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Indian Journal of Community Medicine

Profile of Dog Bite cases attending M.C.D. Dispensary at Alipur, Delhi

Author(s): Anita Khokhar, G.S. Meena, Malti Mehra

Vol. 28, No. 4 (2003-10 - 2003-12)

Deptt. of Community Medicine, Maulana Azad Medical College, New Delhi-110002

Abstract:

Research question: What is the profile of dog bite cases who attend M.C.D. dispensary at Alipur, Delhi?

Objectives: 1. To study the epidemiological characteristics of dog bite injuries.2. To study the knowledge, attitude and practices of the subjects regarding dog bite.

Study design: Cross-sectional.

Setting: M.C.D. dispensary at village Alipur.

Participants: All the 313 dog bite cases who attended the dispensary to receive anti-rabies post exposure immunization.

Statistical analysis: Proportions, chi-square test.

Results: Out of a total of 313 cases of dog bite 69.9% were males. 53.9% of the cases were accounted for by those less than 15 years of age. 82.75% of the victim? suffered from class III exposures. Extremities were involved in majority (88.17%). In majority of the cases the bite was unprovoked. Children less than 15 years of age were more likely to provoke a dog (p<0.05). Maximum of 27.79% of the bites occurred during May-June. 73.80% were bitten by a stray dog. Only 31.03% of the victims reported for treatment within 24 hours. 85.62% had applied chilly paste on the wound. Half of the subjects mentioned that a person could go mad after being bitten by a dog. 68.05% did nothing to control freely roaming dogs that had bitten. Only 2 subjects had reported the matter to the concerned authority.

Key Words: Dog bite, Knowledge, Attitude, Practices

Introduction:

Every day a number of people fall victim to dog bites. About 30,000 people die of rabies annually which accounts for 80% of 36,000 deaths reported to the WHO. In India 96% of the rabies is due to bite from dogs which are mostly stray and ownerless. About 1 million people receive post exposure antirabies vaccine and children constitute 35-40% of these1.

Although cases of dog bite constitute a problem of considerable magnitude, not all the victims of a dog bite seek medical help. Unquestionably the level of knowledge of the community and concern about dog bite injuries has an important role to play in dealing with this problem.

Material and Methods:

Present study was conducted in a dispensary run by Municipal Corporation of Delhi located at village Alipur, Delhi. Between 1st Jan. to 31st Dec. 1999, all the dog bite cases who attended the dispensary to receive antirabies post exposure immunization were interviewed. A pretested and structured oral questionnaire was used to elicit the required information pertaining to the epidemiology of dog bite. Information about knowledge, attitude, practices and beliefs about dog bite injuries was collected from only those subjects who were morethan fifteen years of age.

Classification of exposures was done as per guidelines given by W.H.O.2. A bite was considered as provoked if it resulted from subject initiating interaction with the dog such as playing with the dog or annoying the dog during his meal.

Table I: Age-wise distribution of study subjects.

Age (years) No. %
0-5 88 28.11
5-10 57 18.21
10-15 24 7.66
15-20 16 5.11
20-25 22 7.02
25-30 35 11.18
30-35 17 5.43
35-40 08 1.55
40-45 07 2.23
45-50 09 2.87
50-55 06 1.91
55-60 12 3.83
60-65 06 1.91
65-70 06 1.91
Total 313 100

A total of 342 cases of animal bite attended the dispensary during the study period. 313(91.52%) of the total were victims of dog bite. Males constituted 219(69.9%), whereas, females were 94(30.1%) of the total cases. Children less than 15 years accounted for a maximum of 169(53.99%) of the total.

Table II: Profile of dog bite cases.

