Public Health Official Interview Survey - English

Form Approved

OMB No. 0920-1011

Exp. Date 03/31/2017

Evaluation of Dog Bite Surveillance and Rabies Vaccine Systems in Haiti – Public Health Official

Semi-Structured Key Stakeholder Interview Questions

Public Health Officials

1. ORGANIZATIONAL DESCRIPTION & TRAINING

1. Education: □ Undergraduate Degree □ Master’s Degree □ Professional Degree

□ Other ____________________________________________________

2. Position / Title: ______________________________________________

3. Years in Service at Center _____________________________________

4. What are your job duties? (Use questions below to guide discussion. Note main content of discussion)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1. What disease conditions do you oversee? __________________________________

2. How many bite reports do you investigate per month? _______________________

3. How long does bite investigation take? ____________________________________

4. How many rabies suspect animals do you investigate per month? ______________

5. How many suspect human rabies cases do you investigate per month? __________

6. Do you evaluate animals for signs of disease? Yes, No

7. Do you submit animals to a laboratory for rabies testing? Yes, No

1. How many per month? __________________

2. Which laboratory? ______________________

*Ask for an organizational chart

5. Who in your organization is responsible for investigation of dogs involved in bite events?

1. I am responsible

If another person, may we contact them to discuss bite surveillance activities?

2. Name: ___________________________

3. Position Title: _____________________

4. What are their qualifications?______________________________________________________

5. What are their job duties?_________________________________________________________

6. What percentage of their job activities are rabies related? _______________________________

6. How many dog bite reports did DELR receive from January 1, 2015 – July 1, 2015?

Number: ___________

*Can we have a list of all bite reports by hospital in your commune?

7. Are persons at the commune and department health posts, who are responsible for dog bite investigations, required to be vaccinated against rabies?

Yes [1] No [2] Don’t know [6]

8. Do persons responsible for dog bite investigations receive training in safe dog capture?

Yes [1] No [2] Don’t know [6]

9. Do persons responsible for dog bite investigations receive training in dog sedation?

Yes [1] No [2] Don’t know [6]

10. Do persons responsible for dog bite investigations receive training to euthanize dogs?

Yes [1] No [2] Don’t know [6]

11. Do persons responsible for dog bite investigations receive training in rabies sample collection?

Yes [1] No [2] Don’t know [6]

12. What equipment do you provide for persons responsible for assessment of rabies suspect dogs? (READ ALL, mark all that apply)

1. Leather gloves

2. Control Pole

3. Syringe Pole

4. Gun

5. Machete

6. Leashes

7. Muzzles

8. Nets

9. Face shields

10. Syringes

11. Medications for sedation

12. Medications for euthanasia

Other supplies, please list: ______________________________________________________________________________________________________________________________________________________________________________

13. Are there facilities in Haiti to confine a dog for up to 14 days?

Yes [1] No [2] Don’t Know [6]

*if yes, please request a list of locations for these facilities

Inter-Ministerial Collaborations

14. For which zoonotic diseases does MSPP formally collaborate with MARNDR?

15. Which mechanisms does DELR use to formally report dog bites to MARNDR? (READ ALL, mark all that apply. Ask for names of persons responsible for reporting)

1. No formal mechanisms exist

2. In person

3. By phone

4. By text message

5. By email

6. By Fax

7. By electronic surveillance platform

8. Through a shared electronic system

Other: ______________________________________________________________

16. Which mechanisms does DELR use to formally report animal rabies cases to MARNDR? (READ ALL, mark all that apply, record names of persons responsible for reporting)

1. No formal mechanisms exist

2. In person

3. By phone

4. By text message

5. By email

6. By Fax

7. By electronic surveillance platform

8. Through a shared electronic system

Other: ______________________________________________________________

17. Which mechanisms does DELR use to formally report human rabies cases to MARNDR? (READ ALL, mark all that apply, record names of persons responsible for reporting)

1. No formal mechanisms exist

2. In person

3. By phone

4. By text message

5. By email

6. By Fax

7. By electronic surveillance platform

8. Through a shared electronic system

Other: ______________________________________________________________

1. Please describe the National Sentinel Surveillance System in terms of structural organization and operation: (allow time for them to talk, record notes below)

