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Paghubasan J, Tiglao PJ, Aoki Y, Tan MA, Sarsalijo MS, Aquino GJB, Beronilla-Uraga MG, Agosto LC. Neurotoxic snakebite envenomation treated with Philippine cobra antivenom in the eastern Visayas: a descriptive study between 2016 and 2020. Toxicol Res (Camb) 2024; 13:tfae088. [PMID: 38863797 PMCID: PMC11163182 DOI: 10.1093/toxres/tfae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction There is a significant shortage of observational studies on neurotoxic snakebite envenomation in the Philippines. This lack of data, especially concerning treatment using Purified Cobra Antivenom (PCAV), has prompted the initiation of this foundational study. Methods The target population included snakebite patients admitted to the Eastern Visayas Medical Center and treated with PCAV between 2016 and 2020. A retrospective chart review was conducted for data collection. The investigation analyzed the hospital stay and patient features of individuals who were administered either lower or higher doses of PCAV. Results Eighty-two patients were identified during the study. Of these, 27 (33%) were under 20 years of age and 50 (61%) were male. Most patients, totalling 75 (92%) were hailed from rural areas. Of the 82 patients, 59 (72%) received one or two ampoules of PCAV during the course. However, patients who received more than two ampoules had a longer median hospital stay than those who received less than three ampoules [96 h (interquartile range, IQR 66-122) vs. 125 h (IQR 96-218), P = 0.038]. The study reported five in-hospital mortalities (6.1%). Conclusions The individuals who needed a high dosage of PCAV tended to have more extended hospital stays, yet over 70% of the patient population required a lower dosage. To gain a clearer understanding of the burden of neurotoxic snakebites and determine the optimal PCAV dosage based on disease severity in the area, a more comprehensive, prospective study is recommended.
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Affiliation(s)
- Jonathan Paghubasan
- Department of Emergency Medicine, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Patrick Joseph Tiglao
- Department of Emergency Medicine, Eastern Visayas Medical Center, Tacloban, Philippines
- Department of Emergency Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
- Philippine Toxinology Society, Inc
| | - Yoshihiro Aoki
- Coordination Office for Emergency Medicine and International Response, Acute and Critical Care Center, Nagasaki, Japan
| | - Mariedel A Tan
- Poison Control Center, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Mardie S Sarsalijo
- Poison Control Center, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Grace Joy B Aquino
- Poison Control Center, Eastern Visayas Medical Center, Tacloban, Philippines
| | | | - Lourdes C Agosto
- Poison Control Center, Eastern Visayas Medical Center, Tacloban, Philippines
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Landry M, D’Souza R, Moss S, Chang HH, Ebelt S, Wilson L, Scovronick N. The Association Between Ambient Temperature and Snakebite in Georgia, USA: A Case-Crossover Study. GEOHEALTH 2023; 7:e2022GH000781. [PMID: 37441711 PMCID: PMC10334880 DOI: 10.1029/2022gh000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 07/15/2023]
Abstract
The World Health Organization has identified snakebite envenoming as a highest priority neglected tropical disease, yet there is a dearth of epidemiologic research on environmental risk factors, including outdoor temperature. Temperature may affect snakebites through human behavior or snake behavior; snakes are ectotherms, meaning outdoor temperatures influence their internal body temperature and thus their behavior. Here we investigate the relationship between short-term temperature and snakebites in Georgia, one of the most biodiverse US states in terms of herpetofauna. We acquired emergency department (ED) visit data for Georgia between 1 January 2014 and 31 December 2020. Visits for venomous and non-venomous snakebites were identified using diagnosis codes. For comparison, we also considered visits for non-snake (e.g., insects, spiders, scorpions) envenomation. Daily meteorology from the Daymet 1 km product was linked to patient residential ZIP codes. We applied a case-crossover design to estimate associations of daily maximum temperature and snakebite ED visits. During the 7-year study period, there were 3,908 visits for venomous snakebites, 1,124 visits for non-venomous bites and 65,187 visits for non-snake envenomation. Across the entire period, a 1°C increase in same-day maximum temperature was associated with a 5.6% (95%CI: 4.0-7.3) increase in the odds of venomous snakebite and a 5.8% (95%CI: 3.0-8.8) increase in non-venomous snakebite. Associations were strongest in the spring. We also observed a positive and significant (p < 0.05) association for non-snake envenomation, albeit slightly smaller and more consistent across seasons compared to those for snakebites.
