Rabies Exposures, Post-Exposure Prophylaxis and Deaths in a Region of Endemic Canine Rabies (original) (raw)
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Background: In Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya. Methodology: We interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed. Results: Rabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Conclusion: The availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa.
PLoS Neglected Tropical Diseases, 2013
Background: Rabies is a zoonotic disease that has been prevalent in humans and animals for centuries in Ethiopia and it is often dealt with using traditional practices. There is lack of accurate quantitative information on rabies both in humans and animals in Ethiopia and little is known about the awareness of the people about the disease. In this study, we estimated the incidence of rabies in humans and domestic animals, and assessed the people's awareness about the disease in North Gondar zone, Ethiopia. Methodology/Principal Findings: The incidence of rabies in humans and domestic animals was prospectively followed up for one year period based on clinical observation. A questionnaire was also administered to 120 randomly selected dog owners and 5 traditional healers to assess the knowledge and practices about the disease. We found an annual estimated rabies incidence of 2.33 cases per 100,000 in humans, 412.83 cases per 100,000 in dogs, 19.89 cases per 100,000 in cattle, 67.68 cases per 100,000 in equines, and 14.45 cases per 100,000 in goats. Dog bite was the source of infection for all fatal rabies cases. Ninety eight percent of the questionnaire respondents were familiar with rabies and mentioned dog bite as a means of transmission. But discordant with current scientific knowledge, 84% and 32% of the respondents respectively mentioned any type of contact (irrespective of skin condition) with saliva, and inhalation as a means of transmission of rabies. Eighty four percent of the respondents relied on traditional healers for management of rabies. Conclusions: The study shows high canine rabies burden, and lack of sufficient awareness about the disease and high reliance on traditional treatment that interfere with timely post exposure management. Vaccination of dogs, proper post exposure management, and increasing the awareness of the community are suggested to reduce the disease burden.
Nigerian Veterinary Journal, 2019
Community awareness and assessing the trend of suspected rabies cases play a significant role in preventing its fatality. Therefore, a cross-sectional study design was employed (October 2016-April 2017) to assess community knowledge, attitude and practice (KAP), and Incidence and risk factors to rabies (human and animal) in the study area. A semi-structured questionnaire was employed to collect required information from 1440 study participants. Retrospective data of five-year (2012-2016) from hospitals and health centers (human cases), and veterinary clinics (animal cases) was used. Majority of the study participants (64.3%) were rural residents, 95.2% have heard about rabies and 50.1% were found dog owners. Among the study participants, 72.2%, 66.0%, and 62.4% have a good level of knowledge, attitude, and practices about rabies, respectively. A strong association between knowledge, attitude and practice with sex; educational level; occupation, dog ownership and rural/urban dwellers (p<0.05) was recorded. Furthermore, a total dog bite cases of 398 domestic animals and 4617 humans were found registered on casebooks of both veterinary and human health service centers of the study districts during the five years study period among which the highest percentage (36.4%) was recorded from canines. The highest anti-rabies vaccine coverage recorded was 36.0% in the year 2016, and higher human dog bite cases recorded was 50.1% on individuals aged between 5-15 years (both male and female). Hence, the current findings suggest that there is a need for coordinated and integrated effort of government, professionals (medical and veterinarians), community and other stake holders towards rabies control and prevention.
Infectious Diseases of Poverty, 2015
Background: Domestic dogs are the main targets for rabies control as they are the principal reservoir for transmission of the rabies virus to humans and other domestic animals. The purpose of this study was to identify the factors that contribute to the rabies virus infecting the human population in a rural community of Eastern Tanzania. Methods: Using a cross-sectional study design, field visits were conducted to gather information on villagers' knowledge on and practices associated with canine rabies control and dog vaccination campaigns. Results: A total of 248 individuals were interviewed in the Kilosa district, Tanzania. Almost two-thirds (61.3 %) had a primary school education. The majority (91.1 %) of the respondents were aware that rabies is acquired through dog bites and 66.9 % knew about the clinical signs of rabies in an animal. Very few (17.7 %), however, were aware of the clinical signs of rabies in humans. Only 20.4 % of the respondents knew how rabies is controlled in dogs and 71 % were not aware of dog vaccination campaigns. The average number of dogs kept per household was 4 ± 3.3; 70.0 % of the respondents had one to five dogs, 28.3 % had six to dog dogs, and 1.6 % had 16-20 dogs. The dogs were primarily used to guard livestock and property, and to hunt. About 59.7 % of the respondents indicated that rabies was a public health problem. Low vaccination coverage was observed in the study area, with previous mass vaccination campaigns covering only 24.4 % of the dog population. Dogs appeared to have limited value in the studied community. Furthermore, there were no proper waste disposal facilities and oftentimes wild canids and felids visited the villages to scavenge on kitchen leftovers. Conclusion: Although communities in the Kilosa district had knowledge on rabies in dogs, they were not aware of the public health implication of the disease, which thus led a poor response during mass dog vaccination campaigns. Establishment of a well-coordinated rabies control program, strategic public health awareness campaigns, and active and passive surveillance systems for humans and domestic and wild animals should be considered as strategies to control and eradicate rabies.
