Using causal loop analysis to explore pathways for zoonosis control in low-income setting: The case of dog rabies vaccination in Burkina Faso

Dog vaccination is an effective pathway to control rabies if a minimum of 70% dog vaccination coverage is achieved. For more than six decades, dog vaccination has been adopted as part of the rabies control measures in Burkina Faso. However, the required vaccination coverage in canine population remains challenging and rabies endemic. This study describes the use of systems thinking to explore the dynamics arising from dog vaccination complexity and explain the possibles causes of low vaccination coverage in the dog population. In-depth interviews were conducted in three administrative regions and included various stakeholders. A thematic analysis was performed to analyze the obtained narratives. Subsequently, causal loop diagrams (CLDs) were developed, depicting the causes of low dog vaccination coverage. The CLDs were composed of reinforcing loops and balancing loops, visualizing how different variables including social, economic, technical, political and organizational factors that affect the implementation of rabies vaccination in the country are causally interrelated. Overall, the results revealed the importance of community awareness raising, strengthening the vaccination workforce, enhanced governance and leadership in the dynamics of dog vaccination. The study calls for wide consideration of all drivers and factors that may affect dog vaccination coverage, for the development of any rabies control strategy or vaccination program. Beyond the dog vaccination problem, the methods and findings from this study could be applied to other critical rabies-related questions such as postexposure prophylaxis, epidemiological surveillance, dog population management, laboratory diagnosis, and the One Health collaboration issues, to understand and improve rabies control.