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Affiliation(s)
- Mariah Landry
- Gangarosa Department of Environmental HealthRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Rohan D’Souza
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Shannon Moss
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Howard H. Chang
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Stefanie Ebelt
- Gangarosa Department of Environmental HealthRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | | | - Noah Scovronick
- Gangarosa Department of Environmental HealthRollins School of Public HealthEmory UniversityAtlantaGAUSA
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Paolino G, Di Nicola MR, Avella I, Mercuri SR. Venomous Bites, Stings and Poisoning by European Vertebrates as an Overlooked and Emerging Medical Problem: Recognition, Clinical Aspects and Therapeutic Management. Life (Basel) 2023; 13:1228. [PMID: 37374011 DOI: 10.3390/life13061228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
Europe presents a high number of venomous and poisonous animals able to elicit medically relevant symptoms in humans. However, since most of the accidents involving venomous or poisonous animals in Europe are unreported, their incidence and morbidity are severely overlooked. Here we provide an overview of the European vertebrate species of greatest toxicological interest, the clinical manifestations their toxins can cause, and their treatment. We report the clinical symptoms induced by envenomations and poisoning caused by reptiles, fishes, amphibians and mammals in Europe, ranging from mild, local symptoms (e.g., erythema, edema) to systemic and potentially deadly. The present work constitutes a tool for physicians to recognize envenomation/poisoning symptoms caused by the most medically relevant European vertebrates and to decide which approach is the most appropriate to treat them.
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Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Unit of Clinical Dermatology, Università Vita-Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Matteo Riccardo Di Nicola
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Asociación Herpetológica Española, Apartado de Correos 191, 28911 Leganés, Spain
| | - Ignazio Avella
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado, Campus de Vairão, Universidade do Porto, 4485-661 Vairão, Portugal
- Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, 4099-002 Porto, Portugal
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
| | - Santo Raffaele Mercuri
- Unit of Dermatology and Cosmetology, I.R.C.C.S. San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
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Le Roux G, Guillon M, Bernard L, de Haro L, Lourdais O, Descatha A. What drives the risk of being bitten by a viper? A fine spatial scale study in western France. Toxicon 2023; 228:107130. [PMID: 37080341 DOI: 10.1016/j.toxicon.2023.107130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023]
Abstract
Previous studies on viper bites in France have focused on clinical consequences of envenomation, efficacy of antivenom and epidemiology of bites. Herein, we wanted to clarify temporal and spatial patterns in bite incidence using a fine spatial scale (municipality level). We focused on viper bites recorded over the last 10 years in 4 regions of western France. We addressed the determinants of bite occurrence and number of bites considering the following variables: predicted probability of viper presence, species (V. aspis or V. berus), climatic data, tourism function rate, soil transformation and landscape use. 703 bite cases were retained with significant disparities between areas. Bites occurred either during a garden-related activity (339 cases, 51.2%) or during an activity in the countryside (300 cases, 45.3%). The probability of presence of a viper at the municipality level positively influenced the risk of being bitten (multiplied by 3 for a variation in probability of 0.25 from 0.5) but varied between species (lower in V. berus than V. aspis). Artificial land development had a positive effect on bite risks. Finally, a tourism function rate above 50 beds/100 inhabitants was strongly associated with an increase in the risk of occurrence and frequency of bites. Overall, viper bites recorded in our study were concentrated on the south coastline of Pays de la Loire region. The coastal towns are significant areas of tourist attraction and are located close to preserved semi-natural landscapes that provide favorable habitats for vipers. This convergence may favor human/wildlife encounters.
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Affiliation(s)
- Gaël Le Roux
- Poison Control Center, Academic Hospital CHU Angers, F-49000, Angers, France; University of Angers, Academic Hospital CHU Angers CHU Angers, University of Rennes, INSERM, École des Hautes études en Santé Publique, Institut de Recherche en Santé, Environnement et Travail (Irset) UMR_S 1085, F-49000, Angers, France.
