Health-care quality from patients’ perspective: A cross-sectional study at anti-rabies clinic of a tertiary care center, Bengaluru

Background: Rabies is a highly fatal viral disease, yet preventable through timely administration of post-exposure prophylaxis (PEP). Anti-rabies clinic (ARC) plays an important role in providing PEP. Evaluation is a systematic way to improve current activities and by careful selection of alternative ways for better planning of future. Objective: The study was done with the intention to identify the gaps in the patients’ care in terms of patient satisfaction at ARC of a tertiary care center, Bengaluru. Materials and Methods: A cross-sectional study was conducted among 260 animal bite victims who visited outpatient department of ARC. The study tool comprised three sections; socio-demographic profile, details of animal bite, and patient satisfaction scale (PS-18) which was scored using 5-point Likert scale. T-test, analysis of variance and Pearson’s correlation was used to assess the relationship between quality dimensions and PS-18 scores. Results: The mean age of the study participants was 37.33 (17.71) years and majority were males. The overall mean score of PS-18 was 4.15 (0.42). The highest and lowest mean scores of PS-18 among the components were given to communication, 4.36 (0.61) and accessibility, 3.56 (0.75), respectively. There was significant association between religion, frequency of visit, category of bite, and cost incurred with mean scores of PS-18. Out of 260, about 62.7% of them gave good scoring for PS-18. Conclusions: The study findings showed that more than half of the patients visiting the outpatient department shared a positive experience. Although the mean scores for overall PS-18 scale belonged to the grade of good scoring; due interest to be taken to improve accessibility and convenience which was the least scored among the components of PS-18.

Study of demographic profile of animal bite cases and management practices in a dedicated anti rabies clinic of a tertiary care hospital, Hassan, Karnataka

Background: Animal bites cause a big burden in terms of morbidity and mortality throughout the world. These bites could be caused by rabid animals causing rabies. Annually about 59,000 persons die of rabies, of which 20,000 is from India alone. Rabies though 100% fatal is preventable with post-exposure prophylaxis which includes wound wash, anti-rabies vaccination (ARV) and rabies immunoglobulin. The objectives of the present study was to describe the demographic profile of animal bite cases and to assess the management practices of animal bite cases reporting to dedicated anti-rabies clinic (ARC) of a tertiary care hospital, Hassan, Karnataka.Methods: A cross-sectional study was conducted from the inception of anti-rabies clinic (12th October 2017) to August 2018 among animal bite cases reported to ARC. They were interviewed by using a semi-structured, pre-designed and pre-tested proforma. Data regarding socio-demographic profile were collected from the animal bite victims. All the animal bite cases were managed as per WHO guidelines.Results: The total number of animal bite victims reported to ARC during the study period was 3500. Majority of the bite victims belonged to adult population (20-60 years). Majority were males (66.2%). 77% belonged to the rural population. Dogs (97.1%) were the most common biting animal. 79% of the bites were provoked. Turmeric powder was the most commonly used irritant. Most bites belonged to Category III (84%). Category I, II, III bites were managed appropriately according to WHO guidelines.Conclusions: Knowing the burden, socio-demographic characteristics and the management of animal bite victims in the dedicated ARC of HIMS has helped the programme officer in implementing the National Rabies Control Programme in Hassan district.

Facilities and services of postexposure prophylaxis in anti-rabies clinics: A national assessment in India

Background: The rabies postexposure prophylaxis (PEP) is provided through anti-rabies clinics in the country. It was considered important to assess their facilities under a nationwide multi-centric survey. Objectives: The objective of this study is to assess the facilities available for PEP at the anti-rabies clinics and to ascertain the PEP provided at the anti-rabies clinics. Methods: The cross-sectional assessment was made from May 2017 to January 2018 in selected seven states of India. Thirty-five anti-rabies clinics from both Government and private; urban and rural areas from the states were assessed by an expert team using a pretested checklist for facilities and services available for PEP. Results: On an average, 10 new animal bite cases were attended at each anti-rabies clinic per day. The cold chain facilities for rabies biologicals were satisfactory. The facilities for wound washing (54.3%) and the use of antiseptics to animal bite wounds were not adequate. Rabies vaccines were administered by intramuscular in 54.3% and by intradermal route in 45.7% of the cases. The vaccine stock-outs were reported only in the government sector (18.5%). The type of rabies immunoglobulin (RIG) used was equine (63.2%) and human (36.8%); given free of cost in 40% of Anti rabies clinics. The local wound infiltration of RIG was in practice at 58.6% of anti-rabies clinics. The stock-out of RIG was more in private (50%) hospitals than in Government (40.7%) hospitals. Conclusion: The facilities available for PEP at the anti-rabies clinics were inadequate and have to be improved across the country.

Profile of animal bite victims reporting to intradermal rabies vaccination centre at a tertiary care government hospital: 10 years experience

Background: Rabies is acute, progressive encephalitis caused by a lyssavirus. Over 95% of rabies deaths in humans result from virus transmission through the bites of infected dogs. To provide Post Exposure Prophylaxis to the people, Anti Rabies Clinics have been established in many places, especially at tertiary care centres. The Anti-Rabies Clinic at Mandya Institute of Medical Sciences, Mandya, Karnataka state (ARC-MIMS) is one such centre, the first of its kind in Karnataka state more than ten years ago. We are presenting the clinical profile of the animal bite victims who sought treatment at our centre in the past 10 years.Methods: It was a retrospective record based study conducted at Mandya Institute of Medical Sciences with sample size of 44087 using purposive sampling from May 2018 to June 2018 and data was collected using data extraction sheet.Results: Among the 44087 animal bite victims majority i.e., 66.6% were males, most of them were in the age group of 16-60 years. Sixty percent of the animal bite victims were residing in rural areas. All the category 2 and category 3 bite victims were administered anti rabies vaccination and 15.4% of the category 3 bite victims were administered rabies immunoglobulin.Conclusions: Majority of animal bite victims were presented and treated within 1 day. The practice of giving health education periodically to the school children and making phone calls to remind follow up days which is being practiced should be promoted.