Abstract

INTRODUCTION: Dog attacks, by street or domestic dogs, with injuries from very minor to significant and severe to fatal, are not uncommon. Attacks on the serious end of the spectrum have become the focus of increasing media and public attention.To study the epidemiological characteristics of dog bite injuries and the knowledge, attitude & practices of the subjects regarding dog bite.

MATERIAL & METHOD: A cross-sectional study of 422 dog bite victims reported at ARV Clinic of NKPSIMS&RC, Nagpur for medical advice and post exposure immunization against rabies during past one year has been done.  Statistical analysis was done by Epi Info software.

RESULT & DISCUSSION: 422 victims of dog bite comprised of 75.8%  males, 31.5 %  in 21 - 30 years age-group and  73.93%  class III exposures victims and unprovoked bite in majority of victims. Extremities were involved in 89.33% victims.  Maximum bites occurred during May-June. 80.8% were bitten by a stray dog. Only 52.1% of the victims reported for treatment within 24 hours .Majority of patients did not take any treatment till the time of reporting. Half of the subjects mentioned that a person could go mad after being bitten.  84.1% did nothing to control freely roaming dogs that had bitten.

RECOMMENDATIONS: The type, nature, site, geographical distribution & seasonal variations in dog bite victims show a definite interactive trend.

CONCLUSION: Wisely developed intervention model, based on epidemiological triad, for causation of rabies shall be quite helpful in prevention and control of the rabies victims.

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Introduction:

According to WHOreport, ten million people are bitten by animals (especially Dogs) around the world,considered for prophylaxis and treatment against rabies and almost (55,000) people die from this disease annually( 1) . Canine rabies continues to exist in 87 countries or territories of the world and these accounts for 99 % of all human rabies victims ( 2) .Dog attacks, by street or domestic dogs, with injuries from very minor to significant and severe to fatal, are not uncommon. Attacks on the serious end of the spectrum have become the focus of increasing media and public attention.

Although victims of dog bite constitute a problem of considerable magnitude, not all the victims of a dog bite seek medical help. Unquestionably the level of knowledge of the community and concern about dog bite injuries has an important role to play in dealing with this problem ( 3) . There is no accurate available data regarding the magnitude of dog-bite. Similarly, to the best of our knowledge, there were very few studies on the knowledge, attitudes and practice (KAP)

related to dog-bite in the area, hence the study was conducted to evaluate the knowledge and analyze the data regarding dog bite victims.

Objectives:

  1. To study the epidemiological characteristics of dog bite injuries.
  2. To study the knowledge, attitude & practices of the subjects regarding dog bite.

Material and Method:

The study was conducted in NKP Salve Medical College a tertiary care hospital ofNagpur, between 1st Jan. to 31st Dec. 2013.Total 422 dog bite victims reported for medical advice and post exposure immunization against rabies during one year period and all of them where included for the study. A pretested and structuredoral questionnaire was used to elicit therequired informationpertaining to the epidemiology of dog bite and knowledge attitude and practice of persons regarding dog bite.

Classification of exposures was done as per guidelinesgiven by World Health

Organization (WHO). A bite was considered as provoked, if itresulted from subject initiating interaction with the dog suchas playing with the dog or annoying the dog during his meal. Analysis was done by Epi Info software.

Results:

Table 1: Sex and Age wise distribution of study subjects

Age ( in years) Male female Total Percentage %
≤ 10 37 18 55 13
11-20 52 20 72 17.1
21-30 102 31 133 31.5
31-40 53 7 60 102.2
41-50 37 11 48 11.4
51-60 29 09 38 9.0
≥ 61 10 6 16 3.8
Total 320 102 422 100
A total of 422 victims of Dog bite reported at the ARV clinic during the study period. Males constituted 320 (75.8%), whereas, females were 102 (24.2%) of the total victims. The male female ratio was 3.13. 1. Majority of the victims 133 (31.5%) were in the age group of 21 -30 years. whereas age group of 0 -20 years accounted 127 (30.1%) victims, 31 -50 year age group accounted for 108 (25.6%) victims and above 50 years accounted for 54 (12.8%) victims.

