Abandons de prophylaxie post-exposition au Centre antirabique d’Abidjan, Côte d’Ivoire

Abstract

Despite the availability of effective anti-rabies vaccine, rabies keeps affecting people in developing countries such as Côte d'Ivoire. The low compliance with Post Exposure Prophylaxis (PEP) partially explains this situation. This study was aiming at studying the reasons to abandon PEP. This descriptive and cross-sectional study has taken place at the anti-rabies Center of Abidjan from October 1st to December 2009. Data were collected in two steps: we first interviewed all the patients at the anti-rabies center during their first consultation, and then phone interviews were conducted one month later, only with exposed patients who abandoned their PEP. These phone calls allowed us to complete the questionnaire (the status of the animal and PEP discontinuation). Patients' verbal informed consent was obtained prior to data collection. Besides, patients were explained the risks they were exposed to and were advised to complete immunization. The results obtained revealed that, out of 220 people included in the study, 116 (52.7%) abandoned the PEP. The compliance was lower with the protocol of five injections compared to that of four injections. More than half of the patients abandoned PEP after the first injection. In 32.8% of patients who abandoned PEP, the animal was dead, disappeared, was destroyed or there were no information about it one month after bite or scratch. Animal owners' refusal of taking in charge the victims (20%) and the lack of financial resources for purchasing the vaccine (13.6%) were the most frequent reasons to abandon PEP. To increase the protection of the human population against rabies and to increase the compliance with PEP protocols, the improvement of financial accessibility to the vaccine for population and the elaboration of compulsory regulations for animal owners to take in charge the PEP are necessary.

Rabies vaccine initiation and adherence among animal-bite patients in Haiti, 2015

“…We found a surprisingly high adherence to completion of vaccine administration; 54% of animal-bite patients completed all five doses in our study. In contrast, lower adherence was reported in Iran (16.3%-18.7%), Tanzania (28%), and Cote d’Ivoire (47.3%) [ 6 , 8 , 19 , 20 ]. Two studies in Nigeria had similar or higher completion coverage rates among animal-bite patients identified through a rabies lab registry and a pediatric hospital (60.7%) [ 21 , 22 ].…”

Human rabies in Côte d'Ivoire 2014-2016: Results following reinforcements to rabies surveillance

“…As demonstrated in this study, poor patient compliance (56.6%) with the multi-dose regimens currently in use continues to be a problem that increases the risk of developing rabies after exposure. In Côte d’Ivoire, the most frequent reasons for not completing the immunization schedule have been financial, in that animal owners refused to pay for treatment or that patients were unable to pay for it, though other factors such as awareness and clinic proximity were also responsible [ 21 ]. Other impediments to compliance have been reported to include loss of wages, forgotten dates and the distance and time needed to travel to the clinic [ 13 ].…”

Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014–15: a retrospective follow-up survey

“…We found no other studies that had stratified adherence into these categories, which makes direct comparison of findings challenging. In studies that have reported adherence in countries with endemic rabies, it has been poor, with rates as low as 28% in Tanzania, 40% in Nepal, and 48% in the Ivory Coast, 19–23 and only reaching 60% in Bhutan. 22 Among respondents in our survey who sought medical care and for whom a rabies exposure could not be ruled out, 58% completed at least four doses of vaccine, with the proportion being 81% among those with confirmed or probable exposures.…”