| | - Michaël Guillon
- Centre D'Etudes Biologiques de Chizé, CNRS UMR 7372- Université de La Rochelle, 79360, Villiers-en-Bois, France; Cistude Nature, Chemin Du Moulinat, 33185, Le Haillan, France
| | - Lise Bernard
- Poison Control Center, Academic Hospital CHU Angers, F-49000, Angers, France
| | - Luc de Haro
- Poison Control Center, Academic Hospital APHM, F-13000, Marseille, France
| | - Olivier Lourdais
- Centre D'Etudes Biologiques de Chizé, CNRS UMR 7372- Université de La Rochelle, 79360, Villiers-en-Bois, France
| | - Alexis Descatha
- Poison Control Center, Academic Hospital CHU Angers, F-49000, Angers, France; University of Angers, Academic Hospital CHU Angers CHU Angers, University of Rennes, INSERM, École des Hautes études en Santé Publique, Institut de Recherche en Santé, Environnement et Travail (Irset) UMR_S 1085, F-49000, Angers, France
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Goldstein E, Erinjery JJ, Martin G, Kasturiratne A, Ediriweera DS, Somaweera R, de Silva HJ, Diggle P, Lalloo DG, Murray KA, Iwamura T. Climate change maladaptation for health: Agricultural practice against shifting seasonal rainfall affects snakebite risk for farmers in the tropics. iScience 2023; 26:105946. [PMID: 36818294 PMCID: PMC9932500 DOI: 10.1016/j.isci.2023.105946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Snakebite affects more than 1.8 million people annually. Factors explaining snakebite variability include farmers' behaviors, snake ecology and climate. One unstudied issue is how farmers' adaptation to novel climates affect their health. Here we examined potential impacts of adaptation on snakebite using individual-based simulations, focusing on strategies meant to counteract major crop yield decline because of changing rainfall in Sri Lanka. For rubber cropping, adaptation led to a 33% increase in snakebite incidence per farmer work hour because of work during risky months, but a 17% decrease in total annual snakebites because of decreased labor in plantations overall. Rice farming adaptation decreased snakebites by 16%, because of shifting labor towards safer months, whereas tea adaptation led to a general increase. These results indicate that adaptation could have both a positive and negative effect, potentially intensified by ENSO. Our research highlights the need for assessing adaptation strategies for potential health maladaptations.
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Affiliation(s)
- Eyal Goldstein
- School of Zoology, Department of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Ecosystem Modeling, University of Göttingen, Göttingen, Germany
| | - Joseph J. Erinjery
- School of Zoology, Department of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Zoology, Kannur University, Kannur, India
| | - Gerardo Martin
- Escuela Nacional de Estudios Superiores unidad Mérida, Universidad Nacional Autónoma de México, Yucatán, México
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Ruchira Somaweera
- School of Biological Sciences, University of Western Australia, Perth, WA, Australia
| | | | - Peter Diggle
- CHICAS, Lancaster University Medical School, Lancaster, UK
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David G. Lalloo
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kris A. Murray
- Centre on Climate Change and Planetary Health, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Takuya Iwamura
- School of Zoology, Department of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Department F.-A. Forel for Aquatic and Environmental Science, University of Geneva, Geneva, Switzerland
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Bhaumik S, Beri D, Jagnoor J. The impact of climate change on the burden of snakebite: Evidence synthesis and implications for primary healthcare. J Family Med Prim Care 2022; 11:6147-6158. [PMID: 36618235 PMCID: PMC9810950 DOI: 10.4103/jfmpc.jfmpc_677_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Snakebite is a public health problem in rural areas of South Asia, Africa and South America presenting mostly in primary care. Climate change and associated extreme weather events are expected to modify the snake-human-environment interface leading to a change in the burden of snakebite. Understanding this change is essential to ensure the preparedness of primary care and public health systems. Methods We searched five electronic databases and supplemented them with other methods to identify eight studies on the effect of climate change on the burden of snakebite. We summarised the results thematically. Results Available evidence is limited but estimates a geographic shift in risk of snakebite: northwards in North America and southwards in South America and in Mozambique. One study from Sri Lanka estimated a 31.3% increase in the incidence of snakebite. Based on limited evidence, the incidence of snakebite was not associated with tropical storms/hurricanes and droughts in the United States but associated with heatwaves in Israel. Conclusion The impact of climate change and associated extreme weather events and anthropogenic changes on mortality, morbidity and socioeconomic burden of snakebite. Transdisciplinary approaches can help understand these complex phenomena better. There is almost no evidence available in high-burden nations of South Asia and sub-Saharan Africa. Community-based approaches for biodiversity and prevention, the institution of longitudinal studies, together with improving the resilience of primary care and public health systems are required to mitigate the impact of climate change on snakebite.
