5 years ago

Rabies Postexposure Prophylaxis (PEP) Noncompletion After Dog Bites: Estimating the Unseen to Meet the Needs of the Underserved.

Buchy, In, Tarantola, Dussart, Hing, Bourhy, Blanchi, Cappelle, Ly, Taing, Mary, Peng, Chan
Post exposure prophylaxis prevents human rabies and is accessible in Cambodia principally in Phnom Penh, the capital. Timely, affordable access to post-exposure prophylaxis is a challenge for the mainly rural population. We aimed to identify districts independently associated with post-exposure prophylaxis (PEP) noncompletion to position frontline vaccination centers. We analyzed the 2009-2013 database at the rabies prevention center of the Institut Pasteur du Cambodge, Phnom Penh. Logistic regressions identified non-geographic determinants of PEP noncompletion and districts after adjustment for these determinants. The influence of distance by road was estimated using a boosted regression trees model. A district noncompletion population attributable fraction (Rabies Index) was computed and mapped. A cartographic analysis based on the statistic developed by Getis and Ord identified clusters of high-Rabies Index districts. Factors independently associated with noncompletion were patients' district of residence, male gender, age 15-49, initial visit during rice harvest, the dog's status (culled or disappeared) as well as a prescribed PEP protocol requiring more than three PEP sessions (four and five). Four clusters of high-Rabies Index (RI) districts were identified using this analytical strategy applicable to many vaccination or other health services. Positioning frontline PEP centers in these districts will significantly widen access to timely and adequate PEP.

Publisher URL: http://doi.org/10.1093/aje/kwx234

DOI: 10.1093/aje/kwx234

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