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.

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 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 Suspected dog bite associated HIV horizontal transmission in Swaziland

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Ganizani Mlawanda
Keyword(s):  
Hepatitis C ◽  
Hepatitis B ◽  
Hiv Transmission ◽  
Horizontal Transmission ◽  
Rapid Test ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Dog Bites ◽  
Second Victim ◽  
Exposure Prophylaxis

Background: Dog bites may lead to transmission of bacteria and viruses over and above tetanus and rabies. Theoretically human immunodeficiency virus (HIV), Hepatitis B and Hepatitis C may be transmitted after dog bites where transfer of blood from one victim to another occur in clinical practice HIV, Hepatitis B and Hepatitis C are not considered when making treatment decisions, nor adequate patient history taken to consider all potential risks after dog bites in succession.Objective: To present case of suspected HIV transmission after dog bites in close succession involving two HIV sero-discordant victims.Management and outcome: HIV rapid test and/or HIV Ribonucleic acid (RNA) polymerasechain reaction (PCR) results for the victim(s) at presentation and a month later.Results: Two night patrol guards presented to casualty after dog bites in close succession by the same dog. They were managed according to the dog bite protocol. Thinking out of the box, the first victim was found to be HIV positive by rapid test whilst the second victim was negative based on both HIV rapid test and HIV RNA PCR. One month after the dogbites, a case of HIV sero-conversion was confirmed in the second victim despite post-exposure prophylaxis (PEP).Discussion: Although an isolated case, shouldn’t clinicians re-think the significance of HIV transmission after animal bites where there is repeated blood exposure in several people insuccession?Conclusion: Clinicians should be aware of the potential of HIV, Hepatitis B and C transmission, when faced with dog bites in succession. 

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.

CROSS- SECTIONAL STUDY OF ANIMAL BITE VICTIMS AND RABIES POST EXPOSURE PROPHYLAXIS UNDER NRCP (NATIONAL RABIES CONTROL PROGRAMME) AT A RURAL HOSPITAL OF NORTH 24 PARGANAS OF WEST BENGAL, INDIA.

2021 ◽  
pp. 4-6
Author(s):  
Chinmay Nandi ◽  
Saikat Bhattacharya ◽  
Soumitra Mondal ◽  
Shibasish Banerjee
Keyword(s):  
Cross Sectional Study ◽  
Control Programme ◽  
Post Exposure Prophylaxis ◽  
Sectional Study ◽  
Cross Sectional ◽  
Case Record ◽  
Post Exposure ◽  
Rabies Control ◽  
Animal Bites ◽  
Exposure Prophylaxis

Objectives -Rabies, an Endemic disease, is responsible for extensive morbidity and mortality in India. About 96% of the mortality and morbidity is associated with dog bites. The aim of the study was to estimate the prevalence and pattern of animal bites and rabies post exposure prophylaxis under National Rabies Control Programme Methodology – It was a Record cross sectional study where complete enumeration of all animal bite victims were done. Total 2940 such cases were found in that year. Data of 42 cases was excluded due to incomplete records. Data was analysed using MS Excel. Animal Bite Exposure register under National Rabies Control Programme, Patient Treatment cards, Consolidated reports were evaluated as study tools. Results - Majority of the wounds were found in limbs in 2695 (93%) cases. It is followed by wound in other areas like face 104(3.6%) and back 95 (3.3%). In a few cases site of wound was not mentioned in the case record. Children were most commonly affected (28.2%).Cat -bite is most common (49.3%). Around 84.9% were Category II bite and rest are category III. Conclusion - Dogs and cats are mostly responsible of animal bites in this part of the country. There is need to control stray dogs .Children are found to be most vulnerable for animal bites. There is gap between eligible candidates for vaccine and those who actually received it both in Category II and III animal bite victims.

scholarly journals The changing epidemiology of dog bite injuries in the United States, 2005–2018

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Peter S. Tuckel ◽  
William Milczarski
Keyword(s):  
United States ◽  
New York ◽  
New York City ◽  
York City ◽  
Prevention Programs ◽  
The United States ◽  
Emergency Department Visits ◽  
Dog Bite ◽  
Dog Bites ◽  
Bite Injuries

