Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda

Abstract

Background Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (IQR) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 - 6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 - 3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.

Rabies in Morocco: Epidemiological Aspects and Post-exposure Prophylaxis Management

“…Victims bitten by an animal with an owner are late in reporting to the ARC. These results are in agreement with those of a previous study [ 16 ]. Category III injuries represented 76.8% of exposures.…”

The danger of free roaming dogs in urban settings: A report of two suspected rabid dogs on rampage that inflicted 47 bites to people and domestic animals in peri-urban Uganda

“…We also documented de ciencies in the management of dog bites and adherence to WHO guidelines. We attributed the poor adherence to guidelines to lack of knowledge among the victims which is consistent with previous studies (23,43,44). Most of the individuals sought health care from a traditional healer because they were not fully aware of what to do, which might explain why they were eager to start rabies PEP treatment after sensitisation.…”

“…Interestingly, the traditional healer, who treated the victims with a black stone charged 4 times more than the cost spent to receive rabies PEP from a private health facility. Unfortunately, the e cacy of the black stone is unproven, even though traditional healers in Central Uganda use it to treat dog bite victims (17,23). Although we acknowledge the importance of traditional medicine practices in the management of health conditions at grassroot communities, the Ministry of Health should discourage such practices.…”

“…We encouraged the dog bite victims to utilise the free rabies PEP services at public health care facilities (23), but some of the individuals complained.…”

“…Historically, efforts to control rabies in Uganda have focused on vaccination of owned dogs (9,21) and understanding the knowledge and attitudes on rabies (22,23) and the health-seeking behaviours of dog bite victims (16). In contrast, relatively little is known about the circumstances resulting in dog bites.…”