Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014-15: a retrospective follow-up survey.
Effect of counselling on health-care-seeking behaviours and rabies vaccination adherence after dog bites in Haiti, 2014-15: a retrospective follow-up survey.
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DOI：
10.1016/s2214-109x(17)30321-2
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发表时间：
2017-10
期刊：
影响因子：
--
通讯作者：
Wallace RM
中科院分区：
文献类型：
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作者：
Etheart MD;Kligerman M;Augustin PD;Blanton JD;Monroe B;Fleurinord L;Millien M;Crowdis K;Fenelon N;Wallace RM
海地有一个综合咬伤案例管理（IBCM）计划，向动物咬伤受害者提供关于狂犬病风险和适当治疗的咨询，并有海地动物狂犬病监测计划（HARSP）来检查动物。我们评估了 IBCM 计划的有效性，以促进在低收入狂犬病流行环境中暴露后狂犬病预防的最佳实践。我们对 2014 年 5 月 15 日至 2015 年 9 月 15 日期间接受海地 IBCM 项目咨询的随机选择的咬伤受害者进行了回顾性跟踪调查。我们根据 HARSP 确认、可能、疑似或非狂犬病暴露的决定对参与者进行分类。我们比较了在 IBCM 咨询前寻求医疗护理的人和在咨询后寻求护理的人的医疗保健结果。我们使用决策树来估计医疗保健系统采取行动的概率，从而估计人类死亡。在研究期间，共有 1478 起狗咬伤事件报告给 HARSP 进行评估。 37 例（3%）为确认暴露，76 例（5%）为可能暴露，189 例（13%）为疑似暴露，1176 例（80%）为非狂犬病暴露。调查对其中 115 起案件进行了跟踪调查。 IBCM 咨询与咬伤受害者寻求医疗护理的频率增加 1.2 倍以及疫苗接种率增加 2.4 倍相关。我们估计，在调查期间 IBCM 评估的 1478 人中，将有 4 人因狂犬病死亡，如果没有该计划，则有 11 人死于狂犬病，这相当于狂犬病死亡人数减少 65%。在后续调查时死亡的三人中，有一人在可能接触狂犬病后被认为死于狂犬病。通过 IBCM 计划提供的咨询可能会改善对医疗提供者建议的遵守。
Haiti has an integrated bite case management (IBCM) programme to counsel animal-bite victims on the risk of rabies and appropriate treatment, as well as the Haiti Animal Rabies Surveillance Program (HARSP) to examine the animals. We assessed the usefulness of the IBCM programme to promote best practices for rabies prophylaxis after exposure in a low-income rabies-endemic setting. We did a retrospective follow-up survey of randomly selected bite victims who were counselled by Haiti's IBCM programme between May 15, 2014, and Sept 15, 2015. We classified participants by HARSP decisions of confirmed, probable, suspected, or non-rabies exposures. We compared health-care outcomes in people who sought medical care before IBCM counselling with those in people who sought care after counselling. We used decision trees to estimate the probability of actions taken in the health-care system, and thereby human deaths. During the study period, 1478 dog bites were reported to HARSP for assessment. 37 (3%) were confirmed exposures, 76 (5%) probable exposures, 189 (13%) suspected exposures, and 1176 (80%) non-rabies exposures. 115 of these cases were followed up in the survey. IBCM counselling was associated with a 1.2 times increase in frequency of bite victims seeking medical care and of 2.4 times increase in vaccination uptake. We estimated that there would be four human rabies deaths among the 1478 people assessed by IBCM during the survey period, and 11 in the absence of this programme, which would equate to a 65% decrease in rabies deaths. Among three people dead at the time of the follow-up survey, one was deemed to be due to rabies after a probable rabies exposure. Adherence to medical providers' recommendations might be improved through counselling provided by IBCM programmes.