Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System: e2574
Background Dog-bites and rabies are under-reported in developing countries such as Pakistan and there is a poor understanding of the disease burden. We prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording pa...
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| Veröffentlicht in: | PLoS neglected tropical diseases 2013-12, Vol.7 (12) |
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| description | Background Dog-bites and rabies are under-reported in developing countries such as Pakistan and there is a poor understanding of the disease burden. We prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording patient health-seeking behaviors, access to care and analyzed spatial distribution of cases from Karachi. Methodology and Principal Findings A total of 6212 dog-bite cases were identified over two years starting in February 2009 with largest number reported from Karachi (59.7%), followed by Peshawar (13.1%) and Hyderabad (11.4%). Severity of dog-bites was assessed using the WHO classification. Forty percent of patients had Category I (least severe) bites, 28.1% had Category II bites and 31.9% had Category III (most severe bites). Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non-medical facilities (Odds Ratio = 0.20, 95% CI 0.17-0.23, p-value |
| doi_str_mv | 10.1371/journal.pntd.0002574 |
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We prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording patient health-seeking behaviors, access to care and analyzed spatial distribution of cases from Karachi. Methodology and Principal Findings A total of 6212 dog-bite cases were identified over two years starting in February 2009 with largest number reported from Karachi (59.7%), followed by Peshawar (13.1%) and Hyderabad (11.4%). Severity of dog-bites was assessed using the WHO classification. Forty percent of patients had Category I (least severe) bites, 28.1% had Category II bites and 31.9% had Category III (most severe bites). Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non-medical facilities (Odds Ratio = 0.20, 95% CI 0.17-0.23, p-value<0.01), and had shorter mean travel time to emergency rooms, adjusted for age and gender (32.78 min, 95% CI 31.82-33.78, p-value<0.01) than patients visiting hospitals in smaller cities. Spatial analysis of dog-bites in Karachi suggested clustering of cases (Moran's I = 0.02, p value<0.01), and increased risk of exposure in particular around Korangi and Malir that are adjacent to the city's largest abattoir in Landhi. The direct cost of operating the mHealth surveillance system was USD 7.15 per dog-bite case reported, or approximately USD 44,408 over two years. Conclusions Our findings suggest significant differences in access to care and health-seeking behaviors in Pakistan following dog-bites. The distribution of cases in Karachi was suggestive of clustering of cases that could guide targeted disease-control efforts in the city. Mobile phone technologies for health (mHealth) allowed for the operation of a national-level disease reporting and surveillance system at a low cost.</description><identifier>ISSN: 1935-2727</identifier><identifier>EISSN: 1935-2735</identifier><identifier>DOI: 10.1371/journal.pntd.0002574</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Abattoirs ; Behavior ; Cellular telephones ; Cities ; Costs ; Developing countries ; Disease ; Emergency medical care ; Health care access ; LDCs ; Patients ; Public health ; Software ; Spatial analysis ; Spatial distribution ; Sustainability ; Teaching hospitals ; Tropical diseases</subject><ispartof>PLoS neglected tropical diseases, 2013-12, Vol.7 (12)</ispartof><rights>2013 Zaidi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Zaidi SMA, Labrique AB, Khowaja S, Lotia-Farrukh I, Irani J, et al. (2013) Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System. PLoS Negl Trop Dis 7(12): e2574. doi:10.1371/journal.pntd.0002574</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,864,27924,27925</link.rule.ids></links><search><creatorcontrib>Zaidi, Syed MohammadAsad</creatorcontrib><creatorcontrib>Labrique, Alain B</creatorcontrib><creatorcontrib>Khowaja, Saira</creatorcontrib><creatorcontrib>Lotia-Farrukh, Ismat</creatorcontrib><creatorcontrib>Irani, Julia</creatorcontrib><creatorcontrib>Salahuddin, Naseem</creatorcontrib><creatorcontrib>Khan, Aamir Javed</creatorcontrib><title>Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System: e2574</title><title>PLoS neglected tropical diseases</title><description>Background Dog-bites and rabies are under-reported in developing countries such as Pakistan and there is a poor understanding of the disease burden. We prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording patient health-seeking behaviors, access to care and analyzed spatial distribution of cases from Karachi. Methodology and Principal Findings A total of 6212 dog-bite cases were identified over two years starting in February 2009 with largest number reported from Karachi (59.7%), followed by Peshawar (13.1%) and Hyderabad (11.4%). Severity of dog-bites was assessed using the WHO classification. Forty percent of patients had Category I (least severe) bites, 28.1% had Category II bites and 31.9% had Category III (most severe bites). Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non-medical facilities (Odds Ratio = 0.20, 95% CI 0.17-0.23, p-value<0.01), and had shorter mean travel time to emergency rooms, adjusted for age and gender (32.78 min, 95% CI 31.82-33.78, p-value<0.01) than patients visiting hospitals in smaller cities. Spatial analysis of dog-bites in Karachi suggested clustering of cases (Moran's I = 0.02, p value<0.01), and increased risk of exposure in particular around Korangi and Malir that are adjacent to the city's largest abattoir in Landhi. The direct cost of operating the mHealth surveillance system was USD 7.15 per dog-bite case reported, or approximately USD 44,408 over two years. Conclusions Our findings suggest significant differences in access to care and health-seeking behaviors in Pakistan following dog-bites. The distribution of cases in Karachi was suggestive of clustering of cases that could guide targeted disease-control efforts in the city. Mobile phone technologies for health (mHealth) allowed for the operation of a national-level disease reporting and surveillance system at a low cost.