Determinants of Rabies Post-Exposure Prophylaxis Completion in Sarawak

Abstract

Objective: Rabies remains persistent in Sarawak despite efforts to control its spread. This study investigates the determinants of rabies post-exposure prophylaxis (PEP) completion among individuals in Sarawak that have been exposed to potential rabies transmission through animal bites.Material and Methods: A retrospective cohort study, using a universal sampling approach was employed, utilizing data from the Sarawak i-Bite System. Binary logistic regression was used to identify significant variables: a p-value<0.05 was considered as statistically significant.Results: The mean age of people having experienced animal bites was 38.1 (S.D.=22.4) years. Most were male (51.6%) and of Chinese ethnicity (37.2%). The predominant sites of animal bites were the upper (53%) and lower limbs (39.5%). Category 3 bite injuries and bites from fully confined pets were the most frequently reported (68.9% and 43.9%, respectively). In total 56.5% of the study population had a complete rabies vaccine regimen as post-exposure prophylaxis, while 5.4% had incomplete vaccinations, and 38% received no vaccination. The majority received treatment at government hospitals (59.1%). The significant determinants of rabies post-exposure prophylaxis completion in Sarawak were the Iban ethnicity (odd ratio (OR)=2.9, 95% confidence interval (CI):1.08-2.44, p-value=0.02), grade 3 bite (OR=3.9, 95% CI=,1.86-4.68, p-value<0.001), pet mixed with stray (OR=2.41, 95% CI=1.32-2.33, p-value<0.001), stray animals (OR=2.41, 95% CI=1.78-3.25, p-value,0.001) and treated in a government hospital (OR=0.63, 95% CI=0.47-0.83, p-value<0.001).Conclusion: This study reported that only 56.5% of patients completed the rabies PEP series. The important determinants of PEP completion status were found to be the Iban ethnicity, bite severity, category of animal, and place of treatment. These findings offer valuable insights to assist the Sarawak State Health Department in prioritizing strategies to enhance the compliance rate, with the ultimate goal of eliminating dog-mediated Rabies deaths by 2030.