Abstract
Background: Animal and rodent bites are a common occurrence in Pakistan, but little is known about the characteristics of the injuries incurred and the patient pattern in the Khyber Pakhtunkhwa province of Pakistan. This study aims to describe the injuries caused by the animal and rodent bites and characteristics of the patients presenting at the Emergency Department of the Lady Reading Hospital, Peshawar, Pakistan.

Methods: This cross-sectional study is based on a retrospective analysis of the records of patients presenting at the animal bite clinic from Jan- June, 2018 at the Emergency Department, Lady Reading Hospital using R statistical software. All patients presenting to the clinic during this period with a history of mammalian bite were included in the study.

Findings: A total of 5054 presented during the reporting period of whom 83% belonged to Peshawar district. Dog bite cases were mostly from multiple areas in the outskirts of Peshawar and Yakatoot. Majority of rat bite cases from Peshawar inner city areas, Nothia Cantt and suburbs. Four out of 5 patients were males and the mean age of the patients at 20 years (SD=15.26). More than 80% of bite cases were less than 30 years old in both genders. The prevalence of dog bites was highest at 78.40%, in the patients included in the study, followed by rat bites at 16.30%, and 5.30% by other animals. 52% of bites were caused by stray animals. Upper and lower extremities were predominant sites of bites in contrast to back, head and chest regions. Most frequent exposure category was Category II i.e. nibbling of uncovered skin and abrasions for 3 out of 4 cases (77.20%), followed by Category III i.e. single or multiple transdermal bites and/or contamination of mucous membranes (4.10%). Category I was the least frequent i.e. touching or feeding of animal or human cases and licks on intact skin (2.30%). Around 79.40% patients were treated with antirabies vaccine (ARV) + tetanus toxoid (TT) + antibiotics (Category II patients by dogs and other animals), 16.40% with TT + antibiotic (mostly rat bite patients) and 4.20% with ARV + TT + Immunoglobulin + antibiotics (all category III patients by dogs and other animals).

Conclusions: Bites by dogs and rats constitute the vast majority of cases presenting at the Lady Reading Hospital, Peshawar and signify the enormity of this public health problem at population level. A coordinated and targeted response with multi-sectoral interventions is direly needed to decrease the burden of disease and mortality due to animal bites in Khyber Pakhtunkhwa.

Key words: mammalian bites, dog bites, rat bites, Rabies, emergency department