Compliance of post-exposure prophylaxis (PEP) following animal bite in Indian population: A systematic review and meta-analysis

A BSTRACT Rabies is a life-threatening zoonotic disease in India, leading to numerous fatalities annually. Despite the availability of effective post-exposure prophylaxis (PEP), compliance with completing the vaccination regimen remains low, impeding efforts to control and eliminate the disease. This study aimed to assess PEP compliance rates among individuals exposed to rabies in India and identify key factors contributing to non-compliance. A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases including PubMed, Scopus, Embase, and Web of Science were searched for studies on PEP compliance in India. Eligible studies were community-based or hospital-based and published in English. The Joanna Briggs Institute (JBI) tool assessed study quality. A random effects model calculated pooled compliance rates, with heterogeneity assessed using the I² statistic and a Chi-square-based Q test. Subgroup and sensitivity analyses, as well as Egger’s test, were performed to explore variations and check for publication bias. The analysis included 30 studies, with a pooled compliance rate of 57% and high heterogeneity (I² =99.69%). Compliance was higher with the intradermal (ID) regimen than the intramuscular (IM) regimen, though adherence decreased over time. Economic constraints, logistical challenges, lack of awareness, cultural beliefs, and fear of side effects were major barriers to completion. Compliance was higher among those with severe bites. PEP compliance in India is low, hindered by various barriers. The ID regimen showed better adherence but also faced declining compliance over time. Improving PEP adherence requires targeted interventions such as education, logistical support, and promoting shorter ID regimens.