Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct;5(10):e1017-e1025.
doi: 10.1016/S2214-109X(17)30321-2.

Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014-15: a retrospective follow-up survey

Melissa Dominique Etheart  1 , Maxwell Kligerman  2 , Pierre Dilius Augustin  3 , Jesse D Blanton  4 , Benjamin Monroe  4 , Ludder Fleurinord  3 , Max Millien  3 , Kelly Crowdis  5 , Natael Fenelon  6 , Ryan MacLaren Wallace  4
Affiliations

Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014-15: a retrospective follow-up survey

Melissa Dominique Etheart et al. Lancet Glob Health. 2017 Oct.

Abstract

Background: Haiti has an integrated bite case management (IBCM) programme to counsel animal-bite victims on the risk of rabies and appropriate treatment, as well as the Haiti Animal Rabies Surveillance Program (HARSP) to examine the animals. We assessed the usefulness of the IBCM programme to promote best practices for rabies prophylaxis after exposure in a low-income rabies-endemic setting.

Methods: We did a retrospective follow-up survey of randomly selected bite victims who were counselled by Haiti's IBCM programme between May 15, 2014, and Sept 15, 2015. We classified participants by HARSP decisions of confirmed, probable, suspected, or non-rabies exposures. We compared health-care outcomes in people who sought medical care before IBCM counselling with those in people who sought care after counselling. We used decision trees to estimate the probability of actions taken in the health-care system, and thereby human deaths.

Findings: During the study period, 1478 dog bites were reported to HARSP for assessment. 37 (3%) were confirmed exposures, 76 (5%) probable exposures, 189 (13%) suspected exposures, and 1176 (80%) non-rabies exposures. 115 of these cases were followed up in the survey. IBCM counselling was associated with a 1·2 times increase in frequency of bite victims seeking medical care and of 2·4 times increase in vaccination uptake. We estimated that there would be four human rabies deaths among the 1478 people assessed by IBCM during the survey period, and 11 in the absence of this programme, which would equate to a 65% decrease in rabies deaths. Among three people dead at the time of the follow-up survey, one was deemed to be due to rabies after a probable rabies exposure.

Interpretation: Adherence to medical providers' recommendations might be improved through counselling provided by IBCM programmes.

Funding: None.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Map of animal bite victims by type of rabies exposure and study area
Figure 2
Figure 2. Probabilities of selected health-care-seeking behaviours before and after IBCM counselling
IBCM=integrated bite case management. C=confirmed exposure. P=probable exposure. S=suspected exposure. NC=non-case, exposure ruled out.
See this image and copyright information in PMC

Comment in

References

    1. Hampson K, Coudeville L, Lembo T, et al. Estimating the global burden of endemic canine rabies. PLoS Negl Trop Dis. 2015;9:e0003709. - PMC - PubMed
    1. Fooks AR, Banyard AC, Horton DL, Johnson N, McElhinney LM, Jackson AC. Current status of rabies and prospects for elimination. Lancet. 2014;384:1389–99. - PMC - PubMed
    1. WHO Expert consultation on rabies. Second report World Health Organ Tech Rep Ser. 2013;982:1–139. - PubMed
    1. Lembo T, on behalf of the Partners for Rabies Prevention The blueprint for rabies prevention and control: a novel operational toolkit for rabies elimination. PLoS Negl Trop Dis. 2012;6:e1388. - PMC - PubMed
    1. Lembo T, Hampson K, Kaare MT, et al. The feasibility of canine rabies elimination in Africa: dispelling doubts with data. PLoS Negl Trop Dis. 2010;4:e626. - PMC - PubMed

Publication types

MeSH terms

Substances