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BRIEF RESEARCH ARTICLE
Year : 2021  |  Volume : 65  |  Issue : 4  |  Page : 384-386  

A trend analysis of animal bite cases attending a Tertiary Care Hospital, Odisha during COVID lockdown


1 Professor and HOD, Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India
2 Associate Professor, Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India
3 Senior Resident, Department of Community Medicine, MKCG Medical College, Berhampur, Odisha, India

Date of Submission21-Jan-2021
Date of Decision01-Jun-2021
Date of Acceptance09-Nov-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Debasish Pandit
Department of Community Medicine, MKCG Medical College, Berhampur, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_58_21

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   Abstract 


A nationwide lockdown was imposed from March 25, 2020, to curb the spread of the COVID-19 pandemic. The study aimed to analyze the trend, pattern of animal bite cases and to quantify the reduction in the incidence of animal bite cases due to diminution of exposure time with animals as a result of lockdown. The interrupted time series method was used to evaluate the effect of lockdown on the incidence of animal bite cases. Right after the lockdown, the mean number of reported animal bite cases decreased significantly (P = 0.04) by 8.3%. Furthermore, the month-to-month change of cases for the postlockdown period was in decreasing trend (ß3 = 0.872) and was significant (P < 0.05). Reduction in the exposure time with street animal surely reduce the incidence in animal bite cases and hence, the Government should take appropriate actions to control the intermixing of street dogs with marginal populations at the village and urban slums level.

Keywords: Animal bite, COVID, lockdown, rabies, trend


How to cite this article:
Satapathy DM, Karmee N, Das S, Pandit D, Bhoi JK. A trend analysis of animal bite cases attending a Tertiary Care Hospital, Odisha during COVID lockdown. Indian J Public Health 2021;65:384-6

How to cite this URL:
Satapathy DM, Karmee N, Das S, Pandit D, Bhoi JK. A trend analysis of animal bite cases attending a Tertiary Care Hospital, Odisha during COVID lockdown. Indian J Public Health [serial online] 2021 [cited 2022 Jun 27];65:384-6. Available from: https://www.ijph.in/text.asp?2021/65/4/384/333983



Rabies, a zoonotic disease is one of the most feared infectious diseases and a significant threat to public health.[1] In India, an estimated 20,000 deaths occur due to rabies with almost 17.4 million people being exposed to animal bites every year.[2] Among the dog bite cases, stray dog contributes nearly 63% of the caseload. It predominantly affects the poor and vulnerable population who live in remote locations as nearly 80% of human cases occur in rural areas where humans and animals live in close association.[3]

A nationwide lockdown was imposed from March 25, 2020, and was subsequently extended up to May 3, 2020, in an effort to contain the spread of COVID-19. The number of animal bite cases attending the Anti Rabies Clinic (ARC) decreased which could be because of restricted movement of people decreasing the risk of exposure to street animals. There are no studies on the trend and pattern of animal bite cases during the lockdown. This study was therefore conducted to analyze the trend and pattern of animal bite cases reported to a tertiary care hospital during the lockdown period and to quantify the reduction in the incidence of animal bite cases due to diminution of exposure time with animals.

It was a cross-sectional study conducted at the ARC of MKCG Medical College, Berhampur, Odisha, for the period of 7 months from April to October 2020. The participants were the patients of animal bite cases attending ARC during the period of 1st April to August 31, 2020. To find out the effect of lockdown on the trend of animal bite cases, the current trend was compared with the trend measured taking into consideration of previous 5 years cases for the same months, i.e., from April to August of each year of the last 5 years, i.e., from 2015 to 2019. Interrupted time series (ITS) method was used to evaluate the effect of lockdown on the incidence of animal bite cases. The data was analyzed in “R” software version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria).

The ITS, sometimes known as quasi-experimental time series analysis, is a statistical method involving tracking a long-term period of pre and postintervention to assess the intervention's effect. It is particularly suited to interventions introduced at population level over a clearly defined time period with population-level health outcomes[4] The effect of the intervention is evaluated by changes in the level and the slope of the time-series points and statistical significance of the intervention by segmented regression analysis method. For this study, the outcome was the incidence of the animal bite cases and the intervention was the implementation of lockdown.

