Management Of Dog Bites Research Articles

Medicinal plants used in the traditional management of dog bites by herbalists in Eastern, Western, and Central Uganda

Medicinal plants used in the traditional management of dog bites by herbalists in Eastern, Western, and Central Uganda

Real-Time Surveillance of Dog Bite Incidence in Islamabad: A Cross-Sectional Study from December 2019 to July 2020

Rabies is a neglected viral zoonotic disease with an almost 100% fatality rate. A pilot project was initiated by the National Institute of Health (NIH), Islamabad, in collaboration with Health Security Partners (HSP) to establish a real-time dog bite surveillance in humans in public sector secondary care hospitals of Islamabad. The main objective of this study was to analyze different characteristics of dog bite cases, identify gaps in surveillance, and recommend suggestions to improve and strengthen real-time dog bite surveillance systems. An observational cross-sectional study was conducted in two major public sector hospitals in Islamabad from December 2019 to July 2020. Data on demographic information, site of the dog bite, category of the dog bite, and treatment was collected via a WVS mobile-based application. Descriptive analysis was carried out for different variables at a p-value of <0.05. A total of 338 dog bite cases were captured in the World Veterinary Service (WVS) application, and most cases (n = 226, 85.6%) were reported in December 2019 with a male-to-female ratio of 2:1. Most cases were reported from the age group of 22 to 31 years (n = 178, 53%). Out of the total number of cases, 263 (78%) presented with a single anatomical location, and 174 (51%) had Category II wounds. All dog bite patients were given only the first dose of the anti-rabies vaccine at the hospital level. Real-time dog bite surveillance via a mobile-based application proved to be effective for the timely recording and management of dog bite cases. Young people were reported to be mostly affected by dog bites, and nearly half of the cases were managed in hospitals. Refresher training was conducted for medics and paramedics for mobile-based applications, dog bite management, and proper referral of cases to tertiary care hospitals.

"As long as the patient tells you it was a dog that bit him, why do you need to know more?" A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda.

Dog-mediated rabies is on the increase in Uganda despite the availability of post-exposure prophylaxis (PEP). PEP procedures are expounded in the Uganda Clinical Guidelines (UCG) of 2016. We assessed adherence by health workers to UCG while managing dog bites in two PEP centers and obtained insights into motivations of their practices. Using qualitative methods, we observed the health worker-patient encounters, reviewed medical records, and interviewed 14 health workers that were involved in managing dog bite injuries. We used deductive thematic analysis to identify codes in themes developed from UCG. We found that much of the history of the bites was taken, but it was neither verified nor written down on the patient’s file. Classification of wounds was inaccurate and ancillary laboratory assessments like culture and sensitivity tests were not conducted in all cases. Although antibiotics were given for both treatment and prophylactic purposes, the prescription was based on availability and affordability, not UCG recommendations. Rabies immunoglobulin (RIG) was not administered to deserving patients due to unavailability and high costs to the patient. Anti-rabies vaccine (ARV) was prescribed indiscriminately and some health workers attributed this to pressure from patients. Health education regarding prevention of dog bites was not given to patients due to time constraints on the side of the providers as a result of high caseloads at the emergency departments. Challenges to adherence to guidelines were identified as frequent ARV stock outs; inadequate cooperation among health facilities; and insufficient knowledge and skills on how injuries and rabies should be managed. We conclude that clinical management of dog bites is not fully in line with UCG. We argue that adoption of an integrated bite case management and cost-saving strategies as well as continuing medical education programs on rabies control and management could improve the clinical management of dog bites.

Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies.

In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must immediately wash bite wound for 15 minutes with water, soap, and a disinfectant before seeking medical care. This study investigated the epidemiology of dog bites and the determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog-bite patients at two healthcare facilities. Qualitative data were also collected through 13 in-depth interviews with patients, healthcare workers, herbalists, and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized linear models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied substances that were not recommended e.g. herbs (47/193), antiseptics (46/193), “black stone” (25/193), and unknown creams (10/193). Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47–0.92) and knowing the dog owner, adjPR = 0.65 (0.36–0.93). However, attainment of secondary or higher education, adjPR = 1.76 (1.24–3.79), being in employment, adjPR = 1.48 (1.09–2.31), perception that the dog was sick, adjPR = 1.47 (1.02–2.72) and knowledge about the dog’s subsequent victim(s) adjPR = 0.35 (0.17–0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for deliberate promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.