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Affiliation(s)
- Soumyadeep Bhaumik
- Injury Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia,Injury Division, The George Institute for Global Health, New Delhi, India,Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, India,Address for correspondence: Dr. Soumyadeep Bhaumik, Meta-Research and Evidence Synthesis Unit, George Institute for Global Health, 308, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi -110025, India. E-mail:
| | - Deepti Beri
- Injury Division, The George Institute for Global Health, New Delhi, India
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia,Injury Division, The George Institute for Global Health, New Delhi, India
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Melit RJ, Abraham SV, Radhakrishnan S, Palatty BU, Ajay A, Vimal KS, Das K, Kassyap CK. Retrospective review of case records of snakebite presenting to a single tertiary care centre over a 5-year period. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:326-332. [PMID: 35818091 DOI: 10.25259/nmji_97_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Snakebite is a disease of the poor, and hospitals catering to these individuals are often resource-constrained. Lack of electronic medical records in these resource-limited settings makes the capture of data even harder. Methods Before establishing a snakebite registry in the region, we did a retrospective case record review of all snakebite victims (n=3229) over 5 years who presented to a single tertiary care centre, catering to one of the largest number of snakebite victims in the country. Results Of the 451 cases, 262 (58.1%) presented to the emergency department within 2 hours of the bite. In 170 instances, the snake was brought along and the species of the snake was recorded. Russell's viper was the most common (130; 76.5%). Blood products were used in 237 (52.5%) patients. Acute kidney injury occurred in 165 (36.6%) patients, of whom 37 (8.2%) required dialysis. The mean (SD) duration of hospital admission was 10.5 (7.4) days. There was a significant correlation between number of snakebites with rainfall and humidity. One hundred and seven cases (3.3%) of snakebite resulted in mortality. A majority of mortality records were not available (88%; 94/107), rendering us incapable of doing reliable mortality data correlations or interpretation. Conclusion Viperidae bites predominate in the region, with renal injury being the most common cause for morbidity. Region-specific, prospective snakebite mapping could be a cost-effective strategy that might help in vulnerability analysis of the region. A multi-centric region-specific snakebite registry encompassing not just the clinico-epidemiological characteristics of snakebite victims, but also the demographic data, the pre-hospital care and local remedial practices, geospatial distribution, anti-snake venom and blood product usage, will help in developing better healthcare strategies for snakebite victims in India.
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Affiliation(s)
- Ronald Jaison Melit
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 686005, Kerala, India
| | - Siju V Abraham
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 686005, Kerala, India
| | - Sreekala Radhakrishnan
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 686005, Kerala, India
| | - Babu Urumese Palatty
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 686005, Kerala, India
| | - A Ajay
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Krishan S Vimal
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Krishna Das
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 686005, Kerala, India
| | - C K Kassyap
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur 686005, Kerala, India
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Malhotra A, Wüster W, Owens JB, Hodges CW, Jesudasan A, Ch G, Kartik A, Christopher P, Louies J, Naik H, Santra V, Kuttalam SR, Attre S, Sasa M, Bravo-Vega C, Murray KA. Promoting co-existence between humans and venomous snakes through increasing the herpetological knowledge base. Toxicon X 2021; 12:100081. [PMID: 34522881 PMCID: PMC8426276 DOI: 10.1016/j.toxcx.2021.100081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022] Open
Abstract
Snakebite incidence at least partly depends on the biology of the snakes involved. However, studies of snake biology have been largely neglected in favour of anthropic factors, with the exception of taxonomy, which has been recognised for some decades to affect the design of antivenoms. Despite this, within-species venom variation and the unpredictability of the correlation with antivenom cross-reactivity has continued to be problematic. Meanwhile, other aspects of snake biology, including behaviour, spatial ecology and activity patterns, distribution, and population demography, which can contribute to snakebite mitigation and prevention, remain underfunded and understudied. Here, we review the literature relevant to these aspects of snakebite and illustrate how demographic, spatial, and behavioural studies can improve our understanding of why snakebites occur and provide evidence for prevention strategies. We identify the large gaps that remain to be filled and urge that, in the future, data and relevant metadata be shared openly via public data repositories so that studies can be properly replicated and data used in future meta-analyses.
