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Occurrence and Risk Factors of Dog Bites in Northern Indigenous Communities: A Scoping Review

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The relationship between northern Indigenous people and dogs has evolved over the past years alongside events such as colonization, settlement, proliferation of snowmobiling and other socio-cultural and environmental changes. These changes have had negative impacts on this relationship, and with the endemic presence of arctic fox rabies, dog bites have become an important public health burden. The objective of this study was to synthesize the state of knowledge regarding the occurrence of dog bites and associated risk factors in the specific context of northern Indigenous communities. A scoping review was conducted in seven bibliographic databases, from June 2018 to May 2020. From this search, 257 original studies were identified and eight papers were included for final analysis. Annual occurrence of dog bites in northern Indigenous communities ranged from 0.61 to 59.6/10,000 inhabitants. Dog bites affected 27–62.9% of the population in those regions during their lifetime. Very few studies compared the occurrence of dog bites between people living in northern communities with other populations or settings, but available evidence suggests that Indigenous people living in northern communities are at higher risk of dog bites than the rest of the population. Several individual and environmental risk factors were identified in the selected studies, although the strength of evidence varied significantly. Age (children) and gender (male) were well documented individual risk factors. Other factors, such as organizational barriers to dog management and lack of access to veterinary services, were identified and discussed by several authors. The results of this study support concerns about the higher risk of bites in northern Indigenous communities, and underscore the urgent need for more research into the contextual and environmental factors that impact the mitigation of these risks.
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REVIEW
published: 18 April 2022
doi: 10.3389/fvets.2022.777640
Frontiers in Veterinary Science | www.frontiersin.org 1April 2022 | Volume 9 | Article 777640
Edited by:
Victoria J. Brookes,
The University of Sydney, Australia
Reviewed by:
Harish Tiwari,
The University of Sydney, Australia
Ewaldus Wera,
Kupang State Agricultural
Polytechnic, Indonesia
Maganga Sambo,
Ifakara Health Institute, Tanzania
*Correspondence:
Laurence Daigle
laurence.daigle.1@umontreal.ca
Specialty section:
This article was submitted to
Veterinary Epidemiology and
Economics,
a section of the journal
Frontiers in Veterinary Science
Received: 15 December 2021
Accepted: 23 March 2022
Published: 18 April 2022
Citation:
Daigle L, Delesalle L, Ravel A, Ford B
and Aenishaenslin C (2022)
Occurrence and Risk Factors of Dog
Bites in Northern Indigenous
Communities: A Scoping Review.
Front. Vet. Sci. 9:777640.
doi: 10.3389/fvets.2022.777640
Occurrence and Risk Factors of Dog
Bites in Northern Indigenous
Communities: A Scoping Review
Laurence Daigle 1,2,3
*, Léa Delesalle 1,2,3 , André Ravel 1, Barrie Ford 4and
Cécile Aenishaenslin 1,2,3
1Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC,
Canada, 2Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Faculté de Médecine
Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada, 3Centre de Recherche en Santé Publique de l’Université
de Montréal et du CIUSSS du Centre-Sud-de-l’île-de-Montréal, Montréal, QC, Canada, 4Makivik Corporation, Kuujjuaq, QC,
Canada
The relationship between northern Indigenous people and dogs has evolved over the past
years alongside events such as colonization, settlement, proliferation of snowmobiling
and other socio-cultural and environmental changes. These changes have had negative
impacts on this relationship, and with the endemic presence of arctic fox rabies, dog
bites have become an important public health burden. The objective of this study was to
synthesize the state of knowledge regarding the occurrence of dog bites and associated
risk factors in the specific context of northern Indigenous communities. A scoping review
was conducted in seven bibliographic databases, from June 2018 to May 2020. From
this search, 257 original studies were identified and eight papers were included for final
analysis. Annual occurrence of dog bites in northern Indigenous communities ranged
from 0.61 to 59.6/10,000 inhabitants. Dog bites affected 27–62.9% of the population
in those regions during their lifetime. Very few studies compared the occurrence of
dog bites between people living in northern communities with other populations or
settings, but available evidence suggests that Indigenous people living in northern
communities are at higher risk of dog bites than the rest of the population. Several
individual and environmental risk factors were identified in the selected studies, although
the strength of evidence varied significantly. Age (children) and gender (male) were well
documented individual risk factors. Other factors, such as organizational barriers to dog
management and lack of access to veterinary services, were identified and discussed
by several authors. The results of this study support concerns about the higher risk of
bites in northern Indigenous communities, and underscore the urgent need for more
research into the contextual and environmental factors that impact the mitigation of
these risks.
