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

Abstract

In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must immediately wash bite wound for 15 minutes with water, soap, and a disinfectant before seeking medical care. This study investigated the epidemiology of dog bites and the determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog-bite patients at two healthcare facilities. Qualitative data were also collected through 13 in-depth interviews with patients, healthcare workers, herbalists, and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized linear models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied substances that were not recommended e.g. herbs (47/193), antiseptics (46/193), "black stone" (25/193), and unknown creams (10/193). Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47-0.92) and knowing the dog owner, adjPR = 0.65 (0.36-0.93). However, attainment of secondary or higher education, adjPR = 1.76 (1.24-3.79), being in employment, adjPR = 1.48 (1.09-2.31), perception that the dog was sick, adjPR = 1.47 (1.02-2.72) and knowledge about the dog's subsequent victim(s) adjPR = 0.35 (0.17-0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for deliberate promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.

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

“…Much as this information is important for improvement of care and treatment for dog bite victims, there has been minimum effort to study the factors that are likely to be influencing such delays. Previously, we have reported on pre-clinical practices that dog bite patients undertake before seeking medical care 30 . Here we investigate the compliance to receiving PEP within the first 24 hours and the determinants of delays to initiation of PEP among dog bite patients in rabies-endemic Wakiso and Kampala districts in Uganda.…”

Impact of Educational Intervention on The Knowledge of Epidemiology, Prevention and Control of Rabies Among Paramedical Students, Taxilla

“…Prior to the educational sessions, only 57.3% students were aware of the ineffective role of traditional medicine in the prevention and treatment of rabies. 18 In our study, there was 40% increase in the knowledge of students regarding post-exposure precautionary steps after the training. Whereas, in a similar study done by Auplish et al, there was a 40% increase in the knowledge of study participants regarding rabies post-exposure prophylaxis (PEP) vaccine schedule after the educational session.…”

The potential for the double risk of rabies and antimicrobial resistance in a high rabies endemic setting: detection of antibiotic resistance in bacterial isolates from infected dog bite wounds in Uganda

“…Outstandingly, there were two deaths as a result of suspected clinical rabies and both had delayed to present to the healthcare facilities. The details of the health-seeking behaviour of the study participants is described in our previous paper [ 26 ]. Table 3 shows a comparison of key pre-hospital wound management practices for patients with non-infected and infected wounds.…”

“…Patients with category I bites (44/420, 10.5%) who were assessed as not requiring PET were excluded, leaving a total of 376 study participants. The health-seeking behaviour of the 376 participants and their exposure to the risk of rabies has been decribed in a previous paper [ 26 ]. Quantitative data were collected using questionnaires to record socio-demographic and other patient-related factors (Additional file 1 ).…”