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Description of Animal Bite Cases at Kilifi County Hospital and Administration of Anti-Rabies Vaccine, July 2014 to June
2015
Dr. Omolo Owiti
Kilifi County
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FELTP-Kenya
Animal bites occur mostly due to dog attacks
– Playing with dogs increase the chances of
bites
Other biting animals include
– Cats, donkeys, bees,
snakes, scorpions and
humans
Administration of anti rabies
vaccine is recommended to
be given on day zero
Introduction
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Problem Statement
More than 95% rabies exposures to humans
are due to dog bites
Estimated annual dog bite incidence in Kenya
– 234 per 100,000 persons (Kitala et al)
An average of 2 fatal rabies cases is reported
annually at Kilifi county hospital, both are
related to dog bites
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An average of 1,800 dog bite cases reported
in four main hospitals in Kilifi county
annually
Understand epidemiology of animal bites and
administration of anti-rabies vaccine in the
county
Justification
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Describe animal bite cases reported in Kilifi
County hospital
To determine the time taken by bite victims
to report to health facility
To determine the level of administration of
anti rabies vaccine
Objectives
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Methods
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Study design
Retrospective records review of animal bites registers at Kilifi County hospital
A case was defined as any person seeking animal bite treatment at Kilifi County Hospital between July 2014 to June 2015
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Study Area
County covers an area of 12,609.7 square km
Population- 1,109,735 (535,526 Males: 574,209 Females)
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Data abstracted from anti-rabies vaccine
register using a standardized data
abstraction tool
Variables Collected:– Sex
– Age
– Site of bite
– Location of residence
– Date of bite
– Date of reporting to health facility
– Type of biting animal
– Administration of anti-rabies Vaccine
Data Collection
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Data Analysis
Continuous data was analyzed using
measures of central tendencies and
dispersion
Categorical data was also analyzed using
frequencies and proportions
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Results
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Results 1/8
Total of 308 animal bites cases reviewed
Median age:17 years (Range :1 – 84 years)
Male persons reported more cases at 181 (59%)
The age group 5 – 15 years old had the highest
number of cases (35%)
Leg was the most bitten site at 161 cases (53%)
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Results 2/8
Most bites caused by dog- 302 (98%)
– Owned dog-181 cases (59%)
Median time taken between bite and reporting
to health facility was 2 days (range of 0 – 156
days)
Most bite cases came from Kilifi north sub
county, 166 (55%)
Of the bite cases reported, 299 (97%) received
the first anti rabies injection
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Results 3/8
0.3%
0.3%
0.3%
0.3%
0.7%
1.0%
3.3%
3.3%
3.6%
7.9%
26.0%
53.0%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%
headear
neckstomach
waist
abdomenleg and hand
buttockschestthigh
handleg
Proportion of number of cases
Sit
e O
f B
ite
Distribution of bite cases, by site of bite, Kilifi
county hospital, 2014-2015 (n=308)
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Results 4/8
Time taken to report to health facility following
bite incidence
97 % of all cases received first ARV
20.33%
39.00%
16.33%
7.67%5.00%
3.33%
8.33%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Pro
po
rtio
n o
f cases
<1 1-2 3-4 5-6 7-8 9-10 >10
Days
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Results 5/8
9%
28%
13% 13% 13%11%
9%
4%7%
40%
19%
9% 10%
6%4%
6%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
<5 5-15 15-25 25-35 35-45 45-55 55-65 >65
Pro
po
rtio
n o
f cases
age groupsf m
Distribution of bites cases, by age group and sex,
Kilifi county hospital,2014-2015 (n=308)
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Results 6/8
59%
39%
1% 1%0%
10%
20%
30%
40%
50%
60%
70%
owned dog ownerless dog owned cat ownerless cat
Typ
e o
f b
itin
g a
nim
al(
%)
Type of Biting Animal
Distribution of bite cases by type of biting
animal, Kilifi County Hospital 2014 – 2015 (n=308)
Ownerless animals= Stray animals??
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Results 7/8
2
13
22
37
14
29
16
34
2630 30
23
Jun Jul Aug Sep Oct Nov Dec Feb Mar Apr May Jun
2014 2015
Nu
mb
er
of
cases
Year
Distribution of bite cases, Kilifi county hospital by
month and year, June 2014- July 2015 (n=308)
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Results 8/8
Sub County Number Of Cases Proportion Kilifi North 166 54.61%Kilifi South 70 23.03%
Ganze 61 20.07%Malindi 3 0.99%
Magarini 2 0.66%Mombasa** 1 0.33%
Lamu** 1 0.33%Grand Total 304 100.00%
Distribution of bites, Kilifi county hospital,
2014-2015 by place Sub-County (n=308)
** - counties
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Children and young adults reported higher
number of bites
Almost all bites are caused by dogs
– Mostly by Owned dogs than ownerless
dogs
Most of the bites occur on the extremities
Almost all cases received the fist antirabies
vaccine injection
The time taken to receive the first anti rabies
vaccine was less than 72 hrs for most cases
Conclusions
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Conclusions cont’
September 2014 recorded the highest
number of cases
– Dog mating season
– Dry season, dogs scavenging
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Increase awareness to Children on dog bites
- To be made aware of dangers of dog bites and
ways of safely handling dogs
Enhanced linkages and
collaboration between
veterinary and human
health services
- Judicial administration of PEP
Recommendations
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Recommendations cont’
Increase awareness on responsible pet
ownership
Advocate for 70% rabies vaccination to dogs
and cats vaccination annually
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FELTP-Kenya
References
1. The Merck Veterinary Manual, Ninth Edition
2. World health organization : dog rabies
control
(www.who.int/rabies/animal/dogs/en)
3. CDC rabies information
http://www.cdc.gov/rabies/
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FELTP-Kenya
Acknowledgement
Field Epidemiology & Laboratory Training
Program
Public health team in Kilifi county
headquarters
County veterinary services directorate
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Thank You