Overall, the two dogs caused 47 attacks, 37 in Matugga and 10 in Mawale districts. Of the total attacks, 29 were against humans and 18 were against animals that included goats (6/18), domestic dogs (6/18), cattle (2/18), a sheep (1/16), pigs (2/16) and a duck (Fig. 2). The attacks in Matugga district occurred in three successive days, while those in Mawale occurred in one day.
Figure 2. The injuries inflicted on humans and domestic animals
The behaviour of the dogs
The dog bite victims from both Matugga and Mawale described that the dogs ran restlessly and attacked anything human or animal in their paths without being provoked.
“I was walking to my home; the dog ran from the bush and attacked me. I fought it, and it ran away. Shortly, it attacked another lady who was nearby. That lady was carrying her child, because of the attack, she fell to the ground and dropped the child, the dog also attacked the child.” (Woman, dog bite victim, Matugga)
Laboratory diagnosis for rabies
Histopathological examination of the brain revealed moderate to marked foci of perivascular cuffing by mononuclear inflammatory cells but no significant lesion in the neurons. Morphologically, the lesions were severe non-suppurative encephalitis, suggesting virus-induced encephalitis. The fluorescent antibody test confirmed the presence of rabies in the brain sample (Fig. 3).
Figure 3. Micrographs of histopathology and fluorescent antibody test for rabies diagnosis
The dog bite victims
Twenty-nine individuals were bitten by the rabid dogs (Table 1). Of these, 75.9% (22/29) were children aged 1–11 years. The rest were women aged 32–49 years and a 72-year-old man. The overwhelming majority of dog-bite victims (27/29; 93.1%) sustained category III injuries to various parts of the body. The bites were single (26/29; 89.7%) and multiple (3/29; 10.3%), sustained on the arms and hands (14/29; 48.3%), legs and feet (6/29; 20.7%), trunk (8/29; 27.6%) and head (3/29; 10.3%).
Table 1
The dog-bite victims, category of exposure and health care
ID
|
Age category, sex
|
Category of rabies exposurea,
anatomical site
|
Healthcare interventions sought
|
|
|
|
Primary
|
Secondary
|
1
|
Child, male
|
III, hand
|
Traditional healer
|
|
2
|
Woman
|
II, back
|
Wound cleaned with water and soap, stayed home
|
|
3
|
Child, female
|
III, thigh
|
Traditional healer
|
Private health facility
|
4
|
Woman (mother to #3)
|
III, arm
|
Traditional healer
|
|
5
|
Child, male
|
III, hand
|
Traditional healer
|
|
6
|
Child, female
|
III, arm
|
Wound cleaned with water and soap, traditional healer
|
|
7
|
Child, female
|
III, shoulder
|
Wrapped wound with cloth, Private health facility
|
|
8
|
Child, male
|
III, back
|
Traditional healer
|
|
9
|
Man
|
III, foot
|
Traditional healer
|
|
10
|
Child, female
|
III, hand
|
Self-medicated with herbs
|
|
11
|
Child, female
|
III, shoulder
|
Self-medicated with herbs
|
|
12
|
Child, female
|
III, hand
|
Public health facility
|
|
13
|
Child, female
|
III, head
|
Traditional healer
|
Private health facility
|
14
|
Child, female
|
III, shoulder
|
Self-medicated with herbs
|
|
15
|
Woman (mother to #16)
|
III, thigh and hand
|
Public health facility
|
|
16
|
Child, female
|
III, head
|
Public health facility
|
|
17
|
Child, male
|
III, knee
|
Traditional healer
|
|
18
|
Child, male
|
III, both hands
|
Traditional healer
|
Public health facility
|
19
|
Child, male
|
III, arm
|
Traditional healer
|
Public health facility
|
20
|
Child, male
|
III, hand
|
Traditional healer
|
|
21
|
Child, female
|
III, shoulder
|
Traditional healer
|
Public health facility
|
22
|
Woman
|
III, thigh
|
Public health facility
|
|
23
|
Child, female
|
III, shoulder
|
Traditional healer
|
|
24
|
Woman
|
III, hands and thigh
|
Traditional healer
|
Public health facility
|
25
|
Child, male
|
III, arm
|
Self-medicated with herbs
|
|
26
|
Woman
|
III, trunk
|
Private health facility
|
|
27
|
Child, male
|
III, arm
|
Traditional healer
|
Public health facility
|
28
|
Child, female
|
II, trunk
|
Traditional healer
|
|
29
|
Child, female
|
III, head
|
Public health facility
|
|
Circumstances of dog bites
At the time of the attack, 72.4% (21/29) of the dog-bite victims were either playing or doing household chores in the vicinity of their home, while two women, a child, and an elderly man were attacked on the street. In one scenario, the mother took action to defend her child by confronting the dog, which led to her sustaining a bite in the process.
Compliance with WHO guidelines for preclinical management of animal bites
None of the dog bite victims fulfilled the preclinical guidelines for dog bite cases as recommended by the WHO. Only 6.9% (2/29) of the dog bite victims washed the wound with water and soap after sustaining the dog bite. The most common healthcare intervention sought was a traditional healer (17/29; 58.6%). Fourteen of the 29 individuals (48.3%) sought healthcare from a health facility, while the remainder (5/29; 17.3%) applied herbs at home. Seven individuals sought multiple types of health interventions. We encouraged individuals to seek health care and rabies PEP from reliable health facilities. However, compliance with the rabies PEP regimen was on their own accord. Most individuals were amenable to the advice offered, but we encountered the following challenges.
1. Lack of money for transportation to the hospital
Six individuals reported that they were unable to afford the cost of transportation to the hospital. We worked with local leaders to organise subsidised transportation to a public health facility.
