Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan
Abstract Background Rabies is endemic in southern Bhutan, associated with 1–2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians’ management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce...
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doaj-7aab4c87d75f47ce8944bb78460e1c642020-11-25T03:43:35ZengBMCBMC Infectious Diseases1471-23342020-03-0120111210.1186/s12879-020-4926-yEvaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern BhutanKinley Penjor0Nelly Marquetoux1Chendu Dorji2Kinley Penjor3Sithar Dorjee4Chencho Dorjee5P. D. Jolly6R. S. Morris7J. S. McKenzie8School of Veterinary Science, Massey UniversitySchool of Veterinary Science, Massey UniversitySchool of Veterinary Science, Massey UniversitySchool of Veterinary Science, Massey UniversitySchool of Veterinary Science, Massey UniversityFaculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of BhutanSchool of Veterinary Science, Massey UniversityMorvet Ltd, Consultancy services in health risk management and food safety policy and programsSchool of Veterinary Science, Massey UniversityAbstract Background Rabies is endemic in southern Bhutan, associated with 1–2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians’ management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce unnecessary costs associated with PEP and reach the target of zero human deaths due to rabies by 2023. Methods A cross-sectional survey of 50 clinicians’ management of human cases potentially exposed to rabies was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February–March 2016. Results Data were collected on clinicians’ management of 273 human cases potentially exposed to rabies. The 50 clinicians comprised health assistants or clinical officers (55%) and medical doctors (45%) with a respective median of 19, 21 and 2 years’ experience. There was poor agreement between clinicians’ rabies risk assessment compared with an independent assessment for each case based on criteria in the National Rabies Management Guidelines (NRMG). Of the 194 cases for which clinicians recorded a rabies risk category, only 53% were correctly classified when compared with the NRMG. Clinicians were more likely to underestimate the risk of exposure to rabies and appeared to prescribe PEP independently of their risk classification.. Male health assistants performed the most accurate risk assessments while female health assistants performed the least accurate. Clinicians in Basic Health Units performed less accurate risk assessments compared with those in hospitals. Conclusions This study highlights important discrepancies between clinicians’ management of human cases potentially exposed to rabies and recommendations in the NRMG. In particular, clinicians were not accurately assessing rabies risk in potentially exposed cases and were not basing their PEP treatment on the basis of their risk assessment. This has significant implications for achieving the national goal of eliminating dog-mediated human rabies by 2030 and may result in unnecessary costs associated with PEP. Recommendations to improve clinician’s management of human cases potentially exposed to rabies include: reviewing and updating the NRMG, providing clinicians with regular and appropriately targeted training about rabies risk assessment and PEP prescription, and regularly reviewing clinicians’ practices.http://link.springer.com/article/10.1186/s12879-020-4926-yBhutanClinical risk assessmentNeglected diseasesPost-exposure prophylaxisPublic healthRabies |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kinley Penjor Nelly Marquetoux Chendu Dorji Kinley Penjor Sithar Dorjee Chencho Dorjee P. D. Jolly R. S. Morris J. S. McKenzie |
spellingShingle |
Kinley Penjor Nelly Marquetoux Chendu Dorji Kinley Penjor Sithar Dorjee Chencho Dorjee P. D. Jolly R. S. Morris J. S. McKenzie Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan BMC Infectious Diseases Bhutan Clinical risk assessment Neglected diseases Post-exposure prophylaxis Public health Rabies |
author_facet |
Kinley Penjor Nelly Marquetoux Chendu Dorji Kinley Penjor Sithar Dorjee Chencho Dorjee P. D. Jolly R. S. Morris J. S. McKenzie |
author_sort |
Kinley Penjor |
title |
Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan |
title_short |
Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan |
title_full |
Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan |
title_fullStr |
Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan |
title_full_unstemmed |
Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan |
title_sort |
evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern bhutan |
publisher |
BMC |
series |
BMC Infectious Diseases |
issn |
1471-2334 |
publishDate |
2020-03-01 |
description |
Abstract Background Rabies is endemic in southern Bhutan, associated with 1–2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians’ management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce unnecessary costs associated with PEP and reach the target of zero human deaths due to rabies by 2023. Methods A cross-sectional survey of 50 clinicians’ management of human cases potentially exposed to rabies was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February–March 2016. Results Data were collected on clinicians’ management of 273 human cases potentially exposed to rabies. The 50 clinicians comprised health assistants or clinical officers (55%) and medical doctors (45%) with a respective median of 19, 21 and 2 years’ experience. There was poor agreement between clinicians’ rabies risk assessment compared with an independent assessment for each case based on criteria in the National Rabies Management Guidelines (NRMG). Of the 194 cases for which clinicians recorded a rabies risk category, only 53% were correctly classified when compared with the NRMG. Clinicians were more likely to underestimate the risk of exposure to rabies and appeared to prescribe PEP independently of their risk classification.. Male health assistants performed the most accurate risk assessments while female health assistants performed the least accurate. Clinicians in Basic Health Units performed less accurate risk assessments compared with those in hospitals. Conclusions This study highlights important discrepancies between clinicians’ management of human cases potentially exposed to rabies and recommendations in the NRMG. In particular, clinicians were not accurately assessing rabies risk in potentially exposed cases and were not basing their PEP treatment on the basis of their risk assessment. This has significant implications for achieving the national goal of eliminating dog-mediated human rabies by 2030 and may result in unnecessary costs associated with PEP. Recommendations to improve clinician’s management of human cases potentially exposed to rabies include: reviewing and updating the NRMG, providing clinicians with regular and appropriately targeted training about rabies risk assessment and PEP prescription, and regularly reviewing clinicians’ practices. |
topic |
Bhutan Clinical risk assessment Neglected diseases Post-exposure prophylaxis Public health Rabies |
url |
http://link.springer.com/article/10.1186/s12879-020-4926-y |
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