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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2022; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
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 (inter quartile range) 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.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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Ostrowska A, Susło A, Zabłocka K, Bieńkowski C, Pokorska-Śpiewak M. Analysis of qualification for post-exposure prophylaxis against rabies in children in Poland. Paediatr Int Child Health 2022; 42:142-147. [PMID: 37482764 DOI: 10.1080/20469047.2023.2236480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Rabies is a fatal disease caused by the rabies virus, usually transmitted by a bite by an infected animal. Because there is no effective treatment, prophylaxis is crucial. The aim of the study was to analyse the circumstances of exposure, characterise the animals that were a potential source of infection and evaluate the frequency of post-exposure prophylaxis in children. METHODS This was a retrospective analysis of the medical records of 494 children who had been bitten, scratched or salivated on by an animal and were seen consecutively between 2015 and 2019 in the Department of Paediatric Infectious Diseases, Medical University of Warsaw. RESULTS The study group was children aged 10 months to 17 years 11 months. The animals most commonly involved were dogs (347/494, 70.24%), cats (81/494 (16.40%) and squirrels (10/494, 2.02%). The contact was mainly with tame but unfamiliar animals (359/494, 72.67%, p < 0.001). The most common type of exposure was a bite (457/494, 92.51%). Surgical wound care was required most often after exposure in a town (64/90, 71.11%). A total of 412 children (80.83%) received post-exposure vaccination, including 333/412 using the Essen regimen. In 13/412 cases, the vaccination schedule (3.16%) was not completed because of an absence of signs of disease during veterinary observation of the animal. Anti-rabies immunoglobulin was administered to 13/412 (3.16%). CONCLUSION Most children who are referred after being bitten by an animal require post-exposure prophylaxis. Children are usually bitten by tame dogs with which they are unfamiliar, mostly on the hand. Surgical wound care is needed more often for urban patients than others.
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Affiliation(s)
- Aleksandra Ostrowska
- Students Scientific Group, Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Anna Susło
- Students Scientific Group, Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Zabłocka
- Students Scientific Group, Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Carlo Bieńkowski
- Doctoral School, Medical University of Warsaw, Poland
- Department of Children's Infectious Diseases, Medical University of Warsaw, Poland
- Regional Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children's Infectious Diseases, Medical University of Warsaw, Poland
- Regional Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2021; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/20/2022] Open
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 (inter quartile range) 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.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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Kisaka S, Makumbi F, Majalija S, Bahizi G, Thumbi SM. Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda. AAS Open Res 2021; 4:49. [PMID: 36419540 PMCID: PMC9648361 DOI: 10.12688/aasopenres.13311.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Fredrick Makumbi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
| | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, 00256, Uganda
| | - Gloria Bahizi
- School of Public Health, Makerere University, Kampala, 00256, Uganda
- Department of National Disease Control, Ministry of Health, Uganda, Kampala, 00256, Uganda
| | - SM Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, 00254, Kenya
- Paul G Allen School for Global Animal Health, Washington State University, Washington, 001, USA
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Pekin A, Rynhoud H, Brennan B, Soares Magalhães RJ. Dog bite Emergency department presentations in Brisbane metro south: Epidemiology and exploratory medical geography for targeted interventions. One Health 2020; 12:100204. [PMID: 33364297 PMCID: PMC7750554 DOI: 10.1016/j.onehlt.2020.100204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022] Open
Abstract
Dog bites are a recognized public health issue due to their impact on human and animal health/welfare. This study aimed to investigate demographic and geographic disparities in the epidemiology of dog bites presentations reported to the emergency departments of the four main public hospitals in the Metro South region of Brisbane, Queensland, Australia. Dog bite patient hospitalization data geolocated to the street address were collected from clinical records management systems from the four main public hospitals in the Metro South Hospital Health Service region of Queensland for a 5-year period (ie. 01/07/2013 to 30/06/2017). We investigated the epidemiology of three clinical outcomes including probability of paediatric cases (paediatric vs. adult), probability of dog bites to the head (head injury vs. other injury), and probability of re-presentation to the ED following their initial dog bite (yes or no) by way of univariable then multivariable Bernoulli logistic regression models including patient postcode as a random effect. Residual semivariograms were created to identify spatial trends in the medical geography of dog bites and binomial geostatistical models were created to predict the probability of the outcomes of interest in Brisbane Metro south and surrounding suburbs. Our results demonstrate that compared to adult dog bite cases, paediatric dog bite cases were significantly associated with bites to the head or face or neck (OR 14.65, P < 0.001), bites to the lower body (OR 4.95, P = 0.035) and larger dogs (OR 0.25, P = 0.030 for small dogs). The probability of head injuries was greater in younger age groups (17-39 OR 0.25, P = 0.001; 40-64 OR 0.15, P = 0.001; 65-above OR 0.14, P = 0.029). Attacks by small dogs were more likely to inflict head wounds than large dogs (OR 6.12, P < 0.001). The probability of re-presentation was lower in patients bitten by medium sized dogs (OR 0.29, P = 0.027) than larger dogs. Our predictive maps showed significant clustering of paediatric case probability in the Logan city and Redlands councils associated with socioeconomic status of the places of residence. In conclusion, our findings demonstrate significant demographic and geographic heterogeneity in dog bite ED presentations. Public health interventions to reduce the burden of dog bites should be targeted to the populations most at-risk in the areas identified in this study.
