Toraiz Ahmed (2012-VA-902)

Comprehensive Retrospective Study Of Dog Bites In Lahore Dr. Shakera Sadiq Gill - 2014. - 51p.;

Dog may be the best friend of humans but still they are animals and can bite. Despite of domestication dogs show the behavior of their ancestors as their ancestors (wolves) are voracious, strong, cunning, agile, swift and sharp teeth’s (Keuster et al. 2006). In fact dog bites millions of people every year and half of them are children of age from 5 to 9 (Sacks et al. 1996). One out of every five bite case needs medical interventions and treatment (Shuler et al. 2008). Dog bites are the results of attacks of pet or stray dogs on humans. Humans have close association with dogs in their daily life. This association may be as pet dogs or it may be as stray dogs in developing countries (Shuler et al. 2008). Dog bite injuries vary from common injury to severe condition such as rabies. Most of the studies show the association of dog bites with different breeds and considerable debates are also there that which breed is associated more with dog bites (Patrick and O'Rourke 1998). Regardless the breed, some other things are also important, like dog behavior, human behavior, no supervision of dog or carelessness in control and the scenario or conditions under which the dog is living (Cornelissen and Hopster 2010). Breed is rather not an important point to discuss in developing countries like Pakistan. As in developing countries most of the Dog bites occur due to stray dogs. Mostly the injuries are minor but still dog bites are one of the most important problems for society and health administration authorities as dog bites comprises about 90% of total animal bites. About 4.5 million Americans are bitten by dogs every year and about 30,000 of them require procedures of reconstructive surgery (Wilde 1997). Fortunately the fatalities from dog bites are much less. Dog bite cases turn into fatal condition when patient is bitten by potential rabies virus carrier and infection may occur that can be life threatening. Rabies, a viral disease caused by the bite of an infected animal that can cause acute inflammation of brain in warm blooded animals and humans. It is present in more than150 countries of the world (WHO 2005). An estimate shows that 10 thousand deaths occur worldwide due to rabies. Potentially 3 billion people are at threat of rabies in Africa and Asia and out of the total 84% of rabies deaths occur in rural areas. Millions of cases of dog bites cases go unreported throughout the world. This underreporting hides the actual burden of the problem in the community (Turner 1976). In humans dog bite is one of the complex phenomena that may occur by interaction of three elements, animal, scenario and the victim. Figures on dog bites mostly pool out from studies in public health institutions and hospitals (Jacob John 1997). Most of the studies show the scientific analyzed information only on victim while the circumstances and conditions surrounding the incidence of dog bites remain unknown. Important thing is fatalities from dog bites occur only in very small proportion of dog bites (Cleaveland et al. 2002). However treatment expenses and consequences of injuries have turned the issue of dog bite into significant public health importance (Coleman et al. 2004). The other side of coin is that the aggressive behavior development in dogs leads to relinquishment of shelter and euthanasia, which indicate a problem in term of animal safety (Guy et al. 2001). Public health specialists and Epidemiologists focus that fatal and non-fatal dog attacks can be controlled or prevented through effective preventive measures. For effective and suitable preventive measures it is pertinent to start examining the epidemiological data of the respective community. Epidemiological data is require to define the geographically high risk areas, seasonal patterns associated with the dog bites with respect to the victim, and other triggering factors (Sacks et al. 2000). For the sound preventive and control measures epidemiological data is one of the best tools for better decision making in public health issues (CDC 2003). In developing countries like Pakistan epidemiological studies of dog bites are important and are needed on the multi-dimensional aspects as dog bite incidence and other associated risks are much higher and vary according to area of study. These types of multi-dimensional studies may change the preventive strategy plans with their extra efficiency. Normally control and preventive measures are designed to lessen the risk of dog bites and followed by all communities. Possible control and preventive measures are control of free roaming and unrestrained animals, vaccination, breed or type bans, licensing of dogs, extensive media campaigns specially in rural areas, well defined post bite program, investigation of dog bite incidents (Wilson et al. 2003).
Pakistan is among the world highest cases of rabies with about 50 thousand cases per year. Recent estimates show that 570 peoples die annually in Pakistan because of rabies (WHO 1996). In Pakistan people mostly neglect the minor dog bite cases and due to high illiteracy rate large numbers of cases go unreported (Wasay et al. 2008). This is because people suffering from dog bite normally rely on local remedies, such as rubbing red chilies on the wound from the house the dog belongs (in case of pet dog). Rabies virus can be killed upto 65% by washing with soap only (Burki 2008). Vaccination is the ultimate solution for rabies, but very less amount of people knows about the vaccination of dogs. Post exposure treatment is costly in dog bite cases. Cost analysis of post exposure treatment for dog bites shows the actual picture and importance of dog bites in public health sector. Billions of rupees are spent on the vaccines and treatment of dog bites cases (Chulasugandha et al. 2006). A large number of cases report to quacks and go unreported on official database. For the better decision regarding the public health problem the cases must be reported to official database. Weak reporting system is also an important factor in developing countries like Pakistan. As in Pakistan rabies and dog bites are not notifiable disease. No proper surveillance system is there for rabies is at present. Studies and surveys shows that 55% people didn’t even consider dog bites as a predisposing factor for rabies and they even didn’t know that the dog bite can be fatal (Knobel et al. 2005). To prevent and control dog bite it is necessary to have comprehensive epidemiological data that allows the identification of associated risk patterns. Rabies is endemic in Pakistan so this study is aimed to investigate the problem posed by dog bites in Lahore, Pakistan.
Lahore is the second most populated city of Pakistan with population of 5.143 million (according to 1998 census). This study will help the officials of public health in making better decision regarding dog bites. This study is aimed at investigating the problems posed by dog bites in Lahore.


Epidemiology And Public Health

2202,T


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