Salve Harshal, Kumar Sanjeev, Sa Rizwan, Rai Sanjay K, Kant Shashi, Pandav Chandrakant S
Centre for Community Medicine, Old OT Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
BMC Health Serv Res. 2014 Jun 25;14:278. doi: 10.1186/1472-6963-14-278.
Rabies is the most severe and neglected public health problem in India. Management of animal bite with post exposure prophylaxis is the only existent strategy to prevent rabies related deaths. Cost-effective and sustainable programme for provision of post exposure prophylaxis (PEP) is needed in India.
In this study, we have documented the experience of implementation of intra-dermal anti rabies vaccination in Animal Bite Management (ABM) clinic at Primary Health Centre (PHC). This study facility belonged to Comprehensive Rural Health Services Project, Ballabgarh in Faridabad district of Haryana. Hospital service record of ABM clinic was analyzed and various feasibility issues such as costing of services, vaccine wastage and other operational issues in providing PEP services at PHC level were documented.
A total of 619 patients were treated in the ABM clinic. Service utilization of ABM clinic was increased by 38% in the second year of implementation. Mean age of the patients was 23.9 years (SD: 18.8) and majority (70.4%) were males. Majority (86%) of the patients received the first dose of anti-rabies vaccine within the recommended 48 hours. A total 446 vaccine vials (1 ml) were consumed of which 20.8% was contributed in vaccine wastage. User-fee (350 Indian Rupees) collected from the patients. User-fee was re-used to purchase vaccines, intradermal (ID) syringes and other consumables required to ensure regular availability of ARV services at the PHC.
This study demonstrated the cost-effective and sustainable model of provision of PEP against rabies at primary care level. ID PEP provision at primary care level not only address the unmet need of animal bite management in the community also reduces the out of pocket expenditure of the patients.
狂犬病是印度最严重且被忽视的公共卫生问题。通过暴露后预防措施来处理动物咬伤是预防狂犬病相关死亡的唯一现有策略。印度需要具有成本效益且可持续的暴露后预防（PEP）项目。
在本研究中，我们记录了在初级卫生保健中心（PHC）的动物咬伤管理（ABM）诊所实施皮内抗狂犬病疫苗接种的经验。该研究机构隶属于哈里亚纳邦法里达巴德区巴拉加尔的综合农村卫生服务项目。分析了ABM诊所的医院服务记录，并记录了各种可行性问题，如服务成本、疫苗浪费以及在初级卫生保健中心层面提供PEP服务时的其他操作问题。
ABM诊所共治疗了619名患者。在实施的第二年，ABM诊所的服务利用率提高了38%。患者的平均年龄为23.9岁（标准差：18.8），大多数（70.4%）为男性。大多数（86%）患者在推荐的48小时内接种了第一剂抗狂犬病疫苗。共消耗了446支1毫升的疫苗瓶，其中20.8%造成了疫苗浪费。向患者收取了用户费用（350印度卢比）。用户费用被重新用于购买疫苗、皮内（ID）注射器和其他消耗品，以确保初级卫生保健中心能够定期提供抗狂犬病疫苗服务。
本研究展示了在初级保健层面提供狂犬病PEP的具有成本效益且可持续的模式。在初级保健层面提供皮内PEP不仅满足了社区中未得到满足的动物咬伤管理需求，还减少了患者的自付费用。
