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

2020 ◽  
Author(s):  
Stevens Kisaka ◽  
Fredrick E. Makumbi ◽  
Samuel Majalija ◽  
Alexander Bangirana ◽  
SM Thumbi
Keyword(s):  
Health Education ◽  
Medical Care ◽  
Clinical Guidelines ◽  
Qualitative Data ◽  
Dog Bite ◽  
Public Places ◽  
Post Exposure ◽  
Dog Bites ◽  
Bite Wounds ◽  
Rabies Prevention

AbstractIn rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must wash bite wounds for 15 minutes with soap, water and disinfectant immediately before seeking medical care. This study investigated the epidemiology of dog bites and 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 as also collected through 13 in-depth interviews with patients, healthcare workers, herbalists and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized lineal 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 un-recommended substances such as herbs (47/193), antiseptics (46/193), “black stone” (25/193) and unknown creams (10/193) on the wounds. 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 promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.Author summaryDog-mediate rabies is on the rise, especially in sub Saharan Africa. Though the disease is fatal upon exposure, it can be effectively prevented through appropriate post-exposure management. It is recommended that dog bite victims wash bite wounds for 15 minutes with soap, water and disinfectant immediately before seeking medical care. However, such pre-clinical recommendations are not usually followed in many societies, including in Uganda. There are numerous reports of victims not seeking or delaying to seek healthcare. Additionally, victims have been reported not to wash their wounds and applying traditional herbal concoctions before presenting at health facilities. Such divergence from the recommended standards has negative implications on the effectiveness of post-exposure prophylaxis that is given when victims report to health facilities. Our study investigated the epidemiology of dog bites and preclinical practices for the victims in the context of dog bite prevention and rabies prevention respectively. We call for targeted health education programs to improve pre-clinical behavior, regulation of herbalist activities and interventions that minimize human-dog interactions.

Epidemiological Features of Dog Bites among Children Attending Emergency Room in Al-showmely General Hospital

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Hasan Alwan Baiee ◽  
Weli Hatif
Keyword(s):  
Emergency Room ◽  
General Hospital ◽  
Health Problem ◽  
Lower Limbs ◽  
Care Providers ◽  
Dog Bite ◽  
Female Ratio ◽  
Post Exposure ◽  
Dog Bites ◽  
Bite Injuries

Dog bites are common and can affect victims of different ages.Dog bite injuries in children are a preventable health problem.Dog bites are a serious health problem that cause both physical and emotional damage to victims and considerable cost to communities. Studies on dog bites among Iraqi children were very scarce.This study focuses on theincidence,mechanisms,and epidemiologicalcircumstances ofdog biteinjuriesin a series of pediatric patients who sustained dog bites in emergency Room. MethodologyA cross sectional study was designed to studyall cases of dog bites attending the emergency room in AL-Showmely General Hospital located in the southern district – Babylon province-Iraq, during the period ; from the January, first,2017 through theend of March, 2018.Special constructed were prepared to collect data through interview of victims or their companions who attended the emergency section during this period,ethical clearances were obtained.*A total of 320 children presented to the hospital with dog bite injuries.The incidence rate of dog bites was 275 per 100000 population, the male to female ratio was 3:1.the most common dog bite injuries took place in September44 (13.75%). Injury rates were highest in those aged 0-4,declining thereafter with age. In the 6-10, year age group141 (44.1%), most of cases living in rural district (villages). The most affected location were lower limbs, only 3.4% of the injured children had completed the post exposure anti rabies vaccine. Dog bites are common health problem among children,Children who are younger than 10 years represent the high-risk group for dog attacks. very few of them had complete the prophylactic post exposure vaccine Therefore, prevention strategies should focus on public education,training health care providers and controlling stray dogs.

Pattern and Outcome of Dog Bite Injuries among Children-a Study in 200 Cases

2021 ◽  
pp. 1-5
Author(s):  
Md Waliur Rahman ◽  
◽  
Md Habibullah Sarkar ◽  
Samir Kumar Talukder ◽  
Md Joynal Abedin ◽  
...  
Keyword(s):  
Public Health ◽  
Health Problem ◽  
Public Health Problem ◽  
Hospital Treatment ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Post Exposure ◽  
Dog Bites ◽  
Exposure Prophylaxis ◽  
Bite Injuries

