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. 2021 Jul 14;16(7):e0254650. doi: 10.1371/journal.pone.0254650

Table 1. Summary of themes and concepts that emerged out of the analysis.

Themes Concepts
Taking the history of dog bite events • History was being taken because it has links with the severity of the bite; treatment choices and outcomes.
• History determines the risk of rabies of the biting dog in all cases.
• There were variations in the depth of the history taken due to time constraints and high caseloads.
• Rabies vaccination history was taken in very few cases because healthcare workers assume all victims are not vaccinated.
• Previous dog bite episodes were not investigated.
• History of tetanus vaccination was not investigated.
• Much of the history is taken but it is neither verified nor written down on the
• patient’s file.
Examination of the dog bite injuries • Location of wounds was recorded in all cases although not all clinicians could accurately classify the bites.
• Ancillary tests like radiology; complete blood counts; and culture and sensitivity test are not done.
Treatment of dog bite injuries • Wound sanitation was undertaken in approximately one third of the cases.
• Antibiotics are prescribed for treatment of infection and prophylactic purposes in three quarters of the cases but without sensitivity testing.
• Tetanus vaccination was done in nearly three quarters of the cases.
• Rabies immunoglobulin (RIG) is not given due to its unavailability and costs to the patient, even in the circumstances where it should have been given.
• Anti-rabies vaccine (ARV) is at times given unnecessarily, for example in category I bites.
• Health education regarding prevention of dog bites is not given to patients.
Follow up of dog bite patients • Patients do not go back to the clinician but to the vaccination station where three elements are done: additional post exposure rabies vaccine doses; assessment of wounds; and reporting on the health status of the biting dog.
• Non-compliance includes termination of treatment, violating the vaccination schedule and adding traditional treatments to the wounds.
Challenges in the clinical management of dog bites according to UCG • Absence of the immunoglobulins; frequent stock outs of the vaccine; lack of collaboration and linkages among health facilities; distance to be covered by patients; high costs of treatment; deviations from wound home care instructions; and insufficient knowledge and skills on how rabies and dog bite injuries should be treated.