Each year, an estimated 25000
rabies death occurs in Africa. Post-exposure prophylaxis (PEP) remains the only proven approach in preventing
rabies deaths. Most of
rabies deaths occur among those who delayed, did not receive, or complete
rabies PEP. The aim of this study was to determine the pattern of animal
bite, factors associated with delays in initiating, and nonadherence to
rabies PEP regimen.
METHOD: Data on clients reporting for
rabies PEP in a tertiary hospital setting in Ghana were collected from 2013 to 2016. Demographics, place, and source of exposure were collected. Other information obtained included adherence to the
PEP protocol and GPS coordinates of the town of animal
bites. The shortest distance between the GPS coordinates of town of animal
bite and the site of administration of the
rabies PEP was calculated. A total of 1030 individuals received
rabies PEP over the period.
RESULTS: Overall, 52.9% (545) were males while 47.1% (485) were females. Majority of the cases were between the age group 1-10 years accounting for 29.2%. Dog
bites accounted for 96.5% (n = 994). Cats, nonhuman primates,
human bites, respectively, accounted for 1.8% (n = 18), 1.2% (n = 12), and 0.6% (n = 6) of all
bites. Majority of
bites occurred at home (66.2% (n = 646)). Also, 31.6% (n = 308) and 2.3% (n = 22) of
bites occurred on the streets and neighbors/friends' homes, respectively. Only, 18.7% initiated PEP within 24 hours of
bite.
Rabies PEP regimen completion rate was 95.2% (n = 976). The median distance travelled to access
rabies PEP was 7.87 km (IQR, 3.58-16.27) km. Overall, 34.7% (n = 344) had the animal
bite within 4.99 km radius of the treatment room of KBTH. Clients who delayed in initiating
rabies PEP were 2.6 (95% CI, 1.3-5.1) times more likely to be males and 2.0 (1.1-3.9) times more likely to receive
bites in a location more than 5 km radius from the KBTH treatment room. Gender, age, and distance of
bite from the treatment room were not associated with the likelihood of not completing
rabies PEP schedule. Discussion.
Bites from suspected
rabies infected animals remain a problem in southern Ghana. There are significant delays in initiating PEP for
rabies prevention. Most animal
bite victims are children ten years and below. Male gender and
bites more than 5 km radius from the site of
rabies PEP administration were most significant factors associated with delays in initiating
rabies PEP. There is the need for adopting strategies to encourage prompt initiation and adherence to PEP.