Human rabies post exposure prophylaxis at the Pasteur Institute of Dakar, Senegal: trends and risk factors

Abstract

Background Rabies remains a major public health problem in developing countries. Most fatal rabies cases, especially in children, result from dog bites and occur in low-income countries, such as those in Sub-Saharan Africa. Rabies can be controlled through mass dog vaccination and human deaths prevented through timely and appropriate post-exposure prophylaxis (PEP). As access to appropriate PEP remains a serious challenge for bite-victims, the aim of this study was to understand the use of PEP, to evaluate the knowledge, attitudes and practices with respect to rabies and to identify risk factors related to non-compliance with PEP to define recommendations for improving PEP in Senegal. Methods This study included patients with suspicion of rabies exposure who sought PEP at the Pasteur Institute of Dakar from April 2013 to March 2014. Patients with rabies clinical symptoms, those who had already started PEP and those with exposure outside Senegal or for more than 3 months were excluded. Data on risk factors and propensity to seek and complete PEP were collected using questionnaires and phone interviews. The association between acceptability and compliance with PEP and other independent variables were evaluated using multivariate regression analysis. Results Among the 905 patients enrolled into the study, 67% were male (sex ratio M/F, 2) and 46%, children under 15 years of age. Exposures by animal bites represented 87%, whereas the remainder were due to scratches or contact; 76% were classified as WHO category III and 88% were due to dogs. Among these patients, 7% refused to start PEP and 54.5% completed the full schedule. Main factors reported by non-compliant patients were vaccine costs and affordability, and knowledge on status of biting animal. Conclusion This study shows that despite the awareness about rabies dangers and prevention, only half of the patients completed the full PEP schedule. The following recommendations, such as free of charge prophylaxis or intradermal regimens as an alternative to intramuscular regimens, should be considered to increase the adherence to PEP at the Pasteur Institute of Dakar and in Senegal.

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

“…Moreover, in our study, those with secondary education or more were more likely to access information on dogs and dog bites than those with less education level. Our findings and probable explanation are coherent with research that has suggested that people with higher education tend to have more knowledge about rabies than illiterate ones [46,47].…”

“…applied on the wound by the 193 victims who conducted some pre-clinical care were antiseptic (46), herbs (25) black stone (10) unknown creams or other materials such as beans, dog urine, dust, tobacco, coins, brake fluid, acid, powder made out of dog hair and salt. Notably, only 8 out of 29 study participants who had at least one previous dog bite episode complied with preclinical guidelines.…”

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

“…Moreover, in our study, those with secondary education or more were more likely to access information on dogs and dog bites than those with less education level. Our findings and probable explanation are coherent with research that has suggested that people with higher education tend to have more knowledge about rabies than illiterate ones [44,45].…”

Evaluation of the knowledge, attitudes and practices of students at the University of Abomey-Calavi on rabies in Benin Republic, West Africa

“…This finding is not unique to Benin. Other studies conducted in India and Senegal had respondents report poor compliance with PEP treatment due to the cost [ 19 , 20 ]. Due to this financial burden, the majority of our study´s respondents noted that using traditional recipes which lack empirical evidence of successful rabies treatment increases the risk of a community´s rabies incident.…”