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Affiliation(s)
- Anita Malhotra
- Molecular Ecology and Evolution @ Bangor, School of Natural Sciences, Bangor University, 3rd floor ECW, Deiniol Road, Bangor, LL57 2UW, UK
| | - Wolfgang Wüster
- Molecular Ecology and Evolution @ Bangor, School of Natural Sciences, Bangor University, 3rd floor ECW, Deiniol Road, Bangor, LL57 2UW, UK
| | - John Benjamin Owens
- Molecular Ecology and Evolution @ Bangor, School of Natural Sciences, Bangor University, 3rd floor ECW, Deiniol Road, Bangor, LL57 2UW, UK
- Captive & Field Herpetology Ltd, Wales, 13 Hirfron, Holyhead, Llaingoch, Anglesey, LL65 1YU, UK
| | - Cameron Wesley Hodges
- School of Biology, Institute of Science, Suranaree University of Technology, Muang Nakhon Ratchasima, Thailand
| | - Allwin Jesudasan
- Madras Crocodile Bank Trust, Centre for Herpetology, Post bag No.4, Vadanamelli Village, East Coast Road, Mamallapuram, 603 104, Tamil Nadu, India
| | - Gnaneswar Ch
- Madras Crocodile Bank Trust, Centre for Herpetology, Post bag No.4, Vadanamelli Village, East Coast Road, Mamallapuram, 603 104, Tamil Nadu, India
| | - Ajay Kartik
- Madras Crocodile Bank Trust, Centre for Herpetology, Post bag No.4, Vadanamelli Village, East Coast Road, Mamallapuram, 603 104, Tamil Nadu, India
| | - Peter Christopher
- Madras Crocodile Bank Trust, Centre for Herpetology, Post bag No.4, Vadanamelli Village, East Coast Road, Mamallapuram, 603 104, Tamil Nadu, India
| | | | - Hiral Naik
- School of Animal, Plant and Environmental Sciences, University of the Witwatersrand, Johannesburg. P. O. Wits, 2050, Gauteng, South Africa
- Save the Snakes, R527, Blyderus, Hoedspruit, 1380, South Africa
| | - Vishal Santra
- Captive & Field Herpetology Ltd, Wales, 13 Hirfron, Holyhead, Llaingoch, Anglesey, LL65 1YU, UK
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Sourish Rajagopalan Kuttalam
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, West Bengal 712407, India
| | - Shaleen Attre
- Durrell Institute of Conservation and Ecology, School of Anthropology and Conservation, Marlowe Building, University of Kent, Canterbury, Kent, CT2 7NR, UK
| | - Mahmood Sasa
- Instituto Clodomiro Picado, Universidad de Costa Rica, San José, Costa Rica
- Escuela de Biología, Universidad de Costa Rica, San José, Costa Rica
| | - Carlos Bravo-Vega
- Research Group in Mathematical and Computational Biology (BIOMAC), Department of Biomedical Engineering, University of the Andes, Bogotá, Colombia
| | - Kris A. Murray
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Gambia
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9
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Pintor AF, Ray N, Longbottom J, Bravo-Vega CA, Yousefi M, Murray KA, Ediriweera DS, Diggle PJ. Addressing the global snakebite crisis with geo-spatial analyses - Recent advances and future direction. Toxicon X 2021; 11:100076. [PMID: 34401744 PMCID: PMC8350508 DOI: 10.1016/j.toxcx.2021.100076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023] Open
Abstract
Venomous snakebite is a neglected tropical disease that annually leads to hundreds of thousands of deaths or long-term physical and mental ailments across the developing world. Insufficient data on spatial variation in snakebite risk, incidence, human vulnerability, and accessibility of medical treatment contribute substantially to ineffective on-ground management. There is an urgent need to collect data, fill knowledge gaps and address on-ground management problems. The use of novel, and transdisciplinary approaches that take advantage of recent advances in spatio-temporal models, 'big data', high performance computing, and fine-scale spatial information can add value to snakebite management by strategically improving our understanding and mitigation capacity of snakebite. We review the background and recent advances on the topic of snakebite related geospatial analyses and suggest avenues for priority research that will have practical on-ground applications for snakebite management and mitigation. These include streamlined, targeted data collection on snake distributions, snakebites, envenomings, venom composition, health infrastructure, and antivenom accessibility along with fine-scale models of spatio-temporal variation in snakebite risk and incidence, intraspecific venom variation, and environmental change modifying human exposure. These measures could improve and 'future-proof' antivenom production methods, antivenom distribution and stockpiling systems, and human-wildlife conflict management practices, while simultaneously feeding into research on venom evolution, snake taxonomy, ecology, biogeography, and conservation.
