Rabies Treatment Centres in Madagascar

On World Rabies Day 2011, a new rabies treatment centre was opened in Mandritsara, Madagascar, covering  an area of over 10,500km2 and over  292,000 inhabitants, 945km from the capital.This area is seeing an increasing number of rabies exposures, and previously the nearest rabies treatment centre was 210km away. Representatives of the Ministry of Health and the Pasteur Institute in Madagascar are pictured (left) after theopening, along with the Centre’s new director, his technicians and the Mandritsara Medical Inspector.

The Mandritsara Rabies Treatment Centre is situated within the public health centre in the main town, and is run by a general practitioner, with another doctor as second in command, and three paramedics. The centre is part of the Ministry of Public Health, but enjoys very close collaboration with the Pasteur Institute of Madagascar.

Thereare 27 rabies treatment centres in Madagascar, shared between the island’s 22 regions. Before each centre is established, a management committee must beformed as part of the national strategy for epidemics in Madagascar. As rabies control is multisectoral, collaboration between all main sectors in the district is necessary and obligatory. The management committee includes professionals from medical, veterinary, educational, police and information services sectors and local political, religious and community leaders. Each entity has its own responsibilities, but there is always close collaboration when it comes to an epidemic or any problem connected with rabies.

Through its management committee (pictured), a centre handles all aspects of a rabies outbreak, including investigating bite reports, sampling and monitoring of biting animals, tracing and treatment of bite victims, reporting data to national authorities and news reporting to the local community. Emergency meetings are called to coordinate activities in the event of on outbreak. More routine activities include animal vaccination, dogpopulation management, educational outreach to communities and through schools and general awareness raising amongst the community about rabies. Sojabes,highly respected community elders play a vital role in raising awareness of the severity of rabies and intervening in cases where laws have been broken.

Ongoingtraining also takes part in the rabies centres. In November 2011, health workersin the Mankara District in the south-east, about 745km from the capital, hadidentified gaps in their knowledge about the correct procedures followingrabies exposures, so refresher sessions were organised to upgrade theirtraining, (see photo)

The Mandritsara rabies treatment centre has treated 217 rabiesexposures (all from dog bites) in its first eight and a half months of operation,on average one per day. All patients are activiely followed up to ensure thatthe vaccine course is completed. The costs of vaccine and syringes are met bythe Pasteur Institute of Madagascar, and patients recieve care free of charge.The centre also carried out a local stray dog population management programme.

This report was submitted by Dr. Emilie Fara Ramahefalalao of the InstitutPasteur in Madagascar, and edited by JaneCoutts of GARC.