Abstract
BackgroundDog bites are the main source of rabies infection and death in humans, contributing up to 99% of all cases. We conducted a contact-tracing study to evaluate the health seeking and treatment compliance behaviors of people following potential exposure to rabies in rabies endemic south Bhutan.MethodsUsing information from the rabies post exposure prophylaxis (PEP) register, animal-exposed victims who had visited five hospitals in south Bhutan between January and March 2017 were traced and further data were collected from them using a structured questionnaire. A snowballing technique was used to identify victims who did not seek PEP.The survey was conducted between April and June 2017. Logistic regression was performed to assess factors associated with PEP-seeking and compliance behavior by the victims.ResultsAmongst 630 who reported to hospitals, 70% (444) of people could be traced and additional 8% (39) who did not seek PEP was identified through contact tracing. Therefore, a total of 483 people were interviewed. Seventy one percent (344/483) of exposure were due to animal bites of which 80% (365/455) were considered to be provoked incidents. Common reasons for not seeking health care included assumptions that risks of infection were minor if bitten by an owned or vaccinated dog. The victims who are male (OR: 0.36; 95% CI: 0.16–0.77) and educated (OR: 0.41; 95% CI: 0.17–0.96) were less likely to seek PEP, while those that experienced unprovoked bite (OR: 5.10; 95% CI: 1.20–21.77) were more likely to seek PEP in the hospitals. Overall, 82% of the victims sought PEP from the hospitals within 24 h after exposure. Eighty three percent completed the PEP course prescribed by the physician. The respondents living in urban areas (OR: 2.67; 95% CI: 1.34–5.30) were more likely to complete the prescribed PEP course than rural dwellers.ConclusionsThere is high risk of rabies infection in southern Bhutan. It is critical to bridge knowledge gaps and dispel existing myths which will help to improve PEP seeking and compliance behavior of people exposed to rabies infection from animals. A risk-based advocacy program is necessary to prevent dog-mediated human rabies deaths.
Highlights
Dog bites are the main source of rabies infection and death in humans, contributing up to 99% of all cases
This study evaluated the health seeking and compliance behaviors of people following potential exposure to rabies in south Bhutan using a contact-tracing questionnaire survey
Respondent socio-demographic characteristics During January to March 2017, 630 people reported to five hospitals to seek rabies post exposure prophylaxis (PEP) (Gelephu: 219; Phuntsholing: 219; Deothang: 88; Samtse: 73; Samdrup Jongkhar: 31)
Summary
Dog bites are the main source of rabies infection and death in humans, contributing up to 99% of all cases. To further strategize the national efforts to achieve zero human deaths due to dog-mediated rabies before the global target of 2030 [14], Bhutan One Health Strategy Plan 2017–2021 has been developed and approved by the government to collaboratively implement rabies prevention and control in the country. Towards this end, one of the key tools to prevent human deaths from rabies is to improve accessibility and uptake of PEP following potential exposure, since most human deaths due to rabies occur from ignorance resulting in failure or delay in seeking PEP intervention from hospitals [3, 14]
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