7th Call - Professor Margaret Lartey
Project Title: Evaluation of the Management of Rabies at Primary Care Facilities within the Public Health System in the Greater Accra Region, Ghana.
Principal Investigator: Professor Margaret Lartey (Department of Medicine and Therapeutics, UGMS University of Ghana)
Email Address: mlartey@ug.edu.gh
Award Amount: GHC 25,000.00
Project Status: On-going
Summary:
Rabies is a neglected and under reported disease that claims the lives of many in developing countries like Ghana. About 30% to 60% of dog bite victims in dog-endemic or rabies-endemic areas are children less than 15 years of age. Ghana recorded 144 rabies deaths countrywide between 1986 and 2003 due to dog bites; Greater Accra region alone recorded 2,620 dog bites between 2003 and 2008 out of which 232 (8.9%) were detected positive for rabies. Also, 25 people died in Ghana from rabies between the years 2009 and 2011. All of these were preventable deaths. Prescribers (Doctors, Physician assistants, medical assistants, Midwives and nurse prescribers) constitute an important source of medical care in our communities and are approached for anti-rabies treatment by the victims of animal bites. Most of the observed rabies deaths occurring in Korle-Bu Teaching Hospital were individuals referred from primary care setting within the metropolis who had sought care immediately after the bite. However, most received anti tetanus serum and antibiotics but reported no anti rabies treatment despite reporting with dog bites. Considering the 100 percent case fatality rate and the fact that preventable vaccines are available, the study seeks to evaluate the management of rabies at primary care facilities within the public health system in the Greater Accra Region of Ghana and to determine the reasons for the quality of care being offered/provided. This will provide a baseline to help determine the type if any of interventions to put in place to reverse the trend. The aim of the study therefore is to evaluate the management of rabies at primary care facilities in the Greater Accra Region of Ghana and the reasons for the quality of care given. The study proposes to use mixed methods applying both quantitative and qualitative methods in a cross sectional study over six months. All 42 public health service facilities in the Greater Accra region will be studied. Front line prescribers will be sampled and interviewed using close ended questionnaires. In depth interviews will be conducted with health workers, key informant interviews with ID specialists and senior veterinarians and a focus group discussion in the communities on perception and knowledge on preventing rabies associated deaths and with families of victims.
Proportions will be used to determine the various categories of knowledge. Chi-square test of proportions will be used to determine any significant association between the various categories of prescribers and management of rabies. Qualitative analysis will be done using NVivo 10 and recurrent and divergent themes generated. Data from the qualitative will be analysed together through triangulation.
A report on the management of dog bites and rabies in the region is expected to be produced for comparison with standard of care and expert opinion. This will be the basis for interventions to improve on the management of dog bites and rabies in the region.