Factors associated with delayed rabies post-exposure prophylaxis among dog bite victims in Nyagatare District, Rwanda, 2017 to 2019

Background Rabies is an incurable zoonotic disease of public health concern. After exposure the only effective intervention is Post-Exposure Prophylaxis (PEP). Surveillance data in Rwanda shows that a high number of dog bites do not get PEP in time. Objectives Determine factors associated with delays in post-exposure prophylaxis among victims of dog bites. Methods The retrospective cross-sectional study was conducted in Nyagatare District. It targeted people bitten by dogs and who attended Nyagatare district from January 2017 to December 2019. Review of registers and interview with victims were used to collected data using excel and analyze them using STATA version 15. Odds ratio (OR) and confidence interval (CI) were reported. Results Among 412 dog bite victims, 161 (39%) delayed getting PEP. The more likely to delay in getting PEP, were people living in rural areas, AOR = 3.54, 95%CI [2.12, 5.90], and those without medical insurance, AOR = 4.40, 95%CI [1.82-10.62]. Conclusion Seeking PEP among dog bites victims is subject to delay in Nyagatare district. Local leaders should establish initiatives to support people to get medical insurance while public health officers need to prioritize sensitization for PEP for people living in rural areas.

Amputation labiale par morsure humaine: à propos d'un cas à l'hopital national donka

Les morsures humaines représentent 3 % des morsures rencontrées au service d'urgence. Les preuves et le consensus sur les meilleures pratiques en matière de gestion des morsures humaines font défaut d'échec et de déterminer l'intérêt d'une réparation secondaire. Notre première tentative de reconstitution à partir de la pièce amputée étant échouée alors us avons entrepris cette étude dont les objectifs étaient d'identifier les facteurs OBSERVATION:Une patiente de sexe féminin âgée de 24 ans, ménagère A l'examen endo buccal, on notait une ouverture buccale d'amplitude normale. Les 32 et 31 sont exposées du fait de la perte de substance labiale. L'articulé dentaire conservée, l'hygiène bucco-dentaire défectueuse A l'admission, la patiente détenait dans un verre rempli d'eau minérale la pièce amputée de 2 cm x 1,8 cm dont la couleur laissait présager une vitalité compromise par défaut de vascularisation Les examens biologiques n'ont révélé aucune particularité. Le délai entre l'amputation et l'admission dans le Service était de 7h compromettant plus ou moins la vitalité de la pièce. Un délai nettement inférieur à celui trouvé par Roland et al. dans trois études différentes et qui ont trouvé moins de 14 % des patients ont été admis et plus de 80 % se sont présentés dans les 12 ou 24 heures suivant la morsure. CONCLUSION: Une tentative de replacement intentionnel d'une pièce amputée par morsure humaine sans chirurgie vasculaire est vouée à l'échec par une nécrose évolutive. Cependant la réparation chirurgicale de seconde intention donne un résultat esthétique et fonctionnel satisfaisant.

Profile of dog bite injuries in patients presenting at Kimberley Hospital Complex's emergency and gateway centres, 2015 to 2017

Background: Dog bite injuries in humans remain a public health problem. There is limited nationally representative data on the magnitude of the problem and the epidemiological profile of dog bite injuries in South Africa. Aim: To describe the profile of dog bite injuries in patients presenting to Kimberley Hospital Complex (KHC) emergency and gateway centres. To determine the prevalence of dog bite injuries amongst all patients presenting to these centres and the compliance of mandatory notification of dog bites. Setting: Kimberley Hospital Complex emergency and gateway centres. Methods: A retrospective review of all dog bite cases who presented to KHC from August 2015 to July 2017. The total number of all patients who presented were taken into consideration for calculating the prevalence of dog bite cases. Results: During the study period, 433 dog bite cases were identified out of 107 731 patients seen at emergency and gateway centres, giving a prevalence of 0.4%. Of all cases, 62.4% were male patients and 37.6% were female patients. Most affected age group was between 10 and 19 years (19.6%). Category II exposure type accounted for the majority of the cases (59.4%). Unvaccinated dogs were incriminated in 61.9% of cases. Stray dogs were responsible for 83.1% of all injuries. More than half of the cases (47.9%) were notified by the treating doctors. Conclusion: Dog bite injuries in Kimberley were commonest in children and adolescents. The prevalence tended to decrease in adulthood with advancing age groups. Most bites resulted from unvaccinated stray dogs. Only about half of the cases were notified to the appropriate authorities. Prevalence of dog bite injuries amongst patients presenting at KHC resulted in the low rate of 0.4%. Awareness needs to be created amongst health care providers on the importance of notification of all exposure to rabies. More efforts are required at the prevention of dog bites in children and adolescents through stringent measures to limit the number of free-roaming dogs

Human bites as a weapon of violence: how common are they and do they constitute a significant medical evidence?

