Management of dog bites by frontline service providers in primary healthcare facilities in the Greater Accra Region of Ghana, 2014-2015

Abstract

Background: Dog bites are common in developing countries including Ghana, with the victims often being children. Although some breeds of dogs have been identified as being more aggressive than others, all dog bites carry a risk of infection. Immediate and initial assessment of the risk for tetanus and rabies infection with appropriate interventions such as wound management and subsequent selection of prophylactic antibiotics are essential in the management of dog bites. This study examined the management of patients with dog bites by frontline service providers at primary healthcare facilities in the Greater Accra Region, Ghana.

Methods: We conducted a cross-sectional study in 66 public health facilities in the Greater Accra Region from July 2014 to April 2015. Up to four frontline service providers were randomly selected to participate from each facility. A structured questionnaire was administered to all consenting participants. Continuous variables were presented as means and standard deviations. The frontline service providers' knowledge was assessed as a discrete variable and values obtained presented as percentages and proportions. The chi-square test of proportions was used to determine any significant associations between the various categories of the frontline service providers and their knowledge about the management of rabies.

Results: Regarding the frontline service providers' knowledge about rabies, 57.8% (134/232) were correct in that the rabies virus is the causative agent of rabies, 39.2% (91/232) attributed it to a dog bite, 2.6% (6/232) did not know the cause, and one person (0.4%) attributed it to the herpes virus. Only 15.5% (36/232) knew the incubation period in dogs and the period required to observe for signs of a rabies infection. With respect to the administration of rabies immunoglobulin, 42.2% (98/232) of the frontline service providers did not know how to administer it. Of the facilities visited, 76% (50/66) did not have the rabies vaccines and 44% (102/232) of frontline service providers did not know where to get the rabies vaccines from. Most of the service providers (87.9%; 204/232) had never reported either a dog bite or a suspected case of rabies. Overall, there was gross underreporting of dog bites and suspected rabies cases at public healthcare facilities in the Greater Accra Region of Ghana.

Conclusions: In view of the high morbidity and mortality associated with bites from rabid dogs and the poor knowledge and practices of frontline service providers, there is an urgent need for capacity-building such as training in the management of dog bites and subsequent potential rabies infection.

Keywords: Dog bites; Frontline service providers; Ghana; Greater Accra Region; Healthcare facilities; Rabies.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for the study was obtained from the Ethical Review Committee of Ghana Health Service and Noguchi Memorial Institute for Medical Research. Furthermore, permission to conduct the study was sought from the Greater Accra Regional Health Directorate and the various public sector health facility superintendents.

Identifiers in terms of healthcare service providers’ and facilities’ names were all removed prior to storage and analysis, and only study IDs were used to guarantee participant confidentiality.

All members of the study team were required to participate in and have an active certificate in human subject studies and research ethics from the Collaborative Institutional Training Initiative program.

Written informed consent was sought from all participants prior to questionnaire administration. Data were stored in a secure locked cabinet and access was granted to the principal investigator and co-principal investigator only. Data held on computers were encrypted with a password that was made available only on-a-need-to-know basis.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.