Assessment of Post-exposure Prophylaxis Services for Animal Exposures in Healthcare Facilities of a Municipal Corporation
Background: In India, animal bites are common among lower socio-economic group, who invariably go to Government sector for post exposure prophylaxis. These services depend on the availability of facilities and knowledge, attitude and practice of the service provider.
Objectives:1. To assess the post exposure prophylaxis facilities available at the health facilities. 2. To appraise the availability of rabies biologicals to these centers. 3. To assess the knowledge, attitude and practice of post exposure prophylaxis among medical officers.
Methods: A cross-sectional study was conducted at all 84 health centers of a municipal corporation; to assess the facilities available and their supply logistics. The KAP of 88 medical officers working in these health centres was assessed and the barriers for administration of rabies immunoglobulin were recorded. The KAP data normality was tested using Shapiro-Wilk test and correlation using Spearmanâ€™s Rank correlation.
Results: The post exposure prophylaxis facilities were available at 66 out of 84 centers (78.6%). 18530 vials of anti-rabies vaccine were utilized, 25 centers had 7-20 days/year stock out days; 4982 vials of equine rabies immunoglobulin was used in 6 (9.1%) referral hospitals and 3 centres had stock out days of 30-60 days/year. The rank correlation between knowledge attitude and practice (R=-0.025) had weak negative correlation. The common barriers for rabies immunoglobulin administration were afraid of ADEs (62.5%), time consuming (62.5%) and cumbersome procedure (46.5%).
Conclusion: The post exposure prophylaxis services at the municipal corporation health centres have to be further improved to achieve the goal of eliminating rabies by 2030.
Global alliance for vaccines and immunization [Internet]. Vaccine investment strategy; [cited 2020 Aug 15]. Available from: https://www.gavi.org/about/strategy/vaccine-investment-strategy
Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NS, Narayana DH, Rahman SA, Meslin FX, Lobo D, Ravikumar K, Gangaboraiah. Assessing the burden of human rabies in India: results of a national multi-center epidemiological survey. Int J Infect Dis. 2007;11(1):29-35. [PubMed] [Google Scholar]
WHO South East Asia region. Strategic framework for elimination of human rabies transmitted by dogs in the South-East Asia Region. World Health Organization, Regional Office for South East Asia; 2012. [Google Scholar]
World Health Organization. Rabies vaccines: WHO position paper No. 16. Wkly Epidemiol Rec. 2018;93:201-20. [Google Scholar]
Sudarshan MK, Mahendra BJ, Madhusudana SN, Narayana DH, Rahman A, Rao NS, Meslin FX, Lobo D, Ravikumar K, Gangaboraiah. An epidemiological study of animal bites in India: results of a WHO sponsored national multi-centric rabies survey. J Commun Dis. 2006;38(1):32-9. [PubMed] [Google Scholar]
Haradanhalli RS, Anwith HS, Pradeep BS, Isloor S, Bilagumba G. Health-seeking behaviour and compliance to post exposure prophylaxis among animal bite victims in India. Indian J Public Health. 2019;63(S1):S20-5. [PubMed] [Google Scholar]
National Rabies Control Programme. National guidelines for rabies prophylaxis. National Centre for Diseases Control, Ministry of Health and Family Welfare, New Delhi, India. 2015;7-12.
National Rabies Control Programme. Operational guidelines. New Delhi, India: National Centre for Diseases Control, Ministry of Health and Family Welfare. 2015;6-9.
Ichhpujani RL, Mala C, Veena M, Singh J, Bhardwaj M, Bhattacharya D, Pattnaik SK, Balakrishnan N, Reddy AK, Samnpath G, Gandhi N, Nagar SS, Shiv L. Epidemiology of animal bites and rabies cases in India. A multi-centric study. J Commun Dis. 2008;40(1):27-36. [PubMed] [Google Scholar]
Sudarshan MK, Hardanhalli RS. Facilities and services of postexposure prophylaxis in anti-rabies clinics: a national assessment in India. Indian J Public Health. 2019;63(S1):S26-30. [PubMed] [Google Scholar]
Mahendra BJ, Harish BR, Shivaramakrishna HR, Vinay M. Intradermal rabies vaccination: analysis of benefits at anti rabies clinic of Mandya Institute of Medical Sciences, Mandya, Karnataka State. APCRI J. 2008;10(1):29-30.
Amparo AC, Jayme SI, Roces MC, Quizon MC, Villalon EE, Quiambao BP, Baquilod MS, Hernandez LM, Taylor LH, Nel LH. The evaluation of operating Animal Bite Treatment Centers in the Philippines from a health provider perspective. PLoS One. 2018;13(7):e0199186. [PubMed] [Google Scholar]
Hanumanthaiah AN, Hardanhalli RS. Assessment of procurement, distribution, availability and utilisation of rabies biologicals for postexposure prophylaxis in seven states of India. Indian J Public Health. 2019;63(S1):S31-6. [PubMed] [Google Scholar]
World Health Organization [Internet]. New global strategic plan to eliminate dog-mediated rabies by 2030; 2018 [cited 2020 Mar 15]. Available from: https://www.who.int/news-room/commentaries/detail/new-global-strategic-plan-to-eliminate-dogmediated-rabies-by-2030
Shankaraiah RH, Bilagumba G, Narayan DH, Annadani R, Vijayashankar V. Knowledge, attitude, and practice of rabies prophylaxis among physicians at Indian animal bite clinics. Asian Biomed. 2013;7(2);237-42. [Google Scholar]
Garg A, Kumar R, Ingle GK. Knowledge and practices regarding animal bite management and rabies prophylaxis among doctors in Delhi, India. Asia Pac J Public Health. 2013;25:41-7. [PubMed] [Google Scholar]
World Health Organization. WHO Expert Consultation on Rabies. Third Report. Technical Report Series 1012. Geneva: WHO; 2018. [Google Scholar]
Sustainable Development Goals [Internet]. Goal 3: ensure healthy lives and promote well-being for all at all ages; [cited 2020 May 12]. Available from: http://www.un.org/sustainabledevelopment/health
World Health Organization [Internet]. Zero by 30: the global strategic plan to end human deaths from dogmediated rabies by 2030; 2018 [cited 2022 May 12]. Available from: https://www.who.int/publications/i/item/9789241513838 [Google Scholar]
World Health Organization [Internet]. Driving progress towards rabies elimination: results of Gavi’s learning agenda on rabies and new WHO position on rabies immunization; 2019 [cited 2020 Jul 15]. Available from: https://www.who.int/publications/i/item/WHO-CDSNTD-NZD-2019.01 [Google Scholar]