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.
Highlights
Rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist
prevalence ratios (PRs)=4.06, 95% CI: 2.69 6.10) or primary education, belonging to the lowest socio-economic tertile as compared to the highest, knowing the owner of the article can be found at the end of the article
Delays in PEP were associated with socio-economic status, levels of education attained, knowledge of whether the dog went on to bite someone after inflicting injury on the participant, grade of wound, patient’s perception of the wound severity and number of bite wounds
Summary
A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. Study design and area This study was a cross-sectional survey for all patients that reported to Mulago National Referral Hospital and Entebbe General Referral Hospitals between March 2019 and October 2019, with dog bite injuries. The two health facilities were purposively selected because they were referral hospitals for dog bite PEP services in Kampala and Wakiso districts. These two districts have a high dog population and report the highest annual incidence of animal bites in Uganda[28]. Study population and recruitment The two healthcare facilities were purposively selected based on provision of PEP for dog bites. Can the information on how participants were recruited be provided as well?
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