International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 10 Issue 06, March, 2018

Pages: 49-52

Date of Publication: 28-Mar-2018


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An assessment of Knowledge of Prevention and Management of Rabiesin Second Year MBBS Students of American International Institute of Medical Sciences, Udaipur (Rajasthan)

Author: Abhilasha Mali, Shiv Lal Solanki

Category: Healthcare

Abstract:Background: Rabies is a viral zoonotic disease and human infection usually occurs following transdermal bite or scratch by an infected animal. It is one of the most dangerous, fatal and completely preventable disease.
Objectives: The main objective of present research is to assess the knowledge regarding preventive measures, wound management of Rabies.
Methods: A cross sectional study conducted in November 2017 to December 2017. Data was collected by using questionnaire from undergraduate 150 students studying in second MBBS at AIIMS medical college, Udaipur (Rajasthan) India. Data was entered and analyzed using SPSS V.17. Descriptive statistics and chi-square test were applied. KAP score were calculated. p< 0.05 was considered statistically significant.
Results: In our study 56.67% agreed that pre-exposure vaccination was useful. 60% were male and 40% were female. 62.66% among them had poor KAP score. KAP score associated with sex, native place and history of animal bite.
Conclusion: The study shows that subjects had poor knowledge about preventive practice for pre -exposure vaccination of animal bite and rabies in the study population which needs to overcome immediately with proper training for vaccination in pre \? exposure profile excess.

Keywords: Post exposure prophylaxis, Infection, Zoonotic disease, Fatal

DOI: 10.7324/IJCRR.2018.10610

Full Text:

INTRODUCTION

Rabies is a viral zoonosis and human infection usually occurs following a transdermal bite or scratch by infected animal.1 The clinical signs in dogs include sudden behavioral changes, hyper salivation, paralysis, hydro and photophobia, restlessness, aggressiveness and biting inanimate objects.Rabies causes about 26,000 to 55,000 deaths worldwide per year, more than 95% of which occur in Asia and Africa.3 Every year, more than 15 million people worldwide receive a post?exposure vaccination to prevent the Rabies .We have to prevent hundreds of thousands of rabies death annually.5 Still, rabies is the 10th biggest cause of death due to infectious diseases worldwide.5

About 98% of the human rabies cases occur in developing countries that possess large number of dogs, many of which are stray. Rabies is 100% fatal diseasewhich can be prevented by timely and appropriate anti rabies prophylaxis. Earlier many studies have been done on medical studentshealth care veterinary personals and animal bite victims.6-9 The present study was under taken among second year MBBS students in AIIMS medical college, Udaipur.

Based on available evidence, a fair estimate of rabies burden in India is 2.74 rabies cases/100,000 populations annually.5 In India, the burden is unevenly distributed among different States.

Objectives

To assess the knowledge and preventive measures regarding rabies among second year MBBS medical students.

MATERIAL AND METHODS:

A cross-sectional study was conducted in November 2017 to December 2017 among 150 second year students of American International Institute of medical sciences, Udaipur (Rajasthan). There is no awareness of study about rabies and prevention among second year MBBS students so by considering 95% confidence interval sample size calculated is 150.

Data was collected once in a week, each week around 20-25 students were interviewed randomly, so by 8 weeks end total sample size we have got is 150. Data was collected using a semi structured, pre-designed interview method. The method consisted of questions regarding knowledge, attitude and practice of animal bite and rabies.Proper verbal consent was taken before filling out the questionnaire.

Data analysis was done in department of community medicine by using SPSS version 17. Percentages and chi square testwere applied to test association between categorical variables. KAP (knowledge, attitude and practice) scores were calculated as below

KAP scoring: 20 questions were asked for each participant regarding cause, sources and mode of transmissions, clinical features, pre-exposure prophylaxis  and prevention practices and treatment measures of rabies which was resulted in a response of either, choose the correct answer (had got one mark) or wrong answer (had got zero mark) for each question. The mean scores were calculated for KAP.

The participants who had KAP score more than mean were considered as good and less than mean was considered as poor. Good knowledge was defined as those getting a score of 9 and above, poor knowledge as getting a score less than 9. The data show that majority of study participants were having poor KAP level.

RESULTS

From 150 study population 56 (37.33%) had good KAP whereas 94 (62.67%) had poor KAP about the prevention of Rabies and its treatment protocols.

Table-1

100% of the participants were familiar with the disease. In our study majority of the subjects 89.33% knew the mode of transmissions are bites, licks and scratches by infected animal.It was seen that 60% of the participants knew about other animal like bats, Jackets, pigs, mongoose, catsetc. as reservoirs. 93.33% were aware that infection was the cause ofRabies and 95.33% knew that rabies was transmitted from animal to human. 5.33% thought infection can spread by organ transplant and 83.33% could identify clinical feature of rabies in animal. 24.67% of the participants were not aware about clinical features of Rabies in humans. 38.67% of the participants correctly answered about the incubation period.