To assess the knowledge, attitude and behaviour on dog bites and its management in the prevention of rabies among general population in an urban area in Tamil Nadu

Rabies is a major health issue in the urban areas where there are many free roaming dogs. The absence of knowledge among people regarding the management of dog bites results in increased death due to rabies. Myths and indigenous methods have a greater influence on people than the available vaccines with proven efficacy. Rabies is a 100% fatal disease that can be prevented by timely intervention. Knowledge, attitude and practice among the people play an important role in reducing death due to rabies.So this study aims to assess and evaluate the knowledge, attitude and behaviour on dog bites and its management in the prevention of rabies among general population. A Pretested questionnaire regarding the knowledge, attitude and behaviour on dog bites and it management, containing 34 questions, was used. A cross sectional descriptive study was performed on 205 residents of an urban area (Thirumazhisai) in Tamil Nadu. The data obtained was analysed using SPSS10. A total of 205 subjects were studied. 52 subjects had heard of rabies and knew that it could be spread by animal bite. Regarding the animals that could spread rabies, 52 subjects reported dogs to be the most common source, the second commonest response being cats (24 subjects). Knowledge, attitude and behaviour study suggests that there is need to create awareness amongst the masses regarding epidemiology of the disease and merits of prompt and appropriate post exposure treatment.

Knowledge and attitudes about rabies in dog-bite victims in Bangladesh

Rabies is an important zoonotic disease that causes several thousand deaths in Asian countries. Bangladesh launched an elimination programme in 2010 based on the mass vaccination of dogs, management of dog bites, application of post-exposure prophylaxis and communication and social mobilization. The aim of this study is to ascertain the behaviour of and knowledge about dog-bite victims.A cross-sectional descriptive study was performed on 885 dog-bite victims who presented themselves for post-exposure rabies vaccination to six randomly selected vaccination centers, in addition to a tertiary-level hospital in Bangladesh. Most dog-bite victims were male (70%) and with very low or no education qualifications (75%). Respondents' knowledge of rabies was low: 58% were unaware of the consequences of a dog bite and 52% did not know about any indication of rabies. Most knew that rabies in humans can be prevented after dog bites, but up to 70% did not give a correct answer for other questions related to the prevention and treatment of rabies. Knowledge and attitudes about rabies is closely related to level of education. Finally, 58 of those surveyed (6.4%) did not complete the post-exposure prophylaxis correctly.In conclusion, knowledge about rabies among Bangladeshi citizens is low. An intensive plan to inform and educate people about dog bites, the risk of rabies and measures to adopt for preventing the disease should be implemented in order to reduce risk, including the need to complete post-exposure treatment.

Knowledge and practice regarding dog bite management among general practitioners of District Malir, Karachi.

To assess knowledge and practice regarding dog bite management among general practitioners in a suburban setting. This cross-sectional knowledge and practice study was conducted from March 2017 to October 2017 in district Malir, Karachi, and comprised general practitioners conveniently recruited from 32 randomly selected union councils of the district. The participants were interviewed with the help of a self-generated structured questionnaire. Data were analysed in SS PS 21 . Of the 92 practitioners, 67(72.8%) were males, 43(46.7%) had>10 years' experience, and 63(68.5%)were privately employed. The overall mean age of the sample was 43.77±11.5 years. Mean knowledge scores varied significantly across categories of experience only (p=0.020), withthe lessexperienced practitioners having significantly higher mean knowledge compared to the seniors. The experience of the general practitioners significantly affected their knowledge with recent graduates found to have higher mean k nowledge scores than older graduates.

Capnocytophaga bacteremia precipitating severe thrombocytopenia and preterm labor in an asplenic host.

Capnocytophaga species are gram-negative bacilli that inhabit mammalian oral surfaces and can cause opportunistic infection, especially in asplenic patients. The species Capnocytophaga canimorsus is particularly associated with dog bites and is known to cause endocarditis, meningitis, and sepsis in the general population. In pregnant patients, infections tied to Capnocytophaga species from human flora have been associated with preterm labor, chorioamnionitis, and neonatal septicemia. There is little known about the effects of zoonotically-acquired Capnocytophaga infection in pregnant patients. In this case report, we present a patient with Capnocytophaga bacteremia acquired after a dog bite associated with profound thrombocytopenia and preterm labor. Dog bites are common in the United States, and we present basic recommendations for management of dog bites in pregnant patients in order to avoid morbidity associated with delay in time to antibiotic treatment of infection as described in this case.

