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Indian Journal of Community Medicine

Misconceptions and Myths in the Management of Animal Bite Cases

Author(s): A.S. Sekhon, Amarjit Singh, Paramjit Kaur, Sonia Gupta

Vol. 27, No. 1 (2002-01 - 2002-03)

Deptt. of Community Medicine, Govt. Medical College, Patiala

Abstract:

Research question: What are the common myths and misconceptions in the management of animal bite cases among patients attending antirabies clinic, Rajindra Hospital Patiala.

Objectives: 1. To find out beliefs and misconceptions among patients attending Antirabies clinic. 2. To study distribution of bites in relation to different variables.

Setting: Antirabies clinic, Rajindra Hospital, Patiala (Deptt. of Community Medicine).

Study design: Retrospective study.

Sample size: 4,585 patients who attended the Antirabies clinic in a period of 3 years and 9 months.

Statistical analysis: Simple proportions.

Study variables: Age, sex, place, literacy, class of bite, myths.

Results: Out of 4,585 patients, 71.4% were males and 61.8% reported from urban area. Majority of the patients were in age group 15-30 years and 59.2% were literate. Majority (95%) of cases were of dog bite followed by monkey bite (1.8%), buffalo bite (1.6%) and cat bite (1.3%). 38.6% patients presented with class III bites. Common practices prevalent in the management of wounds were washing with soap and water (21.02%), with only water (9.53%), application of chillies (14.18%), dettol and antiseptic (5.45%), cowdung (0.46%) and carbon (0.89%).

Keywords : Animal bite, Misconceptions, Management

Introduction:

Rabies or hydrophobia is invariably fatal but easily preventable disease of human beings. It is a disease of warm blooded animals that is transmitted to humans through close contact with their saliva (i.e. bites, scratches, licks on broken skin and mucus membranes). Man is the dead end of this infection and does not play any role in its spread to new hosts. In India Rabies occurs in all states with exception of Lakshadweep and Anadaman and Nicobar Islands2,3. Human death toll worldwide is about 60,0005. Approximately 35,000 to 40,000 human deaths occur due to rabies each year in the countries of SEAR. In countries of SEAR, India and Bangladesh belong to high incidence category4. More than 95% of cases are bitten by dogs. Every year 1.1-1.5 million people receive post exposure treatment with either NTV or tissue culture vaccine1. But still there are many myths and false beliefs associated with wound management. These include application of oils, herbs, red chillies on the wounds inflicted by rabid animal, more faith in indigenous medicines which are of unproven efficacy and not wetting the wound because of fear that it would get infected. The study was conducted with an intention to find out the prevalent practices and hence meeting the dire necessity of educating the people lest more cases of rabies would crop up.

Material and Methods:

This retrospective study was undertaken in the Antirabies clinic of Rajindra Hospital, Patiala run by deptt. of Community Medicine. The data was obtained from registers maintained in the antirabies clinic. Total period of study was about 3 years and 9 months (Jan 1998-Sep. 2001). 4,585 cases had visited the clinic during this time period. Information was collected in relation to various variables and especially regarding various misconceptions and myths so prevalent in the community.

Results and Discussion:

Table I: Distribution of patients according to age.

Age (in years) No %
0-15 1232 (26.8)
15-30 2258 (49.24)
30-45 537 (11.71)
45-60 425 (9.27)
>60 133 (2.9)
Total 4585 (100)

Table II: Distribution of patients in relation to sex and area of residence.

Sex No. % Urban %R Rural %
Male 3274 (71.4) 1977 (69.8) 905 (51.6)
Female 1311 (28. 0) 856 (30.2) 847 (48.4)
Total 4585 2833 1752

Figures in parentheses represent percentages.

Total 4,585 cases reported from Jan 98-Sep. 2001. Out of this, 71.4% were males and 28.6% were females. 61.8% of cases were from urban area and 59.2% of the total being literate. Most of the cases belonged to age group 15-30 years (49.24%). Main reason for this is the vulnerability to exposure. Same reason also accounts for more reporting of male cases.

Table III: Distribution of patients according to nature and exposure of bites.

