Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda

Kisaka, Stevens; Makumbi, Fredrick; Majalija, Samuel; Bahizi, Gloria; Thumbi, SM

doi:10.12688/aasopenres.13311.1

Cited by 4 publications

(6 citation statements)

References 34 publications

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“…Victims bitten by an animal with an owner are late in reporting to the ARC. These results are in agreement with those of a previous study [ 16 ]. Category III injuries represented 76.8% of exposures.…”

Section: Discussionsupporting

confidence: 94%

Rabies in Morocco: Epidemiological Aspects and Post-exposure Prophylaxis Management

El Bazi,

El Bardi,

Miloudi

et al. 2023

Cureus

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Background Rabies is a zoonosis transmitted accidentally to humans and is fatal once clinical signs appear. In Morocco, rabies remains a difficult disease to eradicate, with dogs being the main source of contamination. Transmission of this illness can be avoided by promptly implementing post-exposure prophylaxis (PEP) following animal exposure. Inappropriate or delayed PEP increases the risk of acute infection. This study aims to describe and analyze the characteristics of exposure, investigate the factors related to delay in initiating PEP, and evaluate the attitudes and practices of patients towards animal exposure in the region of Ouarzazate between 2016 and 2019. Methods This was a retrospective study with statistical analysis. The data on animal exposure was collected from the Anti-Rabies Center (ARC) located in Ouarzazate Province, Morocco. Results A predominance of male cases (61.3%) among victims of animal exposure was found. The age group of five to 14 years was the most affected (23.5%). The upper limb represented the most frequent site of exposure (49.4%). Around 52.1% of patients presented with multiple lesions. About 54.4% of cases were bitten by a stray animal. Dogs were responsible for 47.8% of the bites. All exposed individuals performed wound cleansing prior to arrival at the ARC. Post-exposure prophylaxis was initiated in 34.5% of cases between 24 to 48 hours, while 26.1% of cases delayed it beyond 48 hours. Around 34% of patients did not complete their vaccination schedule. Regarding the factors associated with the delay in PEP, we found significant associations with patient age, place of residence (urban or rural), distance from the ARC (>30 km or <30 km), nature, number, and injury status (p≤0.05). Significant associations (p≤0.05) were also found with dog bites and their type (domestic or stray). Conclusion Our findings indicate that better awareness about rabies and PEP management is needed, especially among the rural population.

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Section: Discussionsupporting

confidence: 94%

Rabies in Morocco: Epidemiological Aspects and Post-exposure Prophylaxis Management

El Bazi,

El Bardi,

Miloudi

et al. 2023

Cureus

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“…We also documented de ciencies in the management of dog bites and adherence to WHO guidelines. We attributed the poor adherence to guidelines to lack of knowledge among the victims which is consistent with previous studies (23,43,44). Most of the individuals sought health care from a traditional healer because they were not fully aware of what to do, which might explain why they were eager to start rabies PEP treatment after sensitisation.…”

Section: Discussionsupporting

confidence: 81%

“…Interestingly, the traditional healer, who treated the victims with a black stone charged 4 times more than the cost spent to receive rabies PEP from a private health facility. Unfortunately, the e cacy of the black stone is unproven, even though traditional healers in Central Uganda use it to treat dog bite victims (17,23). Although we acknowledge the importance of traditional medicine practices in the management of health conditions at grassroot communities, the Ministry of Health should discourage such practices.…”

Section: Discussionmentioning

confidence: 94%

“…We encouraged the dog bite victims to utilise the free rabies PEP services at public health care facilities (23), but some of the individuals complained.…”

Section: Hesitancy Among Dog Bite Victims In Seeking Medical Assistan...mentioning

confidence: 99%

“…Historically, efforts to control rabies in Uganda have focused on vaccination of owned dogs (9,21) and understanding the knowledge and attitudes on rabies (22,23) and the health-seeking behaviours of dog bite victims (16). In contrast, relatively little is known about the circumstances resulting in dog bites.…”

Section: Introduction Page 4/22mentioning

confidence: 99%

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The danger of free roaming dogs in urban settings: A report of two suspected rabid dogs on rampage that inflicted 47 bites to people and domestic animals in peri-urban Uganda

Tayebwa,

Rashid,

Wilfred

et al. 2023

Preprint

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Background Human rabies cases associated with bites from rabid roaming dogs are prevalent in Uganda. Unfortunately, there is limited documentation of the circumstances surrounding those bites. Here, we documented dog attacks to humans and animals in two peri-urban areas in Central Uganda. Methods We responded to alerts of two suspected rabid dogs on rampage. We traced the dogs responsible for the attacks to diagnose the cause of the aggression and we interviewed the victims and community members to determine the circumstances of the bites and health care sought by the victims. We scheduled follow-up visits after 40 days, to assess compliance of the victims to rabies postexposure prophylaxis (PEP) and to document any challenges encountered in the process. Results The two rabid dogs inflicted 47 recorded attacks to 29 humans, mostly children (75.8%) and 18 domestic animals in Matugga and Mawale parishes in Wakiso and Luweero districts, respectively. Two individuals washed the wound with water and 7 individuals reported to the health facility for treatment in accordance with the WHO-guidelines for preclinical management of bites from suspected rabies cases. By contrast, 17 individuals sought treatment from a traditional healer while 5 individuals self-medicated with herbs at home. We advised those individuals to visit health facilities for proper medical care. All the victims started rabies PEP treatment; however, 2 individuals did not complete their prescription. Although rabies PEP at public health facilities was free, regularly the victims paid 3–5 USD to the clinician as an incentive while the cost at private health facilities was 13–15 USD for a single dose. Due to the unprovoked attacks, the victims and local leaders advocated for elimination of roaming dogs, but the roaming dog owners objected. Conclusions Overall, our results demonstrate the outsized impact that a single-rabid dog can have on a community. They also reveal how poverty, knowledge gaps, community trust in traditional healers, and barriers to healthcare access negatively affect medical care given to dog bite victims in this setting. Educational campaigns and control of roaming dogs should help improve the situation in Central Uganda, as well as in other socioeconomically similar settings.

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Rabies in rural northeast India: A case report emphasising the urgency of the One Health approach

Mohanty,

Boro,

Heydtmann

et al. 2024

One Health

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Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda

Cited by 4 publications

References 34 publications

Rabies in Morocco: Epidemiological Aspects and Post-exposure Prophylaxis Management

Rabies in Morocco: Epidemiological Aspects and Post-exposure Prophylaxis Management

The danger of free roaming dogs in urban settings: A report of two suspected rabid dogs on rampage that inflicted 47 bites to people and domestic animals in peri-urban Uganda

Rabies in rural northeast India: A case report emphasising the urgency of the One Health approach

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