Epidemiologic Features Of Dog Bites In Babylon Province During The Years 2012-2016

Hadeel Turki Bairmani,Hasan Alwan Baiee
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Keywords : Epidemiology, dog bites, Babylon, Iraq.
Medical Journal of Babylon  14:3 , 2018 doi:1812-156X-14-3
Published :06 January 2018

Abstract

Dog bites is a public health problem especially in low and middle income countries including Iraq in which epidemiologic studies on dog bites and rabies are very scarce. A descriptive cross sectional study was conducted using Time Person Place epidemiologic model. Male were significantly more predominate and younger than females victims p<0.001. Children under ten years of age and students constituted the majority of dog bites cases (34.7%) and (37.7%) respectively. The study revealed that one sixth of dog bites victims didn’t receive prophylactic anti rabies vaccine, only 17.8% of them had completed the five recommended doses. Lower limbs were the main body site exposed to biting injuries which constituted 73.7% followed by upper limbs (20%), February and March showed the highest proportion of dog bites (24.7%). the majority of dog bites (36.6%) were reported in Al-Hashmia district. The problem of dog bite is an important health problem in Babylon affecting mainly male children more than four fifth of victims didn’t complete the recommended anti rabies prophylactic vaccination, strategic preventive health plan is strongly requested to prevent and control this health problem.

Introduction

Humans have lived alongside dogs for 14,000 years at least, [1,2]. They have also been familiar with their diseases, which became more common as populations and their animals congregated in the cities that arose in Mesopotamia [3-5]. Distinct copies described Sumerian rules and regulations attesting to the fact that a causal link between the bite of a rabid animal and a human death from rabies was well recognized in Iraq almost 4000 years ago [6]. Dog bites are a serious health problem that cause both physical and emotional damage to victims and considerable cost to communities [7] and constituted the most common animal bites [8,9]. Globally, estimates indicate that human mortality (due to endemic canine-mediated rabies) is highest in Asia. This is closely followed by Africa; however estimates of burden have always been uncertain due to the absence of reliable data, [10]. One of the important methods of controlling rabies is by studying the problem and carrying out interventions to limit the number of dog bites [11]. Rabies, caused by bites of dogs, is almost always fatal after the onset of clinical signs. The disease can efficiently be averted by avoiding contact with dogs andpost exposure prophylaxis [12]. Canine rabies causes approximately 59,000 human deaths globally, over 3.7 million disability-adjusted life years, and 8.6 billion USD economic losses annually [13], the majority of deaths occurring in Africa and Asia [14]. World Health Organization (WHO) supports targets for elimination of human rabies transmitted by dogs in Asia by 2020, aims to halve the currently estimated number of human rabies deaths in endemic countries [15], dog bites lead to different serious other complications such as amputations, Physical scarring, emotional injuries; post-traumatic stress disorders, depression, and cynophobia which is the fear of dogs. Fear of dogs can isolate a person from families or friends that have dogs in their homes[16-17]. In Babylon province there is no data of human rabies death from 2010 to 2014 and the studies about dog bites attacks are very scarce [18]. This study was conducted to determine the epidemiologic features of dog bites among victims who seek healthcare in Babylon province during five years period.

Materials and methods

This study evaluated dog bites cases registered in the communicable diseases unit-public health department in Babylon health directorate for 5-years period (January 1, 2012 to December 31, 2016). The collection and analysis  of data study took about four months from February through May 2016,the registered data were checked by the researcher himself single handy and compared with other sources of data in Babylon veterinary hospital to increase the  accuracy of the collected data.
A descriptive cross sectional study was applied using Time Person Place epidemiologic model, this descriptive epidemiologic model is suitable for describing the demographic characteristics of diseases and health related events depending on available data [19].
The approval of health authority was obtained, the following variables were studied: time factors  include months and years to explain the frequency of occurrences of dog bites according to time  and  to explain the  trend of this health problem in the province, dog bites were categorized according to places of occurrences  by  districts (counties) of the province; variables related to victims (personal characteristics) were studied such as gender , age, occupations , the sites of dog bite (exposure) and the vaccination status. The collected data were analyzed by using  Statistical Package of Social Science (SPSS) version 21, simple descriptive statistics and inferential statistics (Chi  square and t tests were applied  to identify the significant of difference between variables). P value less than 0.05 considered as a level of statistical  significant.




