The burden of rabies in Tanzania and its impact on local communities

Sambo, M., Cleaveland, S., Ferguson, H., Lembo, T., Simon, C., Urassa, H. and Hampson, K. (2013) The burden of rabies in Tanzania and its impact on local communities. PLoS Neglected Tropical Diseases, 7(11), e2510. (doi:10.1371/journal.pntd.0002510)

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Abstract

Background Rabies remains a major public health threat in many parts of the world and is responsible for an estimated 55,000 human deaths annually. The burden of rabies is estimated to be around US$20 million in Africa, with the highest financial expenditure being the cost of post-exposure prophylaxis (PEP). However, these calculations may be substantial underestimates because the costs to households of coping with endemic rabies have not been investigated. We therefore aimed to estimate the household costs, health-seeking behaviour, coping strategies, and outcomes of exposure to rabies in rural and urban communities in Tanzania.

Methods and Findings Extensive investigative interviews were used to estimate the incidence of human deaths and bite exposures. Questionnaires with bite victims and their families were used to investigate health-seeking behaviour and costs (medical and non-medical costs) associated with exposure to rabies. We calculated that an average patient in rural Tanzania, where most people live on less than US$1 per day, would need to spend over US$100 to complete WHO recommended PEP schedules. High costs and frequent shortages of PEP led to poor compliance with PEP regimens, delays in presentation to health facilities, and increased risk of death.

Conclusion The true costs of obtaining PEP were twice as high as those previously reported from Africa and should be considered in re-evaluations of the burden of rabies.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lembo, Dr Tiziana and Hampson, Dr Katie and Cleaveland, Professor Sarah and Ferguson, Professor Heather
Authors: Sambo, M., Cleaveland, S., Ferguson, H., Lembo, T., Simon, C., Urassa, H., and Hampson, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Biodiversity Animal Health and Comparative Medicine
Journal Name:PLoS Neglected Tropical Diseases
Publisher:Public Library of Science
ISSN:1935-2727
ISSN (Online):1935-2735
Copyright Holders:Copyright © 2013 The Authors
First Published:First published in PLoS Neglected Tropical Diseases 7(11):e2510
Publisher Policy:Reproduced under a Creative Commons License
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
522631Epidemiological dynamics of rabies in rural Tanzania and impacts on local communitiesSarah CleavelandWellcome Trust (WELLCOME)087393/B/08/ZRI BIODIVERSITY ANIMAL HEALTH & COMPMED
539491Understanding the role of contact networks in the epidemiological and evolutionary dynamics of zootonic diseaseSarah CleavelandWellcome Trust (WELLCOME)082715/B/07/ZRI BIODIVERSITY ANIMAL HEALTH & COMPMED