Table 2: Classification of exposure

Majority of the victims 312 (73.9%) were of category III, there were 110 (26.1%) victims of category II but no victims has been reported in category I CategoryNo.Percentage %I0000II11026.1III31273.9 CategoryNo.Percentage %I0000II11026.1III31273.9

Table 3: Distribution according to the site of bite .

Most common site of bite was the Extremities, which accounted for 377 (89.3%) victims. Site of biteNumberPercentage %Extremities37789.3Trunk286.7Face174.0 Site of biteNumberPercentage %Extremities37789.3Trunk286.7Face174.0

Table 4: Distribution according to the provocation

Provocation Number Percentage %
Yes 82 19.4%
No 340 80.6%
Unprovoked bites were seen in majority of the victims 340 (80. 6%) whereas provoked bites were seen in only 82 (194%) victims

Table 5: Distribution according to the Ownership of dog

Ownership of dog Number Percentage %
Stray dog 341 80.8%
Pet dog 81 19.2%
Majority of thevictims were due to street dogs 341 (80. 8%),Pet dog accounted for only 81(192%) victims

Table 6: Month wise distribution of victims

Month No. Percentage %
Jan – Feb 61 102.5
Mar – Apr 59 102
May – Jun 103 24.4
Jul –Aug 81 19.2
Sep – Oct 66 15.6
Nov – Dec 52 12.3
Maximum, 103(24. 4%) of the bites occurred in themonth of May-June followed by July-August 81(192%) Least number of victims 52(123%) were reported duringNovember-December

Table 7: Time of reporting to ARV clinic after dog bite

Time (hours) No. Percentage %
<24 220 52.1
24 – 48 1022 33.7
>48 60 102.2
Majority of the victims has reported within 24 hours of the bite 220 (52. 1%)

Table 8: Home Management of wound before coming to ARV clinic

Home management No Percentage %
No home management 197 46.7
Applied chili paste 165 39.1
Washed with water 44 10.4
Washed with water and soap 16 3.8
197 (46. 7%) victims did no management before coming to ARV Clinic In home management majority have applied chili paste 165 (391%), a very few victims used water and soap for cleaning the wound 16 (38%)

Table 9: Knowledge about consequences of dog bite

Response No. Percentage %
Victim goes mad 241 57.1
Victim dies 82 19.4
Convulsions 32 7.6
Do not know 67 15.9
Majority of the victim thought that the person goes mad 241 (57. 1%), only 82 (194%) knew that a person could die due to dog bite

Discussion

Rabies is a deadly disease with no cure which is mainly caused by dog bites . Majority of victims are male as seen in studies (3,4,5,6,13,14,15) and in this study also we found that 75.8% victims were male, explanation of which lies in the fact that men are more likely to go out of their home for work as compared to women. In studies(1,2,3,4,6,8) it is seen that children are the most frequent victim of dog bite, contrary to this we found that majority of the victims 133 (31.5%) were in the age group of 21 to 30 years. This may be attributed to the fact that study area is an educational hub, having many colleges and hostels. Unprovoked (80.6%), category III (73.9%) bites by stray dogs (80.8%) accounted for most of the injuries.(2,3,7,11,12,14,15) . Higher incidence of dog bite during the summer month have been found in this study, similar findings have been found in studies by other authors. (3,7,9,12). Most common site involved in dog bite victims was found to be extremities (89.3%), which is in accordance with findings of other studies.(2,3,4,6,11).Maximum victim reported to ARV Clinic within 24 hours of dog bite as in literatures (2,4,5,12)Only small number of victims (3.8%) have taken proper wound care (washing with water and soap) as compared to large number of victims (96.2%) who had taken either no management or improper management for wound care similar to findings of (2,3,7,8,12,14,15)Only (19.4%) victims were aware that dog bite can be fatal, whereas large number of victims thought dog bite causes madness.(3,7,14)

Conclusion

Unlike the studies published earlier, this study highlights the importance of region wise epidemiological studies looking into the in-depth analysis of the geo-social distribution of population, stray dog population, facility survey, information dissemination, behavioral practices, seasonal variations, observed trends and consolidated concurrent strategic inputs of all interventionists in the field of administration, health care, municipal institutions, social media, educational & social welfare bodies and beneficiaries themselves. Such concerted efforts shall go a long way in gaining long lasting impact on curbing the menace of dog bite & associated illnesses among people bitten and relieving the anxieties among their family members.