[Influence of the knowledge of patients consulting at the Treichville antirabies Center on adherence to post-exposure prophylaxis]. / Influence des connaissances des patients consultant au centre antirabique de Treichville, Côte d'Ivoire, sur l'observance de la prophylaxie post-exposition.

AIM: Human rabies is a major public health problem in many African countries, including Ivory Coast. The objective of this study was to evaluate the influence of human rabies knowledge on compliance with post-exposure prophylaxis. MATERIALS AND METHODS: We conducted a descriptive and analytical cross-sectional study from September 2014 to May 2015 at the Abidjan Rabid Center, Treichville. After having given their consent, were interviewed, patients who came for a first consultation and who gave a mobile phone number available for the appointment reminder after abandoning or not starting the post-exposure prophylaxis. Data were processed with Epi Info version 3.5.3. Pearson's chi-square test and Fisher's exact test were used for statistical analysis with a significance level of 5%. RESULTS: A total of 744 patients were interviewed. Men accounted for the majority (58.2%) of those surveyed, with a sex ratio (M/F) of 1.7. The average age of patients was 24.55 (±17.3) years. The analysis showed that 42.6% (317/744) of the interviewees had heard of human rabies. However, having heard of human rabies did not influence adherence to post-exposure prophylaxis (P>0.05). Nevertheless, the post-exposure prophylaxis regimen was completed more often by subjects who knew that agitation is a sign of rabies than those who did not (ORa=0.4343, 95%CI=[0.204-0.925]). Subjects knowledgeable about disease transmission (animal bites) were less likely to continue their post-exposure prophylaxis than those unaware of this relationship (ORa=8.544, 95%CI=[1.002-72.869]). CONCLUSION: The main factors identified in this study that influenced the observance of post-exposure prophylaxis were knowledge of the manifestation of human rabies (signs of agitation) and of the mode of transmission of this disease (animal bites). With a view for better prevention against human rabies, rural and urban populations should be informed, educated and sensitized about this 100% life-threatening but vaccination-preventable disease.

Factors associated with the abandonment of postexposure prophylaxis at the antirabies center in Abidjan, Côte d'Ivoire.

The main objective of this work is to analyze the factors associated with patients dropping out of postexposure prophylaxis (PEP) at the antirabies center of Abidjan (ARC). This descriptive, analytic cross-sectional study took place at the ARC of Abidjan from September 2014 through May 2015. Data were collected in two stages: first, all patients were interviewed at their first consultation. Exposed patients who failed to return were interviewed by telephone three days later. We recorded 441 subjects (59.3%) who had dropped out of their PEP. After multivariate analysis of social and demographic factors, the dropout rate was low in the groups aged 40-49 years (aOR = 0.40, 95% CI = 0.2, 0.8), 50-59 years (aOR = 0.40, 95% CI = 0.21; 0.82), and 60 years and older (aOR = 0.26, 95% CI = 0.09; 0.76), while it was elevated in retired persons (aOR = 10.07, 95% CI = [1.11, 91 , 7]). Moreover, the choice of protocol influenced PEP adherence, with subjects who chose the 5-dose protocol dropping out more frequently (P≤0.001). The main reason given by the subjects exposed to a suspect animal to explain dropping out of PEP was the lack of financial resources (41.5%). To alleviate this dropout problem, the ARC should strengthen public awareness of human rabies and the Ivorian government must implement universal health coverage to help the poor or make the vaccine available for free to all.

[Discontinuation of postexposure prophylaxis at the anti-rabies Center of Abidjan, Côte d'Ivoire]. / Abandons de prophylaxie post-exposition au Centre antirabique d'Abidjan, Côte d'Ivoire.

Despite the availability of effective anti-rabies vaccine, rabies keeps affecting people in developing countries such as Côte d'Ivoire. The low compliance with Post Exposure Prophylaxis (PEP) partially explains this situation. This study was aiming at studying the reasons to abandon PEP. This descriptive and cross-sectional study has taken place at the anti-rabies Center of Abidjan from October 1st to December 2009. Data were collected in two steps: we first interviewed all the patients at the anti-rabies center during their first consultation, and then phone interviews were conducted one month later, only with exposed patients who abandoned their PEP. These phone calls allowed us to complete the questionnaire (the status of the animal and PEP discontinuation). Patients' verbal informed consent was obtained prior to data collection. Besides, patients were explained the risks they were exposed to and were advised to complete immunization. The results obtained revealed that, out of 220 people included in the study, 116 (52.7%) abandoned the PEP. The compliance was lower with the protocol of five injections compared to that of four injections. More than half of the patients abandoned PEP after the first injection. In 32.8% of patients who abandoned PEP, the animal was dead, disappeared, was destroyed or there were no information about it one month after bite or scratch. Animal owners' refusal of taking in charge the victims (20%) and the lack of financial resources for purchasing the vaccine (13.6%) were the most frequent reasons to abandon PEP. To increase the protection of the human population against rabies and to increase the compliance with PEP protocols, the improvement of financial accessibility to the vaccine for population and the elaboration of compulsory regulations for animal owners to take in charge the PEP are necessary.