# Functions and challenges of a government-run animal bite treatment center in the delivery of rabies post-exposure prophylaxis services in Iloilo City, Philippines: A 6-year descriptive study, 2018–2023

## TL;DR

This study examines the operations and challenges of a government-run animal bite treatment center in Iloilo City, Philippines, in providing rabies treatment from 2018 to 2023.

## Contribution

The study provides a 6-year descriptive analysis of a government-run ABTC's functions and challenges in delivering rabies post-exposure prophylaxis in a Philippine city.

## Key findings

- A total of 20,134 animal bite cases were documented from 2018 to 2023.
- Despite vaccine shortages and other challenges, all patients completed their treatment from 2020 to 2023.
- The lowest proportion of category III ERIG recipients in 2023 was 42.65%.

## Abstract

Animal bite injuries are a serious public health concern due to the risk of rabies infection. In March 2024, the Department of Health (DOH) reported 84 rabies cases with six fatalities from Iloilo City. The most crucial management of animal bite injuries includes immediate wound care and rabies post-exposure prophylaxis (PEP), typically administered at an Animal Bite Treatment Center (ABTC). In 2007, the Philippines established the Republic Act No. 9482, also known as the Anti-Rabies Act, which created the National Rabies Prevention and Control Program (NRPCP) to control and eliminate rabies. This study aimed to describe the functions and challenges faced by one of these government-run ABTCs in Iloilo City, specifically a) provision of rabies PEP for animal bite cases, b) instructions for proper wound care, c) documentation of animal bite cases, and d) conduct of health promotion activities.

This mixed-methods study was conducted at an ABTC in Iloilo City between January and March 2024. The first phase of the study collected secondary data from the official registry from January 1, 2018, to December 31, 2023. In the second phase, data were collected through direct observation of practices during a site visit in February 2024. A validated checklist based on the DOH Manual of Operations and WHO health system framework was developed and used for objective points of observation. Descriptive analyses of frequencies and percentages were conducted using Microsoft Excel and compared with the NRPCP guidelines. Also, Mann-Kendall test was conducted to evaluate the temporal trends in bite incidence proportions.

The non-hospital-based government ABTC operated under the Iloilo City Health Office provided a.) rabies PEP and wound care for animal bite cases, b.) documentation of animal bite cases, and c.) awareness campaigns. A total of 20,134 animal bite cases were documented from 2018 to 2023. Three types of vaccines were delivered to the center: Purified Vero Cell Rabies (PVRV) and Purified Chicken Embryo Cell (PCEC) for active immunization, and Equine Rabies Immunoglobulin (ERIG) for passive immunization. In 2023, the lowest number of category III ERIG recipients was 42.65 % (n = 534). Despite COVID-19 restrictions from 2020 to the middle of 2022, all patients completed their TCV vaccination between 2020 and 2023. Challenges, such as vaccine shortages, record inconsistencies, and referral issues, persist.

The non-hospital-based government-run ABTC has maintained rabies PEP services in Iloilo City from 2018 to 2023, despite challenges. Collaboration with the Local Government Unit (LGU) and DOH, increased campaigns, and lay lectures on the prevention of animal bites and rabies infection, along with increased healthcare funding, are needed for sustainable solutions.