Abstract Background In 2018, the most recent year for which data are available, dog bites ranked as the 13th leading cause of nonfatal emergency department visits in the United States. As dog ownership spirals upwards in the United States, it is important to continue to monitor the epidemiology of dog bite injuries. This study provides contemporary data on the incidence of dog bites injuries in the United States and in New York and profiles individuals who have been treated for dog bites in emergency departments. The study also examines the demographic correlates of the rate of injuries at the neighborhood level in New York City and maps the rate in each neighborhood. Methods At the national level, the study examines longitudinal data on dog bite injuries from 2005 to 2018 gathered by the Centers for Disease Control and Prevention. For New York, the study analyzes data for 2005–2018 collected by the New York State Department of Health. A negative binomial regression analysis was performed on the state data to measure the simultaneous effects of demographic variables on the incidence of dog-related injuries. A thematically shaded map of the rate of dog bite injuries in New York City’s neighborhoods was created to identify neighborhoods with higher-than-average concentration of injuries. Results In both the United States and New York the rate of dog-bite injuries increased from 2005 to 2011 and then underwent a significant decline. Injuries due to dog bites, however, still remain a sizable public health problem. Injuries are more prevalent among school-age children, inhabitants of less-densely populated areas, and residents of poorer neighborhoods. In New York City, poorer neighborhoods are also associated with fewer dogs being spayed or neutered. Conclusions To reduce the rate of dog bite injuries, prevention programs – particularly those which center on teaching the dangers of canine interactions with humans – should be targeted at children. Dog bite injuries tend to be clustered in identifiable neighborhoods. Dog bite prevention programs and stricter enforcement of dog laws can target these neighborhoods.

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.

scholarly journals Development of a questionnaire to determine the case detection delay of leprosy: A mixed-methods cultural validation study

2022 ◽  
Vol 16 (1) ◽  
pp. e0010038
Author(s):  
Naomi D. de Bruijne ◽  
Kedir Urgesa ◽  
Abraham Aseffa ◽  
Kidist Bobosha ◽  
Anne Schoenmakers ◽  
...  
Keyword(s):  
Large Scale ◽  
Health Workers ◽  
Post Exposure Prophylaxis ◽  
Case Detection ◽  
Cultural Validity ◽  
Detection Delay ◽  
Leprosy Case ◽  
The Moment ◽  
Exposure Prophylaxis ◽  
Test Retest Reliability

Background Delay in case detection is a risk factor for developing leprosy-related impairments, leading to disability and stigma. The objective of this study was to develop a questionnaire to determine the leprosy case detection delay, defined as the period between the first signs of the disease and the moment of diagnosis, calculated in total number of months. The instrument was developed as part of the PEP4LEP project, a large-scale intervention study which determines the most effective way to implement integrated skin screening and leprosy post-exposure prophylaxis with a single-dose of rifampicin (SDR-PEP) administration in Ethiopia, Mozambique and Tanzania. Methodology/Principal findings A literature review was conducted and leprosy experts were consulted. The first draft of the questionnaire was developed in Ethiopia by exploring conceptual understanding, item relevance and operational suitability. Then, the first draft of the tool was piloted in Ethiopia, Mozambique and Tanzania. The outcome is a questionnaire comprising nine questions to determine the case detection delay and two annexes for ease of administration: a local calendar to translate the patient’s indication of time to number of months and a set of pictures of the signs of leprosy. In addition, a body map was included to locate the signs. A ‘Question-by-Question Guide’ was added to the package, to provide support in the administration of the questionnaire. The materials will be made available in English, Oromiffa (Afaan Oromo), Portuguese and Swahili via https://www.infolep.org. Conclusions/Significance It was concluded that the developed case detection delay questionnaire can be administered quickly and easily by health workers, while not inconveniencing the patient. The instrument has promising potential for use in future leprosy research. It is recommended that the tool is further validated, also in other regions or countries, to ensure cultural validity and to examine psychometric properties like test-retest reliability and interrater reliability.

