In 2019, the World Health Organization (WHO) featured a story of the death of a 4-year old girl in Kasoa, sparking community outrage.

This is just one of the many reports of human rabies deaths, though this disease is 100% vaccine-preventable. Unfortunately, the Ghanaian syndrome of outrage but inaction has led to several more deaths from rabies.

Rabies is listed as one of the Neglected Tropical Diseases (NTDs) by the Ghana Health Service (GHS). The masterplan for the NTD program in Ghana noted that rabies diagnosis is mainly based on clinical signs by which time, death is almost always inevitable. Noteworthy, is the acknowledgement in the masterplan that human rabies was only preventable through vaccination of dogs and this lies in the domain of the Veterinary Services Department (VSD). Unfortunately, collaboration between these two services has not yielded much results.

Animal Bite Cases Recorded in Ghana

A 6-year (2009-2014) animal bite data from 7 regional hospitals (Central, Greater Accra, Western, Volta, Brong Ahafo, Upper East and Ashanti) was analyzed by a research team headed by Dr. William Tasiame,  to elucidate the regional and sex distribution of bites, and the affected age groups.

A total of 116,995 animal bite cases were recorded, out of which Greater Accra accounted for the highest with 18.8% (21,952/116,995) bite incidents, and the lowest from the Volta region, with 9.0% (10,543/116,995). Other regions ranged from 10,543 - 21,484 animal bite cases.

Data from the 3 remaining regions for the period either had inconsistencies or was unavailable for analysis. High numbers of stray dogs in the capital are one of the prominent factors that accounted for the increased bite cases.

Though the Volta region recorded the lowest animal bite cases, care must be taken when interpreting this since this could be attributed to under-reporting, which is a major phenomenon in rural and less endowed communities with lower basic social amenities. 

Males constituted most animal bite victims, 62.6% (73,228/116,995) as against females with 37.4% (43,767/116,995) across the seven regions. Children within age ranges 0-15 years formed the highest number of victims with 45.5% (53,228/116,995), followed by 16-30 years, 41.9% (48,997/116,995) whilst people aged 60 years and above recorded the least with 1.9% (2,184/116,995).

Other age groups accounted for approximately 10.7%. Higher risk of bites in younger males is reported across the globe and could be attributed to the daring and playful nature of boys with pets leading to bites. In Africa, males are associated with activities including hunting, farming and security, with dogs hence increasing the probability of animal bites. This calls for rabies sensitization for children of school-going age. 

Solutions

The most effective way to control human rabies is the inter-sectoral approach based on “One Health" Concept, which draws together all stakeholders in the Veterinary Services Directorate (VSD), Ghana Health Services, Wildlife Divisions of the Forestry Commision and Environmental Protection Agency (EPA).

Till now, control of Rabies has been segmented in each sector, with little or no collaborations. A multi-sectoral approach will expedite the control and elimination of rabies as it will harness all the strengths and expertise needed from all relevant stakeholders.

High-risk individuals such as Veterinary Staff and students, hunters and Zookeepers just to mention a few, need the pre-exposure rabies vaccinations. This involves an initial three doses of the rabies vaccine, followed by periodic boosters. Management of bites from rabid dogs involves thorough wound washing with soap and water, wound treatment, administration of post-exposure prophylaxis (PEP) consisting of five doses of vaccination and immunoglobulin in critical cases. Unavailability and high cost of rabies vaccine is a major setback for victims in need of the PEP. To solve these concerns, the government should include the human rabies vaccines and immunoglobulin in the National Health Insurance Scheme, for all dog bite victims to have a chance of survival.

Harmonization of rabies data in all regions, surveillance and dog ecology researches by the universities are other methods that could be employed in managing rabies-suspected cases. Current status of rabies elimination program if any, should be made available and accessible online for all to participate in areas they deem fit. Human life should not be juggled with, and all efforts to preserve this precious life from Rabies starts now.

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Authors: Drs William Tasiame, Yesutor Kojo Soku, Ekua Esuon Thompson, Victor Frimpong and Benjamin Kissi Sasu