Determinants of Rabies Post-Exposure Prophylaxis Compliance in Bangladesh: Informing Policy for Elimination by 2030

Rabies remains a preventable yet fatal zoonotic disease and a major public health concern in Bangladesh, which aims to eliminate dog-mediated human rabies by 2030. Despite free availability of post-exposure prophylaxis (PEP), adherence to the WHO-recommended PEP regimen remains low. This study assessed PEP compliance and identified determinants of regimen completion among animal-exposed patients. We conducted a hospital-based observational study using secondary data from 457 patients who initiated PEP at the National Rabies Prevention and Control Centre (NRPCC) in Dhaka, from February 2023 to July 2023. Sociodemographic, clinical, and exposure-related factors were analyzed to identify predictors of compliance. Only 17.1% of patients completed the full PEP regimen, including rabies immunoglobulin (RIG) administration for WHO Category III exposures where indicated. Higher adherence was observed among females, individuals aged ≥15 years, lower-income groups, and those residing within 10 km of the treatment center. Exposure-related factors including dog bites, multiple exposures, unprovoked incidents, and appropriate exposure care were also associated with improved compliance. Despite free access, PEP completion remains critically low. Targeted strategies, including decentralized PEP delivery, improved public awareness, and strengthened follow-up systems, are essential to improve adherence and support progress toward rabies elimination by 2030.