J M e d A l l i e d S c i 2 0 1 4 ; 4 ( 2 ) : 56 61 w w w. j m a s. i n P r i n t I S S N : 2 2 3 1 1 6 9 6 O n l i n e I S S N : 2 2 3 1 1 7 0 X Journal of M e d i cal & Allied Sciences Original article Perceptions of ICDS functionaries of Gwalior and Chambal divisions of Madhya Pradesh regarding the prevention and control of rabies Ranjana Tiwari 1, Manoj Bansal 2, Pawan Adhikari 3, Leena Bhargo 1, Swapnil Jain 1 1 Department of Community Medicine, G.R. Medical College, Gwalior, Madhya Pradesh, India. 2 Department of Community Medicine, Bundelkhand Medical College, Sagar, Madhya Pradesh, India. 3 Department of Community Medicine, S.S. Medical College, Rewa, Madhya Pradesh, India. Article history: Abstract Received 19 March 2014 Revised 24 July 2014 Accepted 25 July 2014 Online 31 July 2014 Print 31 July 2014 Corresponding author Ranjana Tiwari Professor, Department of Community Medicine, G.R. Medical College, Gwalior, Madhya Pradesh, India. Phone: +919425360453 Email: drranjana.tiwari50@gmail.com Rabies is a zoonotic disease and still a major public health problem despite of wide availability of Anti rabies vaccine. The study was conducted to assess the perception of ICDS functionaries about animal bite management and the prevention of rabies. It was a cross sectional study in which 178 ICDS functionaries namely Child Development Project Officers (CDPOs), Supervisors and Assistant Statistical Officers (ASOs) of Gwalior and Chambal divisions were identified who had come to attend a training on infant and child feeding practices, basic sanitation and general health & hygiene, organized by Atal Bihari Bajpai Bal Aarogya Avem Poshan Mission (ABBBA & PM) of Madhya Pradesh. Out of total 178 respondents, 98 (55.05%) and 80 (44.94%) belongs to Gwalior and Chambal divisions respectively. Majority (97.75%) of the respondents heard about the rabies. 70 (71.42%) participants of Gwalior and 67 (83.75%) participants of Chambal division responded that rabies could only be caused by dog bite. A total of 71 (39.88%) participants responded that washing the wound with soap and water is the first line treatment of animal bite while 96 (53.94%) workers responded that oil, salt and amchoor (dried mango powder) should be avoided by the person bitten by a suspected rabid animal. Also, 92 (51.69%) of total respondents knew that rabies is 100% fatal disease. It was felt that the regular training programmes should be organized for all the functionaries regarding prevention and control of rabies. Key words: animal bite, anti rabies vaccine, perception, rabies 2014 Deccan College of Medical Sciences. All rights reserved. R abies is an acute viral encephalitic zoonosis. The disease affects domestic and wild animals and is spread to people through close contact with infected saliva of an animal 1. It continues to be a major public health problem in India despite wide availability of anti rabies vaccine (ARV). Every year 55,000 deaths are estimated to occur in the world 2 and in India 20,000 deaths are estimated to occur. This contributes to 36.4% of the estimated global mortality due to rabies 3. Human rabies death can be prevented by proper wound care along with anti rabies vaccine (ARV) 56
and rabies immunoglobulin (RIG). The simultaneous use of rabies immunoglobulin and cell culture vaccine in all category III exposure remains the corner stone of anti rabies treatment 4. The knowledge of basic principles of rabies prevention especially for category III animal bite is important and it should be imparted to all health personnel. Lack of awareness among ICDS functionaries about the rabies and its management including wound washing, appropriate use of ARV and utility of RIG could be detrimental. The study was therefore carried out with the objective to assess the perceptions about animal bite and its management among the ICDS functionaries namely Supervisors, Child Development Project Officers (CDPOs) and Assistant Statistical Officers (ASOs) of Gwalior and Chambal divisions of Madhya Pradesh. Material and methods The present study was a crosssectional study, carried out from 01 st April to 30 th