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Affiliation(s)
- Anna F.V. Pintor
- Division of Data, Analytics and Delivery for Impact (DDI), World Health Organization, Geneva, Switzerland
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Joshua Longbottom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Carlos A. Bravo-Vega
- Research Group in Mathematical and Computational Biology (BIOMAC), Department of Biomedical Engineering, University of Los Andes, Bogotá, Colombia
| | - Masoud Yousefi
- School of Biology, College of Science, University of Tehran, Iran
| | - Kris A. Murray
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, UK
- MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Fajara, Gambia
| | - Dileepa S. Ediriweera
- Health Data Science Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Peter J. Diggle
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Tidman R, Abela-Ridder B, de Castañeda RR. The impact of climate change on neglected tropical diseases: a systematic review. Trans R Soc Trop Med Hyg 2021; 115:147-168. [PMID: 33508094 PMCID: PMC7842100 DOI: 10.1093/trstmh/traa192] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
Neglected tropical diseases (NTDs) are a diverse group of diseases that continue to affect >1 billion people, with these diseases disproportionately impacting vulnerable populations and territories. Climate change is having an increasing impact on public health in tropical and subtropical areas and across the world and can affect disease distribution and transmission in potentially diverse ways. Improving our understanding of how climate change influences NTDs can help identify populations at risk to include in future public health interventions. Articles were identified by searching electronic databases for reports of climate change and NTDs between 1 January 2010 and 1 March 2020. Climate change may influence the emergence and re-emergence of multiple NTDs, particularly those that involve a vector or intermediate host for transmission. Although specific predictions are conflicting depending on the geographic area, the type of NTD and associated vectors and hosts, it is anticipated that multiple NTDs will have changes in their transmission period and geographic range and will likely encroach on regions and populations that have been previously unaffected. There is a need for improved surveillance and monitoring to identify areas of NTD incursion and emergence and include these in future public health interventions.
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Affiliation(s)
- Rachel Tidman
- Consultant, World Health Organization, Geneva, Switzerland
| | - Bernadette Abela-Ridder
- Department of the Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Department of the Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.,Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Switzerland
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Ediriweera DS, Kasthuriratne A, Pathmeswaran A, Gunawardene NK, Jayamanne SF, Murray K, Iwamura T, Isbister G, Dawson A, Lalloo DG, de Silva HJ, Diggle PJ. Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample. PLoS Negl Trop Dis 2021; 15:e0009447. [PMID: 34061839 PMCID: PMC8195360 DOI: 10.1371/journal.pntd.0009447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 06/11/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Snakebite incidence shows both spatial and temporal variation. However, no study has evaluated spatiotemporal patterns of snakebites across a country or region in detail. We used a nationally representative population sample to evaluate spatiotemporal patterns of snakebite in Sri Lanka. METHODOLOGY We conducted a community-based cross-sectional survey representing all nine provinces of Sri Lanka. We interviewed 165 665 people (0.8% of the national population), and snakebite events reported by the respondents were recorded. Sri Lanka is an agricultural country; its central, southern and western parts receive rain mainly from Southwest monsoon (May to September) and northern and eastern parts receive rain mainly from Northeast monsoon (November to February). We developed spatiotemporal models using multivariate Poisson process modelling to explain monthly snakebite and envenoming incidences in the country. These models were developed at the provincial level to explain local spatiotemporal patterns. PRINCIPAL FINDINGS Snakebites and envenomings showed clear spatiotemporal patterns. Snakebite hotspots were found in North-Central, North-West, South-West and Eastern Sri Lanka. They exhibited biannual seasonal patterns except in South-Western inlands, which showed triannual seasonality. Envenoming hotspots were confined to North-Central, East and South-West parts of the country. Hotspots in North-Central regions showed triannual seasonal patterns and South-West regions had annual patterns. Hotspots remained persistent throughout the year in Eastern regions. The overall monthly snakebite and envenoming incidences in Sri Lanka were 39 (95%CI: 38-40) and 19 (95%CI: 13-30) per 100 000, respectively, translating into 110 000 (95%CI: 107 500-112 500) snakebites and 45 000 (95%CI: 32 000-73 000) envenomings in a calendar year. CONCLUSIONS/SIGNIFICANCE This study provides information on community-based monthly incidence of snakebites and envenomings over the whole country. Thus, it provides useful insights into healthcare decision-making, such as, prioritizing locations to establish specialized centres for snakebite management and allocating resources based on risk assessments which take into account both location and season.
