Children's involvement in the rabies post-exposure prophylaxis: a qualitative study in Bajawa, Indonesia.

Abstract

Background: Children are known to be the most vulnerable group in the world for rabies disease, however, little is known about their involvement in the post-exposure prophylaxis (PEP), including wound cleaning, vaccination, and rabies immunoglobulin administration. This study aims to explore this knowledge gap, by providing factors and possible mechanisms that can explain children's involvement in the rabies post-exposure prophylaxis. This study was conducted in Bajawa district, Flores East Nusa Tenggara, Indonesia. At the time this study was conducted, Bajawa district was endemic for rabies disease.Methods & Materials: Story telling interviews with 23 children (7-15 years) who had a dog bite experience and in-depth interviews with 20 of dog bite victim's parents/caregivers have been conducted. Interviews were then analysed qualitatively using content analysis. Guided by COM-B model, Capabilities, Opportunities, and Motivations were explored.Results: The findings suggest, when a dog bite exposure occurs in children, not only parents/caregivers but also children can influence the involvement of a necessary rabies PEP. Mainly, parents/caregivers conduct the initial phase of wound cleaning, direct vaccination-seeking behaviour, to its completion. Children, in the other hand, could affect greatly the success of PEP in the level of willingness to inform the accident to their parents/caregivers, to conduct the wound cleaning, and to complete the vaccination treatment. Some important factors which can hinder the necessary involvement of children in the rabies PEP are the perception of parents/caregivers and children that scratches from dogs are not a risk, the insecurity among children to report dog bites to their parents, the lack of knowledge and capability on wound cleaning, minimum operating-hours of the treatment facility, and low vaccine availability. Conclusion:This study shows that public health practitioners in Bajawa district may need to involve both children and parents/caregivers in the control measure program of rabies, educate both of them to increase their knowledge and capacity about the proper treatment after dog exposure, and enlarge their opportunities to meet the treatment.