Animal bite injuries in the accident and emergency unit at Mulago Hospital in Kampala, Uganda

Abstract

Introduction: animal bite injuries are a common public health concern in Uganda. We sought to characterize animal bite injuries among patients
presenting to Mulago National Referral Hospital in Kampala, Uganda. Methods: this was a cross sectional study from 1st September to 30th November
2011. Participants were animal bite injury victims presenting to the accident and emergency (A&E) unit at Mulago hospital and were consecutively
enrolled into the study. Socio-demographics, severity and patterns of injury, health seeking and dog handling behaviours were assessed using a
standardized questionnaire. Descriptive statistics was used to summarize participant characteristics and the animal bite injuries. Poisson regression
model's incident rate ratios (IRR) was used to explore the relationship of the number of days to accessing treatment at Mulago hospital with;
a) received prior first aid, b) animal bite injury sustained during day time, c) unknown dog and d) victim resident in Kampala. Data were analyzed
using STATA version 12.0 and statistical significance set at P < 0.05. Results: of 25,420 patients that presented to the A&E unit during the study
period, 207 (0.8%) had animal bite injuries, mean age 22.7 years (SD 14.3), 64.7% male, and 40.1% were <18 years. Majority 199 (96.1%) were
bitten by a lone unrestrained and un-signaled dog that had bitten someone else in 22.2% of cases, and eight victims (0.4%) were attacked in canine
gangs of 2-5 dogs. Rabies vaccination was confirmed in only 23 dogs (11.1%) as 109 (52.7%) were unknown to the victims or the communities.
One hundred and eighteen victims (57.0%) sustained the dog bites within Kampala district whilst the rest occurred near or far from Kampala district,
and the victims especially referred to access anti-rabies vaccine. Of 207, 189 victims (91.3%) presented within 2.6 days (SD ± 4.3). Two hundred
victims (96.6%) sustained extremity injuries while the rest had injuries to other body parts. All injuries were minor and managed on out-patient basis
with wound dressing, analgesics, prophylactic antibiotics and anti-rabies vaccination. Victims who received prior first aid had a rate of 1.7 times
greater for seeking treatment at Mulago hospital (IRR 1.7, 95% CI 1.4-2.1) compared to those that had no prior first aid. Participants who sustained
the animal bite injuries during day time had a rate of 1.6 times greater for seeking treatment at Mulago hospital (IRR 1.6, 95% CI 1.3-2.1) compared
to those that sustained injuries at other times. Participants bitten by unknown dog and participants residing in Kampala had IRR 0.7,
95% CI 0.5-0.9 and IRR 0.6, 95% CI 0.5-0.8 respectively of accessing treatment at Mulago hospital compared to bitten by known dog and not
residing in Kampala. Conclusion: dog bites injuries from unrestrained, un-signaled dogs are the commonest source of animal bite injuries especially
among children (<18 years). Vaccination against rabies was only confirmed for a very small number of dogs, as majority were unknown and likely
stray dogs. Government and public sensitization is urgently required to limit stray dogs, vaccinate dogs and restrain them to prevent a grave
probability of a looming canine rabies epidemic.