Completion of rabies post-exposure prophylaxis in Ouagadougou, Burkina Faso, 2021–2023: A cross-sectional analysis of routine data

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. Author summary: Rabies is a preventable but almost invariably fatal disease once symptoms appear. Post-exposure prophylaxis (PEP), consisting of timely rabies vaccination after a suspected exposure, is highly effective when completed according to recommendations. However, many patients in endemic countries do not complete the full course of treatment, increasing their risk of disease and reducing the effectiveness of rabies control efforts. We analyzed routine data from more than 8,000 patients who received rabies PEP at the Anti-Rabies Treatment Center of Ouagadougou, Burkina Faso, between 2021 and 2023. Overall, six out of ten patients completed treatment, but completion declined sharply over the study period, particularly during a period of vaccine shortage. Men and young adults were less likely to complete treatment than other groups. We also found that many patients discontinued treatment after receiving only the first vaccine dose, highlighting an important point for intervention. Our findings suggest that barriers to PEP completion are driven more by social and health-system factors than by the characteristics of the exposure itself. Improving vaccine availability, decentralizing rabies services, and strengthening patient follow-up could substantially increase treatment completion and contribute to rabies prevention in Burkina Faso and similar settings.