Keywords: scoping review, dog bites, epidemiology, Indigenous, northern communities
Daigle et al. Dog Bites Northern Indigenous Communities
INTRODUCTION
About 7 million people are currently living in the Arctic, about
10% of whom are Indigenous (1). This statistic varies widely
from one territory to another and depends on the definition
of “Arctic” and “Indigenous.” For example, the proportion of
Indigenous people exceeds 75% in Greenland and northeastern
Canada (2,3). Northern Indigenous people are organized across
more than 40 nations (4). Saami, Nenets, and Evenk people
in Eurasia, and Inuit, Cree and Innu people in the Americas
are among the main Indigenous people living in the arctic and
subarctic territories. Many northern Indigenous communities
have relied on dogs to hunt, travel or protect their belongings
and families (5). However, this ancient partnership has also been
profoundly affected by colonization, settlement, proliferation
of snowmobiling and other socio-cultural and environmental
changes (5,6). Despite these recent (and sometime rapid)
changes, dogs still play an important role in many northern
Indigenous communities. In North American communities, dogs
are often abundant and roam free, and the lack of access to
veterinary services, such as neutering, makes it difficult to control
the canine population (7).
Bites are a common dog-related human health threat, and
their incidence depends greatly on the context. In Canada, 0 to
9 dog bites per 10,000 inhabitants (median: 1.9) were reported
by 22 municipalities in a study occurring between 2003 and 2005
(8). Dog bites can lead to physical injury, impact mental health
(post-traumatic stress) and can affect well-being, by creating
concerns about safety and conflicts and misunderstandings
(e.g., whether or not to tie up the dogs, take better care of
dogs. . . ) between community members (9). In northern and/or
Indigenous communities of North America, dog bites are a
common cause of medical consultation, even though their true
incidence is difficult to assess due to various factors, including the
lack of mandatory reporting at the national and regional scales
(10,11).
Dog bites are also the transmission route of various zoonotic
diseases, such as secondary bacterial infections with Pasteurella
sp., Streptococcus sp., Staphylococcus sp. and other anaerobic
agents and viral diseases, such as rabies virus (12,13). The
latter still kills 59,000 people annually worldwide (14). The
Arctic Rabies Virus Variant (ARVV) is endemic among arctic fox
populations in many regions of the Arctic, including northern
Canada, Alaska, Greenland, Svalbard and northern Russia (15
18). In Canada, 105 positive animal rabies cases were detected in
2021, of which 6 were dogs (6/105) (19). The annual incidence
of rabies in foxes in Nunavik (northern Quebec, Canada) is 1.6
cases/year (15). Consequently, exposure of humans to ARVV
through dog bites happens regularly in these areas (11,20). In
some regions, such as Nunavik, there are initiatives to vaccinate
dogs against rabies, but these initiatives are not mandatory
and are often limited (21,22). Limited access to dog rabies
vaccination in some communities may increase the risk of
transmission, and sometimes forces the administration of post-
exposure prophylaxis as the only way to prevent human infection
after a bite. Knowing that climate change may increase the
incidence of ARVV in wild and domestic animals in the next
decades by modifying the movements and interactions of arctic
and red fox populations, public health concerns are increasing
with regard to the risk of bites in these particular regions
(15,23).
Effective prevention of dog bites and rabies exposure requires
a good understanding of their risk factors. In general, dog breed
or size and reproductive status have been suggested as possible
dog-related risk factors. Other human-related factors which
have been proved or suspected by several authors include age
(children), gender (male) and behavior of the victim as well as the
interactions between these factors (20,2426). Previous studies
on dog bite risk factors were conducted in diverse contexts
(geographic locations, urban and rural, among others). Given
the particular context of northern Indigenous communities,
understanding the specificity and importance of those risk factors
is crucial.
This scoping review aims to assess the current state of
knowledge on the occurrence of dog bites and their risk factors in
the specific context of northern Indigenous communities. More
precisely, the research questions behind this scoping review are
as follows:
1) What is known about the occurrence of dog bites in the
specific context of northern Indigenous communities and
how it compares to other contexts (such as southern, urban
or non-Indigenous contexts)?
2) What is known about dog bite risk factors specific to northern
Indigenous communities?
This review is being conducted as preliminary work for a
study aiming to improve the understanding of dog bite risks
factors in Northern Indigenous communities in the province
of Quebec, Canada. In Quebec, “northern communities” mainly
refers to communities of Nunavik, a region which extends to
the 55th parallel. Furthermore, this location is also known
to have animals carrying Arctic fox rabies almost every year
(7,11,18).
METHODS
Protocol and Registration
We conducted an exploratory scoping review applying the
guidance developed by Peters et al. (27) from the Joanna Briggs
Institute and five Joanna Briggs Collaborating Centers, and
following the PRISMA-ScR checklist developed by Peters et al.
(27) and Tricco et al. (28). This type of scoping review was
selected with the objectives of mapping the body of literature
on the subject and identifying research gaps relative to dog bites
in northern communities. The main steps are detailed in this
section: (1) identifying the research question, (2) identifying
relevant studies following a plan that includes the databases,
the terms used and the other criteria, (3) selecting the studies
with specific inclusion and exclusion criteria, (4) charting the
data, and (5) collating, summarizing and reporting results to
provide an overview of the literature on the subject. The protocol
was registered with the Open Science Framework on June 5,
2020 (29).