1. What Ministry/Department oversees the NSSS? ______________________________________

2. How many disease conditions are considered reportable through NSSS? ___________________

3. Who oversees the following reportable conditions (name, title, and contact information)

   1. Dog bites

Name: ________________________________

Title: _________________________________

Contact information: ____________________ _________________________

2. Rabies Vaccine Usage

Name: ________________________________

Title: _________________________________

Contact information: ____________________ _________________________

3. Encephalitis

Name: ________________________________

Title: _________________________________

Contact information: ____________________ _________________________

4. Human Rabies

Name: ________________________________

Title: _________________________________

Contact information: ____________________ _________________________

2. DOG BITE SURVEILLANCE: REPORTING PRACTICES

1. What is the case definition for a reportable bite?

2. What is the case definition for a rabid animal?

3. What is the case definition for human encephalitis?

4. What is the case definition for human rabies?

5. Which of the following are reportable bites to the NSSS?

1. Dog bites

2. Cat bites

3. Rat bites

4. Goat bites

5. Cow bites

6. Snake bites

7. Mongoose bites

8. Bat bites

6. Is there a standardized form to report dog bites to MSPP/NSSS/DELR?

1. Yes 2. No 9. I don’t know

*if yes, please ask for a copy of a blank reporting form

7. If there is a bite surveillance form, is it available in paper or electronic format? (circle all that apply)

1. Paper 2. Electronic 9. I don’t know

8. From where do you receive reports of dog bites? (READ ALL RESPONSES, mark all answers that are affirmative)

1. Directly from medical providers

2. From Rabies Health Officers (MARNDR)

3. From Departmental health officers

4. From Commune Health Officers

5. From Commune Sanitation Officers

6. From Veterinarians

7. From the public

8. I don’t know

9. Other, please describe: _______________________________________________

9. How do you receive reports of dog bites? (READ ALL RESPONSES, mark all answers)

1. Phone Calls

2. A Standardized Form

3. Email/Faxes

4. A Web-based system

5. Mail

6. I don’t know

7. Other, please describe: __________________________________________________

10. Please describe the flow of bite reports, from the time they are recorded at a health facility, to when they are entered into NSSS. If a document exists that describes the flow of data request a copy.

1. List the institutions who should receive a copy of the bite report form (ie commune health department, department health office, DELR).

2. Are bite report forms submitted to these institutions simultaneous or step-wise? Describe reporting flow.

11. Under what circumstances do bite reports need to be submitted? (READ ALL, choose the one best)

1. Always 3. Only if the bite is severe 5. Only when giving PEP

2. Never 4. Only if I know the animal has rabies 6. I don’t know

7. Other _______________________________________________________________

12. When a dog bite report is completed, which organizations should receive a copy of the form? (READ ALL, mark all that apply)

    1. Commune health department

    2. Departmental health office

    3. Ministry of Health (MSPP)

    4. DPSPE – Zoonotic Disease Unit

    5. DELR

    6. Department of Epidemiology and Laboratory Resources (DELR)

    7. Ministry of Agriculture (MARNDR)

    8. Hospitals

    9. We do not report dog bites

    10. Other: ____________________________________________________________

13. How soon after notification of a bite victim should the bite report form be submitted to DELR/NSSS? (READ ALL, choose the one best.)

    1. Immediately

    2. By the end of my shift

    3. By the end of the day

    4. By the end of the week

    5. By the end of the month

    6. It doesn’t matter when I report

    7. I do not report

    8. Other: ________________________________________________________________

14. What methods are available for submission of bite report forms? (READ ALL, mark all that apply)

    1. Phone calls

    2. Mailed reports

    3. Hand delivered reports

    4. Faxed reports

    5. Emailed reports

    6. Electronic surveillance platform

    7. Other: ____________________________________________________________________

15. Are the forms used to track the bite victim’s treatment outcomes?

1. Yes 2. No 9. I don’t know

16. Are the forms analyzed to create epidemiologic summaries of bite events?

1. Yes 2. No 9. I don’t know

17. Does MSPP/DELR share summaries of bite reports with departmental or commune health departments?

1. Yes 2. No 9. I don’t know

1. Are there any other uses for bite reports? [OPEN ANSWER]

2. Are there any other tools or documents you use to record or track bite events?

3. BARRIERS TO REPORTING

1. Are there aspects of the bite form that are difficult to fill out? If yes, please explain.

2. What are some reasons that you have heard for NOT reporting a bite event to MSPP/ DELR (READ ALL ANSWERS, circle if answer is affirmative)