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Affiliation(s)
| | | | | | | | | | - Kris Murray
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, The Gambia
| | - Takuya Iwamura
- Department of Forest Ecosystems and Society, College of Forestry, Oregon State University, Corvallis, Oregon, United States of America
| | - Geoffrey Isbister
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Clinical Toxicology Research Group, University of Newcastle, Waratah, Australia
| | - Andrew Dawson
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Addiction Medicine, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | | | | | - Peter John Diggle
- CHICAS, Lancaster University Medical School, Lancaster, United Kingdom
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12
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Alcoba G, Ochoa C, Babo Martins S, Ruiz de Castañeda R, Bolon I, Wanda F, Comte E, Subedi M, Shah B, Ghimire A, Gignoux E, Luquero F, Nkwescheu AS, Sharma SK, Chappuis F, Ray N. Novel transdisciplinary methodology for cross-sectional analysis of snakebite epidemiology at national scale. PLoS Negl Trop Dis 2021; 15:e0009023. [PMID: 33577579 PMCID: PMC7906452 DOI: 10.1371/journal.pntd.0009023] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/25/2021] [Accepted: 12/01/2020] [Indexed: 12/12/2022] Open
Abstract
Background Worldwide, it is estimated that snakes bite 4.5–5.4 million people annually, 2.7 million of which are envenomed, and 81,000–138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the “Snake-Byte” project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal. Methodology/Principal findings We compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility. Conclusions/Significance This novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases. Snakebite envenoming was recently classified as a priority neglected tropical disease by the World Health Organization. Up to five million people are bitten, more than a million envenomed, and around 100,000 victims die, mainly in rural and remote areas of low- and middle-income countries. Snakebite envenoming not only affects victims acutely, but it can also cause long-term disability, disfiguring scars, and heavy economic burden due to treatment costs and inability to work. Previous studies have analyzed snakebite clinical, epidemiological, or socio-economic impacts independently, and little has been done to assess the impact of snakebite in animals and on the livelihoods of the communities that depend upon them. We present an innovative, holistic, national-scale methodology that includes epidemiology, One Health, economic, and geographic information science approaches into one multi-cluster household survey. We randomly selected 250 sub-district areas from all Cameroonian regions and all Nepali Terai districts, which represented more than 61,000 participants in each country. This methodology could be adapted and implemented in other countries affected by snakebite.
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Affiliation(s)
- Gabriel Alcoba
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Médecins Sans Frontières (MSF), Geneva, Switzerland
- * E-mail:
| | - Carlos Ochoa
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
| | - Sara Babo Martins
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Isabelle Bolon
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Franck Wanda
- Centre International de Recherche, d’Enseignement et de Soins en Milieu Tropical (CIRES), Akonolinga, Cameroon
| | - Eric Comte
- Centre International de Recherche, d’Enseignement et de Soins en Milieu Tropical (CIRES), Akonolinga, Cameroon
| | - Manish Subedi
- B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Bhupendra Shah
- B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Anup Ghimire
- B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Etienne Gignoux
- Epicentre, Médecins Sans Frontières, Geneva, Switzerland/ Paris, France
| | - Francisco Luquero
- Epicentre, Médecins Sans Frontières, Geneva, Switzerland/ Paris, France
| | - Armand Seraphin Nkwescheu
- Cameroon Society of Epidemiology (CaSE), and Faculty of Medicine and Biomedical Science, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
- Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
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13
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Goldstein E, Erinjery JJ, Martin G, Kasturiratne A, Ediriweera DS, de Silva HJ, Diggle P, Lalloo DG, Murray KA, Iwamura T. Integrating human behavior and snake ecology with agent-based models to predict snakebite in high risk landscapes. PLoS Negl Trop Dis 2021; 15:e0009047. [PMID: 33481802 PMCID: PMC7857561 DOI: 10.1371/journal.pntd.0009047] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/03/2021] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Abstract
Snakebite causes more than 1.8 million envenoming cases annually and is a major cause of death in the tropics especially for poor farmers. While both social and ecological factors influence the chance encounter between snakes and people, the spatio-temporal processes underlying snakebites remain poorly explored. Previous research has focused on statistical correlates between snakebites and ecological, sociological, or environmental factors, but the human and snake behavioral patterns that drive the spatio-temporal process have not yet been integrated into a single model. Here we use a bottom-up simulation approach using agent-based modelling (ABM) parameterized with datasets from Sri Lanka, a snakebite hotspot, to characterise the mechanisms of snakebite and identify risk factors. Spatio-temporal dynamics of snakebite risks are examined through the model incorporating six snake species and three farmer types (rice, tea, and rubber). We find that snakebites are mainly climatically driven, but the risks also depend on farmer types due to working schedules as well as species present in landscapes. Snake species are differentiated by both distribution and by habitat preference, and farmers are differentiated by working patterns that are climatically driven, and the combination of these factors leads to unique encounter rates for different landcover types as well as locations. Validation using epidemiological studies demonstrated that our model can explain observed patterns, including temporal patterns of snakebite incidence, and relative contribution of bites by each snake species. Our predictions can be used to generate hypotheses and inform future studies and decision makers. Additionally, our model is transferable to other locations with high snakebite burden as well.