June 2012. The study participants were ICDS functionaries that included Child Development Project Officers (CDPOs), Supervisors and Assistant Statistical Officers (ASOs) of Gwalior and Chambal divisions. A total of 178 participants were involved from five different batches of training programme to gather the data. The participants had come to attend five days training on infant and child feeding practices, basic sanitation and general health & hygiene, organized by Atal Bihari Bajpai Bal Aarogya Avem Poshan Mission (ABBBA & PM) of Madhya Pradesh State held at Gwalior. The participants were from Gwalior division (Gwalior, Guna and Shivpuri district) and Chambal division (Bhind, Sheopur and Morena district). The opportunity was taken and the data was collected on the last day of training programme, where the investigators explained the objectives of the study and verbal consent was obtained from all the study participants and predesigned and pretested questionnaire was distributed to all of them and they were asked to opt one or more of the appropriate responses. The questionnaire was multiple choice questions regarding the personal details like age group, sex, educational status and job duration and awareness and perceptions of them regarding rabies, causative organism, transmission, dietary restriction, prevention strategies, treatment options, cost of anti rabies vaccine, dose of vaccine given for post exposure prophylaxis, any national programme for it and case fatality of the rabies. Also, information about the practices of animal keeping, if any, and vaccination of pet, if done were also enquired. The participants were enquired regarding their awareness for different doses of ARV for post exposure prophylaxis. They were allowed to choose any of the two options; correct response specified that they knew the right answer of five doses while the incorrect response specified anything apart from five doses. After the collection of data, exchange of views for one hour regarding their queries and also many myths and misconceptions were cleared. They were also shown some slides on rabies prevention and control to clear their doubts. Results In the present study, a total of 178 participants were taken, in which the maximum were in the age group of 3645 years and mostly were females. 117 (65.73%) were working with ICDS for more than 10 years and on the basis of their educational status most of them were postgraduate and above (Table 1). Regarding the awareness on rabies, majority 174 (97.75%) heard about the rabies (Fig 1), but just more than half 98 (55.05%) knew that rabies is caused by a virus. Also, 137 (76.97%) of total study population responded that rabies can only be caused after a dog bite while only 10 (5.61%) agreed with the fact that rabies can be transmitted by dog, cat and any wild animal bite. Although the majority 163 (91.57%) of the respondents opted that the rabies is a preventable disease (Fig 2) but only 71 (39.88%) participants agreed that washing the wound with soap and water is an immediate management after an animal bite. More than half 105 (58.99%) participants responded incorrectly about the doses of ARV for the post exposure prophylaxis. 106 (59.55%) respondents opines that the cost of ARV in market ranges from 300 to 350 rupees per injection. Out of total, 38 (21.34%) still think that application of chilly, turmeric and lime over the wound is effective while 96 (53.94%) workers responded that oil, salt and amchoor (dried mango powder) should be avoided to the person bitten by an suspected rabid animal. 76 (42.70%) participants were agreed with the fact that the consumption of raw milk of an animal bitted by a rabid dog can develop rabies. Surprisingly, only 02 (1.13%) of total 178 workers participated in the study were aware about the National Programme for the prevention and control of rabies. Nearly half (51.68%) respondents knew that the rabies is 100% fatal disease (Table 2). 57
