The burden of rabies in Tanzania and its impact on local communities.
BACKGROUND
Rabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. The burden of rabies is estimated to be around US$20 million in Africa, with the highest financial expenditure being the cost of post-exposure prophylaxis (PEP). However, these calculations may be substantial underestimates because the costs to households of coping with endemic rabies have not been investigated. We therefore aimed to estimate the household costs, health-seeking behaviour, coping strategies, and outcomes of exposure to rabies in rural and urban communities in Tanzania.


RESULTS
Extensive investigative interviews were used to estimate the incidence of human deaths and bite exposures. Questionnaires with bite victims and their families were used to investigate health-seeking behaviour and costs (medical and non-medical costs) associated with exposure to rabies. We calculated that an average patient in rural Tanzania, where most people live on less than US$1 per day, would need to spend over US$100 to complete WHO recommended PEP schedules. High costs and frequent shortages of PEP led to poor compliance with PEP regimens, delays in presentation to health facilities, and increased risk of death.


CONCLUSIONS
The true costs of obtaining PEP were twice as high as those previously reported from Africa and should be considered in re-evaluations of the burden of rabies.
Boyd Orr Centre for Population and Ecosystem Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom ; Ifakara Health Institute, Ifakara, Morogoro, Tanzania.
Maganga
M
Sambo
Sarah
S
Cleaveland
Heather
H
Ferguson
Tiziana
T
Lembo
Cleophas
C
Simon
Honorati
H
Urassa
Katie
K
Hampson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001733:Bites and Stings; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D004285:Dogs; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011818:Rabies / Q000191:economics / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult