Abstract
Background: Rabies remains a significant public health threat in Madagascar, particularly in rural areas where access to healthcare and diagnostic facilities is limited. Community-based surveillance (CBS) has been proposed as a cost-effective strategy to improve case detection and reporting. This study evaluates the effectiveness of a CBS program for rabies in rural Madagascar, focusing on case detection rates, reporting timeliness, and community engagement.Methods: A mixed-methods evaluation was conducted from January 2022 to December 2023 in two districts of rural Madagascar. Quantitative data were collected from surveillance records (n=1,247 animal bite reports) and structured interviews with 320 community health workers (CHWs). The CBS intervention included training CHWs, providing mobile reporting tools, and establishing community feedback mechanisms. Effectiveness was measured by comparing detection rates and reporting delays before and after implementation, using Poisson regression and time-to-event analysis. Qualitative data from 40 focus group discussions explored community perceptions and barriers.Results: CBS significantly increased the detection of suspect rabid animals by 42% (incidence rate ratio [IRR]=1.42, 95% CI: 1.18–1.71) and reduced median reporting delay from 5 days to 2 days (pConclusions: CBS is an effective approach for enhancing rabies surveillance in rural Madagascar, improving detection and timeliness. Scaling up CBS with sustained support could strengthen rabies control efforts and contribute to the global goal of eliminating dog-mediated rabies by 2030.