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PLoS One. 2018 Jul 26;13(7):e0200873. doi: 10.1371/journal.pone.0200873. eCollection 2018.

The evaluation of Animal Bite Treatment Centers in the Philippines from a patient perspective.

Author information

Global Alliance for Rabies Control, Sta. Rosa City, Philippines.
South Asia Field Epidemiology and Technology Network (SAFETYNET), Quezon City, Philippines.
Disease Prevention and Control Bureau, Department of Health, Manila, Philippines.
Global Alliance for Rabies Control, Manhattan, United States of America.
University of Pretoria, Pretoria, South Africa.



The Philippines has built an extensive decentralised network of Animal Bite Treatment Centers (ABTCs) to help bite victims receive timely rabies post-exposure prophylaxis (PEP) at little cost. This study surveyed patients in the community and at ABTCs of three provinces to assess animal bite/scratch incidence, health-seeking behaviour and PEP-related out-of pocket expenses (OOPE).


During community surveys in 90 barangays (neighbourhoods), 53% of households reported at least one animal bite /scratch injury over the past 3 years, similar across urban and rural barangays. Overall bite/scratch incidences in 2016-17 were 67.3, 41.9 and 48.8 per 1,000 population per year for Nueva Vizcaya, Palawan and Tarlac respectively. Incidences were around 50% higher amongst those under 15 years of age, compared to -those older than 15. Household awareness of the nearest ABTCs was generally over 80%, but only 44.9% sought proper medical treatment and traditional remedies were still frequently used. The proportion of patients seeking PEP was not related to the distance or travel time to the nearest ABTC. For those that did not seek medical treatment, most cited a lack of awareness or insufficient funds and almost a third visited a traditional healer. No deaths from bite/scratch injuries were reported. A cohort of 1,105 patients were interviewed at six ABTCs in early 2017. OOPE varied across the ABTCs, from 5.53 USD to 37.83 USD per patient, primarily dependent on the need to pay for immunization if government supplies had run out. Overall, 78% of patients completed the recommended course, and the main reason for non-completion was a lack of time, followed by insufficient funds. Dog observation data revealed that 85% of patients were not truly exposed to rabies, and education in bite prevention might reduce provoked bites and demand for PEP. An accompanying paper details the ABTC network from the health provider's perspective.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Funding for this investigator-sponsored study was provided by GlaxoSmithKline Biologicals SA. ACBA, SIJ, MLLM, MPZDC, DAL, MCR, MCLQ, and LHT were funded proportionate to their time spent on the study. GlaxoSmithKline Biologicals SA reviewed and approved the protocol, but did not influence the project implementation, data collection, analysis or interpretation. They were also provided with an opportunity to review a preliminary version of this report for factual accuracy but the authors are solely responsible for final content and interpretation. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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