Abstract
Rabies remains a significant public health challenge in India, contributing to 35-40% of global rabies-related deaths, primarily due to delayed Post-Exposure Prophylaxis (PEP) initiation. This hospital-based cross-sectional study at a tertiary care facility in New Delhi aimed to assess the epidemiological profile of animal bite cases and identify determinants of PEP delays. Data were collected from 1,044 participants using a pretested questionnaire, with delays defined as PEP initiation ≥ 24 h post-bite. Results revealed that 69.5% of participants were aged 20-60 years, 78.3% were male, and 88.6% sustained dog bites. Most cases (83.7%) were Category 3 exposures, and 84.3% received PEP within 24 h. Delays occurred in 15.7% of cases, significantly associated with female gender (20.4% vs. 14.2% males, p = 0.022), rural residence (31.6% vs. 12.4% urban, p < 0.001), and semi-skilled occupations (18.5%). Key barriers included lack of awareness (15.5%), distance to healthcare (23.7%), and work constraints (23.9%). Urban residents and homeowners demonstrated faster PEP access (p = 0.002). The study underscores socioeconomic and systemic challenges, such as limited healthcare access and gender disparities, contributing to delays. Findings align with global patterns but highlight India's unique urban-rural divide and occupational influences. Targeted interventions, including community education, improved rural healthcare infrastructure, and subsidized PEP, are critical to reducing delays. Limitations include single-center design and cross-sectional constraints, limiting generalizability. Strengthening policy implementation and awareness campaigns, aligned with WHO's "Zero by 30" goals, is essential for rabies elimination.