Abstract
Rabies remains a public health challenge of unknown magnitude in Liberia in spite of the goal of ensuring that no human in the country dies of rabies by 2030. The annual prevalence of Dog Bite Victims (DBVs) and true load of Annual Human Deaths (AHDs) due to rabies were not known. We investigated three selected cities of Liberia for annual prevalence of DBVs and true load of AHD due to suspected rabies, using 10–year retrospective record, 2008–2017 obtained from Buchanan, Gbarnga, and Voinjama, three socio-economically important cities in post-conflict Liberia. Data were sourced at County Reference Hospitals and at the Liberia National Institute of Health for these cities and their local environs. In addition, household questionnaire survey was used to identify and audit data quality for unreported DBVs, and treatment received from traditional caregivers. The proportion was used to audit the 10-year data on unreported DBVs in the cities. Descriptive statistics was used to summarize annual DBVs over the 10-year period in the three cities, respectively. A standardized clinical decision tree model was used to estimate AHDs due to suspected rabies. Based on questionnaire survey, 140/365, 148/375 and 146/350 DBVs did not visit any orthodox health facility in Buchanan, Gbarnga and Voinjama cities, respectively in 2014. An estimated total of 559 DBVs died of suspected rabies in the three cities and their environs during the 10-year period. Mean yearly prevalence of DBVs was 179±106.82, 393±257.85 and 76.9±38.11 per 100,000 population, while mean AHDs due to suspected rabies was 14.3±8.47, 35.5±23.25, and 6.1±3.21 per 100,000 population in Buchanan, Gbarnga, and Voinjama cities, respectively. The present findings provide annual prevalence of suspected rabies cases, corrected for under-reporting in three selected cities of Liberia. The findings would be useful in planning for stepwise actions towards rabies elimination, ensuring that no human dies of rabies in Liberia by 2030.
Highlights
An in-country assessment of Stepwise Action for Rabies Elimination (SARE) protocol was conducted in Liberia in 2018 with a score of 1.5 out of 5 ascribed to the country, indicating that the foundational requirements for developing a national rabies control program has been put in place [1]
Care-seeking preferences of dog bite victims (DBVs) who would rather present to traditional caregivers in rural areas than to conventional hospitals have partly contributed to under-reported cases of suspected rabies in Liberia
We reviewed cases of DBVs presented for treatment at human hospitals in Buchanan, Gbarnga and Voinjama cities, and their environs over a 10-year period, 2008–2017
Summary
An in-country assessment of Stepwise Action for Rabies Elimination (SARE) protocol was conducted in Liberia in 2018 with a score of 1.5 out of 5 ascribed to the country, indicating that the foundational requirements for developing a national rabies control program has been put in place [1]. Despite this development, the true load of dog bite victims (DBVs) and annual human deaths due to rabies were not known for all, but Monrovia, the capital city of Liberia [2]. The impact of these efforts might have been small in view of the fact that in Liberia, rabies remains a neglected public health challenge decades after the first report of its clinical diagnosis in DBVs in the country [5]
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