THE FIDELITY OF DOG BITE CASE MANAGEMENT IN AMROHA DISTRICT OF UTTAR PRADESH: AN IMPLEMENTATION RESEARCH

Akash Kumar, Prof. dr. Adi Utarini, M.Sc., MPH., Ph.D; Prof. dr. E. Elsa Herdiana M., M.Kes., Ph.D

2025 | Tesis | S2 Ilmu Kesehatan Masyarakat

The Fidelity of Dog Bite Case Management in Amroha District of Uttar Pradesh:

An Implementation Research

By Akash Kumar | WHO/TDR Implementation Research Program, Universitas Gadjah Mada

This thesis evaluates the implementation fidelity of dog bite case management in Amroha,

Uttar Pradesh, within the framework of India’s National Action Plan for the Elimination of

Dog-Mediated Rabies (NAPRE). India contributes to one-third of global rabies deaths, with

Uttar Pradesh being a high-incidence state. Despite national goals for zero human rabies

deaths by 2030, significant gaps persist in public awareness, healthcare training, and

adherence to post-exposure prophylaxis (PEP) guidelines.

The research, conducted between June 2024 and April 2025, used a cross-sectional

quantitative design at selected health facilities including PHCs, CHCs, and the district hospital

in Amroha. Data were collected from 115 dog bite patients/attendants and 81 healthcare

workers using structured questionnaires and observational checklists. Analysis revealed that

although 83% of community respondents were aware of rabies, knowledge about prevention

and PEP was low, with reliance on traditional remedies still common. Among healthcare

workers, 69% had received training, yet inconsistencies remained in knowledge and practices

regarding intradermal vaccination and PEP protocol

The study applied Carroll et al.’s Implementation Fidelity Framework and found that resource

shortages, training gaps, and misinformation hinder the effective implementation of rabies

control strategies. Recommendations include enhancing IEC campaigns, continuous training

of healthcare providers, ensuring vaccine supply, and better monitoring systems. This study

offers original insights into the fidelity of national health interventions at the district level and

provides actionable recommendations to support India’s 2030 rabies elimination target.

Introduction:  Rabies is a preventable but fatal zoonotic disease, with India bearing

one-third of the global rabies burden. Despite the launch of the National Action

Plan for Rabies Elimination (NAPRE), gaps in adherence to guidelines and resources

allocation persistent. This study evaluates the fidelity of dog bite case management in

Amroha district, Uttar Pradesh, focusing on awareness, healthcare practices, and

adherence to NAPRE protocols.

Objectives:  1. Assess the awareness of patients having dog bites regarding rabies

and the post exposure prophylaxis, 2. ….put the objective 2 here…

Evaluate the adherence of healthcare workers to the established

protocols of prevention, control, and adoption of intradermal route

for post exposure prophylaxis.

Method:  A cross-sectional study was conducted at three primary health centers,

two community health centers, and one district hospital in Amroha district. Data

were collected through structured questionnaires from 115 patients and attendants

and 81 healthcare workers. Observational checklists were used to assess facility-

level of adherence to rabies management protocols. Data was analyzed using SPSS to

evaluate knowledge, attitudes, and practices (KAP) and adherence levels.

Results:  Among patients, 82.6% were aware of rabies, but only 59.1% knew about

its prevention and 60.9?out PEP. Unsafe practices, including reliance on

traditional remedies, were noted in 18.3% of cases. Healthcare workers

demonstrated varying levels of adherence to post exposure prophylaxis protocols,

with 69% having undergone relevant training. Barriers included insufficient

training, inconsistent adherence to intradermal vaccination guidelines, and resources

constraints. Facility assessments highlighted gaps in the availability of vaccines and

immunoglobulins.

Conclusion:  The study reveals critical gaps in both community awareness and

healthcare delivery for rabies management in Amroha district. Strengthening

community education, enhancing healthcare worker training, and improving

resource allocation is imperative to achieve India's goal of zero rabies deaths by

2030.

Kata Kunci : Rabies , Post-Exposure Prophylaxis, dog bite case Management, implementation research, fidelity.