Factors associated with poor compliance to rabies post-exposure prophylaxis among dog bite victims in Maswa District in Tanzania: a cross-sectional study

Abstract

Introduction: administering rabies post-exposure prophylaxis (PEP) in a timely and appropriate manner remains the most fundamental measure for preventing human rabies. However, a number of barriers to accessing and completing PEP exist. Methods: a cross-sectional study was carried out from April to July 2022 to examine individual and societal barriers to accessing human rabies PEP in Maswa in Maswa District, Tanzania. Dog bite patients were interviewed to gather information about the circumstances of the bite, as well as the availability, affordability, and compliance with PEP. Descriptive and inferential analyses were conducted to address the research question. Results: of the 264 bite patients, 57.6% were male and 67.2% were under 15 years old. Dog bites accounted for the highest proportion of cases 95.5% (n=252) and category-III bites were most frequently observed 63% (n=167). About 45.1% (n=119) of patients traveled over 25 kilometers (km) from their residences to reach PEP clinics. The average cost for obtaining PEP doses was USD 51.1. Only 3.8% (n=10) of patients received all five recommended PEP doses. Travel distances and costs were significant factors for poor PEP compliance. Patients who traveled by bicycle to health facilities had higher odds of PEP compliance (aOR =17.12: 95% CI: 14.12 - 23.42) than those who walked (aOR = 6.88: 95% CI: 1.28 - 26.13). Furthermore, patients who utilized buses were four times more likely to comply to PEP (aOR = 4.23, 95% CI: 1.06 - 16.46) than those using motorcycles. Bite patients from urban areas were 6 times more likely to complete the recommended PEP (aOR = 5.79, 95% CI: 1.29 - 15.20) than their rural counterparts. Conclusion: findings from this study inform measures to improve compliance to rabies PEP among dog bite victims. These measures include subsidizing the cost of PEP, improving PEP accessibility, and raising awareness about the dangers of rabies particularly in seeking and completing the recommended PEP focusing on rural communities