scholarly journals Epidemiological Aspect of Dog Bite and Response of The Dog Bite Victims Attending Vaccination Centre of Sadar Hospital, Sirajganj

KYAMC Journal ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 148-152
Author(s):  
Ahmed Nawsher Alam ◽  
Mahmuda Siddiqua ◽  
Asma Siddiqua ◽  
Nasreen Akther ◽  
Moushumi Sarker ◽  
...  
Keyword(s):  
Rural Areas ◽  
Public Health Problem ◽  
Education Level ◽  
Post Exposure Prophylaxis ◽  
Dog Bite ◽  
Primary Level ◽  
Epidemiological Aspect ◽  
Low Education ◽  
Knowledge And Attitude ◽  
Exposure Prophylaxis

Background: Rabies is a public health problem in Bangladesh, with poorer people and children being mainly affected. Objectives: The aim of this study was to investigate the behaviours of dog bite victims following a bite and to assess the knowledge and attitude about rabies among dog bite victims. Materials and Methods: A crosssectional type of descriptive study was designed where individual people who came to the vaccination centre from the month of April 2015 to July 2015 for post-exposure prophylaxis were considered. They were interviewed and followed during subsequent visits until they had received their final dose of vaccination. Result: Among the victims, males 60.9% were more common than females 39.1% and most of them were children aged below 20 years 51 %, mostly from rural areas 69.3%, had very little primary 46.1% or no education 24.7%. Victims were bitten mostly at their legs 89.3%. In response to question regarding what happens following dog bite, 49% couldn't say anything, and 46% mentioned hydrophobia. Most of them (87%) know that rabies can be transmitted from dogs to humans; 68.4% had no idea that rabies can be prevented in dogs. Though 82.3% bite victims didn't know that rabies in humans can be prevented before a dog bite, 77.7% knew that rabies can be prevented after a dog bite. Use of soap and water was found lowest 13.1% among those who had education upto primary level and highest 53.9% in graduates. Conclusion: This study showed that most victims didn't take any washing measures before visiting to hospital which is one of the most important measures recommended by WHO and it was found mostly who had low education level. It also observed that knowledge gap about rabies among the dog bite victims decreased with increased education level. KYAMC Journal Vol. 9, No.-4, January 2019, Page 148-152

Dog Bites in Urban Children

PEDIATRICS ◽  
1991 ◽  
Vol 88 (1) ◽  
pp. 55-57
Author(s):  
Jeffrey R. Avner ◽  
M. Douglas Baker
Keyword(s):  
Young Children ◽  
Early Identification ◽  
Urban Children ◽  
Safety Education ◽  
Dog Bite ◽  
Older Children ◽  
Dog Bites ◽  
Children's Hospital ◽  
The Mean ◽  
Bite Injuries

As a result of a perceived increase in pit bull injuries, all children who presented to The Children's Hospital of Philadelphia during 1989 for evaluation of dog bite injuries were prospectively studied. Epidemiologic information was collected from parents, either at the time of visit or by phone on the following day. A total of 168 children were enrolled; the mean age was 8 years. Males outnumbered females 1.5:1. Most (61%) injuries occurred in or around the home and involved dogs known to the patient (77%). Types of injuries included abrasions (33%), punctures (29%), and lacerations (38%). Thirteen bites had associated complications; nine developed infection. Twelve (7%) children required admission to the hospital. More than 12 different purebreeds or crossbreeds were identified as perpetrators, including German shepherds (n = 35), pit bulls (n = 33), rottweilers (n = 9), and Dobermans (n = 7). Most (54%) animals were contained (ie, leashed, fenced, in-house) at the time of injury. Fewer (46%) were provoked prior to biting. Significantly more pit bull injuries (94% vs 43%, P < .001) were the consequence of unprovoked attacks and involved freely roaming animals (67% vs 41%, P < .01). Children aged 5 or younger were more likely to provoke animals prior to injury than were older children (69% vs 36%, P < .001). It is recommended that families with young children be the target of pet safety education and that measures be sought that would lead to early identification of a potentially dangerous dog and restrict ownership.

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