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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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Kisaka S, Makumbi FE, Majalija S, Muwanga M, Thumbi SM. 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. Antimicrob Resist Infect Control 2022; 11:142. [PMID: 36372895 PMCID: PMC9655799 DOI: 10.1186/s13756-022-01181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/02/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Post-exposure treatment for dog bites in humans aims at alleviating the risk of rabies and promoting wound healing. Wound healing may be complicated by bacteria. This study identified the different bacteria and their antibiotic susceptibilities in infected dog bite wounds (DBWs) in Uganda. METHODS A cross-sectional study was conducted among 376 dog bite patients. Wound swabs from patients with infected DBWs were collected and inoculated into recommended media. They were cultured for both aerobic and anaerobic bacteria. All isolated bacteria were identified based on colony characteristics, gram stain, and standard biochemical tests. Molecular identification was performed for strains that were resistant to three or more antibiotics. Antibiotic susceptibility testing was conducted using the disc diffusion method following the modified Kirby-Bauer method. The data were analysed using Stata version 15 software. RESULTS Approximately half of the patients (52.9%, 199/376) presented with infected wounds. Majority of the swabs (84.4%, 168/199) were culture positive, and yielded a total of 768 isolates where about half (52.9%, 406/768) were gram positive bacteria, and about two-thirds (64.6%, 496/768) were recovered from category II wounds. Among the gram positive bacteria, 339 (83.5%) were aerobes where Staphylococcus aureus (103, 30.4%), Coagulase-negative staphylococci (68, 20.1%), and Corynebacterium spp (33, 9.7%) had the highest prevalence. For the 362 Gram negative isolates, 217 (59.9%) were aerobes and the commonest isolates were P. maltocida (64, 29.5%), Capnocytophaga canimorsus (36, 16.6%) and P. canis (26, 12.0%). Gram-positive isolates were resistant to metronidazole (93.6%), oxacillin (68.5%), ceftriaxone (14.6%) and amoxicillin/clavulanic acid (14.0%). Gram negative isolates were resistant to metronidazole (100%), ampicillin (30.7%), oxacillin (29.3%), and doxycycline (22.9%). Multidrug resistance was in 105 (29.0%) and 121/406 (29.8%) of the gram-negative and gram-positive isolates, respectively. All gram-positive isolates were susceptible to vancomycin and ciprofloxacin. CONCLUSIONS Infection rates of DBWs in Uganda are high and the dominant bacterial isolates are Staphylococcus aureus, Pasteurella spps, and Capnocytophaga canimorsus. Multidrug resistance to commonly used antibiotics is high. The recommendation in the Uganda Clinical Guidelines to use metronidazole in the management of DBWs should be reviewed. DBWs should be enlisted for routine antimicrobial resistance surveillance and rational use of antimicrobial agents should be promoted.
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Affiliation(s)
- Stevens Kisaka
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya.
- School of Public Health, Makerere University, Kampala, Uganda.
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.
| | | | - Samuel Majalija
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Moses Muwanga
- Department of Medicine, Entebbe General Referral Hospital, Entebbe, Uganda
| | - S M Thumbi
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
- Rabies Free Africa, Washington State University, Pullman, USA
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, 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.13311.2] [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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Williams BM, Purcell L, Kayange L, Gallaher J, Charles A. Characteristic and outcomes of human and animal bites in Malawi. Injury 2021; 52:2188-2193. [PMID: 33785190 PMCID: PMC8380653 DOI: 10.1016/j.injury.2021.03.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bites are an important contributor to traumatic injury worldwide. In low- and middle-income countries, data regarding bite injuries outside of rabies is limited. Therefore, we sought to describe the injury characteristics and outcomes of bites in Lilongwe, Malawi, and determine risk factors for animals and human bites. METHODS We performed a retrospective analysis of the Kamuzu Central Hospital trauma registry from 2008-2018. We performed Bivariate analyses comparing bite to non-bite trauma and human to animal bites. Multivariable Poisson regression modeling then estimated risk factors for bites. RESULTS A total of 124,394 patients were captured by the registry, of which 3,680 (3%) had a bite injury mechanism. Human bites accounted for 14.5% of bite injuries, and animals represented the remaining 85.5%. In rare cases, animal bite victims had serious complications, such as amputation (n = 6, 0.2%), orthopedic procedures (n = 5, 0.2%), and death (n = 7, 0.2%). Risk factors for an animal bite included being on a farm, field, or lake and being at home, whereas risk factors for a human bite included alcohol use and being at home. CONCLUSION Animal bite injuries in Malawi can confer a risk of serious complications, such as amputation and, in rare cases, death. Alcohol-associated, in-home interpersonal violence is a significant risk factor for human bite injuries. Further studies are needed to identify risk factors for complications and mortality.
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Affiliation(s)
- Brittney M Williams
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Laura Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Linda Kayange
- Department of Surgery, Kamuzu Central Hospital, Lilongwe Malawi
| | - Jared Gallaher
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 27599, USA; Department of Surgery, Kamuzu Central Hospital, Lilongwe Malawi.
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Changalucha J, Hampson K, Jaswant G, Lankester F, Yoder J. Human rabies: prospects for elimination. CAB REVIEWS : PERSPECTIVES IN AGRICULTURE, VETERINARY SCIENCE, NUTRITION AND NATURAL RESOURCES 2021; 16:039. [PMID: 34765015 PMCID: PMC8580373 DOI: 10.1079/pavsnnr202116039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Almost half of all countries in the world are effectively free of human deaths from dog-mediated rabies. But the disease still affects people in low- and middle-income countries, especially the rural poor, and children. Successful regional elimination of human rabies is attributable to advances in significant and sustained investment in dog vaccination, post-exposure vaccination and surveillance, illustrated by productive efforts to reduce human rabies in Latin America over the last 35 years. Nonetheless, countries still facing endemic rabies face significant barriers to elimination. Using the 2017 Global Strategic Plan to end human rabies deaths from dog-mediated rabies by 2030 as a reference point and an organizing framework, we assess progress toward global rabies elimination by examining the characteristics of successful regional control efforts and barriers to elimination. Although substantive barriers exist for countries where rabies remains endemic, advances in knowledge, technology, institutions, and economics provide a basis for optimism.
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Affiliation(s)
- Joel Changalucha
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 78373, Dar es salaam, 14112, Tanzania
- Boyd Orr Centre for Population and ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12, 8QQ, UK
- College of Veterinary Medicine and Biomedical Science, Sokoine University of Agriculture, P.O. Box 3021, Morogoro, 23, Tanzania
| | - Katie Hampson
- Boyd Orr Centre for Population and ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12, 8QQ, UK
| | - Gurdeep Jaswant
- Boyd Orr Centre for Population and ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12, 8QQ, UK
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), P.O. Box 30197, Nairobi, 00202, Kenya
- Tanzania Industrial Research Development Organisation (TIRDO), P.O. Box 23235, Dar es salaam, Tanzania
| | - Felix Lankester
- Global Animal Health Tanzania, Ngorongoro Conservation Area Authority Building, P.O. Box 1642, Arusha, Tanzania
- Paul G. Allen School for Global Animal Health, Washington state University, P.O. Box 647090, Pullman, Washington, WA 99164 United States of America
| | - Jonathan Yoder
- Paul G. Allen School for Global Animal Health, Washington state University, P.O. Box 647090, Pullman, Washington, WA 99164 United States of America
- School of Economic Sciences, Washington State University, P.O. Box 646210, Pullman, Washington, WA 99164-6210, United States of America
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