2. Hesitancy among dog bite victims in seeking medical assistance from public health facilities
We encouraged the dog bite victims to utilise the free rabies PEP services at public health care facilities (23), but some of the individuals complained.
“I don’t want to go to public health facilities; the doctors there give less attention to people seeking free healthcare services.” (Woman, dog-bite victim, Matugga)
3. Most individuals received treatment from the traditional healer
The individuals reported that they paid 40–65 USD to obtain black stone treatment for the dog bite. When asked why they did not seek medical care from the hospital, they responded.
“I was advised by other members in the community to get treatment from the traditional healer in Kagoma. The ‘doctor’ has been treating people bitten by snakes and dogs for over 20 years.” (Woman, dog bite victim, Mawale)
Access to and compliance with rabies post exposure prophylaxis
The dog bite victims in this report received a 3- or 5-rabies PEP injection series at irregular intervals from public or private health facilities. Four individuals utilised the private health facilities while the rest went to public health facilities. Overall, 93.1% (27/29) dog bite victims completed the rabies PEP regimen. Two of the dog bite victims from Matugga, a minor and a woman, did not complete the rabies PEP shots prescribed by the health facility. Interestingly, the woman above received only 2 shots herself but continued to take the daughter (also a dog bite victim) for complete rabies PEP. When asked about this, she replied.
“For me, my wounds had healed, and I did not have a reason to continue with the treatment. However, I continued to take my child because I cannot take a chance with my child’s life, but for me, it is ok even if I stop” (Woman, dog bite victim, Matugga)
The dog bite victims paid 13–15 USD to receive PEP at private health facilities. Those who went to the public health facilities paid 3–5 USD to access rabies PEP, even though rabies PEP is expected to be free at public health facilities. The cost accrued because the attending clinicians asked the dog-bite victims to pay an incentive before receiving the treatment. Often, others were asked to purchase rabies PEP from privately owned pharmacies near the hospital because the public health facilities were out of stock. In some cases, the individuals who could not pay the demanded sum were asked to pair up and cost share.
“I was informed that the free medicine provided by the government was finished, but the attending clinician said I could pay some money to receive rabies PEP from his own reserve.” (Woman, dog bite victim, Matugga)
Community reactions towards the rampaging dogs
Following the attack, the community leaders in Mawale mobilised men to chase and kill the rampaging dog. The men successfully killed the dog on first day and dumped it in the bush. According to the local leader, three other dogs that had instigated similar attacks previously were killed in the same manner.
After registering several dog bites in Matugga, the local leaders mobilised men in the community to chase and kill the dog, but they failed to locate it. As a result, the community autonomously conducted an elimination campaign of roaming dogs hitting them with sticks and stones in a mob. The suspected rabid dog in Matugga was presumed to have died in bushes hiding. During the follow-up visits, a community member reported what may have happened to that suspected rabid dog:
“Our bull encountered the dog in the morning of January 8th, 2023, (3:00–4:00 am). We did not come out of the house due to fear. At daybreak, the bull had several injuries but no sight of the dog. A few days later, we investigated a foul smell in the nearby bush to find a small brown dog with multiple bruises and injuries all over its body. We disposed it under the Jirikiti tree.” (Woman, owner of the bull, Matugga)
When queried why she did not report the dog to the authority, she replied:
Traditionally, in Buganda, a dead dog is disposed under the Jirikiti tree to avoid curses.
Community attitudes towards roaming dogs
The dog bite victims wanted the roaming dogs removed from the community by any means possible.
“Some members of our community keep up to 10 dogs which they let to roam; such dogs should be poisoned.” (Woman, dog bite victim, Matugga)
Some members of the community wanted the unowned roaming dogs poisoned but had reservations since their domestic dogs roamed.
“I want all those wild roaming dogs poisoned; however, if they do so, my dog may be killed, since it is a roaming dog. It is better for the authorities to inform the community to chain their dogs before applying the poison.” (Male, community member, Matugga)
According to a local leader, the Wakiso District Veterinary unit conducted mass poisoning of roaming dogs in Matugga in 2020. The local leader informed us that he had requested the veterinary department to conduct another mass poisoning following complaints from the community. In Mawale, a mass rabies vaccination had been conducted more than 3 years ago.
Reported ownership of dogs
The community members reported four categories of dogs:
1. Confined-owned dogs. Community members with a perimeter fence around their homes confined their dogs. The interviewed community members reported that such people were rich and that they kept exotic dogs that were expensive to acquire and maintain.
“The rich people keep their dogs in the fences, and they care for them…I have never seen an exotic dog roaming…. however, the local dogs that belong to people who do not care for them are the ones that roam and bite us.” (Woman, dog bite victim, Matugga)
2. Roaming dogs with recognised ownership. These were roaming dogs that were seen emerging or residing at a person’s home. In this scenario, the community members assumed that the owner of that home owned the dog(s). However, complainants reported that such owners often denied ownership of those dogs after they attacked people or livestock.
“My goat was attacked and killed by a roaming dog, but when I contacted the alleged owner, he denied ownership of the dog.” (Woman, community member, Mawale)
3. Roaming dogs with no recognised ownership (feral). The community members reported several dogs that were not owned by any community member. An example was given for a pack of 5–10 dogs that were resident at a nearby cemetery.
4. Community dogs. Some dogs were identified as community dogs because they were known and cared for by many, but no one claimed absolute ownership.
“That dog (a.k.a. Danger) has been living in Kiryagonja town for many years. We do not know where it came from, but the people in the town give it food… it is a very peaceful dog.” (Man, community member, Matugga)