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. |