Suspected rabies exposure among animal-bite human cases in Busia district, Uganda: Prevalence, associated factors and delayed post-exposure care-seeking. A cross-sectional study
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Background
Rabies is a zoonotic neglected public health problem associated with animal bites, especially domestic carnivores claiming 59,000 deaths annually predominantly in developing countries of Africa and Asia. There is a high risk of exposure among rural communities endemic with animal rabies where adoption of prevention strategies is minimal. This study determined the prevalence of suspected rabies exposure, associated factors, and delayed post-exposure care-seeking among animal-bite human cases in Busia district, Uganda.
Methods
This was a cross-sectional study that involved 332 consecutively sampled animal bite human cases that occurred within the period 2023 to 2024. Data for the bite cases from records were collected using a data abstraction tool. In addition, interviewer-administered semi-structured questionnaires were used to collect data on sociodemographic, animal-related and environmental characteristics. Approximate bite locations were collected using Global Positioning System (GPS) coordinates via Kobo collect. Analysis was carried out in STATA 17 using mixed effects modified Poisson regression for factors associated with suspected rabies exposure.
Results
The median age of the bite cases was 18 (IQR: 9-36) with the male gender predominantly affected. The prevalence of suspected rabies exposure was 53.6% (95% Confidence interval - CI: 46.8-60.3). Factors associated were urban versus (vs) rural residence (adjusted prevalence ratio-aPR: 1.04, 95%CI: 1.00-1.08), being bitten by a stray animal (aPR: 1.28, 95% CI: 1.22-1.35) and wild animal (aPR: 1.22, 95% CI: 1.14-1.30) vs domestic animal, vaccination status of the biting animal i.e. vaccinated vs unvaccinated (aPR: 0.76, 95% CI: 0.69-0.85), provoked vs unprovoked bites (aPR: 0.82, 95% CI: 0.79-0.86), and distance to nearest river (≥5km) vs <5km (aPR: 0.93, 95% CI: 0.87-0.99). The prevalence of delayed post-exposure seeking was 23.0% (95% CI: 16.5-31.1) among the suspected rabies exposures.
Conclusion
The study reveals a high prevalence of suspected rabies exposure. Factors associated are multidimensional i.e. are of human, animal and environmental origin. The one health paradigm should be emphasized during routine surveillance of rabies-related cases. The study observed that 1 in 5 bite cases delayed to seek care post bite exposure. We recommend collaborations between sectors, routine vaccination and awareness campaigns, and monitoring of wild carnivore populations and environmental dynamics in rabies-related surveillance.
Author Summary
Rabies continues to be a neglected public health problem in sub-Saharan Africa. Vaccination and treatment following an animal bite is important to prevent clinical disease. Such treatment is costly in developing countries necessitating the use of risk assessment to identify potential suspected cases. We investigated the occurrence of suspected rabies exposures, associated factors and delayed care seeking around bite incidents in a district in Uganda with the highest animal rabies reports. Our study revealed that more than half of the bite cases were suspected to be exposed. Factors associated were of human, animal and environmental related origin. These were urban residence, stray and wild animal bites, provocation status of the bite, type of animal and distance to the nearest river. At least 1 in 5 individuals with suspected rabies exposures delayed to seek for care following the bite incident. Our findings highlight the need for collaboration between stakeholders in the human, animal and environmental sectors to contribute to the eradication of rabies and related instances by 2030.
