Introduction

Rabies is a highly fatal zoonotic disease caused by a virus from the genus Lyssavirus and family Rhabdoviridae, associated with 100% mortality rate; infected animals and humans die within a week after the first neurological signs appear (Taylor, 2009; Depani et al., 2012, Dietzgen and Kuzmin, 2012). It is endemic in Uganda like many African countries, mainly transmitted and maintained through bites of infected animals to other animals and humans (Jemberu et al., 2013). Dogs are the main source of rabies through their bites especially in the developing countries of Africa, Asia and South America (Overall and Love, 2001; Ozanne-Smith et al., 2001; Meslin and Briggs, 2013).

Rabies is an important but underreported and neglected disease of low income countries in Africa and Asia (Knobel et al., 2005; Hampson et al., 2015) associated with poverty affecting vulnerable populations with most deaths occurring in children between 5-15years and the lowest socio-economic sectors who account for about 40% of people exposed to dog bites in rabies endemic areas (Gongal and Wright, 2011; Meslin and Briggs, 2013).

Disparities in the affordability and accessibility of post-exposure treatment and the risks of exposure to rabid dogs result in a skewed distribution of the disease burden across society; with the major impact falling on the rural poor particularly children (Knobel et al., 2005). Highly educated people know more about rabies (Palamar et al., 2013) while uneducated people know less about rabies (Herbert et al., 2012). Even fewer people are aware of the transmission and prevention of rabies (Fieldinget al., 2012). Obstacles to progress against canine rabies in Africa include; a high population of stray dogs, the inability of owners to bring dogs for vaccination annually, lack of canine rabies surveillance and diagnostic capabilities besides insufficient resources for veterinary services delivery (Anderson and Shwiff, 2015).

Consequences of dog bites include direct physical injury, psychological trauma and post-traumatic stress in addition to the risk of contracting rabies (Gilchrist et al., 2008) besides high financial costs for treatment, emergency hospitalization and anti-rabies post-exposure prophylaxis (Overall and Love, 2001). The global burden of canine rabies is approximately $124 billion annually (Anderson and Shwiff, 2015). In developing countries, availability of post-exposure prophylaxis (PEP) is limited to a few referral hospitals and health centers implying that dog bite victims must travel long distances associated with incidental costs including transport, feeding, and accommodation to access PEP. Globally over 15 million people receive the rabies PEP treatment annually following dog bite injuries (Cox, 2012).

When dogs bite and transmit rabies to cattle, goats, sheep, working animals like camels and donkeys (Hampson et al., 2015; Anderson and Shwiff, 2015), they undermine livelihoods of the households who depend on livestock. If these animals die of rabies following dog bites, the livestock farmers suffer severe economic losses. The number of animals and people dying of rabies annually in Uganda are not known since there is neither systematic reporting nor effective surveillance systems to capture all the victims of dog bites or who die of rabies in all districts. Hence, the study was done to estimate the dog bite victims who received PEP from Entebbe Grade A national rabies referral hospital and economic costs involved.

Materials and Methods

The study was conducted at Entebbe Grade A National Rabies Referral Hospital (Grade A) which is located in Katabi sub-county, Busiiro county, Entebbe municipality, Wakiso district in central Uganda. This is a government public hospital offering medical services ranging from surgery, orthopedics, antenatal care, maternity, and immunization against several diseases including rabies. It is approximately 37 kilometers (23 miles) by road from Kampala, southwest of Mulago National Referral Hospital located between coordinates 0°03'50.0"N and 32°28'18.0"E.

The study was retrospective using secondary data from case records of people who reported animal bites at Entebbe Grade A National Rabies Referral Hospital. Data were manually retrieved from the rabies archives. The records indicated the patient’s names, home region i.e. central, western, eastern and northern Uganda where he/she came from to access PEP at the hospital. The patient’s age and sex; the species of the biting animal (dog, cat or wild species e.g. fox), domestic or stray and the date of the bite were extracted from the records. Information about the cost and length of treatment, whether there was an accompanying adult in case of children and the region where they came from were factored in to estimate the financial costs incurred by the victims.

The costs incurred by dog bite victims to access PEP included direct and indirect costs and were estimated according to the approach adopted by (Knobel et al., 2005). The direct costs included the medical costs for the complete PEP treatment and indirect costs such as transport costs for the victim and parents or attendants, food, airtime or communication costs and accommodation costs for people from rural areas. The human PEP administered to dog bite victims in Uganda is a five-dose regimen treatment given at 0, 3,7,28 and 90 days intervals. The data were entered into MS Excel and analyzed using descriptive statistics including percentages and frequencies.

Results

The number of animal bites was relatively constant throughout the two years under study, with a slight peak from March to May in 2014 and April to June in 2015 (Figure 1 and Figure 2). Animal bites were reported among all age groups, although the age bracket below eighteen years was most affected (Table 1). Prevalence of animal (dog) bites in Uganda by region is as shown in Figure 3.

Table 1. Prevalence of dog bites by age group of the victim

Fig. 1.Total number of animal bites in different months and years in Uganda. 

Fig. 2. Two-year prevalence of suspected rabid animal bites at Entebbe National Rabies Referral Hospital

Fig. 3. The prevalence of animal bites by geographical distribution