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Daigle et al. Dog Bites Northern Indigenous Communities
Eligibility Criteria
Inclusion Criteria
The studies included in this scoping review needed to have
relevant and sufficient content related to dog bites in northern
and Indigenous communities. Northern communities in this
review are defined as all the communities located north of the
55th parallel. As explain above, the 55th parallel is also the
southern limit of Nunavik, Quebec, Canada, and the region
where rabies is considered endemic in arctic fox populations; this
scoping review is prior to a study on dog bites in this region. Since
there is no real consensus on a definition for Indigenous peoples
due to the variability of these communities, the term “Indigenous
community” in this review is defined by the characteristics stated
by the United Nations Permanent Forum on Indigenous Issues:
(1) self-identification as Indigenous peoples at the individual level
and accepted by the community as their member, (2) historical
continuity with pre-colonial and/or pre-settler societies, (3)
strong link to territories and surrounding natural resources,
(4) distinct social, economic or political systems, (5) distinct
language, culture and beliefs, (6) form non-dominant groups of
society, and (7) resolve to maintain and reproduce their ancestral
environments and systems as distinct peoples and communities
(30). All types of studies were considered (original studies,
reviews) but opinion papers were excluded.
Additional inclusion criteria were to be written in English
or French and to be peer-reviewed. All articles published and
referenced up to May 2020 were included.
Exclusion Criteria
Papers were excluded if the content was focused on other non-
Indigenous groups of people or if the content addressed poorly
the occurrence of dog bites or the risk factors related to dog
bites, e.g., other animal bites, other diseases related to dogs or
treatments after injuries caused by bites. Finally, if the full text
was not retrievable, the paper was removed from the selection.
Information Sources
We used four health electronic databases [CAB abstract,
Medline (MEDLINE, RRID:SCR_002185), Global Health and
Native Health] and three social sciences electronic databases
(Autochtonia, Popline, and Sociological abstract). References lists
were also examined to extract additional relevant articles.
Search
The research strategy has been developed with the collaboration
of the librarian at the Faculté de Médecine Vétérinaire, Université
de Montréal. The search was conducted in two steps (phases 1
and 2). An initial search occurred in July and August 2018, in
electronic databases (phase 1). Then, a final search was done
in May 2020 to find new relevant papers (phase 2). We used
combinations of key words related to the themes “dog bites,
“northern community” and “Indigenous community,” as “dog
bites”, “dog aggression,” “northern,” “Nordic,” “Nunavik,” “arctic,
“subarctic,” “autochthonous,” “Indigenous,” “american indian,
“native,” and “first nation” (see Supplementary Table 1 in the
Appendix for complete equations used).
BOX 1 | Extraction elds used for the scoping review.
(1) Authors
(2) Year of publication
(3) Title
(4) Journal
(5) Publication type
(6) Inclusion phase
(7) Aims/Purpose
(8) Source origin/Place
(9) Study period
(10) Study design
(11) Study population, sample size
(12) Occurrence of dog bites and method of measurement
(13) Risk/Protective factors influencing dog bites
(14) Importance accorded to the topic of interest
(15) Comparison with other contexts
(16) Authors’ limits and perspectives
Selection of Sources of Evidence
All the records found in databases and additional resources,
as the references lists, were imported in a data-collecting
software, Zotero 5.0 (Zotero, RRID:SCR_013784), and exported
in a Microsoft Excel 2017 spreadsheet (Microsoft Excel,
RRID:SCR_016137) in order to proceed with the classification.
One reviewer (LDa) conducted the first selection of studies based
on their titles and abstracts and removed: (1) duplicates, (2)
studies in a language other than English and French, and (3)
studies which were not peer reviewed. The reasons of exclusions
were noted in the spreadsheets. Two reviewers (LDa and LDe)
carried out the last screening step where the remaining articles
were read in full. The criteria for the inclusion and the exclusion
of articles are listed above. Three reviewers (LDa, CA, and AR)
approved the studies included for the further analysis.
Data Charting Process
A grid, in a single Microsoft Excel 2017 spreadsheet (Microsoft
Excel, RRID:SCR_016137), was made by two reviewers (LDa and
LDe) to extract information from articles. The characteristics of
each study included were extracted by two reviewers (LDa and
LDe) independently and compiled in the grid. The results were
discussed by the reviewers and a consensus on the information
extracted was made.
Data Item
We summarized the data from the articles according to the
characteristics listed in Box 1.
Critical Appraisal of Individual Sources of
Evidence
For all the papers included, the outcomes (occurrence of dog
bites) were interpreted considering the measurement method
and the p-value (if applicable). Each risk factor influencing
dog bites was classified according to whether an association
was demonstrated statistically in the article or whether it was
only stated hypothetically. The studies were also classified by
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Daigle et al. Dog Bites Northern Indigenous Communities
the importance accorded to the main objectives of the scoping
review. For example, when the purpose of the paper was about
dog bites and the title included “dog bites,” the importance given
was then major. When the subject of dog bites was not the
main topic but was covered in some part(s) of the article or
when the protocol included means for investigating the bites, the
importance given was secondary.
