Assessing the burden of dog bites and utilisation of post-exposure prophylaxis in Bengaluru district: A community-based cross-sectional survey and decision-tree modelling study

Background: Rabies is a universally fatal yet preventable viral zoonosis, with dog bites accounting for over 95% of human cases. In urban settings, such as Bengaluru, high densities of stray dogs and inconsistent completion of post-exposure prophylaxis (PEP) contribute to a persistent risk of rabies. This study aimed to estimate the incidence of dog bites, assess PEP utilisation and completion, evaluate community knowledge and practices, and estimate rabies mortality using decision-tree modelling. Methods: A community-based cross-sectional survey was conducted across 30 wards of Bengaluru Urban District using a multistage cluster sampling design. Data on dog bite exposure, wound care, anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) administration, and knowledge–attitude–practice (KAP) scores were collected from 420 households. A decision-tree model, adapted from WHO and national frameworks, was used to estimate annual rabies deaths based on exposure severity and PEP adherence. Descriptive statistics and regression analyses were conducted using R software. Results: The estimated annual incidence of dog bites was 90 per 1,000 population. Among 38 bite victims, 92.1% initiated ARV and 88.6% completed the full schedule. However, only 34.2% practised adequate wound washing, and 42.1% of category III exposures received RIG. Mean KAP score was 11.6 (range: 9–13). The decision-tree model estimated 1.17 annual rabies deaths, primarily among those with incomplete or no PEP. Conclusions: Despite high ARV initiation, gaps in wound care and PEP completion pose ongoing rabies risks. This study highlights the need for targeted awareness campaigns, improved access to RIG, and enhanced adherence strategies. Findings support district-level rabies prevention policies aligned with India’s goal of eliminating dog-mediated human rabies by 2030.