Geographic variation in access to dog-bite care in Pakistan and risk of dog-bite exposure in Karachi: prospective surveillance using a low-cost mobile phone system.
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2013-12-18
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Abstract
BACKGROUND Dog bites and rabies are under reported in developing countries such as Pakistan and there is a poor understanding of the disease burden We prospectively collected data utilizing mobile phones for dog bite and rabies surveillance across nine emergency rooms ER in Pakistan recording patient health seeking behaviors access to care and analyzed spatial distribution of cases from Karachi METHODOLOGY AND PRINCIPAL FINDINGS A total of 6212 dog bite cases were identified over two years starting in February 2009 with largest number reported from Karachi 59 7 followed by Peshawar 13 1 and Hyderabad 11 4 Severity of dog bites was assessed using the WHO classification Forty percent of patients had Category I least severe bites 28 1 had Category II bites and 31 9 had Category III most severe bites Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non medical facilities Odds Ratio 0 20 95 CI 0 17 0 23 p valueUnder0 01 and had shorter mean travel time to emergency rooms adjusted for age and gender 32 78 min 95 CI 31 82 33 78 p valueUnder0 01 than patients visiting hospitals in smaller cities Spatial analysis of dog bites in Karachi suggested clustering of cases Moran s I 0 02 p valueUnder0 01 and increased risk of exposure in particular around Korangi and Malir that are adjacent to the city s largest abattoir in Landhi The direct cost of operating the mHealth surveillance system was USD 7 15 per dog bite case reported or approximately USD 44 408 over two years CONCLUSIONS Our findings suggest significant differences in access to care and health seeking behaviors in Pakistan following dog bites The distribution of cases in Karachi was suggestive of clustering of cases that could guide targeted disease control efforts in the city Mobile phone technologies for health mHealth allowed for the operation of a national level disease reporting and surveillance system at a low cost