Containing rabies, a deadly challenge

Rabies kills about 55 000 people every year in Africa and Asia, according to World Health Organisation. But in Malawi, reversing these deaths needs not only the availability of vaccines but also containing the population of dogs and having them vaccinated. EPHRAIM NYONDO and NICHOLAS MSOWOYA write.

Perhaps Melina Mhone, 26, would not have died if Bolero Rural Hospital, where she initially went to after being bitten by a rabid dog, had anti-rabies vaccine.

Mhone was referred from Bolero to Rumphi District Hospital where she died upon arrival.

 

According to Dr Isaac Gasiga of the Medical Aid Society of Malawi (Masm), rabies is a viral disease transmitted mainly by bite and exposure of saliva from an infected animal to broken skin or mucous membranes.

 

“The virus attacks the central nervous system and ravages the brain and spinal cord,” he explains.  

 

Initial symptoms, he adds, typically resemble the flu and include fever, fatigue and headaches.

 

“Later, sufferers may become aggressive and experience convulsions and hallucinations. If left untreated, it is almost always fatal,” he says.

 

Two days after the fatal disease fell on Mhone in Rumphi, who came from Mzakwacha Village, T/A Chikulamayembe, came another tragedy.  Efrida Mvula, nine, referred from Mzokoto in the same district also died of rabies at the same hospital.

 

According to public relations officer for the hospital, Lovemore Kayange, Rumphi District Hospital has not had vaccine for rabies since February this year.

 

From January to April this year, adds Kayange, the hospital received 133 cases of dog bite patients.  And those who came in and after February had to be sent to buy the anti-rabies vaccine elsewhere.

 

Hundreds of dog bite victims are forced to buy the anti-rabies vaccine from pharmacies and private clinics, at around K7 000 per injection, and K35 000 for a full dosage of five injections.

 

The risk is even bigger considering that poor people cannot afford the vaccine.

 

Unfortunately, it is not just Rumphi Hospital running short of the vaccine.

Wesley Sichali, principal clinical officer for Mzimba North Health District, in-charge of 25 health centres, confirmed the scarcity of the drugs in the health centres under his charge.

 

Mzuzu Central Hospital public relations officer, Twambilire Simukonda, admitted that his hospital does not have the vaccine.

 

Even Henry Chimbali, spokesperson for the Ministry of Health, confirmed the shortage.

 

The question being asked, then, is why are these vaccines running out of stock? Is it because of the increased demand for the vaccine or it is on the supply side?

 

Simukonda attributed the problem to drugs unavailability at the Central Medical Stores.

“Last time we ordered the drugs at the Central Medical Stores, we were told that they did not have,” said Simukonda.

 

While admitting the shortage, public relations officer of the Central Medical Stores Trust (CMST) Herbert Chandilanga said the situation is normalising, revealing that recently 6 000 injections of the vaccine have been made available.

 

Agreeing with Chandilanga, Chimbali, however, adds that it is important not just to explain the shortage from the supply side.

 

“We have noted a rising consumption rate of the vaccine due to increased cases of dog bites in most of our hospitals. This has brought pressure on the vaccine; as such, it has been easily running out. We are being overwhelmed,” he says.

 

He adds: “We are only on the receiving end. Other actors as well need to come into play to help us. Rabies vaccines are quite expensive to purchase, even worse, we have a number of areas to look into.”

Apart from calling on government to stock CMST, a lot needs to be done on the preventive side.

 

Take the statistics from Mzuzu Agricultural Development Division (Mzadd) for instance. In May alone this year, 33 people were bitten by unknown and unvaccinated dogs, against 54 who were bitten by known vaccinated dogs.

 

Animal health officer for Mzadd, Jacob Mwasinga, says less than half the population of dogs is vaccinated in Mzadd which covers Mzimba, Rumphi, Nkhata Bay and Likoma districts.

 

“There are over 80 000 dogs in the ADD, but last year in September we only vaccinated 40 percent of that population due to financial constraints,” says Mwasinga.

 

Director in the Department of Animal Health and Livestock Dr Ben Chimera says there has not been any change to dog vaccine in the country.

 

“Each year, we hold dog vaccine campaign and there is always an overwhelming response from the public because it is free. This year, will roll out the campaign between August and September,” he says.

 

For instance, during last year’s vaccination week, almost 20 000 dogs were vaccinated in Blantyre.

 

In Mzuzu, however, Mwasinga said the challenge has always been inadequate funding.

 

“Our budget ceiling for the exercise is by far inadequate,” he said.

Mwasinga added that the situation is not ideal because government policy is that at least 80 percent of the dog population in an ADD must be vaccinated annually to eliminate rabies.

 

“The cost of vaccinating a single dog by last September was K300, and Mzuzu City alone—with a population of 7 000 known dogs— required over K2 million.

 

And this cost, according to Mwasinga, has likely increased this year, casting doubt on possibility that the veterinary officials will vaccinate the recommended number of the dogs during this year’s vaccination week.

 

According to World Health Organisation (WHO), rabies is a neglected disease of poor and vulnerable populations whose deaths are rarely reported.

 

“It occurs mainly in remote rural communities where measures to prevent dog to human transmission have not been implemented. Under-reporting of rabies also prevents mobilisation of resources from the international community for the elimination of human dog-mediated rabies,” reads information on the website.

 

Rabies is a serious threat to the country. The families of late Mhone and Mvula can attest to this. Although they died due to shortage of anti-rabies vaccine at Rumphi Hospital, experts agree that it is cheaper to vaccinate dogs than treat those affected with the rabies virus.