Table 1: Sociodemographic profile of respondents Variables Age < 25 Yrs 25 35 Yrs 36 45 Yrs 46 55 Yrs > 55 yrs Sex Male Female Education Graduate or below Post graduate and above Job duration < 1 Yr 1 5 Yrs 6 10 Yrs > 10 yrs ICDS workers Gwalior Division (n=98). (%) 05 (5.57) 21 (21.42) 36 (36.73) 27 (27.55) 09 (9.18) 87 (88.77) 17 (17.34) 81 (82.65) 19 (19.38) 15 (15.30) 64 (65.30) Chambal Division (n=80). (%) 08 (10.00) 16 (20.00) 33 (41.25) 20 (25.00) 03 (3.75) 10 (12.50) 70 (87.50) 11 (13.75) 69 (86.25) 17 (21.25) 08 (10.00) 53 (66.25) Total (n=178). (%) 13 (7.30) 37 (20.79) 69 (38.77) 47 (26.40) 12 (6.74) 21 (11.80) 157 (88.20) 28 (15.74) 150 (84.26) 02 (1.12) 36 (20.22) 23 (12.92) 117 (65.73) 120 100 95 (96.93) 79 (98.75) 100 90 80 93 (94.89) 70 (87.50) 80 70 60 60 50 40 40 30 20 0 Gwalior 03 (3.06) 1 (1.25) Chambal 20 10 0 5 (5.11) 00 Gwalior 8 (10) 2 (2.50) Chambal Don't Know Fig 1. Knowledge regarding the term Rabies 15 (15.30%) and 18 (22.50%) respondents of Gwalior and Chambal divisions respectively have their own pet dog. Of them, 11 (11.22%) of Gwalior division and 07 (8.75%) of Chambal division administered vaccination against rabies to their dogs (Table 3). Discussion Rabies is a viral zoonotic disease. In India it is most commonly transmitted to humans by a dog bite. In this study about ¾ of the participants knew Fig 2. Knowledge regarding the prevention for Rabies disease that dog bite can transmit the rabies. Singh et al in their study reported that all of the individuals were aware about rabies and 98.6% people knew about its transmission by dog bite 5. In our study, 21.34% participants responded that application of chilli, turmeric and lime on the wound is effective. Singh et al noted that 19.2% would like to do some religious customs such as chilli application or tobacco leaf application 5. Wasay et al also reported similar findings 6. 58
Table 2: Awareness and perceptions of ICDS functionaries of Gwalior and Chambal divisions about the animal bite and its management Question asked about ICDS workers Gwalior Division (n=98). (%) Chambal Division (n=80). (%) Total (n=178). (%) Have you ever heard about rabies? Causative organism of rabies? Virus Bacteria Protozoa Fungi Which of these animal bites can cause rabies? Dog Dog + Cat Dog + Cat + Wild animal Is the rabies preventable? Immediate management after an animal bite? Wash the wound with soap & water Apply chilly on the wound Give ARV* injections Give TT** injections Doses of ARV* for post exposure prophylaxis? Correct response Incorrect response 95 (96.93) 03 (3.06) 56 (57.14) 20 (20.40) 02 (2.04) 03 (3.06) 17 (17.34) 70 (71.42) 02 (2.04) 05 (5.10) 21 (21.42) 93 (94.89) 05 (5.11) 42 (42.85) 36 (36.73) 09 (9.18) 45 (45.92) 53 (54.08) 79 (98.75) 01 (1.25) 42 (52.50) 27 (33.75) 09 (11.25) 67 (83.75) 01 (1.25) 05 (6.25) 07 (8.75) 70 (87.50) 08 (10.00) 29 (36.25) 18 (22.50) 31 (38.75) 28 (35.00) 52 (65.00) 174 (97.75) 04 (2.25) 98 (55.05) 47 (26.40) 04 (2.24) 03 (1.68) 26 (14.60) 137 (76.97) 03 (1.69) 10 (5.61) 28 (15.73) 163 (91.57) 02 (1.12) 13 (7.31) 71 (39.88) 29 (16.29) 67 (37.64) 11 (6.17) 73 (41.01) 105 (58.99) Cost of ARV* in market? Rs. 150 200 Rs. 200 250 Rs. 250 300 Rs. 300 350 response Applying salt, chilies, turmeric and lime over the wound is the good practice. Oil and Amchoor should be avoided to the bitted person. 05 (5.10) 06 (6.12) 13 (13.26) 63 (64.28) 16 (16.32) 82 (83.67) 52 (53.06) 23 (23.46) 23 (23.46) 01 (1.25) 09 (11.25) 12 (15.00) 43 (53.75) 15 (18.75) 22 (27.50) 58 (72.50) 44 (55.00) 27 (33.75) 09 (11.25) 06 (3.37) 15 (8.42) 25 (14.04) 106 (59.55) 26 (14.60) 38 (21.34) 140 (78.66) 96 (53.94) 50 (28.08) 32 (17.98) 59
Whether a person consumed raw milk of an animal bitted by a rabid dog can develop the rabies? 