Objective: To document the pattern of HBM seen in police clinic Benin City Nigeria.Methods: This is a review of all the human bite mark (HBM) seen at the police clinic.Results: HBM were seen in 68 cases of assault and included 90 separate bites. The youngest victim was 10 years old while the oldest was 59 years with a mean age of 31.9±9.68. Age group 30-39 years accounted for most cases. Female victims were more in number both as victims and as assailants. About 94.1% of theassailants were known. The major events that lead to the use of human bite (HB) were quarrel and fights which accounted for 98.5% of cases. HB was mainly used in conjunction with other weapons. About 77.9%of the HB had single bite marks while complete tissue avulsion were seen in 1.5% of cases. The arm was the commonest site (17.8%), closely followed by the fingers (15.6%).Conclusion: This will serve as a baseline data in Nigeria, while we strongly advocate the development of a proforma for HBM examination following ABFO guideline and HIV PEP for victims with grade 4 HBM andabove

Rage furieuse transmise par un chien errant

Nous rapportons une observation d'un cas de rage furieuse survenue suite à la morsure par un chien errant. La discussion porte sur la clinique, sur la démarche à suivre après morsure par un chien et les difficultés de diagnostic de cette affection dans notre contexte. Les auteurs recommandent le traitement prophylactique antirabique en cas de morsure par un chien errant. Ils rappellent également que la rage est transmise par un animal enragé, et ils interpellent les autorités sanitaires sur la nécessité de former le personnel de santé, de rendre accessible les vaccins et les immunoglobulines antirabiques. Aussi le renforcement de la surveillance de cette anthropozoonose nécessite un laboratoire et un plateau technique capable de confirmer les cas humains de rage. Une action en amont basée sur la vaccination des animaux de compagnie, l'abattage des chiens errants et le traitement prophylactique en cas d'exposition, contribuera à réduire de façon significative l'ampleur de cette maladie./p>

Dog Bites and Human Rabies in the Uthungulu District Of Kwazulu-Natal Province; 2008-2010: a Review of Surveillance Data

The Uthungulu District in KwaZulu-Natal province is the area that is most affected by rabies in South Africa. Usually; the transmission of rabies to humans occurs through the bites of infected dogs. In 2008; Uthungulu commenced a programme to eliminate human rabies in the district. This paper describes the epidemiology of dog bites and human rabies in the UThungulu District from 2008-2010; and the extent of adherence to rabies post-exposure prophylaxis (PEP). The method was a retrospective analysis of dog-bite and human rabies surveillance data that were collected in Uthungulu from January 2008-December 2010. Dog-bite injuries in Uthungulu increased from 1 176 in 2008 to 2 365 in 2009; and decreased to 1 598 in 2010. Of 2 601 patients who were offered rabies PEP in 2009 and 2010; 83.7 [95 confidence interval (CI): 82.4-85.2] completed the treatment. Logistic regression analysis found that investigation of the report by an environmental healthcare practitioner [odds ratio (OR) = 3.95; 95 CI: 2.43-6.43; p-value = 0 .0001]; the availability of patient telephone contact details in the healthcare facility's records (OR = 1.76; 95 CI: 1.02-3.03; p-value = 0.041); and bite wounds that were classified as Category 3 exposure injuries (OR = 2.96; 95 CI: 1.39-6.29; p-value = 0.004); were independently associated with completion of rabies PEP. Seven human rabies cases were reported (four in 2008; two in 2009 and one in 2010). Annualised human rabies incidence rates decreased from four cases per million in 2008 to one case per million in 2010. The findings suggest that the rabies elimination initiative is having an impact on the reduction of the incidence of human rabies in Uthungulu. The district should strengthen the follow-up of people who are exposed to rabies to ensure PEP completion

Incidence of dog bite injuries and clinical rabies in a tertiary health care institution: A 10-year retrospective study

Background: It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre.Materials and Methods: Case records of patients managed at the accident and emergency unit of Ahmadu Bello University Teaching Hospital, Zaria, between June 2000 and May 2010 with diagnosis of dog bite and rabies were retrieved. Relevant clinical data were extracted using a structured questionnaire designed for the study.Results: Eighty-one persons out of 24,683 consultations in the accident and emergency unit presented with dog bite injuries with two clinical cases of human rabies. Mean age of victims of dog bite injuries was 21.1 ± 14.3 years and the majority (55.6%) were children. Males were more affected than females with a male:female ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine.Conclusion: Hospital incidence of dog bite injuries was low, but the use of postexposure prophylaxis was high