Dog Bite Management: The Evidence

Dog Bite Management: The Evidence

A cross sectional study to assess the knowledge and response to dog bite among the urban and rural population of Hubballi taluk

Background: Rabies is a fatal zoonotic disease of the central nervous system, most commonly caused by the bite of rabid dogs. Globally canine rabies causes 59,000 human deaths, over 3.7 million DALYs and 8.6 billion USD economic losses annually. These losses are due to a lack of knowledge about wound management and post-exposure prophylaxis. The objective of the study was to assess the knowledge and practices following dog bite and its management among the urban and rural population.Methods: A cross-sectional study was conducted in the field practice area of KIMS, Hubli. 120 households of the urban and rural locality were interviewed with a semi-structured pretested questionnaire.Results: Overall 89.16% of the study population was aware that the disease can be prevented by vaccination. 35% of the rural and 28% of the urban population believed that the disease can spread from person to person. The knowledge about the site and the number of doses of vaccine was poor among both the population. The harmful practices for treatment of bite were still prevalent among both rural (25%) and urban (8.3%) population.Conclusions: The knowledge about the dog bite management and Rabies prevention is insufficient among both populations. There are myths and misconceptions about the disease and wound management. Practices like application of harmful substances like lime, turmeric, mud are the problems hindering rabies prevention and control. Proper steps need to be taken up to control the canine rabies.

Management of dog bites by the Maxillofacial team

Management of dog bites by the Maxillofacial team

Assessment of Knowledge and Practices on Rabies among Veterinary Staff in Cuttack City, Odisha

Background: Veterinarians and their staff are placed in the high-risk group of acquiring rabies due to the frequent exposure to rabid animals, experiences as a part of their routine job schedule. Research focusing on rabies control among veterinarians is very limited. This study attempts to assess the knowledge and practices regarding rabies prevention and control among veterinary staff of Cuttack city. Objectives 1. To assess the knowledge on rabies among veterinary staff 2. To know the extent of pre- and post-exposure vaccination coverage against rabies among veterinary staff. Methodology: A cross-sectional survey was done among the government veterinary staff in Cuttack city from February to April, 2016. A pretested and predesigned questionnaire was used to collect the data by interviewing method. Results: Most of the surveyed veterinary individuals were aware of the disease rabies. Bite and saliva contact of rabid animals with open wound was known as mode of rabies transmission to 82.5% of the respondents. 42.5% of the study subjects used three or more personal protective measures while handling the animals. Of total 40 respondents, only 22.5% had taken full pre-exposure vaccination against rabies. Conclusion: Despite being a risk group of acquiring rabies because of their job, the total veterinary staff currently vaccinated fully either by pre or post-exposure with anti-rabies vaccine is very low. Proper education and awareness need to be provided to all the veterinary staff regarding seeking dog bite management and the need to take pre-exposure vaccine.

Management of dog bites by frontline service providers in primary healthcare facilities in the Greater Accra Region of Ghana, 2014\u20132015

BackgroundDog bites are common in developing countries including Ghana, with the victims often being children. Although some breeds of dogs have been identified as being more aggressive than others, all dog bites carry a risk of infection. Immediate and initial assessment of the risk for tetanus and rabies infection with appropriate interventions such as wound management and subsequent selection of prophylactic antibiotics are essential in the management of dog bites. This study examined the management of patients with dog bites by frontline service providers at primary healthcare facilities in the Greater Accra Region, Ghana.MethodsWe conducted a cross-sectional study in 66 public health facilities in the Greater Accra Region from July 2014 to April 2015. Up to four frontline service providers were randomly selected to participate from each facility. A structured questionnaire was administered to all consenting participants. Continuous variables were presented as means and standard deviations. The frontline service providers’ knowledge was assessed as a discrete variable and values obtained presented as percentages and proportions. The chi-square test of proportions was used to determine any significant associations between the various categories of the frontline service providers and their knowledge about the management of rabies.ResultsRegarding the frontline service providers’ knowledge about rabies, 57.8% (134/232) were correct in that the rabies virus is the causative agent of rabies, 39.2% (91/232) attributed it to a dog bite, 2.6% (6/232) did not know the cause, and one person (0.4%) attributed it to the herpes virus. Only 15.5% (36/232) knew the incubation period in dogs and the period required to observe for signs of a rabies infection. With respect to the administration of rabies immunoglobulin, 42.2% (98/232) of the frontline service providers did not know how to administer it. Of the facilities visited, 76% (50/66) did not have the rabies vaccines and 44% (102/232) of frontline service providers did not know where to get the rabies vaccines from. Most of the service providers (87.9%; 204/232) had never reported either a dog bite or a suspected case of rabies. Overall, there was gross underreporting of dog bites and suspected rabies cases at public healthcare facilities in the Greater Accra Region of Ghana.ConclusionsIn view of the high morbidity and mortality associated with bites from rabid dogs and the poor knowledge and practices of frontline service providers, there is an urgent need for capacity-building such as training in the management of dog bites and subsequent potential rabies infection.

