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High Incidence of Human Rabies Exposure in Northwestern Tigray, Ethiopia: A Four-Year Retrospective Study.

ABSTRACT: BACKGROUND:Rabies is a fatal zoonotic disease that has been known in Ethiopia for centuries in society as "Mad Dog Disease". It is an important disease with veterinary and public health significance in the North western zone of Tigray where previous studies have not been conducted. Frequent occurrence of outbreaks in the area led the researchers to carry out a four year retrospective study to estimate the incidence of human rabies exposure in Northwestern Tigray, Ethiopia. METHODOLOGY:A referent study was conducted on human rabies exposure cases recorded from 2012 to 2015 at Suhul hospital, Shire Endaselase, Northwestern Tigray, Ethiopia. Exposure cases included in this research constituted victims bitten by unprovoked dogs and who received post exposure prophylaxis (PEP) at the hospital. Two thousand one hundred eighty human rabies exposure cases retrieved from the rabies case database were included in this study. PRINCIPAL FINDINGS:The majority of the exposed cases were males (1363/2180, 63%). Age wise, the most exposed age group was ?15 years in all the study years: 166 (58%), 335 (65%), 492 (66%) and 394 (63%) in 2012, 2013, 2014 and 2015, respectively. Similarly, exposure cases for human rabies increased with age in both males and females across the study years. The incidence of human rabies exposure cases calculated per 100,000 populations was 35.8, 63.0, 89.8 and 73.1 in 2012, 2013, 2014 and 2015, respectively. Binary logistic regression analysis revealed that being male was a risk for human rabies exposure in all the study years. CONCLUSION:The study discovered the highest annual human rabies exposure incidence in Ethiopia. This suggests an urgent need for synergistic efforts of human and animal health sectors to implement prevention and control strategies in this area.

SUBMITTER: Teklu GG

PROVIDER: S-EPMC5245898 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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High Incidence of Human Rabies Exposure in Northwestern Tigray, Ethiopia: A Four-Year Retrospective Study.

Teklu Gebreyohans Gebru GG Hailu Teweldemedhn Gebretinsae TG Eshetu Gebremedhin Romha GR

PLoS neglected tropical diseases 20170106 1

<h4>Background</h4>Rabies is a fatal zoonotic disease that has been known in Ethiopia for centuries in society as "Mad Dog Disease". It is an important disease with veterinary and public health significance in the North western zone of Tigray where previous studies have not been conducted. Frequent occurrence of outbreaks in the area led the researchers to carry out a four year retrospective study to estimate the incidence of human rabies exposure in Northwestern Tigray, Ethiopia.<h4>Methodology ...[more]

PMID: 28060935

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Project description:BACKGROUND: Rabies is one of the oldest known and most feared human diseases. Epidemiological studies provide basic information about the burden of the disease and underline the importance of prevention and control interventions. However, there have been limited studies conducted regarding the incidence of rabies and associated factors in Ethiopia, in general, and in this study area, in particular. Therefore, the aim of this study was to assess the incidence of human rabies exposure and associated factors at the Gondar Health Center, Ethiopia. METHODS: A retrospective cross-sectional study was conducted at the Gondar Health Center where post-exposure prophylaxis (PEP) for rabies was available for the whole population in the North Gondar Zone catchment area. Data of human rabies exposure cases between 2011 and 2013 were collected from the rabies PEP registration book using data abstraction sheets. The data was entered and analyzed using SPSS version 16 statistical software. RESULT: A total of 261 cases of human rabies exposure were reported to the Gondar Health Center from 2011 to 2013. The sex and age specific distribution showed that the majority of these cases were among males (142/226, 62.8%) and children under 15 years of age (87/226, 38.5%). A predominant number of cases were observed in individuals from rural areas (161/220, 73.2%), and during fall and winter seasons (67/222, 30.18%). A significant number of people exposed to rabies (23.2%) came to the health center for PEP two or more weeks after the injury. The incidence of human rabies exposure cases was 4.6, 2.61, and 1.27 per 100, 000 population in 2011, 2012, and 2013, respectively. Being male and living in an urban setting were found to be risk factors for human rabies exposure in 2011. CONCLUSION: A significant number of human rabies exposure cases were reported to the Gondar Health Center. Being male and living in an urban setting were found to be associated with rabies exposure. A community-based follow-up study is recommended to more accurately estimate the incidence of human rabies exposure.

