Epidemiological study of human rabies cases in Bangladesh through verbal autopsy

Abstract

Identification of risk factors is crucial to find ways to reduce rabies deaths. We investigated the hospital records of rabies deceased through contact tracing of the relatives of the victims using enhanced verbal autopsies (VA) to identify why the people had to die from rabies in recent years in Bangladesh. Patients whose deaths were confirmed by physicians based on the history of animal exposure and clinical signs were taken into account for VA. Socio-demographic profile of the deceased, animal exposure, nature of the wound, and history of postexposure prophylaxis (PEP) data were obtained and analysed. The study found 256 cases in which the cause of death was attributed to rabies, most of the victims were male (71.88%), resided in the rural community (80.47%), dependent (49.22%), and children below the age of 15 years (47.27%). Dogs were the single most responsible (81.64%); however, cats (12.11%), jackals (3.91%) and mongoose (2.34%) were also found accountable for rabies incidence (P < 0.05). Significantly, limbs were the most common (67.97%) site of exposure, and the shortest incubation period was identified in the case of bites to head and face (P < 0.05). The majority (86.72%) of the deceased did not receive any PEP; whereas, 66.80% sought treatment from traditional healers. Among the deceased (13.28%, n ¼ 34) who had received PEP, only 8.82% of them completed the full course of the vaccination regimen (P < 0.01); however, none of them had history of taking rabies immunoglobulin (RIG). The study recommends extensive public health awareness programs in the rural community and establishing methods to improve healthcare-seeking behaviours, including receiving PEP instead of visiting traditional healers. Moreover, the availability and accessibility of PEP in the government hospital facilities are desirable, and laboratory-based surveillance with compatible rapid data reporting may be incorporated in the existing policy.

Knowledge, attitudes and perceptions about rabies among the people in the community, healthcare professionals and veterinary practitioners in Bangladesh

“…Dogs are mainly responsible for causing rabies. This is well-reported and known worldwide, including in Bangladesh [ 19 , [35] , [36] , [37] , [38] ]. This study found that over 95% of the respondents from all populations possessed a high awareness about the transmission of rabies from dogs; however, there was a substantial gap regarding rabies transmission dynamics through domestic and wild animals.…”

“…Vaccinating at least 70% dogs in three consecutive years through MDV could attain a significant reduction in the virus transmission [ 47 , 48 ]. Regarding health-seeking behaviours of dog bite victims, recent studies showed that rabies victims sought treatment from by traditional healers (66.8%) instead of visiting hospital and receiving PEP which is the reflection of lack of formal education on rabies at the community level in Bangladesh [ 19 , 38 ]. Through increasing community level education, knowledge about dog bites and its consequences, and especially necessity of taking PEP measures to reduce the risk of becoming rabies infection can be improved.…”

“…Through increasing community level education, knowledge about dog bites and its consequences, and especially necessity of taking PEP measures to reduce the risk of becoming rabies infection can be improved. Moreover, proper management of animal bites cases in both human and veterinary sector with trained staffs and the accessibility of rabies vaccine at government facilities are necessary to reduce human rabies death cases [ 38 ]. It would be preferable to arrange refresher training on time basis for both human and veterinary personnel's at tertiary and district level hospitals to improve their work efficiency and motivation.…”

Roles of traditional medicine and traditional healers for rabies prevention and potential impacts on post-exposure prophylaxis: A literature review

“…From a retrospective study spanning 12 years, Ghosh et al (2020) found 78% of 422 dog bites victims died after only receiving treatment by a traditional healer [ 14 ]. Another retrospective study in Bangladesh stated that 66.8% of 256 dog bite victims died after receiving treatment from a traditional healer [ 46 ].…”

“…Additionally, traditional healers were trained to refer patients for PEP at animal bite treatment centers [ 24 ]. Many KAP and retrospective studies included in this literature review emphasized the need for awareness of rabies prevention and PEP in the respective communities [ 14 , 41 , 43 , 46 , 49 ].…”