Determinants of Rabies Post-exposure Prophylaxis Drop-Out in the Region of San-Pedro, Côte d'Ivoire

Abstract

Despite the fact that death from rabies is 100% preventable with a course of post-exposure prophylaxis (PEP) treatment, canine rabies still causes about 59,000 human deaths worldwide annually, half of which are occurring in Africa. In Côte d'Ivoire, rabies remains a threat partly due to the high drop-out rate of the life-saving human PEP treatment among people exposed to dog bites. Each year, half of the victims starting treatment, do not complete the course. The current study therefore assessed the determinants for drop-out of the life-saving treatment among people exposed to rabies in the department of San-Pedro in Côte d'Ivoire.MethodsA mixed-methods approach was used, including questionnaires, observation, individual interviews and focus group discussions, to gather socio-demographic and economic data from 235 participants about possible reasons for abandoning treatment. The study population consisted of patients and medical and veterinary health professionals who were selected using stratified sampling and purposive selection from a database available at the Rabies Center of San Pedro.ResultThe drop-out of PEP treatment was related to perception bias and a habit of low attendance of health care and vaccination centers in the population. Quantitative analysis shows differences between rural and urban areas and an association with age when it comes to treatment completion. The dropout rate was most significant among patients who, in case of other illness, did not routinely see a doctor or go to vaccination centers. The rate of abandonment was higher among those who believed that dog-related injuries could be easily treated at home, and who believed that a person with rabies could be cured without completing the preventive treatment. Insufficient provision of health information on rabies and logistic constraints related to the practical organization of treatment, including the long distance to the anti-rabies center and weaknesses in the patient follow-up procedure, did not contribute to the completion of PEP.ConclusionEstablished determinants for drop-out provide a framework for effective design and implementation of rabies control strategies to accelerate rabies deaths elimination efforts. In particular, access to PEP and community knowledge about rabies need to be improved and integrated in the health system and education system, respectively.

Rabies incidence and burden in three cities of Cameroon (2004–2013)

“…Dogs have been described as the main reservoir and transmitter of the disease of rabies ( Dah et al, 2023 ; Sofeu et al, 2018 ; Wobessi et al, 2023 ). This finding agrees with reports that dogs are the main reservoir and source of rabies in parts of Asia and Africa ( Lin et al, 2023 ; N'Guessan et al, 2022 ). In agreement with reports done by Ngah Osoe et al (2018) and Wobessi et al (2023) , the incidences of animal rabies were higher in Yaoundé, where there is a higher level of awareness about the disease and access to veterinary structures compared to other cities.…”

Rabies vaccination adherence and associated factors among rabies-exposed patients in Shenzhen, China: a hospital-based cross-sectional study

“…According to the results of this study, respondents aged 31 to 40 years were more likely to not follow the time specified in the rabies vaccination guidelines, possibly because this age group is a prime workforce and often forgets the time in the vaccination protocol guidelines due to objective reasons such as busy work schedules [ 25 ] or is unable to reach the point hospital due to work [ 26 ], thus experiencing PEV delay or discontinuation. The time required to reach the nearest rabies clinic is also an important factor affecting adherence, and some respondents may not be able to receive rabies vaccination in a timely manner because they live too far away, have limited access to transportation, or do not know the exact location of the RPC near their place of residence, similar to the results of some studies that relate to the accessibility of medical services for rabies vaccination [ 27 ]. Adherence was higher in patients who were injured at night to early morning and at places such as schools/laboratories, suggesting that the time and place of injury may influence rabies vaccination adherence in patients with dog and cat injuries, but the mechanism of influence needs to be studied.…”

Human dog-mediated rabies in the Circle of Kati, Mali: An epidemiological situation analysis and the stakeholder’s knowledge regarding rabies and the One Health approach

“…Of the 53 bite cases registered annually in the Circle of Kati, only 50% of them received adequate PEP. Low access to PEP has previously been reported in several African countries, which has been attributed to a lack of awareness on bite case management, high cost of biological products (vaccines and rabies immunoglobulins) and frequent shortages of PEP [13,[18][19][20]. Unfortunately, Mali is not immune to this situation.…”