<p>Distribution of defaults by last dose received.</p>

Background

Rabies remains a major public health concern in low- and middle-income countries, where completion of post-exposure prophylaxis (PEP) is essential to prevent fatal outcomes. Large-scale programmatic evidence from francophone West Africa remains limited.

Material and Methods

We conducted a cross-sectional analytical study using routine data from the Ouagadougou Anti-Rabies Center between 2021 and 2023. Among 8,220 patients receiving rabies prophylaxis, 8,063 (98.1%) received PEP and were included in the analytical component. Completion was defined according to clinical practice, including full vaccination or medically advised discontinuation following risk assessment. Multivariable logistic regression was used to identify factors associated with PEP completion. Dose-specific default patterns were also analyzed.

Results

Overall, 60.2% of patients completed PEP, with a decline from 77% in 2021 to 37% in 2023, coinciding with a documented vaccine stockout. Male sex (aOR=0.89; 95% CI: 0.81–0.98) and age 15–25 years (aOR=0.82; 95% CI: 0.69–0.97) were associated with lower completion. Urban residence was associated with higher completion in the main model (aOR=1.22), although this effect varied significantly by year (interaction p=0.001).

Conclusion

PEP completion in Ouagadougou is primarily driven by socio-demographic and structural factors rather than exposure severity. Early dropout represents a critical intervention point. Strengthening access, decentralizing services, and improving follow-up are essential to enhance completion in endemic settings.