Profile No. %
Classification of exposure
Class 2 54 17.25
Class 3 259 82.75
Site of bite
Extremeties 276 88.17
Trunk 21 6.7
Face 16 5.11
Ownership of Dog
Stray 231 73.80
Friend/neighbor 55 17.57
Victim 27 8.62
Previous History of dog bite
Present 77 24.6
Absent 236 75.4
Whether the bite was provoked
Yes 79 25.24
No 234 74.76
Time of Bite
Morning 189 60.38
Noon 60 19.16
Evening 45 14.37
Night 19 6.07

54(17.25%) of the cases suffered from class II exposures and 259(82.75%) from class III. Bites involved the extremities of the body in 276(88.17%) of the victims followed by trunk in 21(16.7%) and face in 16(5.11%). Stray dogs were responsible for 231(73.8%) of the total cases. Only 27(8.62%) of the dogs who had bitten were owned by the victim. Previous history of dog bite was presentin 77(24.60%) and 234(74.76%) of the bites were unprovoked. Out of a total of 79 provoked bites 63(79.74%) were in children less than 15 years of age as compared to those more than 15 years of age and the difference was statistically significant (p<0.05). As many as 249(79.55%) of the bites occurred during daytime (morning and noon).

Table III: Month wise distribution of cases

Month No. %
Jan-Feb 36 11.50
Mar-Apr 47 15.01
May-Jun 87 27.79
Jul-Aug 59 18.84
Sep-Oct 54 17.25
Nov-Dec 30 9.58
Total 313 100

Maximum, 87(27.79%) of the bites occurred in the month of May-June followed by July-August 59(18.84%). Least number of cases 30(9.58%) were reported during Nov.-Dec.

Table IV: Home management of the wound before coming to the dispensary

Home Management No. %
Applied chili paste 268 85.62
No Home management 31 9.90
washed with water 09 2.87
Washed with soap and water 05 1.59
Total 313 100

94(31.03%) of the subjects reported at the dispensary within 24 hours of the bite. A large majority of 268(85.62%) had applied chilly paste on the wound before coming to the dispensary.

Out of a total of 144 study subjects who were more than 15 years of age only 2 mentioned that they had reported to the concerned authority that stray dog had bitten them. 98(68.05%) took no action against such a dog. 42(29.16%) stated that they made them run away and 3(2.08%) mentioned that they tried to kill them.

Table V: Knowledge about consequences of dog bite (n=144)

Response No. %
Victim goes mad 73 50.69
Victim dies 56 38.88
convulsions 32 22.22
do not know 37 25.69

*Multiple responses.

Regarding consequences of a dog bite 56(38.88%) subjects were aware of the fact that the victim could die. Only 21(14.58%) of the subjects were aware of the importance of observation of a dog who had bitten.

Discussion:

Dog bite injuries remain a problem of significant proportion in this country. Children are the most frequent victim of dog bite2-8. In this study also over 50% of the cases were children less than 15 years of age. In the present study, about 70% of the cases occurred in males explanation of which lies in the fact that men are more likely to go out of their homes for work as compared to women and it compares well with the findings of other studies3-6,9. As in this study other authors have also revealed a higher incidence of dog bites during the summer months3-5

Extremities were the most commonly involved (88.17%). Nimale et al have reported involvement of lower limbs in 65% and upper limbs in 25.4% of the cases, whereas, Bunkar has observed involvement of lower limbs in 65.66% and upper limbs in 23.96%55,6. In this study, most of the subjects were bitten by freely roaming stray dogs that were not known to the victim. Similar observation has also been made by Sudarshan M.K.1. In contrast, studies conducted in other countries have reported most of the bites from in and around the home and by pet dog3,4,8. This discrepancy can be explained by the fact that our study was conducted in rural India where there are no regulations on movements of stray dogs.

Class III bites (82.7%) and unprovoked bites (74.76%) accounted for most of the injuries as also reported by Sekhon et al in a study conducted in anti-rabies clinic in Patiala9.

Children less than 15 years of age were more likely to provoke a dog resulting in a bite (p<0.05). Some have suggested that the younger children may not realize that playful actions may cause an angry or defensive reaction from a dog. Others speculate that behaviours not generally regarded as provocating may be interpreted by a dog as invasion of territory and may incite an attack.

