Anti-rabies Clinic Research Articles

One-year descriptive analysis of patients treated at an anti-rabies clinic-A retrospective study from Kashmir.

Dog bites in humans are a major public health problem in India in general and Kashmir in particular. Canine rabies is almost non-existent in developed countries and exists mainly in the poorer, low socioeconomic strata of society in the developing world. The objective of this study was to determine the characteristics, pattern, and burden of dog bite injuries in the Kashmir valley. Data from Anti-Rabies Clinic of a tertiary care hospital in Srinagar, the summer capital of the state of Jammu & Kashmir, was collated and analyzed. Analysis of records of all the patients who had reported between April 2016 and March 2017 was done. A total of 6172 patients had reported to the Anti-Rabies Clinic for management of animal bites from 1st April 2016 to 31st March 2017. Most of the patients were young males. Almost half (47.7%) of the patients were bitten in the afternoon. Lower limbs were the most common site of bite (71.7%). Most of the bites were of Category III (57.6%) followed by Category II (42.3%); only one case of Category I was recorded. Almost all (98.0%) cases reported being bitten by dogs. Conclusions: Category III dog bites on lower limbs were the most common type of animal bites presenting to the Anti-Rabies Clinic of a tertiary care hospital. Children have more chances of a bite on head and neck region. Serious and workable efforts have to be made to reduce the incidence and consequences of animal bites.

Circumstances of Human-Bat interactions and risk of lyssavirus transmission in metropolitan France.

Since the elimination of dog and terrestrial wild animal rabies, bat exposures remain the only source of autochthonous lyssavirus transmission to humans in Western Europe. European bats have already been found infected with several lyssaviruses, and human-bat interactions represent a risk of viral transmission and fatal encephalitis for humans. In this study, we aim to better characterize exposures to bats in metropolitan France from 2003 to 2016 and to identify circumstances associated with exposures to lyssavirus-positive bats. Two complementary sources of data were analysed: 1/ data associated with bats responsible for human exposure received for Lyssavirus testing by the French National Reference Centre for Rabies (NRCR); and 2/ data pertaining to individuals seeking medical care through the French Anti-Rabies Clinics network after contact with a bat. From 2003 to 2016, 425 bats originating from metropolitan France were submitted to the NRCR and 16 (4%) were found positive with a lyssavirus (EBLV-1b was diagnosed in 9 bats, EBLV-1a in 6 and BBLV in one specimen). The two factors associated with bat positivity in our study were the female sex and the bat belonging to the E. serotinus species. During the same study period, 1718 individuals sought care at an Anti-Rabies Clinic after exposure to a bat resulting in an estimated incidence of human-bat interactions of 1.96 per 106 person-years. The two most frequent circumstances of exposure were handling or bites. Interactions mostly involved one adult human being and one live and non-sick-looking bat. Our study provides new insights about circumstances of human-bat interactions and may be helpful to target prevention interventions to improve the awareness of the population of the risk of lyssavirus transmission.

A cross sectional study of knowledge, attitude and practices regarding rabies and its management among attendees of anti-rabies clinic of tertiary care hospital of central India

Background: Rabies is a viral zoonotic disease which affects all warm-blooded animals. Human infection usually occurs following transdermal bite or scratch by infected animal. Rabies is fatal but preventable disease. Around the world, knowledge, attitude and practices studies about rabies have been widely used to understand disease and preventive measures.Methods: A cross-sectional study was conducted in the anti- rabies clinic of the tertiary care hospital of central India from January 2020 to March 2020. Data was collected using pre-designed, semi structured questionnaire from 424 participants. Descriptive statistics and chi square test were applied.Results: A total 424 attendees participated in our study. Mean age of participant was 35.94 (±15.3) years, 60.37% were male and 39.63% were female. Overall, 53.77% of participants had adequate knowledge and 60.38% had positive attitude and 68.63% had adopted adequate practices towards rabies. A significant association was found between knowledge score and age, gender, education and occupation. Attitude score was significantly associated with age, gender, occupation and education. A significant association was found between practice score and age, gender and education.Conclusions: The study showed that majority of participant had adequate knowledge, positive attitude and adopted appropriate practices about rabies. However there exists some knowledge gaps among participants on treatment and preventive measures. Their knowledge, attitude and practices with respect to prevention and management of rabies can be improved by providing proper health education.

