Rabies is a highly fatal zoonoticdisease associated with 100% mortality rate; infected animals and humans diewithin a week after the first neurological signs appear (Taylor, 2009; Depani et al., 2012). It is endemic in Ugandalike many African countries, mainly transmitted and maintained through bites ofinfected animals to other animals and humans (Jemberu et al., 2013). Dogs are themain source of rabies through their bites especially in the developingcountries of Africa, Asia and South America (Overall & Love, 2001;Ozanne-Smith et al., 2001, Meslin& Briggs, 2013). Rabies is an important but underreportedand neglected disease of low income countries in Africa and Asia (Knobel et al., 2005, Hampson et al.
, 2015) associated with povertyaffecting vulnerable populations with most deaths occurring in children between5-15years and the lowest socio-economic sectors who account for about 40% ofpeople exposed to dog bites in rabies endemic areas (Gongal and Wright, 2011,(Meslin and Briggs, 2013).Disparities in the affordability andaccessibility of post-exposure treatment and the risks of exposure to rabiddogs result in skewed distribution of the disease burden across society; withthe major impact falling on the rural poor particularly children (Knobel et al., 2005). Highly educated peopleknow more about rabies (Palamar et al.,2013) while uneducated people know less about rabies (Herbert et al., 2012). Even fewer people areaware about the transmission and prevention of rabies (Fielding et al.
, 2012). Obstacles toprogress against canine rabies in Africa include; high population of straydogs, inability of owners to bring dogs for vaccination annually, lack ofcanine rabies surveillance and diagnostic capabilities besides insufficientresources for veterinary services delivery (Anderson and Shwiff, 2015). Consequences of dog bites include directphysical injury, psychological trauma and post-traumatic stress in addition tothe risk of contracting rabies (Gilchrist etal., 2008) besides high financial costs for treatment, emergencyhospitalization and anti-rabies post-exposure prophylaxis (Overall & Love,2001). The global burden of canine rabies is approximately $124 billionsannually (Anderson and Shwiff, 2015). In developing countries, availability of post-exposureprophylaxis (PEP) is limited to a few referral hospitals and health centresimplying that dog bite victims must travel long distances associated with incidentalcosts including transport, feeding and accommodation to access PEP. Globallyover 15 million people receive the rabies PEP treatment annually following dogbite injuries (Cox, 2012). When dogs bite and transmit rabies tocattle, goats, sheep, working animals like camels and donkeys (Hampson et al.
, 2015, Anderson and Shwiff, 2015),they undermine livelihoods of the households who depend on livestock. If theseanimals die of rabies following dog bites, the livestock farmers suffer severeeconomic losses. The number of animals and people dying of rabies annually in Ugandaare not known since there is neither systematic reporting nor effectivesurveillance systems to capture all the victims of dog bites or who die ofrabies in all districts. Hence the study was done to estimate the estimate theof dog bite victims who received PEP from Entebbe Grade A national rabiesreferral hospital and economic costs involved.Materialsand MethodsThe study was conducted at Entebbe GradeA National Rabies Referral Hospital (Grade A) which is located in Katabisub-county, Busiiro county, Entebbe municipality, Wakiso district in centralUganda.
This is a government (public) hospital offering medical services rangingfrom surgery, orthopedics, antenatal care, maternity, and immunization againstseveral diseases including rabies. It is approximately 37 kilometers(23 miles) by road from Kampala, southwest of Mulago National Referral Hospitallocated between coordinates 0°03’50.0″N and 32°28’18.0″E.The study was retrospective usingsecondary data from case records of people who reported animal bites at EntebbeGrade A National Rabies Referral Hospital. Data were manually retrieved fromthe rabies archives. The records indicated the patient’s names, home region i.
e.central, western, eastern and northern Uganda where he/she came from to accessPEP at the hospital. The patient’s age and sex; the species of the bitinganimal (dog, cat or wildspecies e.
g. fox), domestic or stray and the date ofthe bite were captured in the records. Information about the cost and length oftreatment, whether there was an accompanying adult in case of children and theregion where they came from were factored in to estimate the financial costsincurred by the victims.
