Estimating the burden of rabies in Ethiopia by tracing dog bite victims

Abstract

In developing countries where financial resources are limited and numerous interests compete, there is a need for quantitative data on the public health burden and costs of diseases to support intervention prioritization. This study aimed at estimating the health burden and post-exposure treatment (PET) costs of canine rabies in Ethiopia by an investigation of exposed human cases. Data on registered animal bite victims during the period of one year were collected from health centers in three districts, i.e. Bishoftu, Lemuna-bilbilo and Yabelo, to account for variation in urban highland and lowland areas. This data collection was followed by an extensive case search for unregistered victims in the same districts as the registered cases. Victims were visited and questioned on their use of PET, incurred treatment costs and the behavioral manifestations of the animal that had bitten them. Based on the collected data PET costs were evaluated by financial accounting and the health burden was estimated in Disability-Adjusted Life Years (DALYs). In total 655 animal bite cases were traced of which 96.5% was caused by dog bites. 73.6% of the biting dogs were suspected to be potentially rabid dog. Annual suspected rabid dog exposures were estimated per evaluated urban, rural highland and rural lowland district at, respectively, 135, 101 and 86 bites, which led, respectively, to about 1, 4 and 3 deaths per 100,000 population. In the same district order average costs per completed PET equaled to 23, 31 and 40 USD, which was significantly higher in rural districts. Extrapolation of the district results to the national level indicated an annual estimate of approximately 3,000 human deaths resulting in about 194,000 DALYs per year and 97,000 exposed persons requiring on average 2 million USD treatment costs per year countrywide. These estimations of the burden of rabies to the Ethiopian society provide decision makers insights into the potential benefits of implementing effective interventions.

Determinants of health seeking behaviour following rabies exposure in Ethiopia

“…In Ethiopia, each district has at least one health centre delivering human post‐exposure prophylaxis services to individuals exposed to rabies. These districts are the same districts for which the burden of rabies in Ethiopia was reported in an earlier paper (Beyene et al., ).…”

“…The list of bite cases collected from the health centres was then sorted into victim's village and given to local health extension workers. Local health extension workers practicing in each village of the districts were trained on techniques to carry out interviews using a structured questionnaire as well as in searching for cases that were not reported to health centres, using the contact tracing method described in our previous work (Beyene et al., ). A local health extension worker went to each victim's house, asked for and confirmed the victim's oral consent to participate in the study, and then interviewed them using the structured questionnaire.…”

“…The health extension workers also asked the bite victims and their families whether they knew of anyone who had been bitten by an animal within their community but reported this to another health centre or went to a traditional/spiritual healer or did nothing. Subsequently, any potential victims identified in this manner were contacted and interviewed using the same structured questionnaire that was used in earlier work (Beyene et al., ).…”

“…An important question to explore is whether these general determinants are able to explain the observed differences among districts in terms of health seeking behaviour (Beyene et al., ) or whether some differences are caused by district‐specific features. To evaluate each dependent variable, two models were created.…”

“…In Ethiopia, in a selected urban district, a rural highland district and a rural lowland district, the annual rabid dog exposures were estimated to be 135, 101 and 86 bites per 100,000 inhabitants, respectively (Beyene, Kidane, Mourits, & Hogeveen, ). That study revealed that 71% of bite victims reported to health centres seeking medical service upon exposure, while only 57% of the bite victims received sufficient doses of PEP.…”