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Animal Bite Patterns and Implementation of Rabies Prevention and Control

Program in Animal Bite Treatment Center

Article · June 2019

DOI: 10.33425/2639-9474.1107

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Research Article ISSN 2639-9474

Research Article Nursing & Primary Care

Animal Bite Patterns and Implementation of Rabies Prevention and Control

Program in Animal Bite Treatment Center
Rachelle Garcia, MAN, RM, RN1, Filipinas Abundabar, MSN, LPT, RN2, Dhonna Cruz-Cambe, MAN, RM,
RN3, Veronica Dancil, MAN, RN3, Haixia Feng, MSN, LPT, RN4, Maricel Nasog, EdD, MAN, RN5 and Bea-
Gracia M. Cruz, FPCHA, CHA, DNM, MAN, RN6

Assistant Professor IV, Far Eastern University, Manila,

1

Philippines.
2
Faculty, Sacred Heart College, Quezon Province, Philippines. *
Correspondence:
3
Faculty, Far Eastern University, Manila, Philippines. Rachelle Garcia, Assistant Professor IV, Far Eastern University,
Manila, Philippines, Tel: 09224264693 E-mail: rax238@hotmail.
4
Faculty, South Eastern University, China. com.

Associate Professor Lyceum-Northwestern University, Dagupan

5 Received: 04 April 2019; Accepted: 06 May 2019
City Pangasinan, Philippines.

OIC- Nursing Director, Our Lady of Lourdes Hospital,

6

Mandaluyog, Philippines.

Citation: Rachelle Garcia, Filipinas Abundabar, Dhonna Cambe, et al. Animal Bite Patterns and Implementation of Rabies Prevention
and Control Program in Animal Bite Treatment Center. Nur Primary Care. 2019; 3(3): 1-5.

ABSTRACT
Rabies is a perennial fatal disease and animal bite is the major culprit. Over the decade, animal bite cases have
been increasing in the Philippines [1].

This is a retrospective descriptive comparative quantitative research design. It aims to describe the pattern of
characteristics of animal bite cases as well as to determine if there is a significant difference in the implementation
of Rabies Prevention and Control Program (RPCP) in government and private Animal Bite Treatment Centers
(ABTC) in Quezon Province both from the standpoint of patients and healthcare providers. It utilized convenience
sampling in selecting the 200 patients and 10 Healthcare Workers (HCW) respondents. Records review and survey
questionnaire (Cronbach's alpha of 0.84) were used to draw the information.

Animal bite pattern in Quezon Province peaked during May, July and August having an ascending trend from 2016
to 2017. Female and age group above 15 years old are the most common victims of animal bites. Dogs are the
most common culprits of animal bites, with the bites predominantly classified as category II. RPCP in government
(WAM=4.87) and private (WAM=4.38) ABTC is often implemented as assessed by patients and HCW. Despite that
RPCP is often implemented, findings revealed that its implementation is significantly different in government and
private ABTC (p-value <.00001 at α level 0.01) as assessed by both patients and HCW.

Despite the high extent of implementation of RPCP animal bite cases remains high and in ascending trend (26.35%).
Identified areas needing improvement is deemed recommended to be corrected and monitored.

