Determinants of Rabies Post-Exposure Prophylaxis Completion in Sarawak

Hsien Liang Melvin Chung; Choo Huck Ooi; Jo Hun Teh; Norliza Jusoh; Huzaimah Husin; Mohammad Norhaizam Ahmad Narawi; Drend  Jores; Yassimear Anak Ugak; Nurul Amirah Masani; ImranAzwan Azizan; Nurul Mufidah Md Nasir; Faiz Mazlan; Mann Chek Ooi; Sin Yee Wong

doi:10.31584/jhsmr.20241089

Authors

Hsien Liang Melvin Chung Bintulu Divisional Health Office, Ministry of Health, Bintulu 97000, Sarawak, Malaysia.
Choo Huck Ooi Sarawak State Health Department, Ministry of Health, Kuching 93150, Sarawak, Malaysia.
Jo Hun Teh Sibu Divisional Health Office, Ministry of Health, Sibu 96000, Sarawak, Malaysia.
Norliza Jusoh Limbang Divisional Health Office, Ministry of Health, Limbang 98700, Sarawak, Malaysia.
Huzaimah Husin Mukah Divisional Health Office, Ministry of Health, Mukah 96400, Sarawak, Malaysia.
Mohammad Norhaizam Ahmad Narawi Betong Divisional Health Office, Ministry of Health, Betong 95700, Sarawak, Malaysia.
Drend Jores Kapit Divisional Health Office, Ministry of Health, Kapit 96800, Sarawak, Malaysia.
Yassimear Anak Ugak Bintulu Divisional Health Office, Ministry of Health, Bintulu 97000, Sarawak, Malaysia.
Nurul Amirah Masani Bintulu Divisional Health Office, Ministry of Health, Bintulu 97000, Sarawak, Malaysia.
ImranAzwan Azizan Bintulu Divisional Health Office, Ministry of Health, Bintulu 97000, Sarawak, Malaysia.
Nurul Mufidah Md Nasir Bintulu Divisional Health Office, Ministry of Health, Bintulu 97000, Sarawak, Malaysia.
Faiz Mazlan Bintulu Divisional Health Office, Ministry of Health, Bintulu 97000, Sarawak, Malaysia.
Mann Chek Ooi Bintulu Divisional Health Office, Ministry of Health, Bintulu 97000, Sarawak, Malaysia.
Sin Yee Wong Bintulu Divisional Health Office, Ministry of Health, Bintulu 97000, Sarawak, Malaysia.

DOI:

https://doi.org/10.31584/jhsmr.20241089

Keywords:

predictors, post-exposure prophylaxis, rabies, Sarawak

Abstract

Objective: Rabies remains persistent in Sarawak despite efforts to control its spread. This study investigates the determinants of rabies post-exposure prophylaxis (PEP) completion among individuals in Sarawak that have been exposed to potential rabies transmission through animal bites.
Material and Methods: A retrospective cohort study, using a universal sampling approach was employed, utilizing data from the Sarawak i-Bite System. Binary logistic regression was used to identify significant variables: a p-value<0.05 was considered as statistically significant.
Results: The mean age of people having experienced animal bites was 38.1 (S.D.=22.4) years. Most were male (51.6%) and of Chinese ethnicity (37.2%). The predominant sites of animal bites were the upper (53%) and lower limbs (39.5%). Category 3 bite injuries and bites from fully confined pets were the most frequently reported (68.9% and 43.9%, respectively). In total 56.5% of the study population had a complete rabies vaccine regimen as post-exposure prophylaxis, while 5.4% had incomplete vaccinations, and 38% received no vaccination. The majority received treatment at government hospitals (59.1%). The significant determinants of rabies post-exposure prophylaxis completion in Sarawak were the Iban ethnicity (odd ratio (OR)=2.9, 95% confidence interval (CI):1.08-2.44, p-value=0.02), grade 3 bite (OR=3.9, 95% CI=,1.86-4.68, p-value<0.001), pet mixed with stray (OR=2.41, 95% CI=1.32-2.33, p-value<0.001), stray animals (OR=2.41, 95% CI=1.78-3.25, p-value,0.001) and treated in a government hospital (OR=0.63, 95% CI=0.47-0.83, p-value<0.001).
Conclusion: This study reported that only 56.5% of patients completed the rabies PEP series. The important determinants of PEP completion status were found to be the Iban ethnicity, bite severity, category of animal, and place of treatment. These findings offer valuable insights to assist the Sarawak State Health Department in prioritizing strategies to enhance the compliance rate, with the ultimate goal of eliminating dog-mediated Rabies deaths by 2030.

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