Project description:BackgroundThe intradermal route of vaccine administration for pre-exposure rabies prophylaxis, endorsed by the Canadian National Advisory Committee on Immunization, was implemented at a large travel clinic in Montréal in 2008. We evaluated the effect of intradermal vaccination availability on uptake of pre-exposure rabies prophylaxis and rates of seroconversion with intradermal vaccination.MethodsWe conducted a retrospective cross-sectional study using data from December 2008 to December 2014. The number of travellers who received pre-exposure rabies prophylaxis before and after the introduction of intradermal vaccination was compared. Postvaccination antibody titres were measured in intradermal vaccination recipients. We compared demographic and travel characteristics between vaccinated and unvaccinated travellers and between travellers in the intradermal and intramuscular groups using univariate and multivariate analyses.ResultsThe proportion of travellers who received pre-exposure prophylaxis increased after the introduction of intradermal vaccination (annual average of 300 travellers from December 2009 to December 2014 v. 183 travellers from December 2006 to December 2007). Seroconversion occurred in 99.9% of those in the intradermal group. Travellers who received pre-exposure prophylaxis were older (mean age 35.8 yr v. 32.1 yr) and had longer travel duration than those who did not receive pre-exposure prophylaxis. Travellers to Asia were more likely to receive pre-exposure prophylaxis, and travellers visiting friends and relatives were less likely to receive it. Travellers in the intradermal group were younger than those in the intramuscular group and were more likely to be travelling for tourism.InterpretationThe introduction of intradermal vaccination for pre-exposure rabies prophylaxis was associated with an increase in vaccination uptake. Reduced cost may be responsible for the increased coverage among younger travellers and those travelling for tourism. The high seroconversion rate after intradermal vaccination supports the effectiveness of this route of administration for pre-exposure rabies prophylaxis in immunocompetent people.

Project description:BackgroundDrug use evaluation is a systematic approach to determining the appropriateness of drug use, identifying drug therapy problems, and proposing interventions. Ceftriaxone is one of the most widely used drugs in hospitals, requiring the performance of drug use evaluation. This study was aimed at evaluating the appropriateness of ceftriaxone use at Kahsay Abera and Mearg hospitals in the Western zone of Tigray, Ethiopia.MethodsAn institution-based retrospective cross-sectional study design was conducted in both hospitals from December 2015 to August 2016 using standardized and pretested data collection formats. Systematic random sampling was used, and a total of 800 patients' medication records (patients who took ceftriaxone) from both hospitals (400 each) were assessed in this study. Statistical analysis was performed by using the statistical package for social sciences (version 20).ResultsThe overall appropriateness of ceftriaxone use in Kahsay Abera and Mearg hospitals was 247 (61.75%) and 252 (63.0%), respectively. The majority of inappropriate use of ceftriaxone was noted in indication errors at both Kahsay Abera (71.2%) and Mearg hospitals (52.0%). The treatment duration in Kahsay Abera (69%) and Mearg hospitals (88%) was in the range of 2-7 days. Mostly, a 2-gram ceftriaxone daily dose was prescribed in both Kahsay Abera and Mearg hospitals, accounting for 285 (71.25%) and 318 (79.5%), respectively. In this study, the top three diseases, indicated for ceftriaxone in both hospitals, were typhoid fever, urinary tract infection, and pneumonia in descending order. Among the medications coadministered with ceftriaxone, the top three coprescribed drugs with ceftriaxone in Kahsay Abera Hospital were metronidazole (17.25%), tramadol 68 (11.28%), and diclofenac (8.96%), but in Mearg Hospital, next to metronidazole, drugs like paracetamol and doxycycline were the most common coprescribed medicines along with ceftriaxone.ConclusionThe appropriateness of ceftriaxone use in Kahsay Abera and Mearg hospitals was 247 (61.8%) and 252 (63%), respectively, in which about one-third of patients' charts were not compliant with the standard treatment guidelines of Ethiopia for general hospitals. In Kahsay Abera and Mearg hospitals, the empiric use of ceftriaxone was 262 (65.5%) and 375 (93.8%), respectively.

