Estimates of Human Cases of Dog Bites and Public Health Burden of Dog Bites in Homa Bay County, Kenya

Abstract

Dog bite is a prevalent but, underreported problem in the developing world. It’s almost always associated with rabies. Rabies, a disease of ancient times, continues to cause untold suffering and death in most of the developing world. Control efforts of the disease have largely been unsuccessful. Part of the reason for control failure is lack of data to inform policy on control. The objectives of the present study were to 1) Estimate human cases of dog bites and and 2) Assess the public health burden of dog bites in Homa Bay County, Kenya. The study was a survey of randomly selected households in three sub-counties of Homa Bay County. Within each selected sub-county, two wards were randomly selected. A transect walk was done within each ward and every 4th household selected until the required sample size was achieved. Two sets of data were collected:- retrospective study of hospital records from 2016 to 2018 and Survey (prospective study) of households in Homa Bay County in 2018. The latter method employed simple and systematic random sampling and data collected through questionnaires administered via personal interviews. There were 291 dogs found in the 198 households visited converting to 1.5 dogs per household. The dog population in the county was large and estimated at 192,000 dogs. The dog to person ratio was 1:6. Dog ownership in the county was common with 71% of the surveyed households owning dogs. The dog population in the county was inadequately protected from rabies through vaccination – only 27% of survey dogs were reportedly vaccinated against rabies. The annual animal bites of humans were 1,571/100,000 population i.e. 1.57% of the population. A large proportion (82%) of xii bites were inflicted in the lower extremities (feet and legs). Children especially those under 15 years of age, were the most affected. Compliance with the recommended five-dose vaccination regimen in humans was low. Only four of the 28 human bite cases reportedly completed the five doses of anti-rabies vaccinations. Reasons for non-compliance included, the prohibitive cost of antirabies vaccines, its non-availability at time of visit and the transport cost to health facility by the victim. The average cost of post exposure prophylaxis (vaccination) was estimated at KES. 3,450 with a range of KES 1200 to 6000. Further, transport cost to hospital was between KES60 and 500 with an average of KES 300. With the requirement of five hospital visits, the cost of transportation alone was approximated at KES 1500. In conclusion, this study has shown that dog bites had an incidence of 1.57%, and is a major public health problem in Homa Bay County. Control of rabies in dogs has not been adequate as shown by the low vaccination levels of dogs in the county which was only 27% as revealed by the study. There is a need to scale up rabies control efforts in the county with public participation being a major component of those efforts. These efforts are essential if the ancient and terrible disease -rabies- is to be controlled and eradicated.