・Naila Al Mahmuda (Research Center for Child Mental Development, Kanazawa University, Japan)
“Does Poverty Perpetuate Rabies In Bangladesh!”
Background and Purpose Rabies, the life-threatening disease with a 100% fatality rate. In developing countries, the burden of human deaths from rabies occurs mostly in the absence of awareness and presence of poverty. Bangladesh, one of the developing countries, is densely populated, where 72% of the population is living in rural areas and 36% of this population is considered below the national poverty level. Apart from rural area, this country has poor suburbs on the outer parts of large cities, with large populations of unowned dogs and limited resources to implement Mass Dog Vaccination (MDV) campaigns and animal birth control programs. The aim of this study is to identify the vulnerable groups, vaccination status following animal exposure, any relationship between poverty with the disease and the schemes of raising awareness among general people at risk from Rabies.
Methods and Materials Data were obtained from the case records of clinically diagnosed human rabies patients of Infectious Diseases Hospital (IDH), Dhaka, Bangladesh from January 2000 to December 2007.
Results The number of rabies cases reported almost identical in every year and most of them were not aware about rabies. 86.7% were from rural areas and children (61.2%) were affected disproportionately by rabies where measures that could prevent it in humans by raising awareness and controlling dog rabies. Male (74.2%) were predominant, whose death often has dire financial consequence for their families. Majority (84.3%) of the cases were not vaccinated, although post-exposure prophylaxis is available but costly. Among the 190 cases who received vaccines, only 15.8% were treated with tissue culture vaccine (TCV) and rest 84.2% were treated nerve tissue vaccines (NTV), because of the financial inability to afford the TCV. Only 4 cases were treated with Rabies Immunoglobulin.
Conclusion Many people died either because of ignorance of effective rabies prophylaxis or cannot access it. Adequate trained manpower, availability of TCV at a lower cost or free of charge and economic stability, are the important effective implementation requirements for a scheme to eliminate such a zoonotic disease, through the committed collaborative actions of nongovernmental organizations, international organizations, and the private sector to promote prevention and control activities to achieve the elimination of human rabies mostly transmitted by dogs in Bangladesh.