Results

Figure 1 shows the distribution of persons with dog bite according to age. Among studied group majority (34.7%) were children below or equal 10 years.

Discussions

Animal bites pose a serious public health threat both in developed and developing nations [20]. The total number of dog bite victims estimated in Babylon province during the study period (2012-2016) was 21519 cases the average number of dog bites in each year is 4303 according to population statistical data of Babylon province the average number of population per year in the study period was 1730000, (only 12737 reported cases have completed data which constituted 59.2% of total dog bites cases). The rate of dog bites in this study is 249 per 100000 population, the real number could be more because many people do not seek medical advice or using both private health services and home therapy leading to under reporting of the real burden of this problem in Iraq, This rate is higher than that reported by other researchers in Islamic Republic of Iran who estimated (144/100000 population) [7]. The studied epidemiological characteristics showed highly significant differences towards male victims who were older than female victims, this finding is similar to the finding reported by other local study carried out in Baghdad [21]. In this study the age-group of (less than 10 years) was most frequently exposed to dog bites which constituted (34.7%), many other authors [22-24] revealed that children under 15 years of age were victims of dog bites, the bites appeared to be provoked by an interaction of the child with dogs. The highest reported victims was during the year 2013 compared to other years, the frequency of multiple dog bites is significantly higher in this year this may be explained by the high number of stray dogs and weak killing attacks implemented in the province due to in security condition together with poor environmental and municipality activities or may be due to the temporary improvement in reporting and recording activities. In our study, there was an evident of increasing of number of dog bite attacks during February and March months, while in Ethiopia [25], there was no significant peak in the monthly distribution of dog bites, while the time of occurrence of dog bite victims living in Ghana [26] and Chandigarh, India [27] showed high number of cases during summer months, dogs being warm blood animals with temperature homeostatic mechanism, have activities relatively independent of temperature [28].This study shows that the highest number of patients lived in Al-hasmia district which has a large numbers of villages, this finding is similar to the findings of other international studies [29,30]. Dog bite injuries mainly involved the lower extremities this finding goes with finding reported by other researchers [31-33], this may be explained by the fact that legs being considered the nearest site to be attacked, our results contradict the findings of Sheikholeslami in Iran who found that dog related lesions was involving the upper extremities [7], while a study on children performed by Chaim et al in South Australia between the years 2009 and 2011 showed that the head and neck region constituted the most common location for injuries [34]. Five doses World Health Organization regime of prophylactic vaccine was followed in our country, one dose of vaccine is administered intramuscularly on days 0, 3, 7, 14, and 28. Injections must be given in the upper arm (deltoid region) or, in small children, into the anterolateral thigh muscle [35,36] however, pre-exposure prophylaxis does not eliminate the need for prompt post exposure prophylaxis [37, 38]. In this study 14.7% patients received the first post prophylactic anti rabies, this proportion of unvaccinated patients is much higher than that reported in a study conducted in Philippine by Quiambao et al who found that the first dose of rabies vaccine was administered to 98.5% of the study population. Rabies vaccination for the second and third dose was continued, as documented in their records, in 53.8% and 43.5%, respectively, these figures of vaccination coverage are higher than our findings [38] this may be related to the better level of Philippines awareness and well established epidemiologic surveillance. In conclusion there is a persistence dog bites public health problem in Babylon province, children are at high risk, more in males, intra provincial variation was noted with a peak of dog bite attacks in February and March months, lower extremity are the most common region to be bite by dogs, only one sixth of victims had completed the prophylactic anti rabies vaccine.

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