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SHORT COMMUNICATION
Year : 2010  |  Volume : 54  |  Issue : 1  |  Page : 40-41 Table of Contents     

A survey of hospitals managing human rabies cases in India


1 Dean/Principal and Professor of Community Medicine & President, Rabies in Asia Foundation, Bangalore, Karnataka, India
2 Associate Professor of Community Medicine & Executive Director, Rabies in Asia Foundation, Bangalore, Karnataka, India

Date of Web Publication29-Sep-2010

Correspondence Address:
M K Sudarshan
Dean/Principal and Professor of Community Medicine, Kempegowda Institute of Medical Sciences & President, Rabies in Asia Foundation, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.70552

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   Abstract 

A survey of 23 infectious diseases (ID) hospitals/ID wards of general hospitals was done during 2008-09 to assess the facilities for and management of rabies patients. All were Government hospitals and 0.5% of total beds was earmarked for rabies cases. The hospitals were mostly run by medical colleges (47.8%) and ID hospitals (30.4%) and located outside city limits (52.2%). The patients were admitted to 'rooms (39.1%)' and 'wards (43.5%)'. The general conditions of rabies sections i.e. sanitation and linen (65%), space and toilet (52% and 56%) and bed (47.8%) require improvements. There is a need to improve staff availability, use of personal protective wears, preventive vaccination of care providers and medicinal supplies. It is recommended to encourage hospitalization of human rabies cases to ensure a 'painless and dignified death' and this must be considered as a 'human rights' issue.

Keywords: Human rabies, infectious diseases hospitals, survey of patient care


How to cite this article:
Sudarshan M K, Ashwath Narayana D H. A survey of hospitals managing human rabies cases in India. Indian J Public Health 2010;54:40-1

How to cite this URL:
Sudarshan M K, Ashwath Narayana D H. A survey of hospitals managing human rabies cases in India. Indian J Public Health [serial online] 2010 [cited 2019 Jun 26];54:40-1. Available from: http://www.ijph.in/text.asp?2010/54/1/40/70552

Human rabies despite advances in medical sciences still remains practically a cent percent fatal disease. It is estimated that annually about 20,000 persons die of this disease in India [1] . World Health Organization (WHO) recommends that the patient should be cared for in a private, quiet and draft free area. Considering the hopelessness of rabies in man, treatment should center on comfort care, using heavy sedation (barbiturates, morphine), avoidance of intubation and life support measures once diagnosis is certain [2] . The WHO-APCRI national multicentric survey conducted in 2004 recommended that efforts are needed to improve hospital care and management of human rabies patients and beginning to be made for laboratory confirmation of rabies in a few centers [3] .

In this context, this survey was conducted as an initiative of world rabies day 2008, during 2008-2009 with the objective of assessing the facilities for and management of rabies patients in infectious diseases (ID) hospitals and ID wards of other hospitals in the country. A pretested and structured survey proforma and standardized guidelines were used. The principal investigators (PIs) /surveyors mainly comprised of members of APCRI (Association for Prevention and Control of Rabies in India), preferably MD qualified Assistant Professors and above from the departments of community medicine of medical colleges. Due representation was given to cover different geographic regions of the country.

A total of 22 medically qualified PIs covered 23 hospitals i.e. North-5 (Srinagar, Shimla, New Delhi, Lucknow and Gwalior); East-5 (Kolkata, Imphal, Agartala, Berhampur and Bhubaneswar); South-7 (Hyderabad, Tirupathi, Chennai, Bangalore, Mysore, Alleppey and Trivandrum) and West- 6 (Ajmer and Beawar, Panaji, Mumbai, Sholapur and Pune). They collected the necessary information by interviewing key administrative staff, perusing the relevant records and conducting an inspection of the physical facilities in these hospitals.

All the hospitals were run by the respective state governments. These included isolation hospitals (30.4%), Medical college hospitals (47.8%) and general/district hospital (21.8%). Majority (52.2%) of these hospitals were located outside city limits, at an average distance of 4.7 kms. Two (8.7%) hospitals were located beyond 5 kms. The general condition of the hospital building and rabies section was satisfactory (82.6%). About 0.5% of total hospital beds was earmarked for rabies cases. The rabies patients were cared for in wards (43.5%), rooms (39.1%) and cells (17.4%) located at a distance from the main buildings of the hospitals.