Synthesis of Results
The synthesis of results is presented as follows: (1) distribution
of articles over time, (2) distribution of the articles among the
different Indigenous communities, (3) occurrence of dog bites
according to the study design, the definition of dog bites, the
study population and sample size (if applicable), (4) studied
risk factors, and (5) importance of the subject of dog bites
among the articles. Identified risk factors were classified using
the One Health framework, which advocates considering the
interdependence between the health and well-being of humans,
animals and the environment to gain a better understanding of
the global complexity (31,32). We extracted the study design
and methods used to estimate the occurrence according to
their epidemiological evidence, whether with a qualitative or
a quantitative design. In the quantitative design, the factors
were identified either with or without a statistically significant
association with the risk of a bite or a suggestion of a possible
association. Finally, we present a qualitative synthesis of the
review results.
RESULTS
Selection of Sources of Evidence
From the database search, 257 records were identified in two
phases, from June 2018 to May 2020 (Figure 1). A total of 75 full-
text articles were assessed for the relevance and the importance of
the northern Indigenous context and the dog bite issue. In total, 8
papers were included for final analysis, seven papers from phase
1 (7,10,20,3437) and one from phase 2 (11).
Characteristics of Sources of Evidence
The first article included was published in 2001 (24), but most
studies (6/8) were published between 2010 and 2019 (Table 1).
The northern Indigenous communities included or mentioned
were Inuit from Nunavik, Canada (3/8) (7,11,20), Sahtu from
Northwest Territories, Canada (1/8) (34), Cree and Assiniboine
from Saskatchewan, Canada (2/8) (36,37), and unspecified
Natives from Alaska, USA (2/8) (10,35). One of the United States
studies (10) also compared dog bite injuries among children
from non-Nordic (American Indian) and Nordic (Alaska Native)
Indigenous communities and mentioned the Navajo and other
American Indian communities from the USA as well. We found
no publications from Eurasia.
The studies used different methodologies, including
quantitative, qualitative, and mixed-method designs (Table 1).
In less than half of the studies (3/8), the importance accorded
to dog bites was major and it was secondary in all the other
studies (5/8).
Sources of Dog Bite Data
Two main data sources were used to estimate dog bite
occurrence: (1) dog bites as reported by local, regional or national
health authorities (based on health records) and (2) dog bites as
reported by study participants (self-reported bites) (see Table 2).
Among the seven included studies that estimated dog bite
occurrence, five used health records. Two of those five extracted
data from health records (10,35). Two estimated the incidence of
potential rabies exposure, therefore included dog bites and bites
by other species (e.g., foxes), scratches or other at-risk contacts
(11,20).
The two studies that used self-reported bites conducted cross-
sectional surveys with Indigenous people from two northern
communities (7,34). They assessed the prevalence of dog-related
injuries by asking participants if they had been bitten or scratched
at least once in their life.
Dog Bite Occurrence
According to the studies based on health records, annual
occurrence in northern Indigenous communities ranges from
0.61 to 59.6/10,000 inhabitants, whereas surveys suggest that dog
bites could affect 27–62.9% of the population in those regions
during their lifetime (Table 2). Some studies (3/8) compared
dog bite occurrence between northern Indigenous population
and others, and only two of those have statistically tested the
difference (Table 3).
Risk Factors Associated With Dog Bites
The information about the different risk factors explored in
each study is synthesized in Table 4. In general, risk factors
were more often discussed than assessed in the included studies.
Some human-related factors associated with higher risk of bites
were identified both by quantitative and qualitative methods,
including age (children), gender (male), behavior toward dogs,
and Indigenous status. Dog related factors (breed, size, roles,
gender, ownership and numbers of dogs implicated) were
sometimes briefly discussed but their effect was never quantified.
Structural and environmental factors were often considered
(never quantified), especially in studies using a qualitative design.
Lack of veterinary services, geographic remoteness, lack of
legislation, density of dogs (overpopulation), free roaming, and
seasonality (summer) were all factors reported to increase the
occurrence of dog bites in these settings.
Age was the most often identified risk factor in the included
studies (6/8). Five papers found differences in the frequency of
dog bites between these subgroups in their descriptive analysis
(10,11,3436). Brook et al. found that children under 17 years
old represent up to 69% of the total victims (34).
Two studies (2/8) have shown an interaction between age
and gender. In Bjork et al. the risk ratio (RR) of being bitten
by a dog for male children was higher compared with female
children (1.8; 95% CI, 1.3–2.6) for the Indigenous people (10). In
Mediouni et al. boys and girls under 14 were equally represented
in potential rabies exposures (mostly caused by dog bites), but
men were overrepresented among victims over the age of 15 (11).
For gender alone, males are generally overrepresented in four of
the studies. The hypothesis raised for the overrepresentation of
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Daigle et al. Dog Bites Northern Indigenous Communities
FIGURE 1 | PRISMA flowchart presenting the selection process (33).
men in certain studies would be related to their riskier activities,
such as hunting and mushing (11).
