Effect of telephone reminders on adherence to anti-rabies vaccine amongst animal bite patients in North India: A randomised, single-blind, parallel-group, single-centre, interventional superiority trial

Objectives

Rabies is a highly infectious viral zoonotic disease of the central nervous system with a near 100% fatality rate. Vaccine adherence is an integral part of achieving effective treatment. India accounts for 27% of the global deaths from rabies yearly. Rabid dog bites are responsible for 99% of these deaths. This study aimed to assess the effect of reminder calls on compliance with the anti-rabies vaccine among animal bite patients.

Methods

An interventional, randomised, single-blinded, parallel-group, single-centre study was conducted at the Anti Rabies Clinic, Rajindra Hospital, Government Medical College, Patiala, a city located in Punjab, India, with a population of approximately 19 lakhs. A sample of 400 patients was enrolled and divided into two groups by lottery method. After obtaining written and informed consent from patients, data were collected using a validated pre-tested, semi-structured proforma. The intervention group received reminder calls before each dose. At the end of the study, complete information regarding compliance was obtained from both groups and analysed.

Results

The median age group of the animal bite patients was 21-40 years, with most being male (69.50%). Most of the bites were on the lower extremities (64.0%), followed by the upper extremities (29.0%) and the face (3.25%). Out of 153 patients who delayed the dose, 137 (89.54%) delayed a single dose. The 4th dose on the 28th day was the most frequently delayed dose (75.16%). Reminder calls increased the vaccine compliance rate from 53.5% in the non-intervention group to 70% in the intervention group (adjusted odds ratio=2.28; P=0.0002). There was no effect of gender, area, educational qualification, or marital status on the compliance.

Conclusions

Reminder calls were found to have significant effect on the adherence to the anti-rabies vaccine. This simple, cost-effective, and patient-friendly intervention must be integrated within the health care system to ensure timely and complete administration of the anti-rabies vaccine to reduce the risk of rabies.