STUDY LIMITATIONS

Several limitations should be considered when interpreting the findings of this study. First, the research team lacked sufficient financial and human resources to conduct systematic community dog surveys, which would have provided a more direct assessment of the intervention's impact on the overall dog population. Furthermore, age-related data were not stratified by sex, preventing a more detailed estimation of juvenile and adult survival rates for males and females. Such information would have enabled the derivation of more robust estimates regarding the proportion of the population requiring annual sterilization. Existing population models primarily rely on the proportion of sexually inactive females to estimate population growth rates. However, in a setting where a considerable proportion of owned males remain unsterilized, the inability to quantify the contribution of these males to impregnating free-roaming females represents an important knowledge gap that could not be addressed in the present study.

The use of clinical intake records and field captures as proxies for population trends may also be regarded as a limitation. Nevertheless, the cumulative numbers obtained correspond closely with the estimated regional dog population, suggesting that these measures provide useful information for monitoring real-world CNVR interventions in resource-limited settings, where funding constraints necessitate balancing research objectives with operational priorities. Similarly, the questionnaire survey may have been affected by selection bias because pet owners attending the clinics are likely to represent a more responsible segment of the community. However, substantial heterogeneity was observed across locations and responses regarding vaccination and sterilization coverage, and the 66.57% response rate is considered high by established standards, supporting the reliability of the findings.

Another major limitation was the lack of comprehensive and well-documented data on dog bites, human post-exposure prophylaxis, and suspected or laboratory-confirmed rabies cases within the project area. This deficiency reflects limitations of the national health information system and is beyond the authors' control. Although district-level data from the Ministry of Health were available and cited, these records do not necessarily reflect the specific epidemiological situation within the project's geographical boundaries. Consequently, the direct contribution of the intervention to reductions in dog bites, human post-exposure prophylaxis requirements, and rabies incidence could not be quantified accurately.