Inconsistent results were found in the different papers
regarding behavior toward dogs (conflictual/provoked). Five
studies report that dog bites may be most often provoked by
the victims (7,11,34,35,37). Two studies (2/5) quantified this
statement with 48% (34) and 56% (11) of dog bites that were
provoked. However, Schurer et al. showed that 67% of the bites
described were unprovoked (36). Furthermore, the presence of
free-roaming dogs was sometimes suggested as a predisposing
factor to dog bites. Some authors reported from interviews with
community members or health professionals that loose dogs
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Daigle et al. Dog Bites Northern Indigenous Communities
TABLE 1 | General characteristics of included scoping reviews (n=8) (total
percentages may exceed 100% as publications have been classified in more than
one category).
Characteristic n(%)
Publication year
2000–2009 1 (12.5%)
2010–2019 6 (75%)
2020 1 (12.5%)
Indigenous communities
Inuit from Nunavik, Canada 3 (37.5%)
Sahtu from Northwest Territories, Canada 1 (12.5%)
Alaska Natives from Alaska, USA 2 (25%)
Cree and Assiniboine from Saskatchewan, Canada 2 (25%)
Study design
Quantitative (Based on health data)3 (37.5%)
Qualitative 1 (12.5%)
Mixed 4 (50%)
Importance accorded to the main subject
Major 3 (37.5%)
Secondary 5 (62.5%)
could increase the risk of dog aggression (7,11). However, several
studies mentioned that tying up dogs could make them less
socialized, more aggressive and promote risky behavior, whereas
free roaming dogs have some advantages, such as providing
companionship and protection for the communities as a whole
(7,37). Indeed, Castrodale showed that many dog bites are caused
by a dog tied up or in a closed space (35).
Several authors also discussed the protective factors against
bites. These approaches and solutions were generally mentioned
briefly in the included articles, even though we found no
study that has tested those hypotheses. This included preventive
education (4/8) (10,20,35,37), access to veterinary services
(5/8) (7,11,34,36,37), implication of para-veterinarians (2/8)
(34,37), collaborative approach in a One Health perspective (5/8)
(7,20,34,36,37), law and legislation enforcement (2/8) (7,34),
density diminution and stabilization of the dog population (3/8)
(20,36,37) and dog bite surveillance enhancements (1/8) (36).
DISCUSSION
This review is the first to compile available evidence on the
occurrence of dog bites and their risk factors in northern
Indigenous communities.
Dog Bites Occurrence
Although this is a recent topic of interest in research and evidence
is still scarce, our results suggest that Indigenous people living
in northern communities are at higher risk of dog bites than
the rest of the population. Indeed, in all studies that have
compared the risk of dog bites in different contexts, regardless
of the design and measurement method, the occurrence was
higher in northern Indigenous people than in: (1) the general
US or Canada population, (2) non-northern Indigenous people,
(3) non-Indigenous inhabitants of northern communities, or
(4) non-Indigenous inhabitants of other rural or remote areas.
Around the world, Indigenous people are generally more prone
to poorer health outcomes, such as higher rates of infectious
diseases, mental disorders, nutritional deficiencies and infant
mortalities (40). These findings on dog bites are concerning, and
reveal an additional health inequity that affect Indigenous people.
Addressing these issues is also relevant in term of the Sustainable
Development Goals, in particular number 3 (“Ensure healthy
lives and promote well-being for all at all ages”) and number 10
(“Reduce inequality within and among countries”) (41).
However, our review also undercover significant
methodological gaps, which should be addressed in future
studies. First, none of the studies used a longitudinal design,
making it hard to robustly quantify the effect of potential risk
factors at the individual level (e.g., age, gender, behaviors).
Second, the demographic characteristics of the sample used
to estimate dog bites occurrence was not always reported
in the included studies, making it difficult to evaluate the
representativeness of the sample.
Both self-reports and health records were used to estimate
the occurrence of bites, leading to very different estimates.
Health records are useful secondary sources of data but they
may underestimate the occurrence since not everyone will
seek medical services after a bite. Furthermore, a potential
bias may arise for the proportions of the age groups affected.
Indeed children, given their small size, are often bitten on
the head, the neck and the face (11,42,43). Consequently,
their injuries are more likely to require medical attention and
thereby to be recorded by health authorities, causing a potential
selection bias. In contrast, self-reported dog bites, collected
using population surveys, may better reflect the true incidence
of bites if a representative sample is achieved, since bites not
reported to health authorities can be included. Surveys are
subject to memory bias, even if the traumatic aspect of dog
bites probably limits it. Often limited to adult participants,
surveys should include questions relative to the bite history
in the household to avoid underestimation of the burden of
dog bites in children (7). We noticed differences in the case
definition of a dog bite, which makes comparison between studies
difficult. This is a methodological issue commonly noted by other
authors (44). Also, for the studies reporting the incidence of
potential rabies exposure (11,20), the data sources did not always
specify the species or route of exposure involved, therefore it is
possible that they exclude a few data related to dog bites that
were not recorded as such, leading to an underestimation of
dog bites.
Surprisingly, included studies focused only on North
American arctic and subarctic regions, overlooking northern
Eurasia. Indeed, reindeer is the main subsistence resource for
a lot of Eurasian Indigenous nations, even if dogs also play a
role for transportation, herding and hunting (4548). However,
a few authors reported concerns among Saami and Nenets
about an increasing number of stray dogs abandoned by shift
workers, and of wolfdog breeding (48). There seems to be a lack
of documentation on this subject and evidence is needed on the
occurrence and risk factors of dog bites in northern Eurasia.
