Child-centered rabies prevention: A systematic review and meta-analysis of behavioral determinants and intervention effectiveness (2015–2024)

Abstract

Background and Aim: Rabies is a fatal yet preventable zoonotic disease, disproportionately affecting children in endemic regions. Despite the availability of post-exposure prophylaxis, behavioral gaps in prevention persist. Understanding the determinants of preventive behaviors and evaluating the effectiveness of educational interventions are critical for achieving the global goal of eliminating dog-mediated human rabies deaths by 2030. This study aimed to systematically review the psychosocial, cognitive, and contextual determinants influencing rabies prevention behaviors in children, and to evaluate the effectiveness of related interventions through meta-analysis. Materials and Methods: This systematic review and meta-analysis was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered in International Prospective Register of Systematic Reviews (CRD420251085699). Four databases (PubMed, SCOPUS, Google Scholar, and Thai Citation Index) were searched for peer-reviewed studies published from 2015 to 2024. Thirteen eligible studies were included: Six observational and seven intervention studies. Effect sizes were synthesized using random-effects models. Subgroup and sensitivity analyses were conducted to examine heterogeneity and moderator effects. Results: Environmental factors (r = 0.28), knowledge, attitudes, and practices variables (r = 0.22), health literacy (r = 0.20), and protection motivation theory constructs (r = 0.16) were significantly associated with rabies prevention behaviors. Parental attentiveness showed a strong inverse relationship with risk behaviors (r = −0.30). Interventions demonstrated large pooled effect sizes (standardized mean differences [SMD] = 1.54–2.10), although statistical significance was affected by heterogeneity (I² >90%). Short interventions (<2 weeks) were significantly more effective (SMD = 1.93) than longer ones (SMD = 0.31). Eastern country settings yielded greater behavioral improvements than Western contexts. Conclusion: Children’s rabies prevention behaviors are shaped by contextual, cognitive, and parental influences. Short, developmentally appropriate, theory-based interventions – particularly those implemented in schools – demonstrate practical effectiveness. Standardized evaluation frameworks and culturally adapted strategies are essential for improving behavioral outcomes and informing One Health policy efforts in high-risk regions.