epidemiological study on animal bite cases

An Epidemiological Study of Animal

Bite Cases Attending A Tertiary Care

Hospital In Western District Of

Rajasthan

Manish Mittal

Final Year Resident

Department of Community Medicine,

Dr .S.N. Medical College, Jodhpur,

Rajasthan

• Introduction

• Objectives

• Material and methods

• Results

• Conclusion

• Recommendations

• References

INTRODUCTION

Rabies has terrified man since antiquity

as it is invariably fatal and perhaps the

most painful and horrible of all

communicable diseases.

Rabies is known to be present in more

than 150 countries and territories.

About 26,400 - 61,000 deaths occur

annually from rabies with more human

deaths occur in Asia than anywhere else

in the world.(30,000 deaths per annum).

Some 84% of deaths from rabies occur

in rural areas, with 4 out of every 10

deaths being a child.

In India, dogs are responsible for about

97% of human rabies, followed by cats

(2%), jackals, mongoose and others (1%).

OBJECTIVESTo assess the knowledge and practices

of animal bite cases attending anti-rabies clinic.

To study the relationship of socio-demographic factors on knowledge and practices of these animal bite cases.

MATERIALS AND METHODS

STUDY DESIGN:

-Hospital based Cross Sectional Study

STUDY SETTING:

-Anti-rabies Clinic at M.G. Hospital,

Jodhpur

STUDY PERIOD:

-From July-2012 to September-2012

STUDY SUBJECTS:

-Total 1,213Animal bite cases.

TOOL:

-Self Designed and Pre-tested Questionnaire

TECHNIQUE:

-Prior consent was taken from cases attending

Anti-rabies clinic.

-Questionnaire developed for the purpose of the

study was filled out for each consecutive patient

through interview.

STASTISTICAL ANALYSIS;

-Data thus generated was

analyzed by using SPSS

version16th

-Appropriate figures and tables

were generated and χ2Test was

used for statistical inferences.

Results

Age wise distribution of Patients(in Years)

0 to 1037%

11 to 2024%

21 to 3013%

31 to 4010%

41 to 508%

51 to 605%

>604%

Distribution of patients according to Education status

Illiterate31%

Primary30%

Middle12%

Secondary13%

Graduate10%

Post-Graduate And Above

5%

Distribution of animal bite victims on the basis of their occupation

Laborers21%

Farming22%

Private service2%Govt. service

4%Business

2%

House wife7%

Unemployed5%

Student37%

Distribution of patients according to residence

Urban60%

Rural40%

Distribution of patients regarding awareness about rabies

Aware66%

Not aware34%

Source of information about rabies(n=802)

32

16

27

5

16

4

0

5

10

15

20

25

30

35

Family members

Other relatives

Neighbours Mass media Health personnel

Others

Pe

rce

nta

ge

Source of information

Knowledge about fatal nature of disease(n=802)

Yes31%

No69%

Knowledge about vaccine preventable nature of the disease(n=802)

Yes81%

No19%

Distribution of animal bite victims on the basis of species of biting animal

94.4

2.22 1.8 0.7 0.880

10

20

30

40

50

60

70

80

90

100

Dog Rat Cat Monkey Others

Pe

rce

nta

ge

Species of animal

Circumstances of Animal bite

Unprovoked74%

Provoked26%

Distribution of animal bite victims on the basis of

manner of cleaning the wound

Not cleaned 67%

Cleaned with water28%

Cleaned with Water and soap

5%

Distribution of animal bite victims on the basis of

type of substance applied on the wound

Dettol6%

Lime2%

Chili powder88%

None4%

Distribution of animal bite victims on the basis of their reporting time in Hospital

On Day of bite52%

After 1 Day37%

After 2 Days5%

After 3 Days3%

After 4 Days2%

After 1 Week or More1%

Distribution of patients according to cause of delay in reporting at hospital(n=583)

12.5

3.77

28.3

52

1.9 1.02 0.510

10

20

30

40

50

60

According to them animal

was normal at the time of bite

Victim/Family decided that there was no

need of treatment

Victim was too busy to come

Due to long distance from residence to

hospital

Lack of money Fear of treatment

Any other reason

Pe

rce

nta

ge

Distribution of animal bite victims on the basis of site of bite

Head and neck10% Upper limb

9%

Lower limb73%

Thorax and abdomen

8%

Distribution of animal bite victims on the

basis of category of bite

0.5%

26 %

73.5%

Category I Category II Category III

Distribution of patients regarding status of treatment completion

Completed94%

Not completed

6%

Relationship between awareness about rabies and literacy status(n=1213)

Awareness

Literacy

status

Yes No Total

Illiterate 129(32.36%) 251(67.64%) 380(100%)

Literate 673(80.79%) 160(19.21%) 833(100%)

Total 802(66.11%) 411(33.89%) 1213(100%)

χ2=255.6, df=1, p = 0.00

Relationship between awareness about rabies and Residence (n=1213)

Awareness

Residence Yes No Total

Urban 501(68.81%) 227(31.19%) 728(100%)

Rural 301(62.06%) 184(37.94%) 485(100%)

Total 802(66.11%) 411(33.89%) 1213(100%)

χ2=5.93, df=1, p = 0.01

Relationship between awareness about rabies and reporting time to the hospital(n=1213)

Awareness

Reported Yes No Total

On the

same day

427(67.77%) 203(32.23%) 630(100%)

Delayed 375(64.32%) 208(35.68%) 583(100%)

Total 802(66.11%) 411(33.89%) 1213(100%)

χ2=1.61, df=1, p = 0.20

Conclusion

• Majority(60%) of the patients belonged to 0-20 yr age group : Children and adolescent.

• Most of the patients were Students(37%) followed by outdoor workers i.e. Laborers (21%)and Farmers(22%) by occupation.

• Both of the above findings shows that outdoor exposure predispose one to be bitten by animal.

Even after easy and high reach property of Mass media ,it was found to play very little role as source of information.

Patient’s awareness regarding rabies is significantly related with literacy and their residence.

However such type of relationship is not seen with reporting time to the hospital.

Recommendations

In the light of findings mentioned in the conclusion we recommend that mass media must be utilized extensively to raise knowledgeabout rabies and intensify the positive attitude and practicesabout essential and complete antirabies vaccination to the animal bite cases.

• Maximum no. of cases belonged to Cat.3 bites. This indicates the importance of need of large amount of quality antirabies serum or HRIG.This can be ensured by promoting pharmaceutical production of these products.

For the same, there is urgent need to introduce training based school programme from the very childhood , addressing methods to prevent dog bite and management of animal bite cases.

There is need of same kind of national level programme for the general public.

References1. http://www.who.int/rabies/about/en/

2. Lozano R et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the GlobalBurden of Disease Study 2010. Lancet, 2012, 380(9859):2095–2128.

3. Murray CJL et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380(9859):2197–2223.

4. Knobel DL et al. Re-evaluating the burden of rabies in Africa and Asia. Bulletin of the World Health Organization, 2005, 83(5):360–368

5. World health Organization.WHO expert consultation on rabies,WHOtechnical report series,Second edition.WHO press,Genewa:WHO;2013.p8

6. National Centre for Disease Control,Directorate General of Health Services Ministry of Health and Family Welfare ,Government of India. National Guidelines on Rabies Prophylaxis. New delhi,India:CDC;2013.p4.