The rabies distribution pattern on dogs using average nearest neighbor analysis approach in the Karangasem District, Bali, Indonesia, in 2019

Background and Aim: Rabies is a severe progressive encephalitis disease in dogs characterized as a zoonosis. The transmission of rabies between animals in Karangasem District, Bali is still high and continues until today; therefore, rabies in the district still actively circulating. The distribution pattern of rabies, especially in the district, is unknown. This research aimed to describe the spatial distribution of rabies in Karangasem District. The information would help in developing effective control strategies for the disease. Materials and Methods: An observational study was carried out using 38 positive rabies cases confirmed by the direct fluorescent antibody test diagnosed at the Disease Investigation Centre of Denpasar from September 2018 to September 2019. The Global Positioning System was used to take the geographical coordinates of the places where positive rabies cases had been confirmed in Karangasem District. The ArcGIS version 10.3 (ESRI) was used to determine and analyze the distribution pattern using the average nearest neighbor (ANN) method. Results: On the basis of the ANN analysis, the rabies distribution pattern in Karangasem District in 2019 was clustered in groups but not significant (Z-score=-1.670309 [<-1.65], p=0.094858 1 . <0.11; nearest neighbor ratio=0.858364). The rabies distribution pattern in each subdistrict of Karangasem was dispersed significantly since it had z-score of more than 2.58. p-value less than 0.1 and nearest neighbor ratio of more than 1. Conclusion: The rabies distribution in Karangasem District had a clustered pattern, although this was not significant. The grouping of rabies in Karangasem District showed a significant dispersed pattern in the subdistricts Abang, Beba.ndem, and Karangasem. The dispersed pattern of the rabies cases in the subdistricts was caused by unidentified stray dogs that lived in rice fields and other fields and by the whole district's hilly and mountainous topography. The ANN analysis suggested that for rabies control in Karangasem District, vaccination, elimination, and sterilization of stray dogs should be conducted in densely populated areas.