A qualitative exploration of perceptions, practices, and systemic barriers to rabies post-exposure prophylaxis in a rural area of Uttarakhand, India

Background Rabies continues to be a universally fatal yet preventable neglected tropical disease (NTD). While most studies conducted on animal bites are predominantly quantitative describing the burden of animal bites, there is limited literature that captures the socio-cultural, behavioural and systemic factors that affect response and health-seeking behaviour following exposure to animal bites and its prophylaxis especially in rural settings. Aim To explore perceptions, practices, and barriers related to Rabies prevention and its post-exposure prophylaxis (PEP) among animal bite victims. Methods A qualitative exploratory study was conducted among individuals who presented with animal bites at a rural health facility in the state of Uttarakhand, India. Purposive sampling was done in order to ascertain variations in severity of exposure, healthcare-seeking behaviour, and PEP compliance and adherence. Semi-structured interviews were conducted telephonically to collect data. Data was then analysed using Braun and Clarke’s six-phase reflexive thematic analysis. Results Five overarching themes were identified: 1. Perceived invulnerability and normalization of animal bites, 2. Misconceptions and fragmented knowledge about Rabies, 3. Culturally embedded and inadequate wound care practices, 4. Structural and cognitive barriers to completion of PEP and 5.Informal health networks. Conclusion It was concluded that prevention of Rabies especially in rural settings is influenced to a great extent by complex interconnected cultural, behavioural and systemic factors. Many myths, traditional socio-cultural practices, economic constraints and infrastructural and logistic related barriers to healthcare collectively undermine the adherence to the recommended PEP schedule.