Project description:INTRODUCTION:Neural tube defects are the major causes of fetal loss and considerable disabilities in infants. Currently, there is no significant research on the incidence of Neural tube defects in the Tigray region of Ethiopia. OBJECTIVE:To determine the incidence and clinical pattern of the Neural Tube Defects. METHODS:A hospital-based cross-sectional study was conducted from October 2016 to June 2017. All pregnancy outcomes were examined for any externally visible birth defects and neurological integrity by trained midwives under the supervision of senior obstetrics and gynecology and a neurosurgeon. Data were collected using a survey tool to collect maternal and newborn demographic data and a checklist developed to capture newborns with Neural Tube Defects. Data were analyzed using SPSS version 20. The prevalence of NTDs was calculated per 10,000 births. RESULT:Out of the 14,903 births during the study period, a total of 195 infants were born afflicted with Neural Tube Defects. The burden of infants with anencephaly and spina bifida was 66.4 and 64.4 per 10, 000 births, respectively. The overall incidence rate of NTDs in this study was 131 per 10, 000 births of which 23% were liveborn and 77% were stillborn. The highest burden of Neural Tube Defects was observed in Adigrat Hospital from Eastern Zone of Tigray (174 per 10,000 births) and Lemlem Karl Hospital from Southern Zone of Tigray (304 per 10,000 births) compared to Kahsay Abera Hospital from Western Zone (72.8 per 10,000 births) and Sihul Hospital from North Western Zone of Tigray (69.8 per 10,000 births). CONCLUSION AND RECOMMENDATION:Assuming that the non folic acid preventable rate should be 5 per 10,000 births, our prevalence rate is 131 per 10,000 births, and then we have a rate or an epidemic that is 26 times what it should be. This just emphasizes the urgency to implement effective programs to get all women of reproductive age to have adequate folic acid to prevent all of folic acid-preventable spina bifida and anencephaly, which would prevent 96% (125/130) of spina bifida and anencephaly in the Tigray Provence.

Project description:Zoonotic diseases continue to affect the health and livelihood of resource limited communities. In Ethiopia, despite the presence of a national master plan for prevention, control and elimination of some common zoonotic diseases, well-organized epidemiological data regarding incidence and distribution are lacking. A retrospective cross-sectional study based on a patient medical data recorded from 2012-2016 in selected districts of Southern Tigray, North Wollo zone of Amhara region and Ab'Ala district of Afar region was conducted to map the distribution and Incidence proportion of major zoonotic diseases. The incidence proportion of four major zoonotic diseases (helminthiasis, tuberculosis (TB), rabies and schistosomiasis) was mapped using qGIS software based on the Health Management Information System (HMIS) data collected from district health facilities. The result indicated that, out of a total 1,273,145 observed human disease cases, 53,614 (4.2%) of them were potential zoonotic diseases that include: helminthiasis (51,192), TB (2,085), rabies (227), schistosomiasis (105) and visceral leishmaniasis (7). The highest incidence proportion of TB (262.8 cases per 100,000 population) and rabies (33.2 cases per 100,000 population) were recorded in Gubalafto and Weldya followed by Raya Alamata (253.4 cases per 100,000 population %), and Ab'Ala and Raya Azebo (29 cases each per 100,000 population) for TB and rabies, respectively. The highest incidence proportion for schistosomiasis was reported in Raya Alamata (50.1 cases per 100,000 population) followed by Gubalafto and Weldya (10.8 cases per 100,000 population). The incidence proportion of visceral leishmaniasis per 100,000 population was 4.1, 1.3 and 1.2 cases for Ab'Ala, Gubalafto and Weldiya, and Raya Azebo districts, respectively. Except rabies, which showed high incidence proportion (p<0.0001) in 5-14 age groups, the other zoonotic diseases showed higher incidence proportion (p<0.0001) in age groups above 15 years. Rabies, helminthiasis and schistosomiasis showed statistically significant variation (p<0.0001) among seasons. Rabies and TB showed decreasing trend within the data recorded years. In animals, only 31 rabies cases and 15 anthrax cases were recorded from 2012 to 2016. This finding highlighted the distribution and incidence of some major zoonotic diseases in the study areas. Systematic and detailed research should be conducted in the future to map the distribution of major zoonotic diseases at regional and country level so as to initiate integrated effort from human and animal health authorities and professionals.

Dataset Information

High Incidence of Human Rabies Exposure in Northwestern Tigray, Ethiopia: A Four-Year Retrospective Study.

Publications

High Incidence of Human Rabies Exposure in Northwestern Tigray, Ethiopia: A Four-Year Retrospective Study.

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