title: Estimating the intra-cluster correlation coefficient for evaluating an educational intervention program to improve rabies awareness and dog bite prevention among children in Sikkim, India: A pilot study.
abstract: BACKGROUND
  Educational initiatives targeting at-risk populations have long been recognized as a mainstay of ongoing rabies control efforts. Cluster-based studies are often utilized to assess levels of knowledge, attitudes and practices of a population in response to education campaigns. The design of cluster-based studies requires estimates of intra-cluster correlation coefficients obtained from previous studies. This study estimates the school-level intra-cluster correlation coefficient (ICC) for rabies knowledge change following an educational intervention program.
  
  
  METHODS
  A cross-sectional survey was conducted with 226 students from 7 schools in Sikkim, India, using cluster sampling. In order to assess knowledge uptake, rabies education sessions with pre- and post-session questionnaires were administered. Paired differences of proportions were estimated for questions answered correctly. A mixed effects logistic regression model was developed to estimate school-level and student-level ICCs and to test for associations between gender, age, school location and educational level.
  
  
  RESULTS
  The school- and student-level ICCs for rabies knowledge and awareness were 0.04 (95% CI: 0.01, 0.19) and 0.05 (95% CI: 0.2, 0.09), respectively. These ICCs suggest design effect multipliers of 5.45 schools and 1.05 students per school, will be required when estimating sample sizes and designing future cluster randomized trials. There was a good baseline level of rabies knowledge (mean pre-session score 71%), however, key knowledge gaps were identified in understanding appropriate behavior around scared dogs, potential sources of rabies and how to correctly order post rabies exposure precaution steps. After adjusting for the effect of gender, age, school location and education level, school and individual post-session test scores improved by 19%, with similar performance amongst boys and girls attending schools in urban and rural regions. The proportion of participants that were able to correctly order post-exposure precautionary steps following educational intervention increased by 87%.
  
  
  CONCLUSIONS
  The ICC estimates presented in this study will aid in designing cluster-based studies evaluating educational interventions as part of disease control programs. This study demonstrates the likely benefits of educational intervention incorporating bite prevention and rabies education.
authors.affiliation: Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia.
authors.forename: Aashima
authors.initials: A
authors.lastname: Auplish
authors.affiliation: Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia.
authors.forename: Alison S
authors.initials: AS
authors.lastname: Clarke
authors.affiliation: Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia.
authors.forename: Trent
authors.initials: T
authors.lastname: Van Zanten
authors.affiliation: Vets Beyond Borders, The Rocks, Sydney, NSW 2000, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Abel
authors.affiliation: Vets Beyond Borders, The Rocks, Sydney, NSW 2000, Australia.
authors.forename: Charmaine
authors.initials: C
authors.lastname: Tham
authors.affiliation: Vets Beyond Borders, The Rocks, Sydney, NSW 2000, Australia; Department of Animal Husbandry, Livestock, Fisheries and Veterinary Services, Government of Sikkim, Sikkim, India.
authors.forename: Thinlay N
authors.initials: TN
authors.lastname: Bhutia
authors.affiliation: Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Wilks
authors.affiliation: Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Stevenson
authors.affiliation: Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia. Electronic address: simon.firestone@unimelb.edu.au.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Firestone
mesh_terms: D000293:Adolescent; D000818:Animals; D001733:Bites and Stings; D002648:Child; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks / Q000517:prevention & control*; D004283:Dog Diseases / Q000453:epidemiology / Q000517:prevention & control*; D004285:Dogs; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D010865:Pilot Projects; D015397:Program Evaluation; D062486:Public Health Surveillance; D011818:Rabies / Q000453:epidemiology / Q000517:prevention & control*; D011819:Rabies Vaccines / Q000276:immunology; D012307:Risk Factors; D012424:Rural Population; D012572:School Health Services; D012574:Schools; D012819:Sikkim / Q000453:epidemiology; D013334:Students; D011795:Surveys and Questionnaires
chemical_list: D011819:Rabies Vaccines
keywords: Educational intervention; Rabies; Veterinary public health; Zoonoses