Determinants of health seeking behavior of animal bite victims in rabies endemic South Bhutan: a community-based contact-tracing survey

Abstract

Background Dog bites are the main source of rabies infection and death in humans, contributing up to 99% of all cases. We conducted a contact-tracing study to evaluate the health seeking and treatment compliance behaviors of people following potential exposure to rabies in rabies endemic south Bhutan. Methods Using information from the rabies post exposure prophylaxis (PEP) register, animal-exposed victims who had visited five hospitals in south Bhutan between January and March 2017 were traced and further data were collected from them using a structured questionnaire. A snowballing technique was used to identify victims who did not seek PEP.The survey was conducted between April and June 2017. Logistic regression was performed to assess factors associated with PEP-seeking and compliance behavior by the victims. Results Amongst 630 who reported to hospitals, 70% (444) of people could be traced and additional 8% (39) who did not seek PEP was identified through contact tracing. Therefore, a total of 483 people were interviewed. Seventy one percent (344/483) of exposure were due to animal bites of which 80% (365/455) were considered to be provoked incidents. Common reasons for not seeking health care included assumptions that risks of infection were minor if bitten by an owned or vaccinated dog. The victims who are male (OR: 0.36; 95% CI: 0.16–0.77) and educated (OR: 0.41; 95% CI: 0.17–0.96) were less likely to seek PEP, while those that experienced unprovoked bite (OR: 5.10; 95% CI: 1.20–21.77) were more likely to seek PEP in the hospitals. Overall, 82% of the victims sought PEP from the hospitals within 24 h after exposure. Eighty three percent completed the PEP course prescribed by the physician. The respondents living in urban areas (OR: 2.67; 95% CI: 1.34–5.30) were more likely to complete the prescribed PEP course than rural dwellers. Conclusions There is high risk of rabies infection in southern Bhutan. It is critical to bridge knowledge gaps and dispel existing myths which will help to improve PEP seeking and compliance behavior of people exposed to rabies infection from animals. A risk-based advocacy program is necessary to prevent dog-mediated human rabies deaths. Electronic supplementary material The online version of this article (10.1186/s12889-019-6559-x) contains supplementary material, which is available to authorized users.

Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies

“…Such non-compliance is driven by factors that affect the healthseeking behavior of people and as well as their knowledge, attitudes, and practices towards dog bite outcome like rabies. This is why compliance to the preclinical guidelines has been attributed to geographical, social, economic, cultural, organizational, as well as dog and wound factors [13][14][15][16].…”

Evaluation of a Rapid Immunochromatographic test kit to the Gold Standard Fluorescent Antibody test for diagnosis of rabies in animals in Bhutan

“…Sporadic outbreaks are also reported in the interior rabies-free areas, especially in eastern Bhutan as a result of incursions and spread from the border areas [4 -6]. Between 2006 and 2016, 17 humans have died of rabies in Bhutan, the majority being children below 15 years of age and around 7,000 dog bite cases (1026 bites per 100,000 people annually) in humans are reported every year in the country [7][8][9]. Nevertheless, Bhutan is on the right track to achieve zero human deaths from dog-mediated rabies by 2030 as several control measures are in place in line with the global strategic plan of "Zero by 30" [3,10,11].…”

Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies

“…Pre-clinical practices that deviate from recommendations have been reported to include not seeking medical care following dog-bites [7], delay in seeking treatment [3,8,9], lack of wound washing or treatment of wounds with chilies, salt, turmeric powder, lime, snuff powder, paste of leaves, acid and ash provided by traditional healers and magicians [10,11]. Non-compliance to the preclinical guidelines has been attributed to geographical, social, economic, cultural, organizational, dog and wound factors [12][13][14][15].…”