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Vaccines, awareness among healthcare workers needed to stop rabies deaths

 Residents of Ilmootiok in Narok West lining up their dogs for vaccination against rabies. [Robert Kiplagat, Standard]

Rabies has been causing preventable deaths in rural Kenya due to lack of knowledge on its prevention and management, a new study says.

To make matters worse, most healthcare workers are not familiar with categories of bite exposures or human rabies, it adds.

Rabies is a preventable viral disease that can spread to people and pets if they are bitten by a rabid animal, mostly dogs.

The study conducted in Makueni County noted that besides inadequate knowledge on World Health Organisation (WHO) guidelines when dealing with rabies, medics were also at sea regarding how to dispense medication, use of dose-sparing vaccination regimes, and lack of post-exposure prophylaxis (PEP).

In the study released in March 2022 and titled, Rabies Elimination in Rural Kenya, scientists interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties.

Out of the 73, only 11 per cent were aware of the dose-sparing intradermal route while 18 per cent reported they would administer PEP for category 1 exposures, even though PEP is not recommended for this category of exposure.

Less than a quarter of the healthcare workers were aware of the WHO categorisation of bite wounds that guides the use of PEP, said the report.

Although thorough wound washing with running water for at least 15 minutes is recommended, the method was not utilised.

"Only 22 (33 per cent) and 28 (43 per cent) of the respondents reported they would clean the wound either with water or with water and soap for bite category II and III, respectively," the study found.

The PEP vaccine was only available in five out of 42 hospitals, while none of the facilities had antibodies.

Scientists observed that availability and use of PEP for rabies was sub-optimal.

The lead researcher, Thumbi Mwangi, co-director of Centre for Epidemiological Modelling Analysis, said a number of healthcare workers had seen rabies cases, but some did not have recommended guidelines on what to do when handling cases.

Prof Mwangi said a rabies bite requires that the wound be washed within 24 hours and the first jab of the vaccine administered.

"Rabies vaccines are at health facilities. But if a health worker is not sure on how to handle the vaccine, there is potential of death," said Mwangi, also an associate professor at Washington State University.

The scientists wanted to find out the knowledge levels of healthcare workers regarding rabies and rabies vaccines in averting rabies bites.

"We found that a number of medics are aware of rabies, but some do not have recommended guidelines of what to do at the finger tips, meaning there is a need for education, even among healthcare workers on appropriate measures to take whenever someone is at risk of rabies," said Mwangi, adding that besides providing vaccines, medics need "sufficient information on handling a patient with a bite" to prevent any deaths from rabies.

In Kenya, rabies is endemic in many counties and causes over 500 deaths annually, with Makueni being one of the most affected in terms of rabies infections.

To prevent diseases from animal to human, healthcare systems need well-stocked emergency drugs like rabies for instant treatment.

"PEP is a lifesaving vaccine. With rabies, every passing hour is increasing chances of getting infections, and when such happens, there is no treatment," said the researcher.

The country is implementing a strategy to end human deaths from rabies by 2030 following the progressive reduction in disease burden approach.

In the study, researchers identified improving availability of and access to PEP, and targeted training of healthcare workers, as the two urgent needs to support rabies elimination programmes.

Healthcare workers also need training on the appropriate risk assessment following bites and use of the dose-sparing intradermal route in facilities seeing multiple bite patients, the study recommended.

Other strategies include mass dog vaccination, prompt provision of PEP, public awareness, enhanced surveillance of rabies in animal and human populations besides dealing with roaming dogs through proper management of garbage and waste.

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