</description><subject>Abattoirs</subject><subject>Behavior</subject><subject>Cellular telephones</subject><subject>Cities</subject><subject>Costs</subject><subject>Developing countries</subject><subject>Disease</subject><subject>Emergency medical care</subject><subject>Health care access</subject><subject>LDCs</subject><subject>Patients</subject><subject>Public health</subject><subject>Software</subject><subject>Spatial analysis</subject><subject>Spatial distribution</subject><subject>Sustainability</subject><subject>Teaching hospitals</subject><subject>Tropical diseases</subject><issn>1935-2727</issn><issn>1935-2735</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNqN0M1OwzAQBGALgUT5eQMOK3FOsONEIdwgtCABUsTftVpSN3EbvMHrFHgeXhQQFVw5zUjznUaIAyVjpXN1tKDBO-zi3oVZLKVMsjzdECNV6CxKcp1t_vYk3xY7zAspsyI7ViPxcWGo8di3toZH9BaDJQfWwWldG2YIBOfURGc2GCjRm--pwqXlgA7QzeDW8hJo_qfGbz3x8COv0GPd2hOoPHFv6mBXBu4GvzK269DVBh7YugYQruk1KokD3NCT7QxULbkv-s7BPO-JrTl2bPbXuSsOJ-P78jLqPb0MhsN0fQBPVZrnRapTrfX_1CfPLWUW</recordid><startdate>20131201</startdate><enddate>20131201</enddate><creator>Zaidi, Syed MohammadAsad</creator><creator>Labrique, Alain B</creator><creator>Khowaja, Saira</creator><creator>Lotia-Farrukh, Ismat</creator><creator>Irani, Julia</creator><creator>Salahuddin, Naseem</creator><creator>Khan, Aamir Javed</creator><general>Public Library of Science</general><scope>3V.</scope><scope>7QL</scope><scope>7SS</scope><scope>7T2</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>F1W</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>H95</scope><scope>H97</scope><scope>K9.</scope><scope>L.G</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20131201</creationdate><title>Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System</title><author>Zaidi, Syed MohammadAsad ; Labrique, Alain B ; Khowaja, Saira ; Lotia-Farrukh, Ismat ; Irani, Julia ; Salahuddin, Naseem ; Khan, Aamir Javed</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-proquest_journals_14779434333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abattoirs</topic><topic>Behavior</topic><topic>Cellular telephones</topic><topic>Cities</topic><topic>Costs</topic><topic>Developing countries</topic><topic>Disease</topic><topic>Emergency medical care</topic><topic>Health care access</topic><topic>LDCs</topic><topic>Patients</topic><topic>Public health</topic><topic>Software</topic><topic>Spatial analysis</topic><topic>Spatial distribution</topic><topic>Sustainability</topic><topic>Teaching hospitals</topic><topic>Tropical diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zaidi, Syed MohammadAsad</creatorcontrib><creatorcontrib>Labrique, Alain B</creatorcontrib><creatorcontrib>Khowaja, Saira</creatorcontrib><creatorcontrib>Lotia-Farrukh, Ismat</creatorcontrib><creatorcontrib>Irani, Julia</creatorcontrib><creatorcontrib>Salahuddin, Naseem</creatorcontrib><creatorcontrib>Khan, Aamir Javed</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database (Proquest)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>ASFA: Aquatic Sciences and Fisheries Abstracts</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 1: Biological Sciences & Living Resources</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 3: Aquatic Pollution & Environmental Quality</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) Professional</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>PLoS neglected tropical diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zaidi, Syed MohammadAsad</au><au>Labrique, Alain B</au><au>Khowaja, Saira</au><au>Lotia-Farrukh, Ismat</au><au>Irani, Julia</au><au>Salahuddin, Naseem</au><au>Khan, Aamir Javed</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System: e2574</atitle><jtitle>PLoS neglected tropical diseases</jtitle><date>2013-12-01</date><risdate>2013</risdate><volume>7</volume><issue>12</issue><issn>1935-2727</issn><eissn>1935-2735</eissn><abstract>Background Dog-bites and rabies are under-reported in developing countries such as Pakistan and there is a poor understanding of the disease burden. We prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording patient health-seeking behaviors, access to care and analyzed spatial distribution of cases from Karachi. Methodology and Principal Findings A total of 6212 dog-bite cases were identified over two years starting in February 2009 with largest number reported from Karachi (59.7%), followed by Peshawar (13.1%) and Hyderabad (11.4%). Severity of dog-bites was assessed using the WHO classification. Forty percent of patients had Category I (least severe) bites, 28.1% had Category II bites and 31.9% had Category III (most severe bites). Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non-medical facilities (Odds Ratio = 0.20, 95% CI 0.17-0.23, p-value<0.01), and had shorter mean travel time to emergency rooms, adjusted for age and gender (32.78 min, 95% CI 31.82-33.78, p-value<0.01) than patients visiting hospitals in smaller cities. Spatial analysis of dog-bites in Karachi suggested clustering of cases (Moran's I = 0.02, p value<0.01), and increased risk of exposure in particular around Korangi and Malir that are adjacent to the city's largest abattoir in Landhi. The direct cost of operating the mHealth surveillance system was USD 7.15 per dog-bite case reported, or approximately USD 44,408 over two years. Conclusions Our findings suggest significant differences in access to care and health-seeking behaviors in Pakistan following dog-bites. The distribution of cases in Karachi was suggestive of clustering of cases that could guide targeted disease-control efforts in the city. Mobile phone technologies for health (mHealth) allowed for the operation of a national-level disease reporting and surveillance system at a low cost.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><doi>10.1371/journal.pntd.0002574</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Abattoirs Behavior Cellular telephones Cities Costs Developing countries Disease Emergency medical care Health care access LDCs Patients Public health Software Spatial analysis Spatial distribution Sustainability Teaching hospitals Tropical diseases |
| title | Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System: e2574 |
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