AN ANALYSIS ON LATE REPORTING OF ANIMAL BITE VICTIMS TO THE ARC CLINIC, BERHAMPUR Dr. D. Shobha Malini, Asst Prof Dept of Community Medicine MKCG Medical College, Berhampur Orissa

Introduction Following exposure of bite victims to a suspected rabid animal, the prevention consists mainly of prompt wound treatment, administration of modern cell culture vaccines and Rabies Immunoglobulin in Cat III bites. This modality of treatment at the ARC clinics is directly depended on the right time of reporting of bite victims to the nearest ARC clinic. Time of reporting and hence starting the right treatment is a crucial factor in prevention of Rabies

Objectives To study the time of reporting of bite victims to the ARC clinic To study the reasons for late reporting To assess the source of information for reporting late and the treatment taken prior reporting to the ARC clinic

Methodology Setting: ARC Clinic of MKCG Medical College hospital, Berhampur Orissa Study period- January2008- December 2008 Participants: 1497 late reported cases out of total 5026 cases who attended the ARC clinic during the study period

Results Total cases (93%) Cat III 251(5%) Cat II 101(2%) Cat I

Out of 5026 cases 1497 (29.8%) cases had reported late (after 2 days)

Results Majority 38% reported within 2-5 dys 32% within 5-7 days 22% 7dys-1 month 8% reported after 1 month or later

Why late reporting?? Reasons of late reportingPercentage Dog alive and traceable62% Bite inflicted not taken serious12% Bite by cat & domestic animals17% Irregular treatment by quacks4% Witchcraft2% Only vaccine and no RIG3%

Source of information for reporting though late From other bite victims of village 64% Patient in village died of Rabies 12%

Tingling sensation and other symptoms at site of bite 16% Animal died then reported to ARC 8%

Treatment prior reporting to ARC Local washing of wound 45% Taken ARC but irregularly 29%

Application of herbal treatment like turmeric and oil, paste of bitter gourd, charring of the wound and application of plant juices -24% and taking out poison and “Jhadh Phoonk” by some traditional healers 2%

Conclusion Majority were Category III cases 29.8% of the cases reported late Majority reported late within 2-5dys 8% reported more than a month without any treatment- risk factor Dog alive was the main cause of non reporting followed by irregular treatment by Quacks Other causes were bite by domestic animals, only vaccine advised and no RIG in Cat III cases and some believed on “Jhadh phoonk”

Contd---- Though reported late the source of information was from other dog bite victims in the village, some patient died of Rabies nearby, some reported after the animal died and some came after some local symptoms developed. Treatment prior reporting to ARC was local wound washing, irregular ARV, some herbal treatment and by Traditional healers

Quotes of WHO APCRI study 2004 The time lag between animal bite and starting ARV was 3 days in majority of cases. About 60% of the victims had resorted to indigenous treatment The most common practice was magico-religious practices followed by herbal therapy

Contd….. Majority of the Rabies cases(50.6%) had died at house without taking any treatment Among those who started vaccine treatment the compliance for completing the full course was less.

Suggestions Awareness creation at the rural areas regarding early reporting of cases Early reporting saves the patient with correct treatment- take home message for all dealing with animal bite patients Proper Referral facilities where treatment is not available Advising Use of RIG and more trainings and campaigns for proper RIG administration No animal bite case to be taken lightly by the grass root level health providers.

Time has come to work beyond the Anti rabies clinics Focus should be given more on community awareness to increase the reporting of hidden/unreported animal bite cases Before saying “Alas” seeing a person dying of Rabies, let us all work on giving right treatment to all animal bite victims

THANK YOU FOR A PATEINT HEARING