As the outcome variable is in count form, Poisson regression was used for modeling and comparing the incidence cases with the following formula:

log(Yt) = ß01* (time)t + ß2* (intervention) t + ß3* (time after intervention)t

Here, Ytis mean number of animal bite cases in a month, time is a continuous variable indicating the time in months (April-August) in each year (2015–2020), intervention is an indicator for time occurring before lockdown (intervention = 0) or after lockdown (intervention = 1) and time after intervention is a continuous variable occurring for number of months after the intervention (25th March) at time t, coded 0 before the lockdown and coded 1–5 after lockdown. ß0 estimates the baseline level of the outcome, i.e., number of animal bite cases at time zero, ß1 estimates the change in the number of animal bite cases that occur with each month before the intervention, ß2 estimates the change in the number of animal bite cases that occur immediately after the intervention and ß3 estimates the change in the trend in the number of animal bite cases after lockdown compared with the number cases before lockdown.

A total of 3088 cases of animal bite were reported for the year-2020 from April to August. The average number of monthly cases during this period was 617.6 ± 150.48. [Figure 1] illustrates the time series plot along with the comparison of trends of reported animal bite cases between prelockdown and postlockdown periods.
Figure 1: Time series plot of animal bite cases showing comparison of trends for the pre- and postlockdown period. Violet line indicates the time of implementation of lockdown. Poisson regression was used to evaluate the trend for both the periods.

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The result indicates that before the lockdown, an average of 706 (confidence interval [CI]: 685.47–727.53) animal bite cases were reported per month. The baseline trend showed an upward slope(ß1) with 1.006 (CI: 1.004–1.008) times increase in the cases load per month from 2015 to 2019. This increasing trend for reported cases was found to be statistically significant (P < 0.05). Right after the lockdown, mean number reported animal bite cases changes(ß2) by a factor of 0.917 (CI: 0.843–0.997) or decreased by 8.3% (i.e., 1-0.917) with subsequent months of lockdown significantly (P = 0.04). Furthermore, the month-to-month change of cases for the postlockdown period was in decreasing trend (ß3 = 0.872) and this finding was statistically significant (P < 0.05).

Among the reported animal bite cases during the postlockdown (April-August 2020) period, 2212 (68.39%) were male, 976 (31.60%) were female, 1517 (47.52%) cases were from rural areas and 1571 (52.48%) were from urban areas. The majority of the cases were dog bite (69.26%) followed by monkey (17.16%) and cat bite (7.15%).

The median total number of cases for the postlockdown period was found to be significantly lower (P = 0.04) when compared with prelockdown period. Similarly, the reported female cases during postlockdown were significantly reduced (P = 0.003) when compared to prelockdown period. The reported animal bite cases from urban areas were significantly reduced (P = 0.001) postlockdown. When analyzing the type of animal bite cases, there was a significant reduction of the number of reported dog bite cases (P = 0.003) during the postlockdown period, however, a significantly greater (P = 0.03) number of monkey bite cases were noted [Table 1].
Table 1: Comparison of various characteristics of the animal bite cases between pre- and -lockdown period

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Animal bite cases decreased dramatically in line with the imposition of nationwide lockdown. The immediate impact was seen on the number of animal bite cases as for April followed by May and June, a lesser number of cases were reported as compared to the same period of last 5 years. It further declined and was lowest in July as government of Odisha further extended the lockdown up to July 31st in Ganjam district.

Our study showed a trend of reporting a higher proportion of males as compared to female cases during postlockdown, similar findings were observed in a study conducted by Rudresh et al.[5]

Majority of the animal bite cases were dog bites in the 5 years period, the findings were similar to the study conducted by Vishwanath et al. on animal bite cases of 5 years (2011–2015) where the most common biting animal was dog (73.9%).[6] However, the number of monkey bite cases increased during the lockdown when compared to the previous 5 years.