Comparison of Safety Profile of Equine and Human Rabies Immunoglobulin in Children below 15 Years, in a Tertiary Care Hospital of Odisha - an Observational Study

Background: The incidence of rabies is equally more in children < 15 year of age i.e. 35.3% as found in the APCRI-WHO Survey in India. Out of the two alternatives (Equine Rabies Immunoglobulin: ERIG and Human Rabies Immunoglobulin: HRIG) for treatment for Category III animal bites, HRIG is invariably the preferred intervention mounting to exorbitantly high economic burden. There is paucity of studies comparing their safety profiles especially in children. Methods: A hospital-based observational study was conducted at the Anti-rabies Clinic of SCBMCH, Cuttack, Odisha from March to April 2019. The enrolment of patients was done in two months period from 1st March to 30th April 2019 and all these patients were followed up for a period of one month till 31st May 2019. New Category III animal bite cases in <15 years of age, taking ERIG and HRIG comprised of two groups A and B, respectively. They were followed up on their subsequent visits on 3rd, 7th and 28th days of treatment to study any local and systemic reactions. Chi square test/ Fischer exact test/ Mann Whitney test were applied to compare the outcomes. Result: Mean age in ERIG (Group A) is 9.84 (±3.9) years and for HRIG (Group B) is 7.1 (±4.1) years and mean weight for ERIG group is 27.63 (±12.4) kg and HRIG group is 24.2 (±23.8) kg. The total amount of immunoglobulin administered was 3.6 (±1.6) ml in ERIG (Group A) and 2.5 (±1.34) ml in HRIG (Group B). Any type of local reaction was seen in 42% cases in Group A (ERIG) and in only 5% cases in Group B (HRIG). Pain, itching, local swelling, oedema, and tenderness were more marked in Group A (ERIG) but were not found to be statistically significant in all cases. These local reactions were managed symptomatically with medications like analgesics and anti-histaminic. Similarly Systemic reactions in form of arthralgia, fever, malaise and generalized rash were also more observed in Group A (ERIG) which could be managed symptomatically with same medications. Conclusion: Safety profiles (in terms of local and systemic reactions) of ERIG and HRIG were comparable in children below 15 years of age. The minor side effects of ERIG can easily be managed by readily available drugs like analgesics and antihistaminics in the ARV OPD itself. How to cite this article:Debta SP, Behera TR, Routray D. Comparison of Safety Profile of Equine and Human Rabies Immunoglobulin in Children below 15 Years, in a Tertiary Care Hospital of Odisha - an Observational Study. J Commun Dis 2020; 52(2): 7-12. DOI: https://doi.org/10.24321/0019.5138.202012

Sociodemographic profile and treatment seeking behaviour of animal bite patients attending the anti-rabies clinic at Patiala, Punjab

Background: Rabies is an acute fatal viral disease. It can be prevented by eliminating exposures to rabid animals or by providing exposed persons prompt post exposure prophylaxis consist of local treatment of wounds in combination with appropriate administration of rabies immunoglobulin and vaccine. Aims and objectives were to study the sociodemographic profile of patients attending anti-rabies vaccination clinic and to study the treatment seeking behaviour and wound cleaning practices among them.Methods: This was a cross sectional study conducted among 150 randomly selected animal bite patients attended Anti Rabies Clinic, Department of Community Medicine G.M.C. Patiala from 1 November 2018 to 31 February 2019. Data collected and statistical analysis was done using epi info7.Results: Most of the patients were male 101 (67.34%). Out of 150 animal bite cases, majority of them were bitten by street dogs 135 (90%). It was found that 122 (81.34%) were category III bite, 26 (17.34 %) were category II bites and 2 (1.34%) were category I bite. Only 92 (61.34%) patients washed wound with water and soap. About 21 (14%) patients applied chilies or turmeric or oil on their wound.Conclusions: Majority of cases had bitten by dogs. Patients were less aware regarding proper wound care and seeking early treatment.