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Daigle et al. Dog Bites Northern Indigenous Communities
TABLE 2 | Dog bite occurrence in northern Indigenous communities.
References Study population Period Data sources Sample size Case definition* Occurrence of dog
bites
Aenishaenslin et
al. (7)
Kuujjuaq, Nunavik,
Canada
Fall 2015 Questionnaires n=35 Inuit and 32
non-Inuit
Dog’s owners and
family member bitten or
scratched in their
lifetime
Inuit: 62.9% (22/35)
Non-Inuit: 15.6% (5/32)
Aenishaenslin et
al. (20)
Nunavik
inhabitants,
Canada
1996–2009 Health records n=112 consultations
for potential exposure
to a rabid animal
Consultations for a
potential rabies
exposure (bites or
scratches)
n=76 dog bites
Bjork et al. (10) Alaskan native
children (<20
years old), USA
2001–2008 Health records 26 hospitalizations
2,530 outpatient visits
Hospitalizations and
outpatient visits with
diagnosis of dog bite
H: 6.1/100,000 per
year
O: 596.4/100,000
per year
Brook et al. (34) Sahtu of NWT,
Canada
2008–2009 Questionnaires n=67 student
respondents
n=41 dog owners
Students and dog
owners bitten at least
once in their life
42% students (N=67)
27% dog owners (N
=41)
Castrodale (35) Alaskan native,
USA
1991–2002 Health records Alaska population in
1997: 609,655 peoples
288 dog-related cases
in total in Alaska for the
period
Hospitalizations 1
day with a diagnosis of
dog bites
9.3/100,000 per year
Mediouni et al. (11) Nunavik
inhabitants,
Canada
2008–2017 Health records Nunavik population in
2017: 13,549a
293 dog-related cases
Consultations for a
potential rabies
exposure
2.5/1,000 per year
(0.45 to 4.6/1,000)
293 dog-related cases
Schurer et al. (36) Cree and Nakota
of SK, Canada
2006–2013 Health records 4 out of 6 communities
of the health area
included
53 dogs attacks out of
59 animal attacks (total
population of the area
in 2016: 1,155b)
Consultations following
an animal bite and/or
scratch
3/1,000 attacks per
year (95% CL:
1.0–6.6/1,000)
90% from dogs (53 of
59 attacks)
*The case definition refers to the considered items that are related to dog bites or altercations in order to include the case as data.
aPopulation of RCM of Administration régionale Kativik (38).
bData from Statistic Canada (39).
TABLE 3 | Comparison of dog bite occurrence between northern Indigenous populations and others.
References Study site Nordic Indigenous Other populationsaTest
Aenishaenslin et
al. (7)
Kuujjuaq, QC, Canada Inuit: 62.9% (22/35) Non-Inuit: 15.6% (5/32) Pearson’s χ2p<
0.001
Bjork et al. (10) Alaska, USA Hospitalizations: 6.1/100,000 Other USA natives: 3.4/100,000
Global USA: 3.9/100,000
None
Outpatients: 596.4/100,000 Other USA natives:
392.4/100,000
None
Castrodale (35) Alaska Natives: 9.3/100,000 Non-natives: 2.8/100,000 None
Hospitalizations: 40.4% were
Indigenous people
% of natives in Alaska
population: 20%
χ2=114, p<0.0001
Mean durationb: 4.6 days
[95%CI =3.7–5.5]
2.5 days [95%CI =2.2–2.9] p<0.0001
aThe term “Other populations” refers to a population that is either non-Indigenous, non-Nordic, or both.
bMean duration represents the period of hospitalization (in days).
Risk Factors
Some of the individual factors highlighted in this review are
well-known to influence the occurrence of dog bites in other
contexts. It is the case for age and gender, which tend to interact
(24,25,4951). Provocative behavior toward dogs, often by
children, is also frequently mentioned as a risk factor in the
literature (24,52,53). It is not specific to northern Indigenous
communities (54,55). Moreover, its effect on dog bites is unclear.
Frontiers in Veterinary Science | www.frontiersin.org 7April 2022 | Volume 9 | Article 777640
Daigle et al. Dog Bites Northern Indigenous Communities
TABLE 4 | Dog bite risk factors identified by the studies included in the scoping review (some studies may have been classified in more than one categories).
