AN ANALYSIS ON LATE REPORTING OF ANIMAL BITE VICTIMS TO THE ARC CLINIC, BERHAMPUR

Dr. D. Shobha Malini, Asst ProfDept of Community Medicine

MKCG Medical College, Berhampur

Orissa

Introduction Following exposure of bite victims to a

suspected rabid animal, the prevention consists mainly of prompt wound treatment, administration of modern cell culture vaccines and Rabies Immunoglobulin in Cat III bites.

This modality of treatment at the ARC clinics is directly depended on the right time of reporting of bite victims to the nearest ARC clinic. Time of reporting and hence starting the right treatment is a crucial factor in prevention of Rabies

Objectives

To study the time of reporting of bite victims to the ARC clinic

To study the reasons for late reporting

To assess the source of information for reporting late and the treatment taken prior reporting to the ARC clinic

Methodology

Setting: ARC Clinic of MKCG Medical College hospital, Berhampur Orissa

Study period- January2008- December 2008

Participants: 1497 late reported cases out of total 5026 cases who attended the ARC clinic during the study period

Results

Total cases-5026 4674(93%) Cat III 251(5%) Cat II 101(2%) Cat I

93%

5% 2%

Cat III Cat II Cat I

Category of cases at ARC

Out of 5026 cases 1497 (29.8%) cases had reported late (after 2 days)

percentage of late reporting cases

80%

29.80%

Results Majority 38%

reported within 2-5 dys

32% within 5-7 days 22% 7dys-1 month 8% reported after 1

month or later

38%

32%

22%

8%

2-5 dys 5-7 dys 7dys-1m > 1mnth

Duration of late reporting cases

Why late reporting??Reasons of late reporting Percentage

Dog alive and traceable 62%

Bite inflicted not taken serious 12%

Bite by cat & domestic animals 17%

Irregular treatment by quacks 4%

Witchcraft 2%

Only vaccine and no RIG 3%

Source of information for reporting though late

From other bite victims of village 64%

Patient in village died of Rabies 12%

64%

from other bite victims

12%

patient died of Rabies

Tingling sensation and other symptoms at site of bite 16%

Animal died then reported to ARC 8%

16%

Tingling sensation

8%

animal died

Treatment prior reporting to ARC

Local washing of wound 45%

Taken ARC but irregularly 29%

45%

local wound treatment

29%

ARV/irregular

Application of herbal treatment like turmeric and oil, paste of bitter gourd, charring of the wound and application of plant juices -24%

and taking out poison and “Jhadh Phoonk” by some traditional healers 2%

24%

herbal treatment

2%

Traditional healers/jhadh phoonk

Conclusion Majority were Category III cases 29.8% of the cases reported late Majority reported late within 2-5dys 8% reported more than a month without

any treatment- risk factor Dog alive was the main cause of non

reporting followed by irregular treatment by Quacks

Other causes were bite by domestic animals, only vaccine advised and no RIG in Cat III cases and some believed on “Jhadh phoonk”

Contd---- Though reported late the source of

information was from other dog bite victims in the village, some patient died of Rabies nearby, some reported after the animal died and some came after some local symptoms developed.

Treatment prior reporting to ARC was local wound washing, irregular ARV, some herbal treatment and by Traditional healers

Quotes of WHO APCRI study 2004

The time lag between animal bite and starting ARV was 3 days in majority of cases.

About 60% of the victims had resorted to indigenous treatment

The most common practice was magico-religious practices followed by herbal therapy

Contd…..

Majority of the Rabies cases(50.6%) had died at house without taking any treatment

Among those who started vaccine treatment the compliance for completing the full course was less.

Suggestions Awareness creation at the rural areas

regarding early reporting of cases Early reporting saves the patient with

correct treatment- take home message for all dealing with animal bite patients

Proper Referral facilities where treatment is not available

Advising Use of RIG and more trainings and campaigns for proper RIG administration

No animal bite case to be taken lightly by the grass root level health providers.

Time has come to work beyond the Anti rabies clinics

Focus should be given more on community awareness to increase the reporting of hidden/unreported animal bite cases

Before saying “Alas” seeing a person dying of Rabies, let us all work on giving right treatment to all animal bite victims

THANK YOU

FOR A

PATEINT HEARING