1. I did not know I was required to report bite events

2. I did not have time to fill out the form

3. I did not have time to send in the report

4. This health department does not report bite events

5. I did not have any bite surveillance forms

6. I do think reporting bites is important

7. Other reason, please describe: ________________________________________________________________________________________________________________________________________________

3. What are some reasons that have caused you to NOT report a bite event to the MARNDR Rabies Surveillance Officers (READ ALL ANSWERS, circle if answer is affirmative)

1. I did not know of this program

2. This program does not operate in my department

3. I did not have time to call the officer

4. I did not know how to contact the officer

5. This health department does not report bite events

6. I am not pleased with the work the surveillance officers have done in the past

7. Other reason, please describe: ______________________________________________________________________________________________________________________________________________

4. DOG BITE SURVEILLANCE: INVESTIGATIONS

1. Who are the people or organizations responsible for investigating dogs that have bitten people? (READ ALL, mark all that apply)

   1. Commune sanitation officers (if yes: always, sometimes, or rarely responsible?)

   2. Commune surveillance officers (if yes: always, sometimes, or rarely responsible?)

   3. Departmental health officers (if yes: always, sometimes, or rarely responsible?)

   4. MARNDR rabies officers (if yes: always, sometimes, or rarely responsible?)

   5. No one

   6. Other (describe): _________________________________________________________

   7. I do not know

2. What are some of the reasons to investigate dogs involved in bite events? (DO NOT READ, mark all that apply)

   1. To assess the dog for rabies virus infection

   2. To remove the aggressive dog from the community

   3. To identify other persons who may have been bitten by the same dog

   4. To determine if the persons bitten need rabies vaccine

   5. Because it is my job

   6. Dogs are not routinely investigated after a bite event

   7. Other reasons: __________________________________________________________________

4. Should investigators look for other people who may have been bitten by the same dog?

   1. Yes

   2. No

   3. Sometimes (describe): ____________________________________________________________________________________________________________________________________________

5. During an investigation of a dog bite, what should the investigators do to the dog? (READ ALL, mark all that apply)

1. Nothing is done to the dog

2. The dog is assessed for signs of illness

3. Healthy dogs are placed in observation for a certain number of days

4. Sick dogs are killed with a machete, stone, or stick

5. Sick dogs are sedated and euthanized with veterinary medications

6. Submit rabies suspect dogs to MARNDR for rabies testing

7. I don’t know

8. Other: _______________________

6. When department and commune health offices identify a rabid dog, who should they report it to? (READ ALL, mark all that apply)

1. commune health department

2. departmental health office

3. MSSP

4. DPSPE – Zoonotic Disease Unit

5. DELR

6. departmental agriculture office

7. MARNDR

8. I don’t know

9. We do not report rabid animals to anyone

7. When department and commune health offices identify a person with rabies, who should they report it to? (READ ALL, mark all that apply)