Introduction: Dog bites in humans are a major public health problem. Globally, millions of people are bitten by dogs but most of the fatal cases occur in children. Dog bites in human are a serious public health problem and have been well documented worldwide. As rabies is not a notifiable disease in Bangladesh and most deaths occur in rural areas where surveillance is poor. Objectives: To determine the pattern of dog bite injuries and associated health problems among children. Methods: The study was an observational retrospective study carried out at the Dept. of General Surgery, Chuadanga Sadar Hospital, Chuadanga, Bangladesh. The study reviewed the clinical data of patients managed for dog bite related injuries and rabies over a four and half year period between January 2016 and June 2020. A proforma was designed to extract relevant clinical data from the case records. Information extracted included the age, sex of the victims, site of the bite, time of presentation in the hospital, pre-hospital treatment, hospital treatment including post-exposure prophylaxis and complication. Results: In all, 200 cases of dog bite injuries were managed constituting 0.89% of the total consultations; 5 (2.5%) had rabies. Most of the victims were aged 6-12 years (55.0%) and majority (67.0%) was boys. Eighty two percent of the victims presented within 24hrs of the injury. 92 (46.0%) had WHO grade 3 dog bite injury at presentation and the lower limb was the commonest (56.0%) bite site. Use of herbal preparation was the most common pre-hospital treatment 60%. Although 95.0% received anti-rabies vaccine, only 55.5% of them completed the vaccination schedule. The case fatality rate for dog bite was 5.0%. The 5 that died all presented late, had no post exposure prophylaxis and died within 24 hours of admission. Conclusion: There is need for public enlightenment on dangers associated with dog bites and also for the government to ensure vaccination for cost of post exposure prophylaxis treatment for children free of cost

scholarly journals “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

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254650
Author(s):  
Stevens Kisaka ◽  
Fredrick E. Makumbi ◽  
Samuel Majalija ◽  
Alexander Kagaha ◽  
S. M. Thumbi
Keyword(s):  
Clinical Guidelines ◽  
Clinical Management ◽  
Health Workers ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Dog Bites ◽  
Rabies Control ◽  
Exposure Prophylaxis ◽  
Control And Management ◽  
Bite Injuries

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.

scholarly journals A Retrospective Study on Dog Bite Associated Rabies in Human and the Use of Post-exposure Prophylaxis in Nepal during 2008 to 2017

2021 ◽  
Vol 11 (2) ◽  
pp. 181-186
Author(s):  
Pushkar Pal ◽  
Hiroshi Shimoda ◽  
Rajendra Bashyal ◽  
Adisorn Yawongsa ◽  
Theera Rukkwamsuk
Keyword(s):  
Population Management ◽  
Human Rabies ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Stray Dogs ◽  
Post Exposure ◽  
Dog Bites ◽  
Stray Dog ◽  
The Government ◽  
Exposure Prophylaxis

A 10-year (2008-2017) retrospective canine-mediated human rabies epidemiology was studied to assess the burden of rabies in Nepal. To this end, the number of dog bites, the use of post-exposure prophylaxis (PEP), and human death records from 2008 to 2017 were retrieved from Sukraraj Tropical Hospital, Kathmandu, Nepal. The findings revealed that the number of human rabies occurrences was consistent with minor fluctuations throughout the study period. There were 252,297 dog bite cases in humans recorded between 2008 and 2017. Every month, 2,102 people were bitten by mostly stray dogs. There was a gradual increase in PEP use throughout 10 years. On average, 36,995 PEP dosages were used per year for stray dog bites. The PEP consumption and the number of human deaths were negatively correlated. A total of 482 human rabies deaths were recorded in Nepal during the study period. On average, 49 people died of canine-mediated rabies each year. Although there was an increase in the use of PEP, the number of human deaths and street dog bites recorded were still high. The high mortality due to rabies could then be attributed to the flawed surveillance system and stray dog population management, and not merely the lack of PEP services. Hence, it is recommended that the government agencies and other concerned stakeholders should organize mass vaccination and population management program for stray dogs in order to reduce the country’s rabies burden.

scholarly journals Management of penile trauma caused by a dog bite

2014 ◽  
Vol 61 (1) ◽  
pp. 103-104
Author(s):  
Miodrag Acimovic ◽  
Uros Babic ◽  
Aleksandar Argirovic ◽  
Ljubomir Acimovic ◽  
Veljko Santric ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Initial Treatment ◽  
Tunica Albuginea ◽  
External Genitalia ◽  
Dog Bite ◽  
Penile Skin ◽  
Case Presentation ◽  
Dog Bites ◽  
Sporadic Cases ◽  
Bite Wounds

Background: Dog bites to the external genitalia are extremely rare. The literature shows only sporadic cases of penile injuries due to dog bites, presenting mostly as children and adolescents. Case presentation: We report the case of a 45-year old patient with avulsion and traumatic degloving of the penile skin, with exposure of the tunica albuginea, which surrounds the cavernous bodies. Conclusion: Dog bite wounds pose a serious medical threat. An effective initial treatment of the wound, as well as adequate supportive treatments are essential for the efficient healing of the resulting infection.

scholarly journals Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda

2021 ◽  
Vol 4 ◽  
pp. 49
Author(s):  
Stevens Kisaka ◽  
Fredrick Makumbi ◽  
Samuel Majalija ◽  
Gloria Bahizi ◽  
SM Thumbi
Keyword(s):  
Formal Education ◽  
Post Exposure Prophylaxis ◽  
Delayed Presentation ◽  
Dog Bite ◽  
Cross Sectional ◽  
Timely Initiation ◽  
Post Exposure ◽  
Bite Wounds ◽  
Exposure Prophylaxis ◽  
To Receive

