible, ensure school and community engagement, and are immediately implementable. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Ethical approval was granted by the Institute Human Ethics Committee of IIT Guwahati (IITEC/2024/IIT/P/). A consent for willingness to participate was obtained from each participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analysed for the current study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that there are no competing interests regarding the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This work was supported by DBT Wellcome Trust India Alliance Intermediate Fellowship to Harish Kumar Tiwari (IA/CPH/21/1/505957)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePM: data collection, curation, and analysis, original draft; SD: conceptualisation, review; SH: conceptualisation, review; AS: resource person, review; HKT: conceptualisation; data analysis, review, editing, supervision, funding acquisition.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Inspector of Schools, Kamrup Metro District; Principals of participating schools; Host school: Ms. Mitra Som Saha, Mr. Satirtha Saha; Resource persons: Dr. Nayanjeet Choudhury, Dr. Smriti Rekha Dutta, Dr. Prasanta Boro; Representatives of Guwahati Municipal Corporation (GMC); Team members: Ms. Sounika Karmakar, Mr. Dipankar Gogoi; \u0026nbsp;Participants: Ms. Anamika Bose, Ms. Antara Chanda, Ms. Arpana Das, Ms. Ashma Khanam, Ms. Banti Bhattacharjee, Mr. Biswajit Goswami, Mr. Chittaranjan Mahanta, Ms. Dipali Medhi, \u0026nbsp;Ms. Jutika Deka, Ms. Krishna Devi, Ms. Madhusmita Chaudhary, Ms. Mallika Das, \u0026nbsp; Ms. Nazneen Begum, Ms. Parama Sharma, Ms. Pranita Devi, Ms. Priyanka Das, Ms. Parbeen Sultana, Mr. Shashadhar Kakati, Ms. Shatabdi Dey, Ms. Tapan Kumar Das.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKhairullah AR, Kurniawan SC, Hasib A, Silaen OSM, Widodo A, Effendi MH, et al. 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Health Promot Perspect. 2020 Nov 7;10(4):316\u0026ndash;24. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Rabies, school children, modified Delphi, awareness, One Health, public health, veterinary health, pedagogical techniques","lastPublishedDoi":"10.21203/rs.3.rs-4445527/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4445527/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRabies poses a significant threat to public health in India, with schoolchildren comprising approximately 40% of mortality due to this zoonotic disease. Despite ongoing interventions in schools to increase awareness about rabies and free-roaming dogs (FRD), the incidence of dog bites and rabies cases among schoolchildren continues to rise. This study addresses the limitations of existing awareness programs by exploring educators' perspectives and proposing innovative, feasible, and cost-effective interventions in schools.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA three-day workshop involving 19 teachers from seven schools representing diverse socio-economic backgrounds followed a modified Delphi method to achieve consensus on interventions identified during the process.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe workshop recommends (a) promoting awareness in morning assemblies, (b) starting a wall magazine on One Health, (c) distributing and displaying information, education, and communication (IEC) materials, (d) encouraging infographics, paintings, sketches, and reels, (e) integrating rabies-related topics in co-curricular activities, (f) initiating interdisciplinary projects focusing on rabies awareness (g) displaying in rabies awareness stalls during exhibitions/school functions, and (h) discussing in parent-teachers meets.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study identifies sustainable and pedagogically sound interventions to raise awareness about rabies and FRD in schools, contributing to the broader goal of reducing rabies-related mortality among school children\u003c/p\u003e","manuscriptTitle":"Improving awareness of rabies and free-roaming dogs in schools of Guwahati, Assam, India: exploring the educators’ perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-07 19:05:45","doi":"10.21203/rs.3.rs-4445527/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-24T10:02:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-23T07:53:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-23T07:53:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-05-19T19:54:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2932c41-486b-4b04-aeb9-0430cf4bee3e","owner":[],"postedDate":"June 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:55:06+00:00","versionOfRecord":{"articleIdentity":"rs-4445527","link":"https://doi.org/10.1186/s12889-025-21892-4","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-02-20 15:57:34","publishedOnDateReadable":"February 20th, 2025"},"versionCreatedAt":"2024-06-07 19:05:45","video":"","vorDoi":"10.1186/s12889-025-21892-4","vorDoiUrl":"https://doi.org/10.1186/s12889-025-21892-4","workflowStages":[]},"version":"v1","identity":"rs-4445527","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4445527","identity":"rs-4445527","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}