Rabies Postexposure Prophylaxis Noncompletion After Dog Bites: Estimating the Unseen to Meet the Needs of the Underserved

Abstract

Postexposure prophylaxis (PEP) prevents human rabies and is accessible in Cambodia principally in Phnom Penh, the capital. Timely, affordable access to PEP is a challenge for the mainly rural population. We aimed to identify districts independently associated with PEP noncompletion to position frontline vaccination centers. We analyzed the 2009-2013 database at the Rabies Prevention Center at the Institut Pasteur du Cambodge, Phnom Penh. Logistic regressions identified nongeographic determinants of PEP noncompletion as well as the districts that were independently associated with noncompletion after adjustment for these determinants. The influence of distance by road was estimated using a boosted regression-trees model. We computed a population attributable fraction (rabies index (RI)) for each district and developed a map of this RI distribution. A cartographic analysis based on the statistic developed by Getis and Ord identified clusters of high-RI districts. Factors independently associated with noncompletion were patients' district of residence, male sex, age 15-49 years, initial visit during rice harvest, the dog's status (culled or disappeared), and a prescribed PEP protocol requiring more than 3 PEP sessions (4 or 5). Four clusters of high-RI districts were identified using this analytical strategy, which is applicable to many vaccination or other health services. Positioning frontline PEP centers in these districts could significantly widen access to timely and adequate PEP.

Human death from suspected rabid dog bite in Zamfara State, Nigeria

“…Previous studies support this view, which showed that most human rabies-related deaths are being recorded from rural communities (Wallace et al, 2016;Tarantola et al, 2017;Qi et al, 2018;Tran et al, 2018). However, access to highly effective intervention such as timely PEP, has been considered challenging especially in rabies-endemic developing countries, where most exposures occur in rural areas (Tarantola et al, 2017). In Africa, maximal number of human rabies deaths is documented amongst underprivileged agrarian people and children (Singh et al, 2017).…”

“…This incident occurred in a rural area at the peak of the farming season, during which outdoor activities of the farmers increased, leading to an enhanced chance of contact with the stray dog and potential exposure to rabies. Previous studies support this view, which showed that most human rabies-related deaths are being recorded from rural communities (Wallace et al, 2016;Tarantola et al, 2017;Qi et al, 2018;Tran et al, 2018). However, access to highly effective intervention such as timely PEP, has been considered challenging especially in rabies-endemic developing countries, where most exposures occur in rural areas (Tarantola et al, 2017).…”

Health Data in Dentistry: An Attempt to Master the Digital Challenge

“…Clinic throughput: monthly numbers of bite patients presenting to clinics to initiate PEP. Total presentations depend on the regimen, its schedule requirements (Table 1), clinic accessibility [15] and patient compliance. Vial size: most rabies vaccines are sold in 0.5 mL or 1 mL vials, at equal cost.…”

Improving the provision of rabies post-exposure prophylaxis

“…9 The geographical distribution of these IDBCs is a crucial issue in many developing countries and will require important efforts from national authorities. 8 The education of populations to increase awareness and perception of the risks related to dog bite exposure and rabies is another complex issue that is starting to be addressed by stakeholders but should be promoted further. 10 Hopefully, Gavi and other national and international stakeholders and donors will keep on supporting field studies so that all these aspects can be better characterised and accounted for in future assessments of rabies control strategies.…”