Situation Analysis of Rabies Surveillance and Dog Bite Management in Manufahi Municipality of Timor-Leste, 2025: A Mixed-Methods Quality Data Audit

Abstract

Objectives: Rabies has emerged as a significant public health threat in Timor-Leste, with 24 recorded human deaths since the disease first appeared in early 2024. While initially concentrated in border areas, the virus has spread to multiple municipalities, including Manufahi Municipality. This study presents a situational analysis of dog bite management concerning rabies risk, the timeliness of surveillance reports, and operational factors in Manufahi Municipality during 2025.

Methods: A mixed-methods quality data audit was employed across four community health centers. Data collection encompassed direct observations of clinical areas, semi-structured interviews with 17 essential health personnel, and a methodical review and cross-verification of outpatient and laboratory register books.

Results: The surveillance system achieved 100% timeliness in weekly reporting. In 2025, Manufahi Municipality recorded 295 dog bite cases, corresponding to an incidence of 4.63 per 1,000 population. Two patients (0.7%) died with clinical signs consistent with rabies. Children aged 5 to 14 years had the highest burden, accounting for 52.9% of cases. While vaccines arrived in June 2025, first-dose anti-rabies vaccine (ARV) coverage reached 84.4% overall (249/295) and 87.7% among eligible category II and III exposures (249/284). However, multi-dose adherence dropped to 28.9% (2 doses; 82/284) and 7.0% (3 doses; 20/284). Rabies immune globulin (RIG) coverage was 13.7% (31/226) among high-risk category III cases.

Public Health Recommendations: Improving rabies control requires standardizing reporting formats and prioritizing the digitalization of surveillance systems. Adopting a "One Health" approach and enhancing community-level vaccine accessibility are vital for sustainable disease elimination.