Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya.
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Front Public Health. 2022 Mar 10;10:769898. doi: 10.3389/fpubh.2022.769898. eCollection 2022.
In Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya.
We interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed.
Rabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% ( = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent ( = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies.
The availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa.
在非洲，狂犬病每年导致约 24000 人死亡。大规模给狗接种疫苗并及时为被狗咬伤的患者提供接触后预防（PEP）是消除人类狂犬病死亡的主要干预措施。有知识的医疗保健人员以及在卫生机构中获得狂犬病生物制剂的机会和可及性对于减少狂犬病死亡至关重要。我们评估了肯尼亚东部马库埃尼和基布韦齐西部县 13 个病房的 42 个医疗单位的 73 名医疗保健工作者对狂犬病的认识和管理，以及 PEP 的可获得性。
我们于 2018 年 11 月在肯尼亚马库埃尼县对来自马库埃尼和基布韦齐西部县 13 个病房的 42 个医疗单位的 73 名医疗保健工作者进行了访谈。收集和分析了人口统计学数据、工作年限、狂犬病知识、咬伤和狂犬病患者管理以及狂犬病生物制剂的可获得性。
只有 5 个（12%）的 42 个卫生设施有狂犬病 PEP 疫苗。在研究时，没有一个卫生设施有狂犬病免疫球蛋白库存。PEP 主要肌肉内给药，只有 11%（=8）的医护人员和 17%（7/42）的卫生设施知道剂量节省的皮内途径。不到四分之一的医护人员了解世界卫生组织对咬伤伤口的分类，这指导了 PEP 的使用。18%（=13）的医护人员报告说，即使对这一类暴露不推荐使用 PEP，他们也会为 I 类接触者提供 PEP。只有六分之一的急性脑炎咨询的受访者考虑狂犬病作为鉴别诊断，这突出了对狂犬病的低怀疑指数。
狂犬病 PEP 的可获得性和使用情况不理想。我们确定了支持狂犬病消除计划的两个紧迫需求：改善 PEP 的可获得性和可及性；并对医疗保健工作者进行有针对性的培训，以提高对咬伤伤口管理、合理使用 PEP（包括对咬伤后的适当风险评估）以及在看到多个咬伤患者的设施中使用剂量节省的皮内途径的认识。为了在非洲有效消除狂犬病，需要制定全球性和国内性的资金计划，以弥补人类卫生部门的这一空白。
