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“As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda

Dog-mediated rabies is on the increase in Uganda despite the availability of post-exposure prophylaxis (PEP). PEP procedures are expounded in the Uganda Clinical Guidelines (UCG) of 2016. We assessed adherence by health workers to UCG while managing dog bites in two PEP centers and obtained insights...

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Autores principales: Kisaka, Stevens, Makumbi, Fredrick E., Majalija, Samuel, Kagaha, Alexander, Thumbi, S. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279313/
https://www.ncbi.nlm.nih.gov/pubmed/34260651
http://dx.doi.org/10.1371/journal.pone.0254650
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author Kisaka, Stevens
Makumbi, Fredrick E.
Majalija, Samuel
Kagaha, Alexander
Thumbi, S. M.
author_facet Kisaka, Stevens
Makumbi, Fredrick E.
Majalija, Samuel
Kagaha, Alexander
Thumbi, S. M.
author_sort Kisaka, Stevens
collection PubMed
description Dog-mediated rabies is on the increase in Uganda despite the availability of post-exposure prophylaxis (PEP). PEP procedures are expounded in the Uganda Clinical Guidelines (UCG) of 2016. We assessed adherence by health workers to UCG while managing dog bites in two PEP centers and obtained insights into motivations of their practices. Using qualitative methods, we observed the health worker-patient encounters, reviewed medical records, and interviewed 14 health workers that were involved in managing dog bite injuries. We used deductive thematic analysis to identify codes in themes developed from UCG. We found that much of the history of the bites was taken, but it was neither verified nor written down on the patient’s file. Classification of wounds was inaccurate and ancillary laboratory assessments like culture and sensitivity tests were not conducted in all cases. Although antibiotics were given for both treatment and prophylactic purposes, the prescription was based on availability and affordability, not UCG recommendations. Rabies immunoglobulin (RIG) was not administered to deserving patients due to unavailability and high costs to the patient. Anti-rabies vaccine (ARV) was prescribed indiscriminately and some health workers attributed this to pressure from patients. Health education regarding prevention of dog bites was not given to patients due to time constraints on the side of the providers as a result of high caseloads at the emergency departments. Challenges to adherence to guidelines were identified as frequent ARV stock outs; inadequate cooperation among health facilities; and insufficient knowledge and skills on how injuries and rabies should be managed. We conclude that clinical management of dog bites is not fully in line with UCG. We argue that adoption of an integrated bite case management and cost-saving strategies as well as continuing medical education programs on rabies control and management could improve the clinical management of dog bites.
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spelling pubmed-82793132021-07-31 “As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda Kisaka, Stevens Makumbi, Fredrick E. Majalija, Samuel Kagaha, Alexander Thumbi, S. M. PLoS One Research Article Dog-mediated rabies is on the increase in Uganda despite the availability of post-exposure prophylaxis (PEP). PEP procedures are expounded in the Uganda Clinical Guidelines (UCG) of 2016. We assessed adherence by health workers to UCG while managing dog bites in two PEP centers and obtained insights into motivations of their practices. Using qualitative methods, we observed the health worker-patient encounters, reviewed medical records, and interviewed 14 health workers that were involved in managing dog bite injuries. We used deductive thematic analysis to identify codes in themes developed from UCG. We found that much of the history of the bites was taken, but it was neither verified nor written down on the patient’s file. Classification of wounds was inaccurate and ancillary laboratory assessments like culture and sensitivity tests were not conducted in all cases. Although antibiotics were given for both treatment and prophylactic purposes, the prescription was based on availability and affordability, not UCG recommendations. Rabies immunoglobulin (RIG) was not administered to deserving patients due to unavailability and high costs to the patient. Anti-rabies vaccine (ARV) was prescribed indiscriminately and some health workers attributed this to pressure from patients. Health education regarding prevention of dog bites was not given to patients due to time constraints on the side of the providers as a result of high caseloads at the emergency departments. Challenges to adherence to guidelines were identified as frequent ARV stock outs; inadequate cooperation among health facilities; and insufficient knowledge and skills on how injuries and rabies should be managed. We conclude that clinical management of dog bites is not fully in line with UCG. We argue that adoption of an integrated bite case management and cost-saving strategies as well as continuing medical education programs on rabies control and management could improve the clinical management of dog bites. Public Library of Science 2021-07-14 /pmc/articles/PMC8279313/ /pubmed/34260651 http://dx.doi.org/10.1371/journal.pone.0254650 Text en © 2021 Kisaka et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kisaka, Stevens
Makumbi, Fredrick E.
Majalija, Samuel
Kagaha, Alexander
Thumbi, S. M.
“As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda
title “As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda
title_full “As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda
title_fullStr “As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda
title_full_unstemmed “As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda
title_short “As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda
title_sort “as long as the patient tells you it was a dog that bit him, why do you need to know more?” a qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in uganda
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279313/
https://www.ncbi.nlm.nih.gov/pubmed/34260651
http://dx.doi.org/10.1371/journal.pone.0254650
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