Rabies Elimination in Nepal: Evaluating the Burden, Surveillance, and Treatment-Seeking Behaviour of Animal Bite Victims

Abstract

Rabies is a universally fatal but preventable zoonosis that remains a major public health challenge in Nepal. Despite decades of free provision of post-exposure prophylaxis (PEP) through government health facilities, preventable human deaths still occur. This paradox reflects a cycle of interlinked challenges: limited awareness and delayed treatment-seeking among bite victims, recurrent shortages of anti- rabies vaccines (ARV) and rabies immunoglobulins (RIG), and persistent underre- porting in national surveillance data. Each factor reinforces the others, weakening the overall effectiveness of rabies control programmes. This thesis examines the rabies burden in Nepal by focusing on animal bite victims as the critical point of intervention. Three complementary approaches are employed: analysis of national surveillance data to assess reporting quality; ethnographic fieldwork with central health authorities and medical centres to eval- uate supply-side constraints and service delivery; and a community-based sur- vey to estimate incidence, describe bite characteristics, and explore treatment- seeking behaviour. The findings reveal substantial underreporting of bite cases, systemic shortages in ARV and RIG provision, and widespread barriers to timely PEP uptake shaped by social, cultural, and economic contexts. Together, these results demonstrate how weak surveillance, constrained supply systems, and gaps in treatment-seeking form a self-reinforcing cycle that sustains the burden of rabies in Nepal. By highlight- ing these interconnected challenges, this work identifies critical gaps that must be addressed to strengthen surveillance, improve access to PEP, and accelerate progress toward rabies elimination.