Descriptive profile of patients attending antirabies clinic: a hospital based study of animal bite cases in Patiala

Background: The word “Rabies” is derived from Latin word ‘Rabus’, which in turn is derived from the Sanskrit word ‘Rabhas’ which means ‘to do violence’. In India, the dog has always existed as the main reservoir of rabies. Globally Asia contributes to highest Rabies mortality; with the highest incidence reported in India followed by China.Methods: A cross-sectional study was conducted at the antirabies clinic during the period of one year (2016-2017). A self-administered, pretested questionnaire was used to extract information on demographic profile, biting animal, nature of biting dog, vaccination status, WHO category of bite, site of bite. Information of 500 animal bite cases were collected during the study period.Results: Maximum cases were reported among children below 15 years age group i.e. 157 (31.4%). Majority reported cases 342 (68.40%) were males and maximum reported cases 338 (67.60%) were from urban area. Majority 472 (94.4%) were bitten by dogs. Approximately two third (66.74%) of the biting dogs were stray while, among the total 157 (33.26%) pet dogs; approximately only one third 59 (37.58%) were vaccinated.Conclusions: Since young children are more at risk of animal bite. So, educational sessions providing knowledge to protect themselves from bites should be a part of School Health Programme. A cooperative approach involving measures like proper garbage disposal, discouraging community owned dogs, helping dog catching squad and sterilization will help to reduce the dog population.

Factors influencing delay in initiating post-exposure prophylaxis for rabies prevention among animal bite victims: A cross sectional study.

Background and Aims:The aim of this study was to identify the delay and the factors associated with delay in initiating post exposure prophylaxis.Methods:A consecutive sampling method was proceeded, and 199 patients attending the anti-rabies clinic with a history of animal bite reported at SMHS Hospital were the subjects of the study.Results:Majority of the patients (72.36%) reported a delay within 6 h after exposure, 18.59% within (6-48) h and 9.04% after 48 h of exposure.Conclusion:Increasing the number of accessible anti-rabies clinics as well as increasing the awareness among general public about timely post exposure prophylaxis in the community are some of the factors that need to be implemented.

Profile of dog bite cases reporting to an antirabies clinic in rhtc of a tertiary care institute in Kashmir: A cross sectional study

Profile of dog bite cases reporting to an antirabies clinic in rhtc of a tertiary care institute in Kashmir: A cross sectional study

Study of demographic profile of animal bite cases and management practices in a dedicated anti rabies clinic of a tertiary care hospital, Hassan, Karnataka

Background: Animal bites cause a big burden in terms of morbidity and mortality throughout the world. These bites could be caused by rabid animals causing rabies. Annually about 59,000 persons die of rabies, of which 20,000 is from India alone. Rabies though 100% fatal is preventable with post-exposure prophylaxis which includes wound wash, anti-rabies vaccination (ARV) and rabies immunoglobulin. The objectives of the present study was to describe the demographic profile of animal bite cases and to assess the management practices of animal bite cases reporting to dedicated anti-rabies clinic (ARC) of a tertiary care hospital, Hassan, Karnataka.Methods: A cross-sectional study was conducted from the inception of anti-rabies clinic (12th October 2017) to August 2018 among animal bite cases reported to ARC. They were interviewed by using a semi-structured, pre-designed and pre-tested proforma. Data regarding socio-demographic profile were collected from the animal bite victims. All the animal bite cases were managed as per WHO guidelines.Results: The total number of animal bite victims reported to ARC during the study period was 3500. Majority of the bite victims belonged to adult population (20-60 years). Majority were males (66.2%). 77% belonged to the rural population. Dogs (97.1%) were the most common biting animal. 79% of the bites were provoked. Turmeric powder was the most commonly used irritant. Most bites belonged to Category III (84%). Category I, II, III bites were managed appropriately according to WHO guidelines.Conclusions: Knowing the burden, socio-demographic characteristics and the management of animal bite victims in the dedicated ARC of HIMS has helped the programme officer in implementing the National Rabies Control Programme in Hassan district.

Myths and unhealthy wound practices regarding animal bite among subjects attending anti rabies clinic in a South Delhi municipal corporation polyclinic in Mehrauli, Delhi

Background: Rabies is one of the highly fatal diseases, with nearly fifty nine thousand deaths annually globally and almost one third of these are in India. Higher rates of dog bites are common in our country, due to large stray dog population. Despite a preventable disease, unhealthy wound practices are still prevailing in the community due to lot of myths related to the disease. The objectives of the study were to assess the magnitude of unhealthy wound practices and to assess the knowledge regarding health seeking behaviour following animal bite.Methods: The present study was a cross sectional study conducted at SDMC Polyclinic, Mehrauli, Delhi from January to December 2015. A total of 160 cases of animal bite that attended OPD and consented were analysed for knowledge, practices and health seeking behaviour towards animal bite.Results: Out of total 160 respondents almost all were bitten by dogs of which 2/3rd was stray dogs and most common site of bite was lower limb. 55% of the subjects did not wash or clean the wounds after bite. 27% of subjects applied chilli powder or its paste with oil and 2.5% used oil and turmeric paste and 1.9% oil on the wound. Only 41.9% of the subjects believed that vaccination is the treatment of the choice following animal bite.Conclusions: Intensive health education through mass media and mid media can be used to create awareness about the disease transmission and preventive measures like wound management and post-exposure prophylaxis. Also, pet vaccination should be made mandatory for all those who keep pets.

