Authors: DR AIMAN ISLAM

Abstract

Dog bites are a significant global public health concern, causing an estimated 55,000 deaths annually, with approximately 31,000 reported from Asia, primarily affecting children under 15. In low- and middle-income countries, like Pakistan, rabies often termed “the disease of the impoverished” remains endemic due to delayed medical care and poor access to post exposure prophylaxis (PEP) .

Telemedicine has emerged as a promising tool to bridge healthcare gaps in underserved settings. By facilitating accurate case categorization, standardized treatment decisions, it supports Pakistan alignment with the One Health approach recommended by WHO to achieve rabies elimination by 2030. The study explores it roles in improving protocol adherence and clinical outcomes dog bite cases at primary health centers.

Objectives: To evaluate the burden of pediatric dog bite cases and access role of telemedicine in optimizing management through protocol adherence and treatment modification in resource limited primary health care centers across Sindh and Balochistan.

Methodology: this was a retrospective study, conducted over a 6month period from December,2024 to May, 2025. data were collected through confidential electronic medical records. Children presenting with dog bite injuries  received second opinion from specialist level physician through ChildLife Foundation (CLF) telemedicine satellite centers (TSCs) operating via fiber optic / VSAT screen with high definition cameras and IP phones on both side. Each case was accessed based on WHO dog bite categorization, and data was extracted on exposure type, treatment advised (wound care, anti- rabies vaccine (ARV), and rabies immunoglobulin(RIG) and physician modifications to management.

Results:  a total of 2121 dog bite cases were managed through telemedicine during the study period. Of these,14.3% (n=303) were advised immediate wound washing indicating the basic care has been missed at the initial point of contact. 4.6%(n=97) were classified as Category II exposures, requiring ARV only and 95.4% (n=2024), classified as Category III exposures, requiring ARV and RIG.

Conclusion:  Telemedicine proved to be an effective tool for guiding frontline healthcare workers in the accurate classification and management of pediatric dog bite cases across underserved regions of Sindh and Balochistan. The high prevalence of Category III exposures highlights the severity of cases presenting at primary care level. Through real time consultations and essential interventions -including wound care, ARV, and RIG- were initiated in accordance with WHO protocol. These findings emphasize the utility of telemedicine in standardizing emergency care, bridging clinical knowledge gaps at the periphery, and potentially reducing the risk of rabies-related mortality in children.

Keywords: TELEMEDICINE,DOG BITE,STANDERED PROTOCOL,RESOURCE LIMITED HEALTHCARE FACILITY