Study design
Risk factors Qualitative design Quantitative design Reported as
hypothesis or cited
from literature
Evidence of
importance by
qualitative methods
Statistically
significant
association with the
occurrence of bites
Suggesting a
possible association
without having
proven it
Individual human factors
Age (children) (11) 0 (10, 11, 33–35) (7)
Gender (male) 0 (10), [11*] (11, 33, 34) (35)
Behavior toward dog (conflictual/provoked) (7, 11, 36) 0 (11, 33, 34), [35*] 0
Sociocultural characteristics (ethnicity) (35) (34) (7, 10, 11) 0
Dog factors
Breeds/size 0 0 (34) 0
Function/role (11) 0 (34) 0
Gender and reproductive status 0 0 0 (35)
Ownership or presence of a keeper 0 0 (34) (36)
Number (lone dogs) 0 0 0 0
Structural and environmental factors
Lack of veterinary service or animal control resources (11, 35) 0 (10) (7, 11, 33, 36)
Geographic remoteness 0 0 0 (31, 33)
Lack of legislative interventions (7, 11) 0 (10) (7, 35, 36)
Density of dogs in the community (overpopulation) 0 0 (10) (7, 11, 33)
Free roaming (7, 11), [7,36*] 0 [34*] (7, 34)
Seasonality (temporal variations) (11) (11) (35) 0
[*] Contradictory result.
On one hand, most of the included studies suggest that a
bigger proportion of bites were “provoked” by the victim, which
generally means that the dog had bitten defensively or out of
fear, for example to defend its food, to protect its litter or in
response to annoyance or mistreatment (44,51). Those defensive
and fear bites seem to happen preferentially if the dog is tied
up, in a confined space or on its territory (house, yard). Risky
behaviors of children have been targeted, amongst other factors,
to highlight the importance of their consideration in future
prevention programs (56). On the other hand, Schurer et al. assert
that “unprovoked” bites were more frequent (36). Unprovoked
bites can sometimes relate to predation. Predation bites are more
likely to happen with packs of loose dogs, and generally cause
more severe wounds (57,58). The reviewed papers also discussed
the role of factors more specifically related to Indigenous
northern communities, including sociocultural characteristics,
ethnicity and some structural and environmental factors.
Figure 2 summarizes individual, community and contextual risk
factors explored in the included papers.
One striking observation that comes from this synthesis is
that several of those context-related factors, like Indigenous
knowledge and practices or colonial history, appears difficult
or impossible to change and are sometimes controversial (26,
54,59,60). The presence or density of free-roaming dogs is
a good example. In this case, disagreement between authors
could be linked to a lack of consensus on the definition of
“free-roaming.” According to World Society for the Protection
of Animals (2008), “roaming dogs are defined as dogs that are
on public areas and not currently under direct control [and]
this term is often used inter-changeably with ‘free roaming, ‘free
ranging,’ or ‘stray’ dogs” (61). The dog roaming loose could
be either owned or unowned by someone, at different types of
property. However, Jervis et al. criticize the western perception
of free-roaming, which often considers this lack of canine
restriction as pathological or a community dysfunction. They
stipulate that there be an “ethnocentric bias that sees all roaming
dogs as strays or feral, born of a construct of “pet ownership”
whereby a dog can only belong to someone—and perhaps be
loved—if it is restricted” (62). The concepts of “pet ownership”
and domestication in relation to Indigenous communities are
criticized by many other authors (5,63). Cohen et al. reported
that the dogs were not seen as property, but rather as part of
the family (64). They then introduce the concept of “keepers”
instead of “owners,” which invokes a vision where the dog can
walk from house to house (multiple keepers) and can be loose.
Different terms are therefore employed for approximately the
same risk factors and several problems emerges in relation to
definitions. This is a good illustration of the lack of appropriate
language to study dog-related issues specific to Indigenous
communities. Partnership with and validation of appropriate
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Daigle et al. Dog Bites Northern Indigenous Communities
FIGURE 2 | Factors capable of influencing the risk of dog bites in northern
Indigenous communities, ranked from individual/familial factors (such as age,
sex, dogs’ ownership, and behavior toward dogs), to community factors (such
as legislation and veterinary service), and contextual factors (such as
seasonality and remoteness). (Hatched purple area), Human related factors;
(Dotted turquoise area), Dog related factors; (Gray area), Contextual factors.
methods (e.g., terms used in a data collection instrument)
by Indigenous communities appear as a crucial condition to
advancing knowledge on this topic. Similarly, Dhillon et al.
highlight that, despite the fact that several authors mention
density of dogs and canine overpopulation as potential risk
factors, none of them have established a clear causal link with the
risk of dog bites (59).
As for occurrence, the capacity to explore risk factors in the
studies depends on the data collection methods. Health records
often provide standardized information on individual factors
socio-demographic data about the victim (age, sex, village), and
may also include data on the dog’s breed and reproductive status.
However, information is often lacking contextual variables.
Indeed, in their studies on dog bite and rabies exposure in
Nunavik (Quebec), Mediouni et al. reported a lot of missing data
for exposure type, exposure site and use of PEP. In most cases,
the commentary field was not filled, giving no information on
the circumstances of the bite (11). Surveys, on the contrary, could
allow a more in-depth exploration of the circumstances of bites,
and document the knowledge, attitudes and behaviors of victims
toward dogs.
Notably, several studies also used qualitative methods (e.g.,
individual interviews) imbedded in mixed-method study designs.
Here, it allows a better understanding of contextual factors,
which are difficult to highlight with a purely quantitative
approach. Such factors may be more specific to northern
Indigenous communities, like the lack of veterinary services and
geographic isolation.