49 (50.00) 49 (50.00) 27 (33.75) 53 (66.25) 76 (42.70) 102 (57.30) Awareness for National Programme for the prevention and control of rabies. Aware t aware 02 (2.04) 96 (97.96) 80 (100.00) 02 (1.13) 176 (98.87) CFR # of Rabies is 100% 55 (56.12) 43 (43.88) 37 (46.25) 43 (53.75) 92 (51.69) 86 (48.31) *Anti Rabies Vaccine, **Tetanus Toxoid, # Case Fatality Rate Table 3: Practices of animal keeping among the respondents of Gwalior and Chambal divisions. Practices of animal keeping Whether you have any pet animal in your house? If yes, name of the animal? @ Dog Cow Buffalo Cat Rabbit Goat If pet animal is dog, then vaccination against rabies given to your dog? ICDS workers Gwalior Division (n=98). (%) 16 (16.32) 82 (83.67) 15 (15.30) 01 (1.02) 04 (4.08) Chambal Division (n=80). (%) 30 (37.50) 50 (62.50) 18 (22.50) 05 (6.25) 12 (15.00) 07 (8.75) 11 (13.75) @The total is not matching as some respondents have two animals as pet in their houses. A multicentric study carried out on general community showed that the application of indigenous products like chillies (11.4%), turmeric (5.6%), lime (6.8%), kerosene oil (2.3%), herbal paste (4.2%) etc was suggested as part of the bite wound management 7. Findings of our study are also supported by the figures reported from Sri Lanka, which show 90% awareness about dogs being the main carriers for rabies, 79% knew that it can be fatal, and 88% reported that it can be prevented by vaccination 8. A study conducted by Chakraborty et al also supports the findings 9. Conclusion and recommendations Total (n=178). (%) 46 (25.84) 132 (74.15) 33 (18.53) 06 (3.37) N=51 12 (6.74) 18 (10.11) 15 (8.42) Ninety eight study participants (55.05%) knew that rabies is caused by virus, 137 (76.97%) knew that it can be transmitted through dog bite. 163 (91.57%) knew that rabies is preventable. It was alarming that 29 (16.29%) responded that the chillies should be applied on the wound while only 67 (37.64%) responded regarding the use of giving ARV injections for post exposure prophylaxis. Regarding the doses of ARV given for post exposure prophylaxis, 73 (41.01%) gave correct response while 105 (58.99%) gave incorrect response. 76 (42.70%) were aware about consumption of raw 60
milk of animal bitted by a rabid dog can develop rabies. Though ICDS functionaries are part of health personnel still, 176 (98.87%) did not even knew about the National Programme for the Prevention and Control of Rabies. Based on the findings of the present study the authors reiterate the need for more knowledge regarding the post exposure prophylaxis for rabies prevention among the ICDS functionaries and also similar such studies needs to be done periodically to assess their knowledge and to plan awareness programme among the healthcare providers. Acknowledgment Authors would like to thank Mr. S.C. Tomar, Joint Director, ICDS, Gwalior division for giving the time to the investigators during their training programmes to interact with the participants in all the five batches for collecting the data and then giving time to answer the queries of the participants. We would also like to thank the participants for their active participation and cooperation. The study was not funded by any funding agency. Conflict of interest: ne References 1. http://www.whoint/topics/rabies [Last accessed in June 2012]. 2. WHO Expert Consultation on Rabies. WHO Technical Report Series 931, Geneva, WHO; 2005. 3. Association for Prevention and Control of Rabies in India. WHO Sponsored Multicentric Rabies Survey, 2004. Available at http://www.apcri.org 4. Das S, Satpathy DM, Malini DS. Perception of AYUSH Doctors in Rabies Prevention. APCRI 2012; 14(1):3739. 5. Singh US and Choudhary SK. Knowledge, attitude, behavior and practice study on dogbites and its management in the context of prevention of rabies in a rural community of Gujarat. Indian Journal of Community Medicine 2005; 30(3):8183. 6. Wasay M, Malik A, Fahim A, et al. Knowledge and attitudes about Tetanus and Rabies: A populationbased survey from Karachi, Pakistan. J Pak Med Assoc 2012; 62(4):378382. 7. Ichhpujani RL, Chabra M, Mittal V, Bhattacharya D. Knowledge, attitude and practices about animal bites and rabies in general community. Journal of Communicable Diseases 2006; 38:355362. 8. Matibag GC, Kamigaki T, Kumarasiri PV, Wijewardana TG, Kalupahana AW, Dissanayake DR, et al. Knowledge, attitudes, and practices survey of rabies in a community in Sri Lanka. Environ Health Prev Med 2007; 12:8489. 9. Chakraborty P and Bashar A. A study to assess the awareness of common animal and insect bites among the parents. Oxford Journals Medicine Epidemiologic Reviews 2002; 27:2135. 61