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Affiliation(s)
- Alexander Pekin
- UQ Spatial Epidemiology Laboratory, The School of Veterinary Science, University of Queensland, Gatton, 4343, QLD, Australia
| | - Hester Rynhoud
- UQ Spatial Epidemiology Laboratory, The School of Veterinary Science, University of Queensland, Gatton, 4343, QLD, Australia
| | - Bradley Brennan
- Logan Hospital, Metro South Hospital Service, Logan, 4131, QLD, Australia
| | - Ricardo J Soares Magalhães
- UQ Spatial Epidemiology Laboratory, The School of Veterinary Science, University of Queensland, Gatton, 4343, QLD, Australia.,UQ Children's Health Research Centre, Children's Health and Environment Program, The University of Queensland, Gatton, 4343, QLD, Australia
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De la Puente-León M, Levy MZ, Toledo AM, Recuenco S, Shinnick J, Castillo-Neyra R. Spatial Inequality Hides the Burden of Dog Bites and the Risk of Dog-Mediated Human Rabies. Am J Trop Med Hyg 2020; 103:1247-1257. [PMID: 32662391 PMCID: PMC7470517 DOI: 10.4269/ajtmh.20-0180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022] Open
Abstract
Since its reintroduction in 2015, rabies has been established as an enzootic disease among the dog population of Arequipa, Peru. Given the unknown rate of dog bites, the risk of human rabies transmission is concerning. Our objective was to estimate the rate of dog bites in the city and to identify factors associated with seeking health care in a medical facility for wound care and rabies prevention follow-up. To this end, we conducted a door-to-door survey with 4,370 adults in 21 urban and 21 peri-urban communities. We then analyzed associations between seeking health care following dog bites and various socioeconomic factors, stratifying by urban and peri-urban localities. We found a high annual rate of dog bites in peri-urban communities (12.4%), which was 2.6 times higher than that in urban areas (4.8%). Among those who were bitten, the percentage of people who sought medical treatment was almost twice as high in urban areas (39.1%) as in peri-urban areas (21.4%).
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Affiliation(s)
- Micaela De la Puente-León
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Michael Z. Levy
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amparo M. Toledo
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
| | - Sergio Recuenco
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Julianna Shinnick
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ricardo Castillo-Neyra
- Zoonotic Disease Research Laboratory, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Arequipa, Perú
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
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Epidemiological study on animal bite cases referred to Haji Daii health Center in Kermanshah province, Iran during 2013-2017. BMC Public Health 2020; 20:412. [PMID: 32228562 PMCID: PMC7106602 DOI: 10.1186/s12889-020-08556-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background Over thousands of animal bite cases are reported annually worldwide and in Iran placing a large financial burden on the health and economy. The aim of this study was to evaluate the epidemiology of animal bite cases in Kermanshah, Iran through 2013–2017. Methods In this cross-sectional study, 5618 animal bite cases in Kermanshah from 2013 to 2017 were studied. Data were analyzed using descriptive and inferential statistics. Results In the study period, 5618 animal bite cases were found. The prevalence of animal bites was estimated between 42.55–45.66 per100000 populations during 2013–2017. An increasing significant trend was found for prevalence of animal bites (Average annual percent change [AAPC] + 4.9, P-trend< 0.001) over a 5-years’ time period. The mean age of the subjects was 32.7 ± 18.3 years. Of the studied subjects 76.3% were male, and 34% had non-governmental jobs. Dogs were found as the cause of animal bites in 72% of the cases. Of the studied cases, 82% had received rabies vaccination for three times. Conclusion The results showed an increasing significant trend for animal bites in Kermanshah. Development of interventional programs, such as limiting stray dogs, vaccination of dogs and raising public awareness are essential.
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