TY  - JOUR
PY  - 2018//
TI  - Rabies postexposure prophylaxis (PEP) noncompletion after dog bites: estimating the unseen to meet the needs of the underserved
JO  - American journal of epidemiology
A1  - Tarantola, Arnaud
A1  - Blanchi, Sophie
A1  - Cappelle, Julien
A1  - Ly, Sowath
A1  - Chan, Malen
A1  - In, Sotheary
A1  - Peng, Yiksing
A1  - Hing, Chanthy
A1  - Taing, Chun Navy
A1  - Ly, Sovann
A1  - Bourhy, Hervé
A1  - Buchy, Philippe
A1  - Dussart, Philippe
A1  - Mary, Jean-Yves
SP  - 306
EP  - 315
VL  - 187
IS  - 2
N2  - Post exposure prophylaxis prevents human rabies and is accessible in Cambodia principally in Phnom Penh, the capital. Timely, affordable access to post-exposure prophylaxis is a challenge for the mainly rural population. We aimed to identify districts independently associated with post-exposure prophylaxis (PEP) noncompletion to position frontline vaccination centers. We analyzed the 2009-2013 database at the rabies prevention center of the Institut Pasteur du Cambodge, Phnom Penh. Logistic regressions identified non-geographic determinants of PEP noncompletion and districts after adjustment for these determinants. The influence of distance by road was estimated using a boosted regression trees model. A district noncompletion population attributable fraction (Rabies Index) was computed and mapped. A cartographic analysis based on the statistic developed by Getis and Ord identified clusters of high-Rabies Index districts. Factors independently associated with noncompletion were patients' district of residence, male gender, age 15-49, initial visit during rice harvest, the dog's status (culled or disappeared) as well as a prescribed PEP protocol requiring more than three PEP sessions (four and five). Four clusters of high-Rabies Index (RI) districts were identified using this analytical strategy applicable to many vaccination or other health services. Positioning frontline PEP centers in these districts will significantly widen access to timely and adequate PEP.<br><br>© The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<p />  <p>Language: en</p>
LA  - en
SN  - 0002-9262
UR  - http://dx.doi.org/10.1093/aje/kwx234
ID  - ref1
ER  -