Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies
Authors: Kisaka Stevens , Makumbi Fredrick E. , Majalija Samuel , Bangirana Alexander , Thumbi SM 
Published: February 2020

In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must wash bite wounds for 15 minutes with soap, water and disinfectant immediately before seeking medical care. This study investigated the epidemiology of dog bites and determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog- bite patients at two healthcare facilities. Qualitative data as also collected through 13 in-depth interviews with patients, healthcare workers, herbalists and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized lineal models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied un-recommended substances such as herbs (47/193), antiseptics (46/193), “black stone” (25/193) and unknown creams (10/193) on the wounds. Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47 - 0.92) and knowing the dog owner, adjPR=0.65 (0.36 - 0.93). However, attainment of secondary or higher education, adjPR= 1.76 (1.24 – 3.79), being in employment, adjPR = 1.48 (1.09 – 2.31), perception that the dog was sick, adjPR = 1.47 (1.02 – 2.72) and knowledge about the dog’s subsequent victim(s) adjPR=0.35 (0.17 - 0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.

Author summary

Dog-mediate rabies is on the rise, especially in sub Saharan Africa. Though the disease is fatal upon exposure, it can be effectively prevented through appropriate post-exposure management. It is recommended that dog bite victims wash bite wounds for 15 minutes with soap, water and disinfectant immediately before seeking medical care. However, such pre-clinical recommendations are not usually followed in many societies, including in Uganda. There are numerous reports of victims not seeking or delaying to seek healthcare. Additionally, victims have been reported not to wash their wounds and applying traditional herbal concoctions before presenting at health facilities. Such divergence from the recommended standards has negative implications on the effectiveness of post-exposure prophylaxis that is given when victims report to health facilities. Our study investigated the epidemiology of dog bites and preclinical practices for the victims in the context of dog bite prevention and rabies prevention respectively. We call for targeted health education programs to improve pre-clinical behavior, regulation of herbalist activities and interventions that minimize human-dog interactions.