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- Title
Accessibility to rabies centers and human rabies post-exposure prophylaxis rates in Cambodia: A Bayesian spatio-temporal analysis to identify optimal locations for future centers.
- Authors
Baron, Jerome N.; Chevalier, Véronique; Ly, Sowath; Duong, Veasna; Dussart, Philippe; Fontenille, Didier; Peng, Yik Sing; Martínez-López, Beatriz
- Abstract
Rabies is endemic in Cambodia. For exposed humans, post-exposure prophylaxis (PEP) is very effective in preventing this otherwise fatal disease. The Institut Pasteur du Cambodge (IPC) in Phnom Penh was the primary distributor of PEP in Cambodia until 2018. Since then, and to increase distribution of PEP, two new centers have been opened by IPC in the provinces of Battambang and Kampong Cham. Data on bitten patients, who sometimes bring the head of the biting animal for rabies analyses, have been recorded by IPC since 2000. However, human cases are not routinely recorded in Cambodia, making it difficult to establish a human burden of disease and generate a risk map of dog bites to inform the selection of future PEP center locations in high-risk areas. Our aim was to assess the impact of accessibility to rabies centers on the yearly rate of PEP patients in the population and generate a risk map to identify the locations where new centers would be the most beneficial to the Cambodian population. To accomplish this, we used spatio-temporal Bayesian regression models with the number of PEP patients as the outcome. The primary exposure variable considered was travel time to the nearest IPC center. Secondary exposure variables consisted of travel time to a provincial capital and urban proportion of the population. Between 2000 and 2016, a total of 293,955 PEP patient records were identified. Our results showed a significant negative association between travel time to IPC and the rate of PEP patients: an increase in one hour travel time from the living location to IPC PEP centers leads to a reduction in PEP rate of 70% to 80%. Five provinces were identified as the most efficient locations for future centers to maximize PEP accessibility: Banteay Meanchey, Siem Reap, Takeo, Kampot and Svay Rieng. Adding a PEP center in every provincial capital would increase the proportion of Cambodians living within 60 minutes of a PEP center from 26.6% to 64.9%, and living within 120 minutes from 52.8% to 93.3%, which could save hundreds of lives annually. Author summary: Rabies is a fatal viral disease that affects the nervous system. It is endemic in many countries in Africa and Asia where free roaming dogs form a reservoir. Transmission to humans occurs most often through a dog bite. However, post-exposure prophylaxis (PEP), if administered before symptom onset, is highly effective at preventing the disease. In Cambodia, a few number of centers offer PEP, with the Institut Pasteur du Cambodge in Phnom Penh being the main one. These few locations lead to limited accessibility for rural areas distant from Phnom Penh and underestimations of the dog-bite burden and PEP needs. Through statistical modelling, we measured the impact of accessibility on the number of PEP patients and predicted the impact of opening new centers in other locations. We found that travel time was significantly associated with the rate of PEP patients. IPC opened new rabies centers in Battambang and Kampong Cham provinces in 2018 and 2019, respectively, and we identified four provinces where future openings would be the most beneficial: Banteay Meanchey, Siem Reap, Takeo, Kampot and Svay Rieng. This study is part of a broader drive to eradicate rabies in Cambodia by 2030 through increased PEP infrastructure and control measures in the dog population.
- Subjects
CAMBODIA; PHNOM Penh (Cambodia); DOG bites; RABIES; BAYESIAN analysis; BITES &; stings; VIRUS diseases; CITY dwellers
- Publication
PLoS Neglected Tropical Diseases, 2022, Vol 16, Issue 6, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0010494