A study on trend analysis of animal bite cases by Kulkarni. conducted in Maharashtra found a greater number of cases from urban areas as compared to rural areas (urban: Rural; 1.7:1).[7] Furthermore, study conducted by Kinge and Supe in Nagpur, Maharashtra found majority of the animal bite cases were from urban areas (89.4%), which was similar to the previous trend in our study.[8] In our study, though there were more cases from urban areas, there was an increase in the number of cases from rural areas as compared to the previous year even though there was lockdown and difficulty in transportation. This could be because though the general OPD services were closed, the ARC of the tertiary level hospital was functional throughout the lockdown period.

A study conducted by Satapathy et al. showed a decreasing trend of animal bite cases for each month from April to August as well as from 2014 to 2018 years which was similar to our findings but and the average number of cases per day for 2014–2018 was higher as compared to 2020 daily caseload indicating the effect of lockdown in the district.[9]

A study conducted by Dixon and Mistry.[10] found a threefold increase of dog bite cases among children during COVID pandemic lockdown which was opposite to our findings. However, the increase in cases was due to a greater number of domestic dog bites.

There was a decrease in the trend of animal bite cases in the post lockdown period. Most of the bites were by dogs though there was an increase in the number of monkey bites as compared to the prelockdown period. The wildlife protection agencies should take care of the monkeys so that the human-animal contact can be reduced. Similarly, government should take appropriate actions to control the intermixing of street dogs with marginal populations at the village level, hence, reducing the exposure to stray dogs and the risk of biting.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Rattanavipapong W, Thavorncharoensap M, Youngkong S, Genuino AJ, Anothaisintawee T, Chaikledkaew U, et al. The impact of transmission dynamics of rabies control: Systematic review. Vaccine 2019;37 Suppl 1:A154-65.  Back to cited text no. 1
    
2.
Kumar S, Gupta A, Sachdeva A, Chaudhary A, Chamotra S. Epidemiological profile of animal bite patients attending emergency department at a tertiary care health facility in a northern Hilly Indian city. Int J Community Med Public Health 2019;6:3014-7.  Back to cited text no. 2
    
3.
WHO. Rabies. World Health Organization, Geneva. https://www.who.int/news-room/fact-sheets/detail/rabies. Published 2020. [Last accessed on 2020 May 16].  Back to cited text no. 3
    
4.
Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol 2017;46:348-55.  Back to cited text no. 4
    
5.
Rudresh HB, Jagadeesh B, Rajgopal J. Profile of animal bite victims reporting to intradermal rabies vaccination centre at a tertiary care government hospital: 10 years experience. Int J Community Med Public Health 2019;6:1545-8.  Back to cited text no. 5
    
6.
Vishwanath GR, Rajderkar SS, Sangrulkar TV, Sharma SK, Gajbhiye RI. Animal bite cases in western Maharashtra, India: A retrospective study 2010-2015. Int J Community Med Public Health 2018;5:1610-2.  Back to cited text no. 6
    
7.
Kulkarni SK. Trend of animal bite victims reported to anti rabies vaccination clinic at a tertiary care hospital Nanded Maharashtra. Dent Med Sci 2016;15:36-9.  Back to cited text no. 7
    
8.
Kinge K, Supe A. Epidemiology of animal bite cases reported to anti-rabies vaccination OPD at a tertiary-care hospital, Nagpur. Int J Med Sci Public Health 2016;5:1579-82.  Back to cited text no. 8
    
9.
Satapathy D, Karmee N, Reddy N, Pandit D. Seasonal trend of animal bite victims attending anti rabies clinic of a tertiary care hospital, Berhampur. APCRI J 2020;XXI:33-9.  Back to cited text no. 9
    
10.
Dixon CA, Mistry RD. Dog bites in children surge during coronavirus disease-2019: A case for enhanced prevention. J Pediatr 2020;225:231-2.  Back to cited text no. 10
    


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