Factors associated with delay in initiating postexposure prophylaxis for rabies prevention in a district of Madhya Pradesh, India: 2023.

Introduction: India reports more than 9 million animal bite cases and 5000 deaths due to rabies every year, which postexposure prophylactic vaccines can prevent. Delayed vaccination can be fatal. We assessed the causes of the delay in initiating postexposure prophylaxis (PEP) in the Shivpuri district of Madhya Pradesh, India. Methodolgy: We defined delay as >24 h between the bite and initiation of PEP. We interviewed all animal bite cases reported in the outpatient or emergency departments at the District Hospital of Shivpuri in Madhya Pradesh for PEP from January to September 2023 using a structured questionnaire on the sociodemographic profile, nature, site, animal of the bite, and treatment time of the cases. In-depth interview of the cases who delayed the treatment about the factors responsible was done. Chi-square was applied as a significance test for factors associated with delay in treatment, and Results: A total of 422 animal-bite cases were interviewed; males were 289 (68%), rural residents were 293 (69%), and those aged 10-19 years were 100 (24%). Dogs caused 394 (93%) of bites, affecting lower limbs 220 (52%). Treatment delay occurred in 157 (37%) of cases. Factors were closed facilities due to holidays or delay in reaching, 56 (36%); work-related, 51 (32%); treatment unawareness, 38 (24%); lack of accompaniment, 22 (14%); and financial, 21 (13%). Delays were significantly higher among rural residents, those living >10 km from facilities, and cases with income <₹10,000/month. Conclusions: We recommend awareness campaigns in rural areas regarding rabies and extending timings of healthcare facilities.