Introduction
Keywords Rabies is one of the neglected communicable diseases that is a
Animal Bite Center, Animal Bite Pattern, Animal Bite Treatment perennial health concern in the Philippines. The country is one of
Center, Implementation, Rabies Prevention and Control Program. the top 10 countries in the world with rabies problem. It is the
most acutely fatal infectious disease responsible for deaths which
Nur Primary Care, 2019 Volume 3 | Issue 3 | 1 of 5
ranges from 245 to 266 with an average of 258 cases per year This study was conducted in three (3) ABTC in Quezon Province
from 2014-2017. Out of the 144 reported human rabies cases in the within a period of one month from October 24 – November 23,
Philippines, 6 (4.2%) came from Quezon Province [1]. 2018. It utilized convenience sampling also known as availability
sampling, a specific type of non-probability sampling method
As such, Philippines indicated its commitment to rabies control that relies on data collection from population members who
measures by passing the Anti-Rabies Act of 2007 (Republic are conveniently available to participate in study. The study
Act No. 9482). Specifically, Section 2 of the said republic act was conducted among 200 respondents, with 100 patients from
declared that it is the policy of the state to protect and promote government ABTC and 100 patients from private ABTC. The
the right to health of the people. Thus, a system for the control, study also obtained the assessment of the healthcare providers
prevention of the spread and eventual eradication of human and having a total of ten (10) respondents, six (6) healthcare providers
animal rabies through the development of a National Rabies from government ABTC and four (4) healthcare providers from
Prevention and Control Program (NRPCP) was established. private ABTC.
Animal Bite Treatment Centers and Animal Bite Centers (ABC)
were established to facilitate the implementation of the said Data on the pattern or characteristics of animal bite were obtained
program. The government facilitates ABTC network operations from review of records in the ABTC from January 2016 to
while ABC which are operated and owned by private individuals December 2017. The extent implementation of the program
or companies/corporations. The number of ABTCs governed by was assessed using a 21-item research questionnaire which was
the Philippine government has been steadily rising since 1997 to a adopted from the DOH / CHD Self-Assessment Tool Manual of
total of 513 by July 2017, and consequently the number of bitten Operations (2012) on National Rabies Prevention and Control
patients treated has risen. However, records of the numbers of Program. It was modified and translated into a Filipino vernacular
bitten patients treated in many private Animal Bite Clinic facilities for the convenience and better understanding of the respondents.
in the Philippines are not compiled and consequently were not The tool utilized five-point Likert scale as follows: (5) always
available for analysis [2]. implemented, (4) often implemented, (3) sometimes implemented,
(2) seldom implemented, and (1) not implemented.
Animal bite is the major mode of transmission for rabies. According
to Dr. Nicole Perreras, medical specialist 3, Head of Animal Bite Pilot testing was administered to ten (10) patients of ABTC in
Clinic at the Research Institute for Tropical Medicine, the number Bulacan Province. The results were statistically computed using
of animal bite patients in the country has become more alarming the Cronbach’s Alpha SPSS statistics which yielded a good
over the years with 100-130 cases of animal bites patients a day, reliability (0.841). The questionnaire was modified for precise,
anywhere from scratch to a real dog or cat bite [3]. explicit and completeness prior to its distribution. Informed
consent was secured from the respondents. The purpose of the
Similarly, the DOH Rabies Surveillance noted that the animal study was properly explained to each respondent with assurance
bite cases have been increasing for the past 10 years despite the that all responses will be treated with confidentiality. After the
effort of both private and government sectors to implement rabies retrieval of the questionnaires, data were gathered, organized,
prevention and control programs [1]. It is extremely important to interpreted, and analysed using SPSS.
reflect on how well these programs are being implemented to help
in developing recommendations to strengthen the implementation Results
process and achieve nation’s goal of being rabies-free by 2020. Animal bite pattern in Quezon Province which usually peaked
during May (10.53%), July (10.38%) and August (10.18%) having
This study is designed to describe the pattern of characteristics an ascending trend (26.35%) from 2016 to 2017. Moreover,
of animal bite cases in Quezon Province. Its main thrust is to female (51.54%) and age group above 15 years old (61.41%)
determine if there is significant difference in the implementation are the most common victims of animal bite. Dogs (62.41%) are
Rabies Prevention and Control Program in government and private the most the most prevalent culprits of animal bites which are
Animal Bite Treatment Centers in Quezon Province both from the predominantly classified as category II bites (71.79%). RPCP in
standpoint of patients and health care workers (HCW). government (WAM=4.87) and private (WAM=4.38) ABTC is often
implemented as assessed by patients and HCW. Despite that RPCP
Methods is often implemented, findings revealed that its implementation is
The research study utilized a retrospective descriptive comparative significantly different in government and private ABTC (p-value
quantitative research design as it used existing data from the <.00001 at α level 0.01) as assessed by both patients and HCW.
private and government ABTC census of animal bite incidents and
patterns from January 2016 to December 2017. The study aimed Discussion
to describe the pattern or characteristics of animal bite cases and Findings revealed that animal bite pattern in Quezon Province
determine if there is a significant difference in the implementation peaked during May (10.53%), July (10.38%) and August (10.18%)
of RPCP in government and private ABTC in Quezon Province having an ascending trend (26.35%) from 2016 to 2017. According
both from the standpoint of patients and HCW. to Sarah Fraser, co-founder of Instinct Dog Training, summer is the
season of dog bites and that dogs are being potentially put in more
Nur Primary Care, 2019 Volume 3 | Issue 3 | 2 of 5
social-gathering situations that make them very uncomfortable
[4]. Moreover, dogs can be irritable in the heat and grumpy when
another gets in their space for, they lack the normal sweat glands
compared with humans and other species [5]. Consequently, if the
animal finds itself in a stressful situation whether they are scared
or startled, it may bite to defend itself or its territory. This explains
why animal bite is increased during July and August which are
rainy months and season of thunderstorms that makes dogs and cats
more anxious or freak out, thus, they bite to protect themselves [6].
Figure 3: Distribution of Animal Bite Cases According to Age Group.