1. commune health department

2. departmental health office

3. MSSP

4. DPSPE – Zoonotic Disease Unit

5. DELR

6. Departmental agriculture office

7. MARNDR

8. I don’t know

9. We do not report rabid animals to anyone

5. POST EXPOSURE PROPHYLAXIS

1. Where does your institution get rabies vaccine from? (READ ALL, mark all that apply)

   1. International donations from governments

   2. International donations from Non-Government Organizations (WHO, PAHO, World Bank, etc)

   3. Purchased by Haitian Government

   4. Vaccine manufacturers

   5. Private companies

   6. Private Pharmacies

   7. I do not know

   8. We do not carry rabies vaccine

   9. Other: ___________________________________________________________

2. How much does rabies vaccine cost bite victims? (READ ALL, mark all that apply)

   1. It is free to all dog bite victims

   2. Sliding scale, based on how much the bite victim can afford

   3. Specify Total Cost One Vaccine Dose: $_______________

   4. I do not know

3. Does your institution currently have rabies vaccine available for bite victims?

1. Yes 2. No 9. I don’t know

Other ________________________________________________________

4. In the last six months, has your institution experienced a shortage of rabies vaccine?

1. Yes (describe circumstance): _________________________________________

2. No

3. Don’t know

5. Is there a standardized form to report rabies vaccine use to MSPP/DELR?

1. Yes 2. No 3. I don’t know

*if yes, please request a blank copy of the form

6. If there is a rabies vaccine form, is it available in paper or electronic format? (circle all that apply)

1. Paper 2. Electronic 9. I don’t know

7. When do institutions need to fill out a rabies vaccine form? (READ ALL, choose the one best)

1. After every dose administered 2. After the course is completed 3. Never

Other _______________________________________________________________

8. How soon after giving a rabies vaccine should the vaccine form be submitted to DELR? (READ ALL, choose the one best)

   1. Immediately

   2. Report by the end of my shift

   3. Report by the end of the day

   4. Report by the end of the week

   5. Report by the end of the month

   6. It doesn’t matter when I report

   7. Report after the person completes the course of vaccination

   8. I do not report

   9. I don’t know

9. Which organizations should receive a copy of the rabies vaccine form? (READ ALL, mark all that apply)

   1. Commune health department

   2. Departmental health office

   3. Ministry of Health (MSPP)

   4. DPSPE – Zoonotic Disease Unit

   5. DELR

   6. Hospitals

   7. We do not report dog bites

   8. Other: ____________________________________________________________

1. Which methods are available for submission of vaccine forms to DELR? (READ ALL, mark all that apply)Hand deliver

2. Phone Calls

3. Email/Faxes

4. A Web-based system

5. Mail

6. I don’t know

Other, please describe: _________________________________________________

10. Are the forms used to track the bite victim’s vaccination schedule?

1. Yes 2. No 9. I don’t know

11. Are the forms required to be submitted to DELR to receive more vaccine?

1. Yes 2. No 9. I don’t know

12. Does MSPP/DELR share summaries of rabies vaccine forms with health department?

1. Yes 2. No 9. I don’t know

13. Where you do distribute rabies vaccine to? (READ ALL, mark all that apply)

    1. Departmental health department

    2. Commune health departments

    3. Non-government organizations (MSF, etc)

    4. Private hospitals

    5. Government run hospitals

    6. Other: __________________________________________________

14. Are there any other uses for rabies vaccine forms? [OPEN ANSWER]

15. Are there any other tools or documents you use to record or track rabies vaccine usage?

16. Please describe how rabies vaccine usage is tracked

17. Please describe how rabies vaccine is distributed

18. Please describe how rabies vaccine institutions request rabies vaccine

19. Where does your institution get rabies immune globulin from? (READ ALL, mark all that apply)

    1. International donations from governments

    2. International donations from Non-Government Organizations (WHO, PAHO, World Bank, etc)

    3. Purchased by Haitian Government

    4. Vaccine manufacturers

    5. Private companies

    6. Private Pharmacies

    7. I do not know

    8. We do not carry rabies vaccine

    9. Other: ___________________________________________________________

20. What type of rabies immune globulin do you use?

    1. Human RIG

    2. Equine RIG

    3. Other: ___________________________________

21. How much does rabies immune globulin cost bite victims? (READ ALL, mark all that apply)

    1. It is free to all dog bite victims

    2. Sliding scale, based on how much the bite victim can afford

    3. Specify Cost per Vial: $_______________

    4. I do not know

22. Does your institution currently have rabies immune globulin available for bite victims?

1. Yes 2. No 9. I don’t know

23. In the last six months, has your institution experienced a shortage of rabies immune globulin?

1. Yes (describe circumstance): _________________________________________

2. No

3. Don’t know

24. When a provider gives rabies immune globulin does this need to be reported to anyone?

1. Yes 2. No 3. Don’t know

If Yes, who should rabies immune globulin usage be reported to? ________________________________________________________________________

25. PEP PROTOCOLS

1. When should the bite wound be washed with disinfectants (ie soap) and water?

1. Always

2. Sometimes

3. Never

4. Don’t know

5. Other: ____________________________________________________

2. When should Rabies Immune Globulin be administered to bite victims? (DO NOT READ, circle ONE best answer)

1. Always

2. Sometimes (describe) ________________________________________

3. Never

4. Don’t know

5. Other: ____________________________________________________

3. When should Rabies Vaccine be administered to bite victims? (DO NOT READ, circle ONE best answer)

1. Always

2. Sometimes (describe) ________________________________________

3. Never

4. Don’t know

5. Other: ____________________________________________________

4. Which rabies vaccine schedules are used (list days administered)? (DO NOT READ, circle all that apply)

1. 0, 3, 7, 14, 28

2. 0, 3, 7, 14

3. 2-1-1 (2x0, 7, 21)

