Determinants of delay in initiating post-exposure prophylaxis for rabies prevention among animal bite cases: hospital based study.

Background: India is highly endemic for rabies. Although fatal, rabies is a preventable disease. Several factors interfere with the timely utilization of post exposure prophylaxis (PEP) in the population. There is a need to explore the factors leading to delay in PEP initiation.

Objective: To study the factors associated with delay in initiation of PEP among animal bite cases attending anti-rabies clinic in the out-patient department (OPD) of a hospital in Delhi.

Materials And Methods: A cross-sectional hospital based study was conducted among 200 patients attending the anti-rabies clinic. After obtaining informed consent, the patients were interviewed using a pre-tested, semi-structured questionnaire to find out the delay in initiation of PEP and the factors associated with it.

Results: Most common biting animal was found to be dog (96%). Out of the studied subjects (n=200), 134 (67%) were males, 123 (61.5%) were from rural areas and 61 (30.5%) were illiterate. Delay in initiation (vaccine initiation in more than or equal to 48 h) of PEP was found among 41% of the studied subjects. The mean time spent during each visit by the study subjects were 3.46 h (SD 1.60). Delay was more likely in people living at a distance of more than 10 km from the vaccination centre (p<0.001) and with a monthly family income less than 5000 INR (p=0.004). Delay showed an increasing trend with age (p=0.041). Most commonly cited reasons by the respondents (n=82) for the inability to come early for vaccination included work related barriers (42.68%), anti-rabies clinic being closed on Sundays/national holidays (36.59%) and unawareness about timely PEP (31.71%).

Conclusion: Accessibility and lower economic status were the major factors associated with delay in initiation of PEP for rabies prevention.