Cost–benefit analysis of controlling rabies: prioritizing areas in rural setting of Maner: a cross sectional study

Background: Rabies being a preventable disease with no treatment available once onset starts but can be easily prevented by post-exposure among all animal bite victims. So it is essential to take the full course of vaccination for complete protection.Methods: The present study was a hospital based cross sectional study and was carried out in rural health training centre in Maner, Patna.Results: Our study included 340 patients who attended anti rabies clinic for post exposure prophylaxis. Among them 65% were children (<15 years) comprising mostly males (69%) and mostly of category III exposure. Direct cost of post exposure vaccination when compared with the cost of pre exposure prophylaxis is one-third (approx).Conclusions: Compliance to anti-rabies vaccination for post-exposure prophylaxis is still low and they are still at risk of developing rabies. Reasons being irregular supply of vaccine and immunoglobulin in government hospitals, loss of wages, forgotten dates, cost incurred to buy from outside and distance from the hospital if referred to other centre. Seeing the current scenario, planning and prioritizing areas to achieve our goal and lessen economic burden is need of the hour. We infer that pre exposure prophylaxis may be a cost effective strategy which can aid in the control and elimination of rabies in endemic settings.

Differences in health seeking behavior of animal bite patients between urban and rural areas of Aurangabad city

Background: The present study explores the variation in epidemiology and treatment seeking behavior of animal bite patients in rural and urban areas. The rural urban differences would be imperative in effective policy making, planning and implementation of preventive and control measures.Methods: This cross-sectional study was carried out in 50 urban patients were from anti-rabies vaccination clinic of government medical college Aurangabad and 50 rural patients from areas of Paithan from January 2016 to May 2016. All patients were subjected to socio-demographic profile and detailed history of animal bites, wound toileting and treatment including both active and passive immunization.Results: Overall, 66% were males and 34% were females. Most of the people in rural area were bitten by stray dog (42%) followed by wild animals like pig, monkey (16%) as compared with 38% of stray dog bite cases in urban areas. The commonest site of animal bites was found to be lower limb followed by upper limb, trunk and head in both areas. Maximum cases belonged to category III (84%) in rural areas followed by category I (10%). Also, most of the rural patients (46%) preferred home remedies of treatment i.e. application of oil, salt, red chilies, and turmeric paste applications as compared with 10% urban patients.Conclusions: Our study revealed that majority of the patients from rural areas were inflicted upon by stray dogs (54%) and relied more upon home remedies thereby reporting late to government hospitals.

Profile of Animal Bite Cases at Anti-Rabies Clinic of Tertiary Care Hospital: A Record Based Study

Profile of Animal Bite Cases at Anti-Rabies Clinic of Tertiary Care Hospital: A Record Based Study

Profile of animal bite victims reporting to intradermal rabies vaccination centre at a tertiary care government hospital: 10 years experience

Background: Rabies is acute, progressive encephalitis caused by a lyssavirus. Over 95% of rabies deaths in humans result from virus transmission through the bites of infected dogs. To provide Post Exposure Prophylaxis to the people, Anti Rabies Clinics have been established in many places, especially at tertiary care centres. The Anti-Rabies Clinic at Mandya Institute of Medical Sciences, Mandya, Karnataka state (ARC-MIMS) is one such centre, the first of its kind in Karnataka state more than ten years ago. We are presenting the clinical profile of the animal bite victims who sought treatment at our centre in the past 10 years.Methods: It was a retrospective record based study conducted at Mandya Institute of Medical Sciences with sample size of 44087 using purposive sampling from May 2018 to June 2018 and data was collected using data extraction sheet.Results: Among the 44087 animal bite victims majority i.e., 66.6% were males, most of them were in the age group of 16-60 years. Sixty percent of the animal bite victims were residing in rural areas. All the category 2 and category 3 bite victims were administered anti rabies vaccination and 15.4% of the category 3 bite victims were administered rabies immunoglobulin.Conclusions: Majority of animal bite victims were presented and treated within 1 day. The practice of giving health education periodically to the school children and making phone calls to remind follow up days which is being practiced should be promoted.