PloS one, 2018
The vast majority of rabies deaths occur in developing countries and rural areas. Due to the absence of surveillance and the lack of reliable information, many endemic countries are not able to assess their rabies burden and implement appropriate solutions. This study reports the incidence of animal bites considered at risk of rabies transmission, along with rates and determinants of the adherence to post-exposure prophylaxis (PEP) between 2008 and 2014 in Dodoma Region, Tanzania. A retrospective analysis of rabid animal bites considered at risk of rabies transmission at Dodoma Regional Referral Hospital (DRRH) during 2008-2014 was conducted. Data were collected from the registers of patients presenting to the hospital because of a potential rabies exposure. The patients were assessed by a trained health worker and each bite was considered as "at risk of rabies" based on the victim's description of the event. Overall, 10,771 patients coming from Dodoma Region attended ...
Journal of Global Infectious Diseases, 2010
The aim of this study was to determine the incidence of humans being bitten by rabies-suspected animals, and the victims' adherence to post-exposure prophylaxis (PEP) regimen. Materials and Methods: A retrospective analysis of data of victims treated at Bugando Medical Centre during the period 2002-2006 (n=5 years) was done. Results: A total of 767 bite injuries inflicted by rabies-suspected animals were reported, giving a mean annual incidence of ~58 cases per 100,000 (52.5% males, 47.5% females). The proportion of children bitten was relatively higher than that of adults. All victims were treated by using inactivated diploid-cell rabies vaccine and were recommended to appear for the second and third doses. However, only 28% of the victims completed the vaccination regime. Domestic dogs were involved in 95.44% of the human bite cases, whereas cats (3.9%), spotted hyena (Crocuta crocuta) (0.03%), vervet monkey (Cercopithecur aethiops) (0.01%) and black-backed jackal (0.01%) played a minor role. The majority of rabies-suspected case reports were from Nyamagana district and occurred most frequently from June to October each year. Conclusions: In conclusion, this study revealed that incidences of humans being bitten by dogs suspected of rabies are common in Tanzania, involve mostly children, and victims do not comply with the prophylactic regimen. Rigorous surveillance to determine the status of rabies and the risk factors for human rabies, as well as formulation and institution of appropriate rabies-control policies, is required.
medRxiv, 2020
Background: Rabies a neglected tropical disease, mostly affecting poor and vulnerable populations living in remote rural areas in developing countries. The disease continues to pose a significant public health a threat with an estimated 59,000 dog-transmitted human deaths, of which an estimated 21,476 human deaths occur in Africa each year. The global strategy has been set by the quartite World Health Organization (WHO), the World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO) and the Global Alliance for Rabies Control (GARC), aiming for "zero human deaths associated with dog transmitted rabies by 2030". African countries, however, face several challenges and there are still gaps in controlling rabies. The aim of this study review is to determine rabies prevalence, mortality and associated risk factors in both human population and animal population and to evaluate the presence or absence of integrated one health surv...
Epidemiological dynamics of rabies in Tanzania and its impacts on local communities
2012
Rabies is a fatal viral zoonotic infection caused by a Lyssavirus. Rabies exerts a major public health and economic burden; it is responsible for at least 55,000 deaths worldwide, predominantly in Africa and Asia. More than 90% of rabies deaths are caused by domestic dogs. Global expenditure on rabies prevention and control exceeds US$500 million per annum. Although human rabies is 100% preventable, through vaccination of animal reservoirs and post-exposure prophylaxis (PEP) of people exposed to bites, no effective large-scale control of rabies has been achieved in sub-Saharan Africa. Effective implementation of sustainable rabies control and prevention programs, involves full participation of individuals, veterinary and medical services. Veterinary services must control rabies transmission through mass dog vaccination campaigns because human deaths are caused by epidemics in domestic dogs, medical services must provide PEP to prevent disease in exposed individuals and exposed indiv...
The Pan African medical journal, 2018
Introduction: Rabies is a fatal neglected zoonosis killing 55,000 people worldwide annually. It is endemic in Nigeria with 10,000 people exposed annually through dog-bites. To inform adequate intervention due to the rise in reported dog-bite cases, we assessed knowledge, attitudes and practices (KAP). Methods: We carried out a cross-sectional study among 224 residents in Abuja Municipal Area Council. We used structured questionnaires to collect data on sociodemographic characteristics, knowledge and attitudes on rabies prevention. Knowledge score of ≥ 8 points based on ten-point domain question were regarded as satisfactory. We analyzed data using Epi-Info and Excel for proportions and associations were determined at 5% significance level. Results: A total of 123 (55%) respondents owned dogs. One hundred and eighty four (82%) respondents had satisfactory knowledge on rabies prevention, about 87% knew where to get dogs vaccinated and would seek medical treatment from the hospital when bitten by a dog. Majority (58%) did not know the frequency of anti-rabies administration for dogs and 63.3% did not know the appropriate first aid actions following dog-bites. Of 123 dog owners, 35% would allow their dogs roam without restriction and 94% reported vaccinating their dogs against rabies. Dog owners were more likely to have satisfactory knowledge of rabies compared to non-dog owners (OR 7.8, 95% CI 1.0-62.0, p = 0.02). Conclusion: Knowledge on rabies is satisfactory but with gaps in the frequency of dog anti-rabies vaccination, appropriate first-aid following dog bites and non restriction of dog movement. To prevent rabies, these gaps need to be addressed through public enlightenment and enforcement of dog movement restrictions laws.