Determinants of abandonment of rabies post-exposure prophylaxis at the Bouaké Anti-rabies Center; Ivory Coast

M’bégnan Coulibaly, Damus Paquin Kouassi, Henri auguste Yao Gnissan, Arsène Deby Kouame, N’Guessan Konan, Sory Ibrahim Soumahoro, Harvey Attoh-Toure, Issaka Tiembre

Résumé


In Côte d'Ivoire, a high number of exposed people abandoned the Post-Exposure Prophylaxis. Our objective was to determine the factors influencing the adherence to the Post-Exposure Prophylaxis  at the anti-rabies Center of Bouaké. Methods: we carried out an ambispective study, based on the review of patient records from January 2014 to December 2015 and on contacting all patients by phone.

Results: A total of 1487 people at risk of rabies infection received Post-Exposure Prophylaxis, whom 54, 4% abandoned their treatment. The majority of the victims was under of 15 years old (56, 8%) and was male (59, 1%). Lesions were predominantly of category III (55, 3%) and 2, 3% was located on the head. In 87% of cases, the biting animal was not properly vaccinated and 66% of the victims consulted within 48 hours after exposure. Among the exposed subjects, 54% had discontinued treatment; the main reasons were cost (76%) and neglect (28%) and it was influenced by household’s average income RR=0,741; IC95%= [0,353-0,838].

Conclusion: Vaccine prevention, the only effective way to prevent human rabies, faces to high drop-out rate of post-exposure prophylaxis. The main obstacles to the correct observance of this treatment are related on the one hand to the distance of care structures for the rural populations and on the other hand to financial inaccessibility.

Keywords : Rabies, Post-exposure prophylaxis, Abandonment, associated factors

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