Specificities of Northern Indigenous
Communities
The reasons why northern Indigenous people appear more
exposed to dog bites remain unclear. Indeed, most of the
risk factors highlighted in this review aren’t specific to this
context (like age, gender or behavior toward dogs). Limited
access to veterinary services and geographical isolation may
be present in other remote areas. Canine overpopulation and
high proportion of free-roaming dogs have been described in
several African, South American and Asian communities (65
67). According to several authors, dog bites tend to be more
frequent in low-income areas (6870). Indigenous people tend
to have lower income levels and higher poverty rates than
non-Indigenous people (71,72). Attributing health differences
to ethnic or racial differences is always problematic, as it
can foster inappropriate bias and lead to underestimation of
the influence of social and health inequities. Indeed, in the
context of dog bites, some risk factors, such as lower income
and the lack of animal health services, are the consequences
of years of colonial practices that have profoundly harmed
Indigenous communities across the world. Understanding the
social and cultural context is important to design effective
and culturally adapted preventive interventions in Indigenous
communities, but the role of ethnicity as a risk factor should be
interpreted with caution (40,73,74). Importantly, we find no
evidence of dog bites studies led or conducted by Indigenous
researchers and/or communities, or which explicitly integrates
Indigenous knowledge’s in its research methods or interpretation.
Since dogs have been part of the lifestyle of most northern
Indigenous communities for centuries, addressing this gap would
contribute to advancing knowledge and understanding of this
complex issue.
Limitations
This scoping review used a recognized and rigorous protocol
through all steps of the methodology. A combination of search
methods (databases from different disciplines, reference lists,
internet search, snowball technique) was used to ensure the
widest and the most accurate search possible. The literature was
rescanned in May 2020 to include new articles that were yet
published during the first phase. However, this scoping review
may not have identified all the papers about dog bites in Nordic
and Indigenous communities.
Key words used for this scoping review may also have
unintentionally excluded publications concerning certain areas,
as Indigenous people designation vary across countries. In
addition, although our research included papers in English or
French, our key words were only in English. Although unlikely,
it may be possible that articles from Eurasia were unknowingly
excluded in this way. Despite this limitation, a quick scan
of the selected databases with key words specific to Eurasian
Indigenous nations (for example Saami AND “dog bite,” or Evenk
AND “dog bites,” etc.) tends to confirm a lack of international
Frontiers in Veterinary Science | www.frontiersin.org 9April 2022 | Volume 9 | Article 777640
Daigle et al. Dog Bites Northern Indigenous Communities
scientific literature about dog bites in Indigenous communities
of northern Eurasia.
CONCLUSION
This scoping review testifies to the significant knowledge gap
concerning the occurrence of dog bites and their risk factors
in northern Indigenous communities. The heterogeneity in
data collection strategies, the absence of longitudinal designs
and the lack of information on the representativeness of the
sampled populations limits obtaining an accurate picture of the
situation. More studies are needed to better understand the
context particularities, and to allow the development of effective
animal and public health interventions. Nevertheless, our review
confirms that previously studied northern Indigenous people
tend to be more exposed to dog bites than any other population in
Canada or the US. Our findings also highlight the complexity of
this health issue, which involves multiple factors, from humans
and animals to social, structural and environmental; all likely
to interact. Being systemic, multidisciplinary and intersectoral,
the One Health approach could offer a framework fully
addressing this complexity. Moreover, Indigenous knowledge
and perspectives should be acknowledged, in order to better
define local particularities and to facilitate the appropriation of
the findings by the communities that need them.
AUTHOR CONTRIBUTIONS
LDa (45%) and LDe (35%) research and sorting of articles,
analysis and interpretation of articles, and writing of the literature
review. AR (7%) and CA (10%) contribution to the analysis
and interpretation and revision of the manuscript. BF (3%) final
revision of the manuscript. All authors contributed to the article
and approved the submitted version.
FUNDING
This study was provided by the Fond du Centenaire of Faculté
de Médecine Vétérinaire at Université de Montréal, the Fonds
de recherche du Québec – Santé (FRQS), the Northern Scientific
Training Program (NSTP), and the Canadian Institutes of Health
Research (CIHR). The funders were not involved in the study
design, collection, analysis, interpretation of data, the writing of
this article or the decision to submit it for publication.
ACKNOWLEDGMENTS
We would like to thank the team working on the global project
on dogs in the North called Balancing Illness and Wellness at the
Human-Dog Interface in Northern Canada. We would also like
to thank Audrey Simon and Yves Rondenay, as members of the
advisory committee for the master’s degree of LDa. We would
also like to say a big thank you to Natasha Bowser who helped
with the English writing quality review.
SUPPLEMENTARY MATERIAL
The Supplementary Material for this article can be found
online at: https://www.frontiersin.org/articles/10.3389/fvets.
2022.777640/full#supplementary-material
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Conflict of Interest: BF was employed by Makivik Corporation.
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Copyright © 2022 Daigle, Delesalle, Ravel, Ford and Aenishaenslin. This is an
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Frontiers in Veterinary Science | www.frontiersin.org 12 April 2022 | Volume 9 | Article 777640
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