Rabies: A public health problem
Rabies is fast becoming a serious public health problem in this country. Despite its high fatality rate, the disease seems to be ignored and perceived as a low priority compared to other infectious diseases. Reports about human exposure to the disease are common. On January 18 2014, Zodiak Broadcasting Station (ZBS) carried a story about three people who recently died of the disease in Mulanje after failing to access rabies vaccine.
The disease is caused by rabies virus which is spread from animals to humans through infected saliva passing through bites and scratches. Most human exposures are from domestic dogs. The incubation period, the time between exposure to the virus and when signs and symptoms become evident, varies from one week to a year. The virus damages the body’s central nervous system, which comprises the brain and spinal cord.
The World Health Organisation (WHO) reports that over 15 million people worldwide receive post-exposure rabies vaccination every year. More than 55 000 people in Asia and Africa die of rabies disease every year. During the launch of last year’s dog vaccination campaign at Mpherembe in Mzimba, the Ministry of Agriculture and Food Security reported that the disease claims lives of over 200 Malawians every year.
There are two forms of rabies. There is furious rabies whereby the infected person shows signs of hyperactivity, excited behaviour and hydrophobia. Death follows a few days later resulting from failure of the heart and breathing system. The other form is called paralytic rabies which takes a longer course as compared to the furious form. In the paralytic form, paralysis gradually develops starting from the site of the bite or scratch then the infected person goes into coma which is followed by death.
The most effective way to prevent rabies in people is by eradicating rabies in dogs. The Ministry of Agriculture and Food Security should be commended for carrying out a national rabies campaign last year. The ministry expected to vaccinate about 80 percent of the total dog population as a way of reducing human exposure to the disease. However, there is still a lot to be done to reduce the prevalence of this deadly disease.
It has been observed that the ministry uses central-point (CP) strategy whereby dog owners are expected to take their dogs to one central point for vaccination. This strategy has challenges which may lead to insufficient vaccination coverage. One of the challenges is that the strategy depends on attitude of the dog owners whose compliance may be affected by long distance to the designated point for vaccination as well as cultural or religious beliefs.
It would be prudent for the ministry to consider combining the CP strategy with other strategies like house-to-house dog vaccination to ensure good coverage. Vaccination fee should also be scraped off as this would limit other people from taking their dogs for the injection. We also seem to have an overpopulation of dogs in the country as evidenced by the number of stray dogs that are seen on our roads, some of which are hit by motor vehicles. Why can’t the Ministry embark on a campaign to kill all stray dogs?
There is also need for more community veterinary officers to provide veterinary services, including dog vaccination at community level. The approach of taking services to the community has proved to be effective in the Ministry of Health where health surveillance assistants (HSAs) who are stationed in the communities offer basic public health services, including immunisation for children. It is undisputable that these HSAs have substantially contributed to our success stories in achieving Millennium Development Goal number 4 on reduction of child mortality.
Finally, when one gets exposed to a suspect rabid animal, flushing and washing of the wound with soap and water or any detergent is recommended as a first-aid measure. It is important to seek medical attention for immediate prophylactic treatment to prevent onset of the disease and death. Treatment includes a course of rabies vaccine and treatment of the wound. It is, therefore, essential that this vaccine is made available in our public health facilities.
The author is a lecturer in medical and surgical nursing at Kamuzu College of Nursing.
