Resource Centre for Infectious Diseases, Department of Internal Medicine, Dodoma Regional Referral Hospital, Dodoma, Tanzania.
'Lazzaro Spallanzani' National Institute for Infectious Diseases INMI-IRCCS, Rome, Italy.
PLoS One. 2018 Jul 2;13(7):e0197996. doi: 10.1371/journal.pone.0197996. eCollection 2018.
The vast majority of rabies deaths occur in developing countries and rural areas. Due to the absence of surveillance and the lack of reliable information, many endemic countries are not able to assess their rabies burden and implement appropriate solutions. This study reports the incidence of animal bites considered at risk of rabies transmission, along with rates and determinants of the adherence to post-exposure prophylaxis (PEP) between 2008 and 2014 in Dodoma Region, Tanzania. A retrospective analysis of rabid animal bites considered at risk of rabies transmission at Dodoma Regional Referral Hospital (DRRH) during 2008-2014 was conducted. Data were collected from the registers of patients presenting to the hospital because of a potential rabies exposure. The patients were assessed by a trained health worker and each bite was considered as "at risk of rabies" based on the victim's description of the event. Overall, 10,771 patients coming from Dodoma Region attended DRRH because of a bite from a suspected rabid animal, giving a mean incidence of 74 bites at risk of rabies transmission per 100,000 persons per year. Overall, only 46.0% of people exposed received a complete course of PEP and 61.6% attended the clinic within 48 hours after the bite. Multivariate analysis shows that people age >15 years, residence in rural areas and occurrence during the rainy season were independently associated to delayed access to care. Male gender, age below 15 years. and bites occurring during the dry season were associated with completion of PEP. In this area with a high rate of at-risk bites, several factors-mainly related to health care access and to the affordability and delivery of rabies vaccines-still need to be addressed in order to reduce gender and social inequalities in rabies prevention and control. Further efforts are required to establish an efficient rabies surveillance system in Dodoma Region.
绝大多数狂犬病死亡发生在发展中国家和农村地区。由于缺乏监测和可靠信息，许多地方性流行国家无法评估其狂犬病负担并实施适当的解决方案。本研究报告了 2008 年至 2014 年在坦桑尼亚多多马地区考虑有狂犬病传播风险的动物咬伤的发生率，以及暴露后预防 (PEP) 依从率和决定因素。对 2008-2014 年期间多多马地区转诊医院 (DRRH) 考虑有狂犬病传播风险的狂犬病动物咬伤进行了回顾性分析。从因潜在狂犬病暴露而到医院就诊的患者登记册中收集了数据。由经过培训的卫生工作者对患者进行评估，根据受害者对事件的描述，每个咬伤都被视为“有狂犬病风险”。总体而言，来自多多马地区的 10771 名患者因疑似狂犬病动物咬伤而到 DRRH 就诊，平均每年每 10 万人中有 74 人有狂犬病传播风险的咬伤。总体而言，仅有 46.0%的暴露者接受了完整的 PEP 疗程，61.6%的人在咬伤后 48 小时内就诊。多变量分析表明，年龄>15 岁、居住在农村地区和雨季发生的人独立与获得医疗保健的时间延迟相关。男性、年龄<15 岁和在旱季发生的咬伤与 PEP 的完成相关。在这个有高风险咬伤率的地区，一些因素——主要与获得医疗保健以及狂犬病疫苗的可负担性和提供有关——仍需要解决，以减少狂犬病预防和控制方面的性别和社会不平等。需要进一步努力在多多马地区建立有效的狂犬病监测系统。
