PhD Thesis Proposal by Dr. Stevens M. B. Kisaka
W80/52986/2018
University of Nairobi
ABSTRACT
Introduction: There
is a rise in dog bites in Uganda. These may result into stigma, morbidity and death.
However, the actual burden in the community is not known since all victims do
not report to health facilities. In addition, adherence to pre-clinical and
clinical guidelines of managing dog bites
are not well known. Furthermore, the bioburden of these injuries and treatment outcomes have not been well assessed.
are not well known. Furthermore, the bioburden of these injuries and treatment outcomes have not been well assessed.
Objectives: To
assess the community burden, pre-clinical care practices and clinical
management for dog bite injuries as well as their bearing on the bioburden and outcomes
in high rabies burden districts of Wakiso and Kampala in Uganda.
Methods: The community incidence
will be determined in households of 2 sub counties of Kawempe (Kampala
district) and Nansana Town Council (Wakiso district) for a period of 3 years using
an ambi-directional study design. Incidence will be expressed per 10,000
population and defined using descriptive statistics, spatial analysis and spot
maps. In both Entebbe and Mulago Hospitals, 360 patients reporting for
post-exposure prophylaxis and treatment for dog bite injuries will be
interviewed for practices undertaken before presentation to the health
facility. Association between adherence to guidelines and associated factors
will be determined using logistic regression
with Odds ratios (OR: 95% CI). In addition, health worker practices for treating dog bites will be assessed qualitatively using observations, review of medical records and in-depth interviews with those managing dog bites. Grade II and III wounds will be aseptically swabbed and culture anaerobic
and aerobically for bacterial growth. Bacterial strain identification will be by colony, biochemical characteristics and Matrix Assisted Laser Desorption Time of Flight Mass Spectrometry. Antimicrobial susceptibility testing will be done using Epsilometer test against Metronidazole, methicillin, amoxicillin, doxycycline and cotrimoxazole. The findings will be interpreted using
Guidelines by European Committee on Antimicrobial Susceptibility Testing and analyzed by descriptive and inferential statistics. Lastly, predictors for infection will be determined using a prospective study among the 360 patients who will be followed up for 6 months. Stratified analysis, inferential statistics using logistic regression (RR: 95% CI); Descriptive statistics and Survival analysis: Kaplan meier curves and using Cox regression will be used to assess infection, healing and other outcomes.
with Odds ratios (OR: 95% CI). In addition, health worker practices for treating dog bites will be assessed qualitatively using observations, review of medical records and in-depth interviews with those managing dog bites. Grade II and III wounds will be aseptically swabbed and culture anaerobic
and aerobically for bacterial growth. Bacterial strain identification will be by colony, biochemical characteristics and Matrix Assisted Laser Desorption Time of Flight Mass Spectrometry. Antimicrobial susceptibility testing will be done using Epsilometer test against Metronidazole, methicillin, amoxicillin, doxycycline and cotrimoxazole. The findings will be interpreted using
Guidelines by European Committee on Antimicrobial Susceptibility Testing and analyzed by descriptive and inferential statistics. Lastly, predictors for infection will be determined using a prospective study among the 360 patients who will be followed up for 6 months. Stratified analysis, inferential statistics using logistic regression (RR: 95% CI); Descriptive statistics and Survival analysis: Kaplan meier curves and using Cox regression will be used to assess infection, healing and other outcomes.
Expected outcomes: Community
incidence of dog bite injuries within a 3-year period; factors associated with
pre-clinical practices for dog bites; adherence to clinical practices by health
care providers; antimicrobial resistance associated with management of dog
bites; and predictors of outcomes of dog bite management.
Key
words: dog bite, risk factor, antimicrobial resistance, post-exposure prophylaxis,
pre-treatment, clinical, practices, outcomes.
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