The burden of rabies in Tanzania and its impact on local communities.

Maganga Sambo,Tiziana Lembo,Cleophas Simon,Heather Ferguson,Katie Hampson,Sarah Cleaveland,Honorati Urassa,Charles E Rupprecht

doi:10.1371/journal.pntd.0002510

Abstract

BackgroundRabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. The burden of rabies is estimated to be around US$20 million in Africa, with the highest financial expenditure being the cost of post-exposure prophylaxis (PEP). However, these calculations may be substantial underestimates because the costs to households of coping with endemic rabies have not been investigated. We therefore aimed to estimate the household costs, health-seeking behaviour, coping strategies, and outcomes of exposure to rabies in rural and urban communities in Tanzania.Methods and FindingsExtensive investigative interviews were used to estimate the incidence of human deaths and bite exposures. Questionnaires with bite victims and their families were used to investigate health-seeking behaviour and costs (medical and non-medical costs) associated with exposure to rabies. We calculated that an average patient in rural Tanzania, where most people live on less than US$1 per day, would need to spend over US$100 to complete WHO recommended PEP schedules. High costs and frequent shortages of PEP led to poor compliance with PEP regimens, delays in presentation to health facilities, and increased risk of death.ConclusionThe true costs of obtaining PEP were twice as high as those previously reported from Africa and should be considered in re-evaluations of the burden of rabies.

Highlights

Rabies is a fatal zoonotic infection of the central nervous system caused by a lyssavirus [1]
The true costs of obtaining post-exposure prophylaxis (PEP) were twice as high as those previously reported from Africa and should be considered in re-evaluations of the burden of rabies
Annual expenditure for rabies control and prevention in Asia and Africa has been estimated to exceed US dollars (US$)500 million, with most of these costs spent on provision of post-exposure prophylaxis (PEP) [3]

Summary

Introduction

Rabies is a fatal zoonotic infection of the central nervous system caused by a lyssavirus [1]. Annual expenditure for rabies control and prevention in Asia and Africa has been estimated to exceed US$500 million, with most of these costs spent on provision of post-exposure prophylaxis (PEP) [3]. Despite the effectiveness of PEP, many thousands of people still die from rabies especially in rural areas of Asia and Africa where canine rabies is endemic These deaths are affected by the accessibility and affordability of PEP, which are key factors in determining human disease risk [14]. The burden of rabies is estimated to be around US$20 million in Africa, with the highest financial expenditure being the cost of post-exposure prophylaxis (PEP) These calculations may be substantial underestimates because the costs to households of coping with endemic rabies have not been investigated. We aimed to estimate the household costs, health-seeking behaviour, coping strategies, and outcomes of exposure to rabies in rural and urban communities in Tanzania

Methods

Results

Discussion

Conclusion