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ORIGINAL CONTRIBUTION |
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| Year : 2000 | Volume
: 54
| Issue : 6 | Page : 233-237 |
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Animal bites : Factors for delay in post exposure prophylaxis
RR Tiwari, PN Kulkarni, Sonali Ingole
Department of Preventive and Social Medicine, Indira Gandhi Medical College, Nagpur, India
Correspondence Address:
R R Tiwari
Department of Preventive and Social Medicine, Indira Gandhi Medical College, Nagpur
India
How to cite this article:
Tiwari R R, Kulkarni P N, Ingole S. Animal bites : Factors for delay in post exposure prophylaxis. Indian J Med Sci 2000;54:233-7 |
Rabies, also known as hydrophobia is an, acute highly fatal; viral disease of the central nervous system. It is a zoonotic problem of considerable magnitude in India, wish an estimated hum - n mortality of 25,000 a year, while 3 million people receive peat exposure prophylaxis each year. [1] Apart from the factors such as site of bite, severity of bite, number of wounds, amount of virus injected etc., the incubation period of the disease also depends Upon the delay in receiving post exposure prophylaxis. [1] The . importance of immediate post exposure prophylaxis is also increased by the fact that ii takes a minimum of 7 days for antibodies to develop and hence any delay in receiving timely post exposure prophylaxis provides an opportunity to the virus to get fixed. [2] Also, because of poverty, illiteracy and other social factors ,he wound is not properly cared, which again increases the importance of timely post exposure prophylaxis. [2] Hence, this study was under taken to study the delay in receiving post exposure prophylaxis among cases of animal bites and the factors associated with such delay.
| ¤ Material and Methods | |  |
The present study was designed as cross-sectional study and was carried out during August 1998 at the anti-rabies vaccination centre of Indira Gandhi Medical College, Nagpur. All the cases of animal bites who came for the first time to receive post exposure prophylaxis (incident case) during the study period were included as the study subjects. A total of 509 incident cases of animal bites reported at antirabies vaccination centre for receiving post exposure prophylaxis and all were included in the study. Interview technique was used as a tool to collect information on a predesigned proforma which contained questionnaire regarding demographic characteristics and characteristics related to animal bite. Statistical analysis included the calculation of percentages and proportions and application of tests of significance such as chi square test and z-test. [3]
| ¤ Results | | |
[Table1] shows the distribution of study subjects according to sociodemographic characteristics. Majority (51.2%) of the subjects belonged to the age group of 5-25 years, while 36(7.1%) subjects were in <5 years age group and 66(12.9%) were in >45 years age group. Of the total 509 subjects 73.5% were males and 135 subjects were female. 68 (13.4%) subjects were illiterate while only 30(5.9%) subjects had educational status above graduation. Among the rest 103(20.2%) had education upto primary level, 143(28.1%) upto middle school level, 121 (23.8%) upto secondary school level and 44(8.6%) upto higher secondary level. Bulk of the subjects (53.0%) to lower socio-economic strata according to modified Kuppuswamy's socio-economic scale [4] while only 37(7.3%) were in upper socio-economic strata.
[Table 2] shows the characteristics of animal bites. In 88.9 of cases dog was the biting animal with majority (63.1%) of the subjects having class II bites. In 382 cases of bite the animal was either pet animal or observable animal. Majority (64.8%) of the subjects took post exposure prophylaxis with in 24 hours of bite while 16.7%; of the subjects delayed it for 48 hours or more. [Table 3] shows the distribution of mean time (in hours) in receiving post exposure prophylaxis according to various factors. The mean time was significantly more in those having low educational level, low socio-economic status, living at rural area and living at a distance >5 km from the vaccination centre. The mean time in class I bite (27.10 hrs) was higher than in class II and class III bites (25.96 hrs) but it was statistically non-significant. Similarly, the difference was statistically non-significant in a case of age and observability of animal.
| ¤ Discussion | | |
The present study among 509 incident cases of animal bites revealed that the 5-25 years age group is the major group inflicted by animal as suggested by other studies. [1] Being a governmental institution the bulk of patients belonged to lower socio-economic classes. Dog which creates the urban cycle of the rabies was found to be responsible for 88.9% of the cases of animal bites. [1],[2],[5] The mean time (in hours) In receiving the post exposure prophylaxis for animal bite was found to be 26.11 hours. The mean time for ages <12 and >12 years was more or less same suggesting that animal bite is considered as serious injury in all age groups. Statistically significantly higher mean time among those having lower socio-economic status and lower educational status suggest that as for other diseases these are two important social factors impeding the prevention of disease. [6] Heal h education regarding fatality of disease and importance of receiving early post exposure prophylaxis for animal bite are recommended to improve the situation. In class I bites (Where bleeding is absent or history of contact with a case of hydrophobia is present) the subjects were found to be more reluctant to receive vaccination earlier as compared to severe bites of class II and class III. This is shown by higher mean time among subjects having class I (27.10 hrs) bites as compared to class II or III bites (25.96 hrs.) This high-risk behaviour should be changed by imparting health education. Significantly higher mean time in receiving vaccination among Those living far away from vaccination centre and in rural area suggest that the post exposure prophylaxis should he regularly provided through primary health centers and other peripheral outlets.
| ¤ Summary | | |
The present study among 509 cases of animal bites found a higher prevalence among 5-25 years age group and in males. Most of the bites were class II or class III while dog was responsible animal in 88.9% of cases. The mean time in receiving post exposure prophylaxis was 26.11 hours. The mean time was significantly higher among those having lower educational and socio-economic level and those living far from vaccination centre and in rural areas.
| ¤ References | | |
| 1. | Park K. Textbook of Preventive and Social Medicine. 14th edition. Jabalpur, Banaisidas Bhanot Publishers. 1831:328-30.  |
| 2. | Anderson LJ, Nicholson KG, Tauxe RV, Winkler WG. Human Rabies in the United States, 1960 to 1979 Epidtmiology Diagnosis and Prevention. Ann Intern Med 1984;100: 728-35. [PUBMED] |
| 3. | Mattson DE. Statistics : Difficult concepts, understandable explanations, 1st edition, London. The C.V. Mosby Company, 1981 : 147-154. |
| 4. | Mahajan SK and Gupta MC. Textbook of Preventive and Social Medicine, 2nd edition. New Delhi, Jaypee Publishers, 1995:135-137. |
| 5. | Nicholson KG. Rabies. Medicine International. 1997;15:22-24. |
| 6. | Marks JS, Halpin TJ, Irvin JJ, Johnson DA, Keller JR. Risk factors associated with failure to receive vaccination Paediatrics 1979; 64:304-9. |
[Table1], [Table 2], [Table 3]
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