Description of Animal Bite Cases at Kilifi County Hospital and Administration of Anti-Rabies Vaccine, July 2014 to June

2015

Dr. Omolo Owiti

Kilifi County

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FELTP-Kenya

Animal bites occur mostly due to dog attacks

– Playing with dogs increase the chances of

bites

Other biting animals include

– Cats, donkeys, bees,

snakes, scorpions and

humans

Administration of anti rabies

vaccine is recommended to

be given on day zero

Introduction

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Problem Statement

More than 95% rabies exposures to humans

are due to dog bites

Estimated annual dog bite incidence in Kenya

– 234 per 100,000 persons (Kitala et al)

An average of 2 fatal rabies cases is reported

annually at Kilifi county hospital, both are

related to dog bites

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An average of 1,800 dog bite cases reported

in four main hospitals in Kilifi county

annually

Understand epidemiology of animal bites and

administration of anti-rabies vaccine in the

county

Justification

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Describe animal bite cases reported in Kilifi

County hospital

To determine the time taken by bite victims

to report to health facility

To determine the level of administration of

anti rabies vaccine

Objectives

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Methods

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Study design

Retrospective records review of animal bites registers at Kilifi County hospital

A case was defined as any person seeking animal bite treatment at Kilifi County Hospital between July 2014 to June 2015

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Study Area

County covers an area of 12,609.7 square km

Population- 1,109,735 (535,526 Males: 574,209 Females)

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Data abstracted from anti-rabies vaccine

register using a standardized data

abstraction tool

Variables Collected:– Sex

– Age

– Site of bite

– Location of residence

– Date of bite

– Date of reporting to health facility

– Type of biting animal

– Administration of anti-rabies Vaccine

Data Collection

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Data Analysis

Continuous data was analyzed using

measures of central tendencies and

dispersion

Categorical data was also analyzed using

frequencies and proportions

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Results

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Results 1/8

Total of 308 animal bites cases reviewed

Median age:17 years (Range :1 – 84 years)

Male persons reported more cases at 181 (59%)

The age group 5 – 15 years old had the highest

number of cases (35%)

Leg was the most bitten site at 161 cases (53%)

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Results 2/8

Most bites caused by dog- 302 (98%)

– Owned dog-181 cases (59%)

Median time taken between bite and reporting

to health facility was 2 days (range of 0 – 156

days)

Most bite cases came from Kilifi north sub

county, 166 (55%)

Of the bite cases reported, 299 (97%) received

the first anti rabies injection

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Results 3/8

0.3%

0.3%

0.3%

0.3%

0.7%

1.0%

3.3%

3.3%

3.6%

7.9%

26.0%

53.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

headear

neckstomach

waist

abdomenleg and hand

buttockschestthigh

handleg

Proportion of number of cases

Sit

e O

f B

ite

Distribution of bite cases, by site of bite, Kilifi

county hospital, 2014-2015 (n=308)

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FELTP-Kenya

Results 4/8

Time taken to report to health facility following

bite incidence

97 % of all cases received first ARV

20.33%

39.00%

16.33%

7.67%5.00%

3.33%

8.33%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

Pro

po

rtio

n o

f cases

<1 1-2 3-4 5-6 7-8 9-10 >10

Days

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Results 5/8

9%

28%

13% 13% 13%11%

9%

4%7%

40%

19%

9% 10%

6%4%

6%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

<5 5-15 15-25 25-35 35-45 45-55 55-65 >65

Pro

po

rtio

n o

f cases

age groupsf m

Distribution of bites cases, by age group and sex,

Kilifi county hospital,2014-2015 (n=308)

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Results 6/8

59%

39%

1% 1%0%

10%

20%

30%

40%

50%

60%

70%

owned dog ownerless dog owned cat ownerless cat

Typ

e o

f b

itin

g a

nim

al(

%)

Type of Biting Animal

Distribution of bite cases by type of biting

animal, Kilifi County Hospital 2014 – 2015 (n=308)

Ownerless animals= Stray animals??

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Results 7/8

2

13

22

37

14

29

16

34

2630 30

23

Jun Jul Aug Sep Oct Nov Dec Feb Mar Apr May Jun

2014 2015

Nu

mb

er

of

cases

Year

Distribution of bite cases, Kilifi county hospital by

month and year, June 2014- July 2015 (n=308)

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Results 8/8

Sub County Number Of Cases Proportion Kilifi North 166 54.61%Kilifi South 70 23.03%

Ganze 61 20.07%Malindi 3 0.99%

Magarini 2 0.66%Mombasa** 1 0.33%

Lamu** 1 0.33%Grand Total 304 100.00%

Distribution of bites, Kilifi county hospital,

2014-2015 by place Sub-County (n=308)

** - counties

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Children and young adults reported higher

number of bites

Almost all bites are caused by dogs

– Mostly by Owned dogs than ownerless

dogs

Most of the bites occur on the extremities

Almost all cases received the fist antirabies

vaccine injection

The time taken to receive the first anti rabies

vaccine was less than 72 hrs for most cases

Conclusions

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Conclusions cont’

September 2014 recorded the highest

number of cases

– Dog mating season

– Dry season, dogs scavenging

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Increase awareness to Children on dog bites

- To be made aware of dangers of dog bites and

ways of safely handling dogs

Enhanced linkages and

collaboration between

veterinary and human

health services

- Judicial administration of PEP

Recommendations

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Recommendations cont’

Increase awareness on responsible pet

ownership

Advocate for 70% rabies vaccination to dogs

and cats vaccination annually

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References

1. The Merck Veterinary Manual, Ninth Edition

2. World health organization : dog rabies

control

(www.who.int/rabies/animal/dogs/en)

3. CDC rabies information

http://www.cdc.gov/rabies/

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Acknowledgement

Field Epidemiology & Laboratory Training

Program

Public health team in Kilifi county

headquarters

County veterinary services directorate

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Thank You