Rabies Elimination in Rural Kenya: Need for Improved Availability of Human Vaccines, Awareness and Knowledge on Rabies and Its Management Among Healthcare Workers.
Rabies Elimination in Rural Kenya: Need for Improved Availability of Human Vaccines, Awareness and Knowledge on Rabies and Its Management Among Healthcare Workers.
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DOI：
10.3389/fpubh.2022.769898
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发表时间：
2022
影响因子：
5.2
通讯作者：
Thumbi SM
中科院分区：
文献类型：
--
作者：
Chuchu VM;Kitala PM;Bichanga P;Ksee D;Muturi M;Mwatondo A;Nasimiyu C;Maritim M;Mutono N;Beyene TJ;Druelles S;Hampson K;Thumbi SM
在非洲，狂犬病每年造成约24，000人死亡。大规模的犬只疫苗接种加上及时的犬咬伤患者暴露后预防（PEP）是消除人类狂犬病死亡的主要干预措施。一个消息灵通的卫生保健工作人员和狂犬病生物制剂在卫生设施的可用性和可及性是减少狂犬病死亡的关键。我们评估了肯尼亚东部农村地区对狂犬病的认识和知识，以及医护人员对狂犬病的管理和PEP的可用性。我们于2018年11月采访了肯尼亚马奎尼县马奎尼和Kibwezi West分县13个病房42个医疗单位的73名医护人员。收集并分析了人口统计学数据、工作经验、狂犬病知识、咬伤和狂犬病患者的管理以及狂犬病生物制剂的可用性。42个卫生设施中只有5个（12%）提供狂犬病PEP疫苗。在研究时，没有卫生机构有狂犬病免疫球蛋白库存。PEP主要通过肌内注射给药，只有11%（n = 8）的医疗保健工作者和17%（7/42）的医疗保健机构知道剂量节省的皮内给药途径。不到四分之一的医护人员知道世界卫生组织对咬伤的分类，指导PEP的使用。18%（n = 13）的医护人员报告说，他们将管理PEP的第一类暴露，即使PEP是不推荐的这类暴露。只有1/6的急性脑炎咨询的受访者认为狂犬病作为一个鉴别诊断，强调狂犬病的怀疑指数低。用于狂犬病的PEP的可用性和使用情况不理想。我们确定了支持狂犬病消除计划的两个迫切需要：改善PEP的可用性和可及性;有针对性地培训医疗保健工作者，以提高对咬伤伤口管理的认识，明智地使用PEP，包括咬伤后的适当风险评估，以及在多咬伤患者的设施中使用剂量节省的皮内途径。为了在非洲有效消除狂犬病，需要制定全球和国内供资计划，解决人类卫生部门的这些差距。
In Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya. We interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed. Rabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent (n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies. The availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa.
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DOI：
10.1093/trstmh/trab123
发表时间：
2022-03-02
影响因子：
2.2
作者：
Nadal D;Beeching S;Cleaveland S;Cronin K;Hampson K;Steenson R;Abela-Ridder B
通讯作者：
Abela-Ridder B
影响因子：
3.8
作者：
Hampson K;Coudeville L;Lembo T;Sambo M;Kieffer A;Attlan M;Barrat J;Blanton JD;Briggs DJ;Cleaveland S;Costa P;Freuling CM;Hiby E;Knopf L;Leanes F;Meslin FX;Metlin A;Miranda ME;Müller T;Nel LH;Recuenco S;Rupprecht CE;Schumacher C;Taylor L;Vigilato MA;Zinsstag J;Dushoff J;Global Alliance for Rabies Control Partners for Rabies Prevention
通讯作者：
Global Alliance for Rabies Control Partners for Rabies Prevention
影响因子：
7.6
作者：
Velasco-Villa A;Escobar LE;Sanchez A;Shi M;Streicker DG;Gallardo-Romero NF;Vargas-Pino F;Gutierrez-Cedillo V;Damon I;Emerson G
通讯作者：
Emerson G
影响因子：
5.5
作者：
Rajeev M;Edosoa G;Hanitriniaina C;Andriamandimby SF;Guis H;Ramiandrasoa R;Ratovoson R;Randrianasolo L;Andriamananjara M;Heraud JM;Baril L;Metcalf CJE;Hampson K
通讯作者：
Hampson K
影响因子：
5.5
作者：
Wentworth D;Hampson K;Thumbi SM;Mwatondo A;Wambura G;Chng NR
通讯作者：
Chng NR