Free Roaming Dogs: A Threat to Public Health

Free roaming dogs are increasing in numbers. They live in unhygienic conditions and are not vaccinated mostly. They create several problems in the community, particularly health threats to human. Dog biting is a commonly reported case in some hospitals in Bangladesh. Rabies is one of the killers of people in Bangladesh and transmission occurs mostly due the dog biting. Death commonly occurs in children due to rabies. Rabies death is completely preventable by vaccinating dogs at national level. Many steps have already been taken. Source identification of dogs, animal birth control program and proper surveillance are necessary. Sustainable implementation of programs to manage dog population, dog bite management and awareness raising among population can bring out fruitful result in this situation. Inhumane killing of dogs to reduce the number can never be a permanent solution. Vaccinating dogs is the most effective strategy suggested by experts. Therefore, it is not too late to implement action plans with regular monitoring and evaluation for the sake of human and animal health.

Community Perception towards Traditional Healers and Health Centers on Management of Dog Bites and its Relation with Veterinary Public Health Activities

A survey was conducted to investigate whether the community uses traditional healers or modern health centers after exposure to dog bites and veterinary public health responses on the issues in Arba Minch, Ethiopia. Two stage cluster and simple random sampling procedures were employed to select inhabitants and other target study population for this study. The data were collected from 300 permanent inhabitants, 75 physicians, 28 veterinarians and 10 directors and vice directors of health centers/hospital through personal interview face to face using pre-tested structured questionnaires. Among the permanent inhabitants, 36.9% faced one or more incidents of dog bite in their family in past twelve months. Out of those victims the majority (42.45%) used treatment by traditional healers. The majority (60.6%) of the respondents (both victim and non victim families) accepted the practice of traditional healers. Statistically significant difference (P<0.05) was observed between; residents living area, economic statues, educational level and the choice of treatment (traditional healers, health centers or both) for dog bite. Statistically significant difference (P<0.05) was also observed between; purpose of keeping dog, vaccination practice, reason not to vaccinate, economic status and residents’ living area. Analysis of data from directors/vice directors of health centers revealed higher proportion (70%) of directors/vice directors believe that veterinarians should be very much involved in zoonoses education for the patients. It was also confirmed by large proportion (60%) of officials that there was no health center/institution/hospital with a department specifically working on zoonoses in the area. Smaller proportions (40%) of directors/vice directors of health centers/hospital responded there were zoonoses departments in health centers, but without public health veterinarians. In the conclusion, this study confirmed the high preference common use of traditional healers to modern health centers for rabies suspected dog bite management. Besides, the study revealed a very minimal role of veterinary public health in the area. Strong participatory education about the risk of dog bites and rabies should be given to the residents of the area.

OCCURRENCE AND MANAGEMENT OF SUSPECTED RABIES IN LIVESTOCK SPECIES DUE TO DOG BITES AT SATKANIA UPAZILLA VETERINARY HOSPITAL, BANGLADESH AND MADRAS VETERINARY COLLEGE HOSPITAL, INDIA

The study was carried out to record all clinical cases of dog bites in different livestock species at two internship placements in India during October to November and Bangladesh during July to September 2012. The study aimed to determine the proportionate prevalence of suspected rabies in livestock species, frequency of observed clinical signs and the therapeutic management of dog bites. A structured record keeping sheet was used to obtain the necessary information. The prevalence of suspected rabies in cattle was 38% and 3.5% each in goat and horse respectively. The prevalence of rabies in non-vaccinated animal was 84.6%. Female cattle had higher suspected rabies cases (24.1%) than male cattle. 51.7% dog bites were managed by washing the biting site with alkaline soap followed by dressing the wound with either antiseptic or antibiotic powder. Post-exposure vaccines were used in 24.1% cases. Strict adherence to vigorous wound washing and immediate medical evaluation after animal bites will prevent the development of Animal rabies. Veterinarians and animal control officers should handle potentially rabid animals with extreme caution.

