title: Determinants of delay in initiating post-exposure prophylaxis for rabies prevention among animal bite cases: hospital based study.
abstract: 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.
  
  
  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%).
  
  
  CONCLUSIONS
  Accessibility and lower economic status were the major factors associated with delay in initiation of PEP for rabies prevention.
authors.affiliation: Department of Community Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India.
authors.forename: Jessy
authors.initials: J
authors.lastname: Joseph
authors.affiliation: Department of Community Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: N
authors.affiliation: Department of Community Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India. Electronic address: khanamirmaroof@yahoo.com.
authors.forename: Amir Maroof
authors.initials: AM
authors.lastname: Khan
authors.affiliation: Department of Community Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India.
authors.forename: O P
authors.initials: OP
authors.lastname: Rajoura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001733:Bites and Stings / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000706:statistics & numerical data; D011818:Rabies / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D011819:Rabies Vaccines / Q000008:administration & dosage; D012307:Risk Factors; D055815:Young Adult
chemical_list: D011819:Rabies Vaccines
keywords: Animal bite victims; Anti-rabies vaccine; Delay; Post-exposure prophylaxis