Abstract
BackgroundRabies is the most severe and neglected public health problem in India. Management of animal bite with post exposure prophylaxis is the only existent strategy to prevent rabies related deaths. Cost-effective and sustainable programme for provision of post exposure prophylaxis (PEP) is needed in India.MethodsIn this study, we have documented the experience of implementation of intra-dermal anti rabies vaccination in Animal Bite Management (ABM) clinic at Primary Health Centre (PHC). This study facility belonged to Comprehensive Rural Health Services Project, Ballabgarh in Faridabad district of Haryana. Hospital service record of ABM clinic was analyzed and various feasibility issues such as costing of services, vaccine wastage and other operational issues in providing PEP services at PHC level were documented.ResultsA total of 619 patients were treated in the ABM clinic. Service utilization of ABM clinic was increased by 38% in the second year of implementation. Mean age of the patients was 23.9 years (SD: 18.8) and majority (70.4%) were males. Majority (86%) of the patients received the first dose of anti-rabies vaccine within the recommended 48 hours. A total 446 vaccine vials (1 ml) were consumed of which 20.8% was contributed in vaccine wastage. User-fee (350 Indian Rupees) collected from the patients. User-fee was re-used to purchase vaccines, intradermal (ID) syringes and other consumables required to ensure regular availability of ARV services at the PHC.ConclusionsThis study demonstrated the cost-effective and sustainable model of provision of PEP against rabies at primary care level. ID PEP provision at primary care level not only address the unmet need of animal bite management in the community also reduces the out of pocket expenditure of the patients.
Highlights
Rabies is the most severe and neglected public health problem in India
Non-availability or irregular supply in public health system and high cost of Tissue Culture Vaccine (TCV) contributes to significant out-of-pocket expenditure (OOP) in the range of 1500-1800 Indian Rupees (Rs) for five doses under post exposure prophylaxis (PEP)
The objective of this study is to document various feasibility issues related with provision of rabies ID-PEP services at a rural Primary Health Centre (PHC) in Haryana state in north India
Summary
Rabies is the most severe and neglected public health problem in India. Management of animal bite with post exposure prophylaxis is the only existent strategy to prevent rabies related deaths. Cost-effective and sustainable programme for provision of post exposure prophylaxis (PEP) is needed in India. Annual incidence of human rabies is estimated to be between 30,000- 70,000 with more than 90% of cases reported from developing countries. This contributes to 20,000 deaths attributed to Rabies and 17.4 million cases of animal bite per annum. Loss of wages due to required multiple visits to the health facility has been incriminated in poor compliance to PEP. This has been identified as a reason for increased rabies deaths especially in rural areas [12]. The possibility of PEP provision for rabies via self-sustaining mechanism at primary care level becomes worth exploring
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