In terms of bite classification, the findings are congruent with the

results of the studies that majority (71.79%) of the cases were
category II which includes the following: nibbling of uncovered
skin, minor scratches or abrasions without bleeding [8,11,23].
Likewise, Category II rabies exposure involves bites sustained
from animals which are thought to have rabies such as dogs,
cats, monkeys, swine, rabbits, cattle and goats, necessitating
administration of anti-rabies vaccination and local treatment of
Figure 1: Monthly Distribution of Animal Bite Cases. wound [24].

Furthermore, findings show that female (51.54%) are more likely Animal bite which includes single or multiple transdermal bites,
to sustain animal bite [7] which refute the studies conducted in such as puncture wounds, lacerations and avulsions, licks on
India, Iran and other countries claiming that males are the more broken skin or scratches/abrasions with spontaneous bleeding;
likely to be afflicted by dog bite [8-11]. This can be attributed to contamination of mucous membrane with saliva from licks and
the fact that dogs are domesticated and taken cared of mostly by contacts with bats [24], falls in Category III [22]. This need
women, since they are more likely the ones who stay at home. both anti-rabies vaccines and passive-immunization of e-rabies
immunoglobulin (RIG) as well as local treatment of the wound. In
this study, Category III (26.16%) falls only in second in rank while
in India majority (97.1%) of animal bite victims falls in Category
III.

Figure 2: Distribution of Animal Bite Cases According to Sex.

Additionally, victims of animal bite cases in Quezon Province Figure 4: Distribution of Animal Bite Cases According to Bite Category.
are more likely above 15 years old (61.41%) which negated other
studies which tell otherwise [9,12-19]. Animal bites occur more
frequently in adult since it is usually the adult member in the family
who is often associated with handling and caring for the animal.
Also, adults are more adventurous and risk takers making them
more prone to bite of stray animals. These findings are congruent
with the cases in Aklan, Davao and Cebu City, Philippines and India
which clinched that nearly half of the cases occurred in persons
of economically productive age group [8,20,21]. However, deaths
due to human rabies contributes to almost one third are among
children less than 15 years old, an almost half of rabies exposure
are among schoolchildren in which cases are usually higher in Figure 5: Distribution of Animal Bite Cases According to Biting Animal.
summer where children spend more time playing outdoors [22].
Nur Primary Care, 2019 Volume 3 | Issue 3 | 3 of 5
Lastly, Category I which includes touching or feeding animals, or HCW, animal bite cases in Quezon Province remains to be in
licks on intact skin [24] had very minimal occurrence (1.94%), this increasing trends from 2016 to 2017. The study also concluded
is attributable to the idea that it does not need any post exposure that government ABTC is significantly more compliant compared
prophylaxis so very few victims under this category seeks medical with private ABTC in the implementation of RPCP according
consultation. to patients and HCW. Therefore, monitoring of implementation
of RPCP in private ABTC must be given considerable attention.
Moreover, findings of this study affirm with most literatures Further qualitative exploration on the reasons for the increasing
that dogs (62.41%) were responsible for majority of bite cases incidence of animal bite is recommended.
[2,15,17,18,22,24,26,27], followed by cat bite (36.75%.), and
other animals (0.84%) such as monkeys, horses, pigs and rabbit. Acknowledgement
The researchers would like to express their deepest gratitude to the
Bites happen when playing with a pet or trying to feed animal or patients, healthcare providers and Administrators in Animal Bite
dealing with stray animals. This can be attributed to Filipinos being Treatment Centers in Quezon Province for their full cooperation
great lovers of dogs with over a million registered dog owners [28] in the study. Special acknowledgement also to the Trinity
as such the pet industry in the Philippines is growing and in fact University of Asia Doctor of Nursing Program which motivated
according to Canine Club Inc., there were 1,169,659 registered the researchers to extend efforts to complete this study. The team
with studbook in 2017, which is for pure-bred dog alone [3]. is also appreciative to the friends and family of Mrs. Filipinas
Afundabar who have been the extension arms of the researchers
Dogs and cats in the Philippines are typically domesticated. during the implementation of the study.
However, when the number of pet dogs and cats increase the
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