Background   Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (inter quartile range) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 -  6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 -  3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.

scholarly journals Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda

2021 ◽  
Vol 4 ◽  
pp. 49
Author(s):  
Stevens Kisaka ◽  
Fredrick Makumbi ◽  
Samuel Majalija ◽  
Gloria Bahizi ◽  
SM Thumbi
Keyword(s):  
Formal Education ◽  
Post Exposure Prophylaxis ◽  
Delayed Presentation ◽  
Dog Bite ◽  
Cross Sectional ◽  
Timely Initiation ◽  
Post Exposure ◽  
Bite Wounds ◽  
Exposure Prophylaxis ◽  
To Receive

Background   Although rabies in dog bite patients is preventable through timely initiation of post-exposure prophylaxis (PEP), a number of barriers to achieving PEP exist. This study investigated the delays to initiation of PEP among dog bite patients in the emergency departments of two PEP centers in Uganda. Methods A cross-sectional study was conducted among dog-bite patients that presented to two selected rabies PEP centers. A semi-structured questionnaire was used to collect data. Delay to receive PEP was defined as reporting for PEP beyond 24 hours after the bite event. Generalized linear models were used to calculate prevalence ratios and the 95% confidence intervals as a measure of association between delay and patient factors. Results Out of 376 participants, just over half (53.5%) were males. The majority of participants (54.0%) were 15 years or older and 28.5% had no formal education. Just over three-quarters (77.9%) had category II dog bite wounds. Nearly 40% delayed to receive PEP, and median (IQR) lag time between bite event and seeking medical care of 18 (41) hours. Compared to education level of secondary or above, patients with no formal education (adj. PR=4.06, 95% CI: 2.69 -  6.10) or primary education (adj.PR=2.15, 95% CI: 1.37 -  3.35), belonging to the lowest socio-economic tertile as compared to the highest (adj.PR=1.58, 95% CI: 1.10 - 2.28), knowing the owner of the biting dog (adj.PR=1.30, 95% CI: 1.02 - 1.65) and having category II wounds (adj.PR=2.31, 95% CI: 1.43 - 3.71) were all associated with delayed presentation for PEP. Conclusions and recommendations Delays to receive PEP are common and are associated with poor level of education or low socio-economic status, knowledge of who the dog owner is and less severity of bite wounds. Seeking care irrespective of wound severity or knowledge of dog owner should be promoted.

Organization of immunobiological therapy for severe bronchial asthma in the Sverdlovsk region

2021 ◽  
Author(s):  
Evgeny K. Beltyukov ◽  
Valery A. Shelyakin ◽  
Veronika V. Naumova ◽  
Alexander V. Vinogradov ◽  
Olga G. Smolenskaya
Keyword(s):  
Differential Diagnosis ◽  
Targeted Therapy ◽  
Medical Care ◽  
Clinical Guidelines ◽  
Medical Insurance ◽  
Continuation Therapy ◽  
Insurance Program ◽  
Routine Medical Care ◽  
Insurance Funds ◽  
Stay Hospital

Background: Biologicals use in severe asthma (SA) is associated with problem of targeted therapy (TT) availability. Ensuring availability of biologicals can be resolved within the territorial compulsory medical insurance program (TCMIP) in day-stay or round-the-clock hospital. Aims: development and implementation of program for introduction of immunobiological therapy (IBT) for SA in Sverdlovsk Region (SR). Materials and methods: Program for introduction of IBT for SA was developed in SR in 2018 to provide patients with expensive biologicals within the TCMIP. Program includes: SA prevalence study in SR; practitioners training in differential diagnosis of SA; organization of affordable therapy for patients with SA; register of SA patients сreation and maintenance; patients selection and management of patients with SA in accordance with federal clinical guidelines. Results: Atopic phenotype in SA was detected in 5%, eosinophilic - in 2.3% of all analyzed cases of asthma (n=216). Practitioners of SR were trained in differential diagnosis of SA. The orders of the Ministry of Health of SR were issued, regulating the procedure for referring patients with SA to IBT, a list of municipal medical organizations providing IBT in a day-stay or round-the-clock hospital; approved regional register form of SA patients requiring biologicals use; ungrouping of clinical and statistical groups of day-stay hospital was carried out depending on INN and dose of biologicals; patients with SA are selected for TT and included in the regional register. Initiating of TT in round-the-clock hospital and continuation therapy in day-stay hospital provides a significant savings in compulsory medical insurance funds. Conclusions: introduction of IBT for SA in SR is carried out within framework of developed program. Principle of decentralization brings highly specialized types of medical care closer to patients and makes it possible to provide routine medical care in allergology-immunology profile in context of restrictions caused by COVID-19 pandemic.

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