Table-2

36.67% of participants had proper knowledge about first aid after bite. Only 43.33% esponded for full course of vaccination. 66.67% were aware about anti rabies immune globulin whereas 43.33% had no idea about pre-exposure prophylaxis.

 

Table-3

It shows that 97.33% participants knew for immediate wash of wound of animal bite. 48.67%, 58%,84% of the participants correctly responded about antiseptic use, suturing and cauterization respectively.

Factors associated with preventive practice score towards rabies

Association between independent   variables and KAP scores on rabies was assessed using Pearson's chi square. There was significantly association between Knowledge,attitude and practice score with sex (X2=4.853 p<0.05) the good scores were highest in urban native place, history of animal bite was significantly associated with knowledge and attitude scores (X2=7.8031, p<0.05).

DISCUSSION

Rabies is 100% fatal zoonotic disease which canbe preventable by pre and post exposure prophylaxis in the form of anti-rabies vaccination and anti-rabies serum, but once contracted the disease is invariably fatal.10??????? In our  study 60% of study population were male and 40%  females.  In present study 93.33% of students were aware of the viral cause of rabies which was near to a study done by Nayak RK et al 2011 in Belgaum, India.11 Similar findings were obtained in a study by Singh et al where all subjects knew about Rabies and 89.33% were aware about the transmission of rabies.7However, in the present study 40% of the study subjects did not know that  other animals could also transmit the disease.16.67% of the study population did not know about the clinical features of rabies in animal, whereas hydrophobia as the presenting feature was known to majority of subjects in a study by Kishore et al.12

In our study the knowledge about first aid and importance of full course of vaccination after dog bite  were known to 36.67% and 43.33% respectively.

In another study though majority of the subjects  knew about first aid after animal bite, but they did not have the  knowledge about use of anti-rabies immunoglobulin which is very essential for the management of dog bite.12 In a study conducted by Chandan N et al, 67% of the study participants had heard about vaccination for animal bite.13

In our study 89.33% know about mode of transmission but only 38.67% students knew incubation period which was less in compare to a study done in Karachi in 2007 by Shah SF et al. where data was 51.7%.14 In our study, 35.33% were not aware of the vaccination of dogs and 37.33% not aware about educating people about the pre and post exposure preventive measures can prevent rabies. 

In the present study, it was seen that the attitude towards wound wash for animal bite was good in more than half of the study population and  97.33% opined that they would wash the wound. Similar findings were also obtained by Chandan et al where majority of the subjects would wash the wound with soap and water if bitten by animal.13 However, Ichhpujani et al in their study observed that less than 50 %were in favour of wound toileting after dog bite8, majority i.e. 62% said that animal bite is a serious condition and 51% were willing to go for complete vaccination. In the study by Kamble et al, 89 % of study population considered vaccination to be necessary after animal bite for rabies prevention.15

97.33% of the participants responded regarding immediate wash, 48.67% regarding antiseptic use, 58% regarding suturing and 84% regarding cauterization. A study done in interns by Chowdhury R. et al. (2012) found that 96.2% of the participants responded regarding wound management, 77.5% regarding antiseptic use, 83.8% regarding suturing, and 75% regarding cauterization.5

This study highlighted that knowledge regarding a Fatal and endemic disease as rabies is inadequate in second year students of the medical college. Also, it revealed that the overall knowledge and attitude of the students regarding prevention and management was poor with inadequatevariablesex, native place and history of animal bite. This implies students are lacking in practical exposure.

Animal bites cases are frequently reported at all government or private hospitals in India and this lack of knowledge among health care professionals leads to loss of several lives which could have been saved. This, most likely happens, either because the first line treatment providers are just out of medical college with no practical exposure or due to inadequate knowledge which is not in accordance with the current guidelines. So, keeping this in mind, teaching hospitals should arrange for interactive animal bite clinic visits for students and posting of interns, CMEs to address specific knowledge gaps. These would give them a practical exposure, reduce the public health burden of rabies and also reduce the health care budget on vaccines and immunoglobulin wastage resulting from improper use.

ACKNOWLEDGEMENT

Authors acknowledgement the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Funding: No funding sources

Conflict of interest:  None declared

 Ethical approval: The study was approved by the Institutional Ethics Committee

References:

  1. WHO, 1992. Eighth report of the WHO Expert committee on rabies: Technical report. Available at http://onlinelibrary.wiley.com/doi/10.1111/j751-0813.1993.tb06098.x/abstract.
  2. Fooks AR. Rabies the need for a ‘one medicine’ approach. Veterinary Record. 2006;161: 289-90.
  3. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859): 2095?128.
  4. Rabies fact sheet. World Health Organization. Retrieved on 15.10.2014. Available at http: //www.who.int/mediacentre/factsheets/fs099/en/.
  5. Baxter JM. One in a million or one in thousand. What is the morbidity of rabies in India? JOGH. 2012;2(1): 1?4.
  6. Singh NK. Clinical knowledge and attitudesof clinicians toward rabies caused by animal bites. JEMDS.

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Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
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A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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