Original Incidence of dog bite in rural area (Chountra), District Rawalpindi, Province Punjab, Pakistan

Pakistan is a developing country having huge burden of communicable disease, now having ever increasing number of non-communicable disease cases. This combine burden of communicable and non-communicable disease is over stretching already scarce health resources. The objective of this study was to accesses the incidence of dog bite in Chountra, District Rawalpindi, Province Punjab, Pakistan. This is descriptive study conducted on medical record of dog bite cases between 2011 and 2013. Total numbers of cases were 150. Most of the cases were registered during summer especially in the months of May to August. Most of the victims were male and found to be more common in children. The commonest site of the dog bite was lower limb. Vaccine availability was 60-70%. For cold chain management of vaccine, the backup generator was in working condition in 75-85% of the times but fuel availability was relatively low around 50-60%. To con-clude, in rural setup of Pakistan dog bite cases are considerably high and impose significant burden on health service despite the fact that it is preventable.

Pakistan is a developing country having huge burden of communicable disease, now having ever increasing number of non-communicable disease cases. This combine burden of communicable and noncommunicable disease is over stretching already scarce health resources. The objective of this study was to accesses the incidence of dog bite in Chountra, District Rawalpindi, Province Punjab, Pakistan. This is descriptive study conducted on medical record of dog bite cases between 2011 and 2013. Total numbers of cases were 150. Most of the cases were registered during summer especially in the months of May to August. Most of the victims were male and found to be more common in children. The commonest site of the dog bite was lower limb. Vaccine availability was 60-70%. For cold chain management of vaccine, the backup generator was in working condition in 75-85% of the times but fuel availability was relatively low around 50-60%. To conclude, in rural setup of Pakistan dog bite cases are considerably high and impose significant burden on health service despite the fact that it is preventable. 1 . Such cases are seen all over the world including developing and developed countries. However, developed countries have controlled dog bite cases but the developing countries like Pakistan still trying to control 2,3 . Dog bites can lead to laceration of soft tissues, severe infections and disability. A microorganism (Pasturella) is commonly isolated from infected bite wounds. Other aerobes (Staphylococcus, Streptococcus) and anaerobes (Fusobacterium and Bacteriodes) are commonly found in infected wounds 4 .
Rabies is a deadly zoonotic disease commonly associated with rabies-infected mammal bites. Rabies represents an economic burden for both developed and developing countries due to the costs of human post exposure treatment, diagnosis, surveillance, immunization of animals most importantly the number of humans suffering and deaths due to rabies This study was planned to assess the incidence of dog bite cases among population of Chountra region of Rawalpindi district, Pakistan.

Materials and methods
Study design: This was a retrospective descriptive study.
Study population: Medical records from emergency department were screened and dog bite cases were selected for further analysis.

Sampling technique: Convenient sampling
Data collection: A structured data recording form was used to record the desired information.

Data analysis: Analysis was done using MS Excel version 2007.
Study period: The time consumed in recording, analyzing and interpret data was two months.
Ethical consideration: The Ethical Committee, Sarhad University, Peshawar, reviewed the synopsis and after its approval, study was carried out. Written permission for the study was obtained from In-charge of RHC Chountra.

Results
The total number of dog cases registered in the 2011 were 57 of which 19% of the dog bite cases were registered in July. In 2012, 48 cases were registered and mostly in May and August. Total number of cases registered were 45 in 2013. Similar seasonal trend was seen during this 3 year period, with higher number of cases in summer than in winter.   In most of the cases vaccine was available. However there were also such cases in which vaccine was not available due to limited resources of the health centre. Site of dog bite was predominantly the lower limb. In most of cases, for maintenance of cold-chain refrigerator and backup generator fuel was available.

Discussion
Rabies is a fatal viral infection that can infect all mammals, but stray dogs cause over 99% of all human deaths from rabies. Human rabies can be prevented through prompt administration of postexposure prophylaxis (PEP) to victims of bites by rabid animals 6 , and infection can be eliminated at source through sustained mass vaccination of reservoir populations 7 . PEP costs, the second largest component of the economic burden, could be reduced in many areas through more judicious and cost-effective administration.
Dog bite cases were more in summer than in winter as reported in this study. Males were more vulnerable population than females. 2 nd vulnerable population group were children as highest number of cases of dog bites were found children as indicated by this three year data. The vaccine availability was 60-70% over the three years record. These finding were similar to the results of the studies 3,8 conducted in rural and urban setting which showed similar pattern. Dog bite incidence rate for males was higher than for females, half of the bites were in summer. Eighty percent of the bites were class II or III and leg bites were most common. The most common victims of dog bite were children. The findings of our study are similar with the Sri lankan study which showed the highest numbers of bites (48%) were in the ages of 6-12 years 9 .
An essential component of vaccination/immunization is cold-chain management so that vaccines are effective. Our study also documented the unique feature regarding availability of refrigerator in working condition and fuel to run the backup generator. The refrigerator was in working condition in 75-85% of the times and generator fuel availability was relatively low around 50-60%. This finding is not doucement in any other reseach article.

Recommendations
It is highly recommended to control the population of dogs in the areas where dog bite cases are common. It is also recommended to equip the health care centers with vaccines and their storage protocols to fight against the cases of dog bite, especially those health care centers where the reported cases are greater in numbers.

Conclusion
To conclude, in rural setup of Pakistan dog bite cases are considerably high and impose significant burden on health service despite the fact that it is preventable. Also, it can be said that children are more at risk of being bitten by dogs than adults and younger children need particular attention because their injuries are more serious.