4. Don’t know

5. Other _____________________________________________________

5. Which routes of rabies vaccine administration are used? (DO NOT READ, circle all that apply)

   1. Intramuscular

   2. Intradermal

   3. Subcutaneous

   4. Don’t know

   5. Other ___________________________________________________

26. Who is responsible to ensure that the bite victim completes the full course of rabies vaccination? (READ ANSWERS, mark all that apply)

    1. The bite victim or the victim’s family

    2. The Hospital

    3. The commune health department

    4. The departmental health office

    5. MSPP

    6. DPSPE – Zoonotic Disease Unit

    7. DELR

    8. No one is responsible

    9. I don’t know

    10. Other:____________________________________________________

6. Rabies Knowledge and Surveillance Attitudes

1. Which of the following animals can get rabies? (READ ALL, mark all that apply)

1. Cows Yes [1] No [2]

2. Goats Yes [1] No [2]

3. Pigs Yes [1] No [2]

4. Snakes Yes [1] No [2]

5. Dogs Yes [1] No [2]

6. Cats Yes [1] No [2]

7. Birds Yes [1] No [2]

8. Fish Yes [1] No [2]

2. What are the signs that a dog might have rabies? (Circle all that the interviewee states)

Lethargy [1] Lack of muscle control [5] Difficulty Breathing [9]

Fever [2] Weakness [6] Excessive Salivation [10]

Vomiting [3] Paralysis [7] Abnormal Behavior [11]

Anorexia [4] Seizures [8] Aggression [12]

3. Have you ever seen a rabid dog?

Yes [1] No [2] Unknown [3]

4. Have you ever seen a person with encephalitis?

Yes [1] No [2] Unknown [3]

5. How many cases of encephalitis were reported in Haiti in 2014?

Number: _________________

6. Have you ever seen a person with rabies?

Yes [1] No [2] Unknown [3]

7. How many rabies victims were reported in Haiti in 2014?

Number: _________________

Do you agree or disagree with these statements:

1. Rabies is a significant problem in dogs in Haiti

Agree [1] Disagree [2]

2. Rabies is a significant problem in people in Haiti

Agree [1] Disagree [2]

3. Rabies is easily diagnosed in a person based on clinical signs

Agree [1] Disagree [2]

4. All dog bite victims should receive rabies vaccination

Agree [1] Disagree [2]

5. Only persons bitten by sick dogs should receive rabies vaccination

Agree [1] Disagree [2]

6. Washing the wound, in the absence of vaccination, will prevent a person from getting rabies

Agree [1] Disagree [2]

7. Rabies vaccination consists of only one shot

Agree [1] Disagree [2]

8. Bite events are quickly investigated by:

   1. MSPP: Agree [1] Disagree [2] NA [3]

   2. Commune Health Officer: Agree [1] Disagree [2] NA [3]

   3. Sanitation Officer: Agree [1] Disagree [2] NA [3]

   4. MARNDR: Agree [1] Disagree [2] NA [3]

   5. Other:________________ Agree [1] Disagree [2] NA [3]

9. Results of animal investigations are routinely reported back to me when conducted by:

   1. MSPP: Agree [1] Disagree [2] NA [3]

   2. Commune Health Officer: Agree [1] Disagree [2] NA [3]

   3. Sanitation Officer: Agree [1] Disagree [2] NA [3]

   4. MARNDR: Agree [1] Disagree [2] NA [3]

   5. Other:________________ Agree [1] Disagree [2] NA [3]

10. It is important to report dog bites to MSPP/NSSS/DELR because it can save lives

Agree [1] Disagree [2]

11. I have contacted the Ministry of Agriculture to evaluate a dog bite

Agree [1] Disagree [2]

12. Were you happy working with them (if yes or no, why)

Yes (describe): _______________________________________________________

No (describe): ________________________________________________________

What are the three most urgent issues needing to be addressed to improve bite surveillance in Haiti:

What are the three most urgent issues needing to be addressed to improve PEP surveillance in Haiti:

What are the three most urgent issues needing to be addressed to improve human rabies surveillance in Haiti: