{"title":"Availability of anti-rabies vaccine and rabies immunoglobulin in Indian health facilities: a nationwide cross-sectional health facility survey","authors":"Navaneeth S. Krishna , Jeromie Wesley Vivian Thangaraj , Shanmugasundaram Devika , Aruna Sasi , Suganya Egambaram , D Sudha Rani , Siraj Ahmed Khan , Anitha Delli , Ashok Kumar Srivastava , Ayush Mishra , Basavaraj Shrinivasa , Chandhini Pandiyan , Devendra Gour , Debjani Ram Purakayastha , Nirmal Verma , Parul Sharma , Ravinder Kumar Soni , Sabarinatha Ramasamy , Sreelakshmi Mohandas K , Subrata Baidya , Manoj V. Murhekar","doi":"10.1016/j.lansea.2025.100608","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Ensuring the uninterrupted availability of the anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) in health facilities is crucial to achieve the global target of zero dog-mediated human rabies deaths by 2030. This study aimed to estimate the availability of ARV and RIG across health facilities in India.</div></div><div><h3>Methods</h3><div>We conducted a nationwide health facility-based, cross-sectional study across 60 districts selected by multistage probability sampling from 15 Indian states. In each district, we selected nine health facilities. We interviewed staff involved in the rabies control program in each of the selected health facilities, and abstracted and physically validated information on the availability of ARV and RIG.</div></div><div><h3>Findings</h3><div>Of the 534 health facilities surveyed, 467 (87.5%) were public sector health facilities. ARV was available in 372 (79.7%, 95% CI: 75.7%–83.2%) public sector health facilities, ranging from 60.0% to 93.2% in different geographic regions. Availability of ARV was lowest in Urban Primary Healthcare Centres (UPHCs) (58.9%, 95% CI: 45.0%–71.9%). RIG was available in 95 (20.3%, 95% CI: 16.8%–24.3%) public sector health facilities, with the highest availability in southern states (27/88, 30.7%). The availability of RIG ranged from 1.8% (95% CI: 16.8%–24.3%) in UPHCs to 69.2% (95% CI: 48.2%–85.7%) in medical college hospitals.</div></div><div><h3>Interpretation</h3><div>Considerable geographic and facility-level variations exist in the availability of ARV and RIG across India. Bridging the gap in the availability of ARV and RIG should be prioritised to achieve the goal of zero-dog-mediated human rabies deaths by 2030.</div></div><div><h3>Funding</h3><div><span>Indian Council of Medical Research</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"38 ","pages":"Article 100608"},"PeriodicalIF":6.2000,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Lancet regional health. Southeast Asia","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2772368225000794","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
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Abstract
Background
Ensuring the uninterrupted availability of the anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) in health facilities is crucial to achieve the global target of zero dog-mediated human rabies deaths by 2030. This study aimed to estimate the availability of ARV and RIG across health facilities in India.
Methods
We conducted a nationwide health facility-based, cross-sectional study across 60 districts selected by multistage probability sampling from 15 Indian states. In each district, we selected nine health facilities. We interviewed staff involved in the rabies control program in each of the selected health facilities, and abstracted and physically validated information on the availability of ARV and RIG.
Findings
Of the 534 health facilities surveyed, 467 (87.5%) were public sector health facilities. ARV was available in 372 (79.7%, 95% CI: 75.7%–83.2%) public sector health facilities, ranging from 60.0% to 93.2% in different geographic regions. Availability of ARV was lowest in Urban Primary Healthcare Centres (UPHCs) (58.9%, 95% CI: 45.0%–71.9%). RIG was available in 95 (20.3%, 95% CI: 16.8%–24.3%) public sector health facilities, with the highest availability in southern states (27/88, 30.7%). The availability of RIG ranged from 1.8% (95% CI: 16.8%–24.3%) in UPHCs to 69.2% (95% CI: 48.2%–85.7%) in medical college hospitals.
Interpretation
Considerable geographic and facility-level variations exist in the availability of ARV and RIG across India. Bridging the gap in the availability of ARV and RIG should be prioritised to achieve the goal of zero-dog-mediated human rabies deaths by 2030.
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