Class No. (%)
Class I 1221 (26.6)
Class II 1595 (34.8)
Class III 1769 (38.3)
Provoked bites 1756 (38.3)
Unprovoked bites 2829 (61.7)

Most patients suffered class III (38.6%) bites. The no. of unprovoked bites exceeded that of provoked bites. This demands the necessity of adequate knowledge about managing the wound in early stage so that patient doesn't succumb to this disease.

Table IV: Distribution of animal bites.

Animal No. (%)
Dog Cat 4354 (95)
Mongoose 61 (1.3)
Rat 8 (0.17)
Monkey 83 (1.8)
Buffalo 73 (1.6)
Contact with rabid patient 6 (0.13)
Total 4585 (100)

Table V: Distribution of animals as per nature and immune status.

Immunised status and nature No. (%)
Immunised 1535 (33.5)
Unimmunised 2347 (51.2)
Don't Know 543 (11.8)
Partially immunized 160 (3.5)
Pet 1927 (42)
stray 2658 (58)

As we know that dogs are the main source of rabies in India and in this study too 95% of cases were bitten by dog. Not even a single case reported with history of rat bite. Of all the animals, 58% were stray, 33.5% were immunised and 51.2% were unimmunised. This highlights the danger humans are facing amidst such a huge population of unvaccinated dogs. But the main danger is posed by the ignorance about the disease and the common prevalent practices in the management of wounds.

Table VI: Common prevalent practices.

Practices No. (%)
Applied nothing 1444 (31.5)
Washed with soap and water 964 (21.02)
Chillies 650 (14.18)
Washed with water 437 (9.53)
Dettol and antiseptic 250 (5.45)
Surma or carbon 41 (0.89)
Salt 33 (0.72)
Cowdung 21 (0.72)
Ghee 14 (0.31)
Chillies and soil 13 (0.28)
Turmeric 11 (0.23)
Kerosene 9 (0.19)
Tied animal hair 4 (0.08)
Hydrogen peroxide 4 (0.08)
No Information available 690 (15.04)

It was quite surprising that inspite of so much awareness still the majority of patients (31.5%) didn't apply anything on the wound before seeking treatment. But it was appreciable to find that practice of washing the bite site with soap and water (21.02%) or water (9.53%) is quite prevalent. Other practices included application of chillies (14.18%), cowdung (0.46%), dettol and antiseptic (5.45%) and surma (0.89%).

Recommendations:

Undoubtedly the timely institution of post exposure treatment or observation of the dog and then treating the patient accordingly with antirabies vaccine is the only way to prevent human death toll. But the initial management of wounds is also of vital importance as it removes the saliva of rabid animal that contains the large number of rabies virus.

IEC activities should be given impetus to dispel all misconceptions and false beliefs. Moreover, control of rabies in wild animals is quite complicated and tremendous research is necessary to develop effective tools to understand its dynamics and control of disease. Development of oral vaccines and appropriate delivery systems are the areas in which notable progress is to be achieved.

Various strategies to control rabies in animals should incorporate following components:

  1. Mass vaccination of reservoir animals e.g. dogs against rabies is most important weapon in rabies control. The dog population in India is estimated to be around 25 million and most of them are not protected against rabies9. Studies have shown that, in general, 80-95% of the dog population is accessible for vaccination thus confirming the concept of controlling rabies through mass vaccination 8 .
  2. Dog population management either
    • By humane killing
    • By sterilization
    • Development of some oral bait for dogs which has not been developed till date 7
  3. Community participation.
References:
  1. Park JE: Text book of Preventive Medicine, Nai Dunia Printing Press, Keshar Bagh Road, Indore (India), 2001; 204-8.
  2. CD Alert: October, Volume 4: No. 10: 2000.
  3. Sehgal and R Bhatia (1985). Rabies current status and proposed control programs in India, NICD, Shamnath Marg, Delhi-54.
  4. World Health Organization: Weekly epidemiological record 1999; 74: 381-4.
  5. WHO (1998), WHR, Life in 21st century, A vision for all, Report of the Director General, WHO.
  6. WHO (1973) Tech Rep. Ser. No. 523.
  7. Debbie, JG (1998), W.H. Forum, 9(4) 536.
  8. The work of WHO 1986-87, P.-176.9.
  9. WHO (1999), Health situation in the South East Asia Region 1994-97, Regional office of SEAR, New Delhi.
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