People living in rural areas have such a life style, which demands early start to day's work in the morning and early retirement to their homes in the evening. This reflects the reason why majority of the dog bites occurred during daytime. Nimale et al from Aurangabad agrees with this finding5. Before coming to the dispensary as many as 85.62% had applied chilly paste on the wound and only 1.59% had washed the wound with soap and water, whereas, in Patiala 31.55% of the cases had applied chilly paste and a higher proportion (21.02%) had washed the wound with soap and water. This discrepancy could be due to lack of information in the rural population of the current study about the management of the wound as compared to the cases attending the anti-rabies clinic of a hospital in Patiala9. Knowing that rabies once contracted is 100% fatal, number of cases reporting within 24 hours for medical help (31.03%) was unsatisfactory. Bunkar has reported this figure to be 37.03% and Nimale et al 47% at anti-rabies clinic at Government Medical College Hospital, Aurangabad. The fact that as many as 25% of the subjects were not aware of any consequence of a dog bite and that only 23.64% were aware about the need to observe a dog who had bitten emphasizes the need to disseminate correct information about the dog bite and its possible consequences so that the community can avail of the treatment promptly. Local treatment of the wound right after a bite is an important step in the management of a case and this fact was highly lacking in the subjects. Total indifference to roaming of stray dogs in the community has led to increase in the problem as was seen in this study, only 2 of the cases had made an effort to report the concerned authority about the stray dog who had bitten.

The tendency of a dog to bite is a product of many factors including genetic predisposition towards aggressiveness, early socialization to people training or maltreatment, quality of care and supervision and behaviour of the victim10. Therefore, prevention of dog bite injuries and their management must include a variety of approaches. High number of injuries involving dogs who were freely roaming suggests that such legislation which includes an increased effort to remove stray dogs and encourage owners to properly contain their dogs should be implemented. Since young children are more prone to provoke a dog resulting in a bite they should be the target of anticipatory guidance by the parents and the teachers. Furthermore, infants and young children should never be left unsupervised around any dog no matter how friendly the dog may appear1. Efforts should be made to educate the community about the hazards of dog bite and its consequences and management of such a wound at home.

References:

  1. Sudershan MK. Travel Medical News share -3rd Quarter 1998.
  2. Park K. Park's Textbook of Preventive and Social Medicine, Banarasidas Bhanot Publishers, Jabalpur, 16th edition, 2000:208.
  3. Maetz HM. Animal bites a public health problem in Jefferson County. Alabama Public Health Reports 1979; 94(6): 529.
  4. Werss HB, Cohen HJ. Incidence of Dog bite injuries treated in emergency department. JAMA 1998; 279(1): 51-3.
  5. Nimalae NE, Gatteni PL, Katke DN. Study of animal bite cases reporting at ART centre, GMC Hospital Aurangabad at the 26th Annual Conference of IAPSM Surat, Jan 27-30. 1999.
  6. Bunkar G. A study of animal bite cases attending Rabies Clinic at Udaipur (Rajasthan) at 26th Annual Conference of IAPSM, Surat Jan 27-30, 1999.
  7. Mishra A, Jian S. A study of animal bite cases attending 9. Sekhon AS, Singh A, Kaur P, Gupta S- Misconceptions antirabies clinic, GRMC Gwalior (MP) at the Jointand myths in the management of animal bite case. National Conference of IPHA, Indian Association of Indian I Comm Med 2002; XXVII(l): 9-11. Epidemiology and Indian Society for Malaria and other 10. Chun YT, Berkelhamer JE, Herold TE. Dog bites in Communicable disease at Agra 10-12th March, 2000, children less than four year old. Pediatrics 1982; 69(1): Agra. 119-20.
  8. Jeffery RA, Baker MD. Dog bites in urban children. 11. Lauer EA, White WC, Lauer B A. Dog bites: a neglected Pediatrics 1991; 88(1): 55-7. problem in accident prevention. AJDC 1982; 136: 202-4.
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