The costs incurred by dog bite victimsto access PEP included direct and indirect costs and were estimated accordingto the approach adopted from (Knobel etal., 2005). The direct costs included the medical costs for the completePEP treatment and indirect costs such as incidental costs such as transportcosts for the victim and parents or attendants, food, airtime or communicationcosts and accommodation costs for people from rural areas. The human PEP administered to dog bite victims inUganda is a five dose regimen treatment given at 0, 3,7,28 and 90 daysintervals. The data was entered into MS Excel and analyzed using descriptivestatistics including percentages and frequencies.Ethical statementThe researchers obtained an introductoryletter from the Dean School of Veterinary Medicine, Animal Resources andBiosecurity, College of Veterinary Medicine, Animal Resources and Biosecurity MakerereUniversity which they used to approach the department of Veterinary PublicHealth in the Ministry of Health (MOH).
The researchers obtained an introductoryletter from the Assistant Commissioner Veterinary Public Health in the MOH tothe District Health Officer (DHO) Wakiso district who then gave anauthorization letter to conduct the study in Entebbe Grade A Hospital. We tookthe authorization letter from DHO to the Medical Superintendent of the Hospitaland were granted access to the rabies victims’ records for the two years 2014 and2015.Resultsand Discussion The number of animal bites wasrelatively constant throughout the two years under study, with a slight peakfrom March to May in 2014 and April to June in 2015 (Figure 1 and Figure 2).Animal bites were reported among all age groups, although the age bracket beloweighteen years was most affected (Table 1). Prevalence of animal (dog) bites inUganda by region is as shown in Figure 3. The prevalence of dog bites reported atEntebbe Grade A Hospital in the two years 2014 and 2015 was highest for centralUganda (Figure 3). Probably this could be explained by the location of thehospital within central Uganda therefore making it more accessible to victimsfrom this region as opposed to those from Northern, Eastern and Western Uganda.
More males were bitten by animals including dogs than females. This may beattributed to the fact that many times when females are attacked they cry outfor help and males run to their rescue thus coming in confrontation with thevicious animals (Table 2). Dog bites have economic implications.They are costly to treat and involve substantial monetary expenses to accessPEP as shown in Table 3. A person from Arua district (one of the farthestdistricts) spends an estimated 980,000 Ugandan shillings (288.234 USD) to receivea full dose of the five regimens PEP at Entebbe Grade A Hospital.
A dog bite victim from Kampala incentral Uganda spends approximately 310,000 Ugandan shillings (91.177 USD) getthe same PEP treatment at Entebbe Grade A. So the person spends between 91.177USD to 288.234 USD to receive the PEP at Entebbe Grade A referral hospitaldepending on one’s place of residence. The exchange rate of: 1USD = 3400 UgandanShillings was used.
The prevalence of dog bites (90.5%) wasvery high, a picture similar to Knobel etal., (2005) despite under-reporting of dog bites in Uganda given that thecountry lacks an active surveillance system for dog bites and rabies, many dog bite victims from the rural areas donot report to health centers and are excluded.
It is possible to prevent aperson from becoming ill with rabies after a dog bite by neutralizing the viruswith antibodies vaccination and or use of immunoglobulin (post-exposureprophylaxis) before the virus invades the nervous tissue (Nilsson, 2014). Majority of dog bite victims were malesbelow 18 years which is in agreement with (Meslin and Briggs, 2013) that mostof the people who suffer from dog bites and rabies are children. This can beattributed to the fact that mainly boys participate in outdoor activities suchas herding and hunting. Young boys also stay out of home longer and later thangirls of the same age. Hence educationof the public about dog behavior particularly children is very important inpreventing dog bites (Lakestani et al.,2011). The cost of complete PEP treatment fordog bite victims at Entebbe Grade A hospital ranged from USD 91.
177 to USD288.234. The variance is attributed to the incidental costs such as transport,food and accommodation which depend on the region and district of origin wherethe victims come from to access PEP at Grade A. ConclusionsMass dog vaccination must be intensifiedthroughout the country since it is the cheapest and most effective means for preventingexposure of people to rabies.
Public awareness and education should be steppedup to highlight the risk of contracting rabies from dog bites as well asencourage responsible dog ownership and communities to ensure that dog bitevictims are taken to health facilities for PEP.