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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