Post exposure compliance of rabies vaccination among cases attending anti-rabies clinic at tertiary care centre, Rajasthan

Background: Rabies is one of the deadliest diseases of mankind, and has terrified since antiquity. It is 100 per cent fatal, however, 100% preventable. In India, rabies causes an estimated 20,565 deaths with 17.4 million exposures to animal bites, mainly dog bites, occurring every year. In India a person is bitten by an animal in every 2 seconds and someone dies from rabies every 30 second. Complete post-exposure prophylaxis is necessary among the animal bite cases for complete protection. Hence this study aims to determine the patient’s compliance for intradermal anti-rabies vaccination and also to determine the constraints for compliance.Methods: A retrospective record based study was conducted in the ARC of S.M.S.M.C, Jaipur where patients were provided intradermal rabies vaccination (updated Thai Red Cross regimen) for post-exposure prophylaxis. The records maintained at ARC-SMSMC under department of community medicine from March 2016- February 2017 were analysed. The total number of patients was 8873 from which 8590 subjects were recruited for the study after excluding category I cases, pre-exposure cases rat bite, human bite, re-exposure and pre-exposure cases. The major constraints were found out by interviewing the patient/guardian through the telephone.Results: The compliance rate for intradermal rabies vaccination (IDRV) is 81.87%. The major constraints were timings not convenient, personal or social workload, long distance from the hospital, forgotten the dates.Conclusions: The compliance rate for rabies vaccination is considerably low for this highly fatal disease. Considering these major constraint factors, the animal bite victims should be motivated effectively through health education at the time of initiation of vaccination course to attain the goal of rabies free India.

Cost Savings of Using Updated Thai Red Cross Intradermal Regimen in a High-Throughput Anti-Rabies Clinic in New Delhi, India

Replacement of the Essen intramuscular (EIM) by the updated Thai Red Cross intradermal (UTRCID) regimen for rabies post-exposure prophylaxis (PEP), in high-throughput hospitals of India, has been advocated since 2006 thanks to its cost-effectiveness. However, several anti-rabies clinics in India and other parts of the world have not initiated this switchover of regimens because of the paucity of financial literature, generated in realistic settings, regarding the same. We calculated the procurement costs of various items required for providing rabies vaccinations via the EIM regimen and UTRCID regimen, on an annual basis, a year before and after the switchover. From a healthcare provider’s perspective, the cost of vaccination per patient was calculated to be 5.60 USD for the EIM regimen and 2.40 USD for the UTRCID regimen. The switchover to the UTRCID regimen from the EIM regimen reduced the financial burden of the rabies vaccination by almost 60%. Procurement of vaccine vials contributed to the majority of the cost (>94%) in both of the regimens. Procurement of syringes with fixed needles contributed negligibly (<6%) to the financial burden in both the regimens. A policy to progressively switch over to the UTRCID regimen from the EIM in all high-throughput anti-rabies centers of India would dramatically reduce the economic burden of running a successful anti-rabies program.

Economic Burden of Rabies: An Experience from a Tertiary Care Hospital in Kashmir, India

Background: Post-exposure prophylaxis (PEP) is the mainstay of prevention in suspected exposure to rabies virus. Exposed patients are able to obtain anti-rabies vaccine in the anti-rabies clinic pro bono but they have to pay for passive immunization and cover other associated costs.&#x0D; Aim: To estimate and analyze the direct and indirect costs of rabies PEP.&#x0D; Methods: This study was conducted on 429 patients, who were exposed to bites from various animals and reported to Shri Mahraja Hari Singh Hospital (SMHS), an associated tertiary hospital of Government Medical College, Srinagar, Kashmir. Patient socio-demographic profile, details of animal bite exposure, the cost incurred for PEP was collected. The data were analyzed using a descriptive statistic.&#x0D; Results: The study revealed a total median cost incurred on patients for receiving a PEP as 29.3 USD (United States Dollar), with an Inter-quartile Range (IQR) of 0.2 USD to 43.1USD. The direct median cost was 20.5 USD with an IQR of 6.2 USD to 29.4USD, while the indirect median cost was 20.3USD with an IQR of 13.5USD to 24.4USD.&#x0D; Conclusion: Post-exposure prophylaxis imposes a significant economic burden to bite victims especially those of low socio-economic strata for whom the cost is substantial.