Prevalence of Dog Bites in Rural and Urban Slums of Delhi: A Community-based Study.

Background:Rabies is a fatal disease of the central nervous system caused by the bites of warm-blooded animals. One of the important methods of controlling rabies is by interventions to limit the number of dog bites, the most common source of transmission of rabies to humans in the community. Community-based data on dog bites are rare from India.Aim:The aim of this study is to determine the prevalence of dog bites and knowledge and practices relating to its management and prevention in an urban and a rural slum of North West Delhi, India.Subjects and Methods:A cross-sectional house to house survey of 500 households covering a population of 2887 individuals was conducted. The families were selected by systematic random sampling. A pretested and a prevalidated questionnaire was used. Chi-square test was applied for comparing proportions related to the categorical variables and t-test was used for comparing means.Results:The dog bite incidence rate for the study population for the last year was 25.2/1000 population with higher rates in urban (30.1/1000) than rural (19.6/1000) slum. Two-fifths of the dog bite patients did not wash the wound with soap and water. The practice of washing the wound with soap and water was significantly higher in urban than rural slum. One-fifth of the patients did not receive anti-rabies vaccine. There was lower coverage in rural than urban slum. A majority (79.0%) of the patients did not receive anti-rabies serum.Conclusion:A high prevalence of dog bites coupled with poor knowledge and dog bite management practices is a worrisome trend which policy makers should take into account to make India rabies free.

G97(P) Audit of safeguarding of children presenting with dog bites to the emergency department

Aims Recently there has been much media coverage of dog attacks on children. NICE guidelines for management of dog bites recommend that inadequate supervision should prompt consideration of child neglect. We aimed to retrospectively analyse emergency department records to examine the nature of paediatric dog bite incidences, demographics, management, and child safeguarding actions. Methods This was a retrospective case series review of routinely collected data, reviewing electronic notes of emergency departments attendances coded for animal bites, stings, or wounds, between 1st May 2013 and 31st of May 2014. The audit was registered with the audit department, ethics committee approval was not required. We obtained records for 193 patients between 0 and 17 years of age. 33 patients were excluded (17%), 7 due to insufficient documents, 19 due to bites from other animals, and 7 re-attendances. Results 160 patients were analysed, the mean age was 9.4 years of age, with 66 female (41%) and 94 male (59%). There were 105 injuries to the limbs and 50 facial injuries. Most injuries occurred within the family home (n = 43) or in a public place (n = 43). The commonest culprit was the family’s own dog (n = 47), the next commonest being a relative’s dog (n = 22). 135 patients received antibiotics, and 17 required referral to other specialities. There were 3 safeguarding referrals to social services within the department, and 4 referrals to health visitors by clinicians. However the trust employs paediatric liaison nurses who retrospectively review notes and take further actions if there are child protection issues. The paediatric liaison team made 32 referrals to school nurses and 21 referrals to health visitors, though no social services safeguarding referrals. Conclusion Our study suggests children attending emergency departments with dog bites are commonly attacked by the family dog within the family home. There was a low overall rate of child safeguarding actions taken though the trust paediatric liason team made more referrals than clinicians. As a result of this audit we will update our online emergency department guidelines for clinicians. Moreover, we will distributea patient information leaflet including advice regarding supervision of children around dogs.

Human rabies: a descriptive observation of 21 children in Kinshasa, the Democratic Republic of Congo

Objectives:Human rabies has recently emerged as a significant public health threat in Kinshasa, Democratic Republic of Congo (DRC). However, there is little epidemiological information on human rabies especially in children.Methods:We performed at Pediatrics Department of General Reference hospital of Kinshasa between December 2008 and July 2009, a retrospective study to assess the incidence and to describe their clinical aspects and outcome.Results:A total of 21 cases were observed, rather three cases per month. There were 12 boys (57·1%) and 9 girls (42·9%). Biting animal was found to be dog in all cases (100%). The dog was not immunized in all of cases. On admission, all patients (100%) showed furious rabies manifestations. Only two (9·5%) had their wounds treated and received an anti-rabies vaccine (ARV) after the bite incident. Two (9·5%) patients received rabies immunoglobulin (RIG). The case-fatality rate was 100%.Conclusions:The disease emerges as a new major public health problem because of a lack of knowledge regarding rabies risk, the poor management of dog bites. Preventative vaccination for rabies should be recommended in the population of Kinshasa, area at high risk to contract rabies, particularly in children.

The definitive management of dog bites

The definitive management of dog bites