An assessment of the general condition/status of rabies section in these hospitals was found to be satisfactory as pertinent to space availability (56.5%), lighting (86.9%), ventilation (82.6%), Sanitation (65.2%), bed (47.8%), linen (65.2%) and toilet (52.2%).

There was an overall staff vacancies of 16.2% and it was more in the cadres of ancillary (22.1%) and paramedical personnel (10.3%) than medical personnel (3.9%). The provision and use of personal protective wears/devices was not satisfactory viz. goggles (8.7%), masks (43.8%), gowns (34.8%) and gloves (65.2%). The coverage of staff for preexposure rabies vaccination was far from satisfactory viz. medical and paramedical staff (26.1%) and ancillary staff (21.7%).

Regarding the status of medicinal and other supplies except for IV fluids (100%) and antipyretics/analgesics (100%) improvements were needed for antibiotics (95.7%), sedatives (87%), anticonvulsants (65.2%), muscle relaxants (56.5%) and equipments/ facilities for intubation (56.5%) and suction (78.3%).

About 38.8% cases left the hospitals against medical advice which was unfortunate. In 2004, 35.3% of rabies patients died in the hospital [3] while in 2008-09 in this survey it was about 49.5%, which in some way is an improvement in the right direction. Though the facilities for postmortem was available in 52.2% hospitals, it was not done at all, may be due to socio-cultural reasons. The facilities for laboratory diagnosis of rabies did not exist in any of these hospitals [Table 1].
Table 1 :Statistics of human rabies cases and other facilities [N=23]

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Rabies is a horrifying disease and the death in most instances is very painful and agonizing. Once the symptoms and signs appear, these patients usually survive for 3-7 days. Hence, it is one of the most feared diseases of man. It is important that these patients receive adequate comfort care, with suitable and appropriate emotional and physical support [2] . In this context, the hospitals which admit these patients must provide these facilities and care and ensure a humane and painless death of these unfortunate victims. Majority of these patients belong to poor and low socioeconomic status [3] . As it is a practically 100% fatal disease, contrary to the widely practiced preference for 'dying at home' in the 'company of near and dear ones' to ensure less painful / painless death, it is recommended to encourage hospitalization of these patients. Besides at home, though the disease is not readily communicable still there is a risk of its transmissibility to attendants and care givers and hence hospitalization is preferred. Consequently, these hospitals must have adequate facilities and manpower to care for these hapless victims.

The results of this survey show that vast improvements are needed in these hospitals right from abolishing the 'rabies cells' wherever these exist to improving space, general sanitation, beds, linen, toilet, staff availability, providing and promoting use of personal protective wears, medicinal supplies and preventive vaccination of staff. Attempts should be made to start conducting postmortem and laboratory confirmation of the diagnosis/disease at least in select cases. Lastly, in the context of overall socioeconomic improvements in the country, the right to "a dignified and painless death" for these patients must be considered as a 'human rights' issue and the concerned welfare agencies and organizations must work in this direction treating this as a 'noble cause'.


   Acknowledgements Top


The authors gratefully acknowledge the efforts and cooperation of principal investigators of the survey without whose help this survey would not have been possible. The authors thank Rabies in Asia (RIA) Foundation for providing grants for the survey.

 
   References Top

1.Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NS, Ashwath Narayana DH, Rahman SA, et al. Assessing the burden of human rabies in India: results of a national multi-center epidemiological survey. Int J Infect Dis 2007;11:29-35.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.World Health Organization. WHO Expert consultation on rabies. First report, Technical Report Series 931, Geneva, Switzerland, 2005.  Back to cited text no. 2      
3.WHO-APCRI. National multicentric rabies survey, A report. May 2004, Bangalore, India Available from: http://www.apcri.org [last cited on 2004].  Back to cited text no. 3      



 
 
    Tables

  [Table 1]


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