Background: Despite the availability of effective post-exposure prophylaxis, South Africa records at least 10 human rabies deaths each year. Many animal bite victims initially seek help from Traditional Health Practitioners (THPs) before considering allopathic medicine. Prompt referral of animal bite victims for PEP initiation by THPs can be lifesaving. Our study aimed to assess the knowledge, attitudes, and referral practices regarding human rabies among THPs in one district in KwaZulu-Natal Province, South Africa.

Methods: We conducted a cross-sectional study among registered THPs consulting patients in the eThekwini District. We used a structured standardized questionnaire to collect data through physical and telephonic interviews. Multivariate logistic regression was used to analyze factors associated with knowledge, attitudes, and referral practices of human rabies.

Results: We interviewed 204 THPs; 74% (150/204) were female. The median age was 43 years (inter-quartile range: 22‒75 years) and 31% (64/204) had over 10 years of experience. The majority (80%, 163/204) of THPs had inadequate knowledge, and poor referral practices (73%, 149/204). However, 91% (186/204) had positive attitudes toward human rabies prevention. Having more experience was associated with adequate knowledge (aOR: 4.13 95% CI: 1.52-11.21), and positive attitudes (aOR:12.62 95% CI:1.49-106.61). THPs who had adequate knowledge (aOR:2.30 95% CI: 1.12‒4.75) and positive attitudes (aOR:1.21 95% CI: 0.37-3.89) had higher odds of having good referral practices.

Conclusions: Despite THPs in eThekwini District having positive attitudes towards rabies prevention, gaps exist in their knowledge and referral practices. Having more experience as a THP was found to be a strong predictor of better knowledge and positive attitudes. This study established that among the factors associated with referral practices, knowledge and attitude were the ones modifiable. Educational interventions to improve knowledge and attitudes among THPs might result in better referral practices of animal bite victims for post-exposure prophylaxis initiation.