A retrospective analysis of rabies post-exposure prophylaxis in Kapilvastu District, Nepal.

BACKGROUND: Rabies remains a fatal yet preventable zoonotic disease in Nepal, particularly in the Terai region where human-animal conflict is frequent. This study analyzes the epidemiological patterns of animal bites and evaluates the timeliness and completeness of Post-Exposure Prophylaxis (PEP) administration in Kapilvastu District to guide local public health interventions. METHODS: A retrospective analysis was conducted using data from the anti-rabies vaccine register of Kapilvastu Hospital from 1 June 2022 to 31 May 2023. All recorded animal bite victims (N = 2,853) were included. Descriptive statistics were used to characterize demographics and exposure patterns. Multivariable logistic regression was performed to identify factors associated with delayed PEP initiation (> 24 h after exposure). RESULTS: The study recorded 2,853 animal bite cases, predominantly males (64.5%) and children aged 0–10 years (31.4%). Dogs were responsible for the vast majority of bites (91.6%). While the PEP completion rate for the full three-dose intradermal regimen was high (93.6%), a critical delay in treatment initiation was observed; only 14.1% of victims received their first dose on the day of exposure. Multivariate analysis revealed that victims residing in municipalities outside the district headquarters had significantly higher odds of delaying treatment (AOR: 1.48; 95% CI: 1.22–1.80). Adolescents (11–20 years) were also more likely to delay PEP compared to younger children (AOR: 1.35; 95% CI: 1.07–1.70), whereas victims with high-risk bites (head/neck/hand) sought care more promptly (AOR: 0.77; 95% CI: 0.62–0.95). CONCLUSIONS: Although vaccine coverage and completion rates in Kapilvastu are commendable, the dangerous delay in initial treatment remains a critical gap in rabies prevention. Public health interventions must specifically target adolescents and remote communities to emphasize the urgency of immediate PEP, regardless of wound severity or distance to healthcare facilities.