ABSTRACT
Introduction: Rabies is an infectious viral disease that isalmost always fatal. It is present on all continents, exceptAntarctica, with over 95% of human deaths occurring in theAsia and Africa regions. Treating a rabies exposure, wherethe average cost of rabies post-exposure prophylaxis (PEP) isUS$ 40 in Africa, and US$ 49 in Asia, can be a catastrophicfinancial burden on affected families whose average dailyincome is around US$ 1–2 per person. Study was conductedwith the objectives to analyse the direct and indirect out ofpocket expenditure of the post exposure prophylaxis ofanimal bites in spite of free supply of anti-rabies vaccine andimmunoglobulin.Material and methods: A cross sectional observational studywas carried out at Anti Rabies Clinic, SMS Hospital Jaipur,Rajasthan from October 2018 to March 2019 to know out ofpocket expenditure of animal bite patients and its determinants.Prior approval from institutional ethics committee andinformed consent were taken and a pre-designed, pre-testedproforma was filled from the persons attending anti rabiesclinic on last visit of post-exposure prophylaxis (PEP). Apartfrom socio-demographic details, information about director indirect out of pocket expenditure due to animal bite wasrecorded and analysis was done using chi square test, ANOVAtest, ‘t’-test and univariate and multivariate regression.Results: Total out of pocket expenditure by 81 studied patientswas Rs. 53201.00, out of which 91.69% i.e. Rs. 48780.00 wereindirect expenses and 5.04% i.e. Rs. 2681.00 was expenditureon medical and surgical management including registrationand consumables. Only 3.27% i.e. Rs. 1740.00 was on postexposure anti-rabies prophylaxis of 81 patients. Mean out ofpocket expenditure was Rs. 656.80±1387.76 ranging from Rs.0.00 to Rs. 8550.00 per patient with median of Rs. 290.00.Conclusion: Despite free supply of anti-rabies vaccine andanti-rabies serum under Mukhyamantri Nishulk Dava Yojna(MNDY) the indirect out of pocket expenditure in animal bitetreatment is still high, which should draw attention for policymakers.
ABSTRACT
Background: Rabies is one of the deadliest diseases of mankind, and has terrified since antiquity. It is 100 per cent fatal, however, 100% preventable. In India, rabies causes an estimated 20,565 deaths with 17.4 million exposures to animal bites, mainly dog bites, occurring every year. In India a person is bitten by an animal in every 2 seconds and someone dies from rabies every 30 second. Complete post-exposure prophylaxis is necessary among the animal bite cases for complete protection. Hence this study aims to determine the patient’s compliance for intradermal anti-rabies vaccination and also to determine the constraints for compliance.Methods: A retrospective record based study was conducted in the ARC of S.M.S.M.C, Jaipur where patients were provided intradermal rabies vaccination (updated Thai Red Cross regimen) for post-exposure prophylaxis. The records maintained at ARC-SMSMC under department of community medicine from March 2016- February 2017 were analysed. The total number of patients was 8873 from which 8590 subjects were recruited for the study after excluding category I cases, pre-exposure cases rat bite, human bite, re-exposure and pre-exposure cases. The major constraints were found out by interviewing the patient/guardian through the telephone.Results: The compliance rate for intradermal rabies vaccination (IDRV) is 81.87%. The major constraints were timings not convenient, personal or social workload, long distance from the hospital, forgotten the dates.Conclusions: The compliance rate for rabies vaccination is considerably low for this highly fatal disease. Considering these major constraint factors, the animal bite victims should be motivated effectively through health education at the time of initiation of vaccination course to attain the goal of rabies free India.