Dog Bites to the Head; Neck and Face in Children

Dog bites are a poorly understood and complex public health problem. Children are most frequently the victims of dog bites and the face is often the favoured target. A review of dog bite wounds in small children presenting to the Red Cross War Memorial Children's Hospital was carried out over a period of 13.5 years (1991-2004). One thousand eight hundred and seventy-one dog bite wounds were admitted from a total of 125;677 patients treated. From 1;871 patients presenting with dog bite injuries; we identified 596 children who sustained injuries to the head; face or neck. Dog bites to the head; face or neck were responsible for 0.5of all trauma unit presentations and 32of all dog bite injuries. The mean age of the children was 5.1 years. Male children accounted for 68of the patients. The peak incidence was noted in children aged 2 to 4 years old. One hundred and seventy-two (29) bites occurred between the summer months of December and February. Two hundred and forty-nine (42) patients presented to hospital between the hours of 12:00 and 18:00 hours and 275 (46) children presented between 18:00 and 0:00 hours. A large proportion of all attacks occurred either inside or outside the victim's own home and at the home of friends or family. Superficial injuries were treated with wound cleaning; suturing and dressing. There were no fatalities. Dog bites are relatively common in small children; but do not represent a major cause of morbidity and mortality

Dog Bites to the Head; Neck and Face in Children

Dog bites are a poorly understood and complex public health problem. Children are most frequently the victims of dog bites and the face is often the favoured target. A review of dog bite wounds in small children presenting to the Red Cross War Memorial Children's Hospital was carried out over a period of 13.5 years (1991-2004). One thousand eight hundred and seventy-one dog bite wounds were admitted from a total of 125;677 patients treated. From 1;871 patients presenting with dog bite injuries; we identified 596 children who sustained injuries to the head; face or neck. Dog bites to the head; face or neck were responsible for 0.5 of all trauma unit presentations and 32 of all dog bite injuries. The mean age of the children was 5.1 years. Male children accounted for 68 of the patients. The peak incidence was noted in children aged 2 to 4 years old. One hundred and seventy-two (29) bites occurred between the summer months of December and February. Two hundred and forty-nine (42) patients presented to hospital between the hours of 12:00 and 18:00 hours and 275 (46) children presented between 18:00 and 0:00 hours. A large proportion of all attacks occurred either inside or outside the victim's own home and at the home of friends or family. Superficial injuries were treated with wound cleaning; suturing and dressing. There were no fatalities. Dog bites are relatively common in small children; but do not represent a major cause of morbidity and mortality

Acquired Lip Defects - Presentation and Management at Orlu; Nigeria

Background: Acquired defects of the lips are quite a heterogeneous group of defects; posing diverse challenges to the reconstructive surgeon. Recent reports have advocated primary closure in this environment. Aim: To highlight the pattern of presentation and management of acquired lip defects in Imo State University Teaching Hospital.Method: The case records of patients with acquired defects of the lip in a 12 - month period (March 2007 to February 2008) were reviewed. Information on biodata; clinical presentation; treatment; complications and outcome were extracted from the case notes. The extent of lip loss was given as a percentage of the inter-commissural length of the involved lip. The data were analyzed using descriptive statistics. Results: Ten patients with acquired lip defects were treated in the period under review. There were 5 males and 5 females ( M:F= 1:1). They were all adults. Four (4) had upper lip defects while 6 had lower lip defects. The commonest cause was human bite; followed by tumour resection. The commonest procedure for the upper lip defects was bilateral cheek advancement with a central Abbe flap; while for the lower lip; it was wedge excision and lateral lip advancement. All defects were repaired primarily. Results were satisfactory. Conclusion: Human bite and tumour excision are major causes of acquired lip defects in our centre. Primary reconstruction gives good results

Human Bite and Human Immune Defiency Cirus (HIV) Transmission

Background: The concentration of human immune deficiency virus (HIV) in the saliva of a carrier is low. As a result; human bite is not considered the traditional route of HIV infection transmission.Aim: To report a case of HIV sero-positivity following a human bite. Setting: University of Port Harcourt Teaching Hospital; Port Harcourt.Case report: A 30-year-old HIV sero-negative woman who became sero-positive following a bite by a known HIV infected commercial sex worker is presented. Both were engaged in a physical fight over a disagreement.Conclusion: This case highlights the possibility of HIV infection through human bite