Improper wound treatment and delay of rabies post-exposure prophylaxis of animal bite victims in China: Prevalence and determinants

Abstract

BackgroundRabies is invariably a fatal disease. Appropriate wound treatment and prompt rabies post-exposure prophylaxis (PEP) are of great importance to rabies prevention. The objective of this study was to investigate the prevalence and influencing factors of improper wound treatment and delay of rabies PEP after an animal bite in Wuhan, China.MethodologyThis cross-sectional study was conducted among animal bite victims visiting rabies prevention clinics (RPCs). We selected respondents by a multistage sampling technique. A face-to-face interview was conducted to investigate whether the wound was treated properly and the time disparity between injury and attendance to the RPCs. Determinants of improper wound treatment and delay of rabies PEP were identified by a stepwise multivariate logistic regression analysis.Principal findingsIn total, 1,015 animal bite victims (564 women and 451 men) responded to the questionnaire, and the response rate was 93.98%. Overall, 81.2% of animal bite victims treated their wounds improperly after suspected rabies exposure, and 35.3% of animal bite victims delayed the initiation of PEP. Males (OR = 1.871, 95% CI: 1.318–2.656), residents without college education (OR = 1.698, 95% CI: 1.203–2.396), participants liking to play with animals (OR = 1.554, 95% CI: 1.089–2.216), and people who knew the fatality of rabies (OR = 1.577, 95% CI: 1.096–2.270), were more likely to treat wounds improperly after an animal bite. Patients aged 15–44 years (OR = 2.324, 95% CI: 1.457–3.707), who were bitten or scratched by a domestic animal (OR = 1.696, 95% CI: 1.103–2.608) and people who knew the incubation period of rabies (OR = 1.844, 95% CI: 1.279–2.659) were inclined to delay the initiation of PEP.ConclusionsOur investigation shows that improper wound treatment and delayed PEP is common among animal bite victims, although RPCs is in close proximity and PEP is affordable. The lack of knowledge and poor awareness might be the main reason for improper PEP. Educational programs and awareness raising campaigns should be a priority to prevent rabies, especially targeting males, the less educated and those aged 15–44 years.

Cost-effectiveness of dog rabies vaccination programs in East Africa

“…Programs designed to notably reduce, even eliminate, human dog rabies deaths have to rely on the expansion of dog rabies vaccination coverage. Human PEP does save lives, but it can be relatively expensive and it is difficult to ensure that all persons potentially exposed to dog rabies have timely access to PEP [ 6 , 34 , 41 , 47 , 48 ]. It may well be difficult to implement-and-maintain PEP programs over several years that achieve 99% coverage ( Table 7 ).…”

Myths and unhealthy wound practices regarding animal bite among subjects attending anti rabies clinic in a South Delhi municipal corporation polyclinic in Mehrauli, Delhi

“…11 Liu et al mentions that males are more likely to treat wounds improperly or do nothing after exposure which might involve several indicators in men's decisions, comprising biological, psychological and sociological considerations. 12 Due to the small sample size and unequal distribution of gender among the subjects this can't be commented upon.Our findings were comparable to that reported by Joseph et al where reasons for delay in initiating PEP given by respondents were the inability to come early for vaccination included work related barriers (42.68%), anti-rabies clinic being closed on Sundays or national holidays (36.59%) and unawareness about timely PEP (31.71%). 13 A significant finding which was observed in our study that 27% of subjects used chilli powder or its paste with oil and 2.5% used oil and turmeric paste and 1.9% only oil for application on the wound.…”

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

“…Although the rabies virus can infect all mammals, over 99% of all human rabies cases are transmitted through dog bites [2]. Consequently, in addition to mass dog vaccination that breaks rabies transmission cycles, strategies for prevention of rabies in humans include prevention of dog bites and appropriate post-exposure treatment (PET) [2,3].…”

“…These preclinical guidelines are summarized as: wash the bite wound with running water for 15 minutes; disinfect the wound with substances with capacity to kill the rabies virus (soap, disinfectant); and seek medical care immediately to receive post-exposure prophylaxis vaccines. Appropriate washing and disinfection of wounds can prevent one-third of rabies infections [3,5]. Inadequate dog bite wound care has been associated with increased likelihood of PET failure and progression to rabies [5,6].…”

“…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].…”