Clinical safety profile of Premi-Rab a new indigenous equine rabies immunoglobulin for cat III animal bite victims at anti rabies clinic of a tertiary care hospital, Karnataka

Background: WHO guidelines recommend for treating Cat III animal bite victims with local infiltration of Equine Rabies Immunoglobulin (ERIG) into and around animal bite wounds followed by anti-rabies vaccine (ARV).The main reason for non-use of ERIGs by medical profession is the fear of anaphylaxis and laborious process. The present study was taken up with the objectives to assess the clinical safety of a new ERIG, describe sociodemographic profile of ERIG recipients and compliance to Intra Dermal Rabies Vaccine (IDRV), who reported to Anti Rabies Clinic (ARC) of Mandya Institute of Medical Sciences (MIMS), Mandya.Methods: Descriptive study at ARC, MIMS, Mandya for a period of one year. The data was collected using structured questionnaire. The data was entered into Microsoft excel and results were expressed using descriptive statistics.Results: The study revealed that cat III animal bite victims were 3400 (56.3%), of these only 545 (16.0%) opted for the new ERIG. Skin Sensitivity Test (SST) showed positive results in 17 (3.1%) cases. Among the ERIG recipients 28 (5.1%) had mild adverse reaction to ERIG. The compliance rate was 49.2% for all 4 doses of IDRV.Conclusions: 3.1% showed positive result to SST. 5.1% had mild adverse reaction to ERIG.

Facilities and services of postexposure prophylaxis in anti-rabies clinics: A national assessment in India.

The rabies postexposure prophylaxis (PEP) is provided through anti-rabies clinics in the country. It was considered important to assess their facilities under a nationwide multi-centric survey. The objective of this study is to assess the facilities available for PEP at the anti-rabies clinics and to ascertain the PEP provided at the anti-rabies clinics. The cross-sectional assessment was made from May 2017 to January 2018 in selected seven states of India. Thirty-five anti-rabies clinics from both Government and private; urban and rural areas from the states were assessed by an expert team using a pretested checklist for facilities and services available for PEP. On an average, 10 new animal bite cases were attended at each anti-rabies clinic per day. The cold chain facilities for rabies biologicals were satisfactory. The facilities for wound washing (54.3%) and the use of antiseptics to animal bite wounds were not adequate. Rabies vaccines were administered by intramuscular in 54.3% and by intradermal route in 45.7% of the cases. The vaccine stock-outs were reported only in the government sector (18.5%). The type of rabies immunoglobulin (RIG) used was equine (63.2%) and human (36.8%); given free of cost in 40% of Anti rabies clinics. The local wound infiltration of RIG was in practice at 58.6% of anti-rabies clinics. The stock-out of RIG was more in private (50%) hospitals than in Government (40.7%) hospitals. The facilities available for PEP at the anti-rabies clinics were inadequate and have to be improved across the country.

Health-care quality from patients' perspective: A cross-sectional study at anti-rabies clinic of a tertiary care center, Bengaluru

Background: Rabies is a highly fatal viral disease, yet preventable through timely administration of post-exposure prophylaxis (PEP). Anti-rabies clinic (ARC) plays an important role in providing PEP. Evaluation is a systematic way to improve current activities and by careful selection of alternative ways for better planning of future. Objective: The study was done with the intention to identify the gaps in the patients’ care in terms of patient satisfaction at ARC of a tertiary care center, Bengaluru. Materials and Methods: A cross-sectional study was conducted among 260 animal bite victims who visited outpatient department of ARC. The study tool comprised three sections; socio-demographic profile, details of animal bite, and patient satisfaction scale (PS-18) which was scored using 5-point Likert scale. T-test, analysis of variance and Pearson’s correlation was used to assess the relationship between quality dimensions and PS-18 scores. Results: The mean age of the study participants was 37.33 (17.71) years and majority were males. The overall mean score of PS-18 was 4.15 (0.42). The highest and lowest mean scores of PS-18 among the components were given to communication, 4.36 (0.61) and accessibility, 3.56 (0.75), respectively. There was significant association between religion, frequency of visit, category of bite, and cost incurred with mean scores of PS-18. Out of 260, about 62.7% of them gave good scoring for PS-18. Conclusions: The study findings showed that more than half of the patients visiting the outpatient department shared a positive experience. Although the mean scores for overall PS-18 scale belonged to the grade of good scoring; due interest to be taken to improve accessibility and convenience which was the least scored among the components of PS-18.