Madjadinan Alladoumngar, Mbaipago Nodjimbadem, Sougou Ndèye Marème, Diongue Mayassine, Zinsstag Jakob, Heitz-Tokpa Kathrin, Lechenne Monique
Centre de Support en Santé Internationale, N'Djamena, Chad.
Institute of Health and Development, Dakar, Senegal.
Front Vet Sci. 2022 Oct 10;9:866106. doi: 10.3389/fvets.2022.866106. eCollection 2022.
This study aims to identify factors on the community, the human health and the animal health provider level that determine access to Post Exposure Prophylaxis (PEP) and animal rabies diagnosis in the light of a future integrated bite case management (IBCM) approach for rabies control in Chad. The study was embedded in an overall project conducted from 2016 to 2018, to determine rabies burden and vaccine demand in West and Central Africa. Data collection took place during the projects closing workshops with stakeholders organized between August and September 2018 in the three study zones in Chad covering Logone Occidental and Ouaddaï province and parts of Hadjer Lamis and Chari Baguirmi province. A qualitative approach based on focus group discussion and in-depth interviews was used to get insights on access to care and animal investigation after suspected rabies exposure. A total of 96 participants, including 39 from the community (bite victims, dog owners) and 57 human and animal health providers (health center managers, chief veterinary officers, chief district medical officers, chiefs of livestock sectors) contributed to the study. Based on an existing conceptual framework of access to health care, several points of dissatisfaction were identified, in particular the unaffordability of human rabies vaccine for PEP (affordability) and the distance to travel to a health facility in case of a bite (accessibility). In addition, there are unfavorable attitudes observed highlighted by the importance given to traditional or local rabies care practices to the detriment of PEP (acceptability) and a low level of knowledge among Chadian communities regarding bite prevention, coupled with a very inadequate information and awareness system regarding the disease (adequacy). As for human and veterinary health services, both sectors suffer from insufficient resources for PEP on the human health and rabies diagnosis on the veterinary side impacting negatively on availability and accessibility of both these services. Action to improving provision of rabies health services and increasing knowledge about risk and prevention of the disease among the population need to be undertaken to implement IBCM, improve access to PEP and achieve the goal of eliminating dog mediated human rabies by 2030 in Chad.
本研究旨在根据乍得未来狂犬病控制的综合咬伤病例管理（IBCM）方法，确定社区、人类健康和动物健康服务提供者层面上决定暴露后预防（PEP）和动物狂犬病诊断可及性的因素。该研究是2016年至2018年开展的一个整体项目的一部分，旨在确定西非和中非的狂犬病负担及疫苗需求。数据收集于2018年8月至9月在乍得的三个研究区域与利益相关者举行的项目结束研讨会上进行，这些区域覆盖西洛贡省和瓦达伊省以及哈杰尔拉米斯省和沙里-巴吉尔米省的部分地区。采用基于焦点小组讨论和深入访谈的定性方法，以了解疑似狂犬病暴露后获得医疗护理和动物调查的情况。共有96名参与者为该研究做出了贡献，其中包括39名来自社区的人员（咬伤受害者、狗主人）以及57名人类和动物健康服务提供者（卫生中心管理人员、首席兽医官、首席地区医务官、畜牧部门负责人）。基于现有的获得医疗保健的概念框架，确定了几个令人不满的方面，特别是用于PEP的人用狂犬病疫苗价格过高（可负担性）以及咬伤后前往医疗机构的路程较远（可及性）。此外，观察到一些不利态度，其表现为重视传统或当地的狂犬病护理做法而损害了PEP（可接受性），乍得社区对咬伤预防的知识水平较低，同时关于该疾病的信息和宣传系统非常不完善（充分性）。至于人类和兽医卫生服务，这两个部门在PEP的人力健康资源以及兽医方面的狂犬病诊断资源方面均不足，对这两项服务的可获得性和可及性产生了负面影响。为了实施IBCM、改善PEP的可及性并实现到2030年在乍得消除犬传人狂犬病的目标，需要采取行动改善狂犬病卫生服务的提供，并提高民众对疾病风险和预防的认识。