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Affiliation(s)
- Eyal Goldstein
- School of Zoology, Department of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Joseph J. Erinjery
- School of Zoology, Department of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Zoology, Kannur University, Kannur, India
| | - Gerardo Martin
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Grantham Institute—Climate Change and Environment, Imperial College London, London, United Kingdom
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | - Peter Diggle
- CHICAS, Lancaster University Medical School, Lancaster, United Kingdom
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Kris A. Murray
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Grantham Institute—Climate Change and Environment, Imperial College London, London, United Kingdom
- MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Atlantic boulevard, Fajara, The Gambia
| | - Takuya Iwamura
- School of Zoology, Department of Life Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Forest Ecosystems and Society, College of Forestry, Oregon State University, Corvallis, Oregon, United States of America
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Rother HA. Controlling and preventing climate-sensitive noncommunicable diseases in urban sub-Saharan Africa. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 722:137772. [PMID: 32199361 DOI: 10.1016/j.scitotenv.2020.137772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/12/2020] [Accepted: 03/05/2020] [Indexed: 06/10/2023]
Abstract
Research continues to highlight the link between climate change and health outcomes. There is, however, limited evidence in research, policies and in the Sustainable Development Goals (SDGs) about the impact of environmental factors on noncommunicable diseases (NCDs) for people living in urban areas of sub-Saharan Africa (SSA). Important is that 80% of NCDs are taking place in low- and middle-income countries (LMICs) and linked to a third of the deaths in SSA. The question is, what would these statistics look like if environmental risk factors (e.g., pollution, chemicals) for NCDs, linked to climate change, were prevented and controlled. This article presents a framework for understanding climatic pathways' impacts on climate-sensitive NCDs and achieving the SDGs. It further explains how current global mitigation interventions in high income urban settings, with implied health co-benefits for NCD reduction (i.e., promoting use of less polluting vehicles, bicycles, walking, public transport, green spaces), experience major implementation challenges in SSA cities (i.e., too costly, lack of availability, poor road conditions, gender and cultural norms, security problems). Recommendations are made for applying this framework to control climate change impacts on NCDs and achieving the SDGs in SSA cities. These include, support for more research on the climate - NCD nexus, ensuring health professional training includes sustainable health education, and including a focus on climate change and health in primary and secondary school curricula. Further recommendations for addressing climate-sensitive NCDs and urban environmental health towards achieving and sustaining the SDGs, are linked to promoting climate-sensitive and health policies and governance, as well as controlling the influence of advertising. Lastly, improving communication of research findings for policy makers and the public in a manner for informed policy making, and how to comprehend this information to promote the reduction and prevention of NCDs in urban SSA, is key.
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Affiliation(s)
- Hanna-Andrea Rother
- Division of Environmental Health, and Centre for Environmental and Occupational Health, School of Public Health and Family Medicine, University of Cape Town, Anzio Rd., Observatory 7925, South Africa.
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15
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Assessing the Increase of Snakebite Incidence in Relationship to Flooding Events. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2020. [DOI: 10.1155/2020/6135149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Snakebite envenoming causes up to 138,000 deaths and 400,000 permanently disabled victims worldwide every year. Flooding is one of the many factors that seems to influence the incidence of snakebite. The catastrophic floods from late 2018 in Kerala (India) were widely broadcast and are an example of how flooding events are related to the increased incidence of snakebite. This relationship has been mentioned regularly in scientific and grey literature, but usually quite scarcely in comparison to other topics linked to snakebite. Additionally, web media, mobile communications, and social media have started playing an important role not only in providing access to information on flooding-related snakebite events, but also in snakebite prevention at a larger scale. In order to better understand to what extent the relationship between snakebite incidence and flooding is reported and quantified and appraise the importance of mobile communications and social media in snakebite prevention and management, we performed multiple searches in generic (Google) and specialized (PubMed, Web of Science, Google Scholar) databases. We retrieved 68 scientific articles and 5 reports ranging from 1892 to 2018 mentioning or analyzing flooding and the increased incidence of snakebite. Additionally, we found 68 web media reports linking flooding and snakebite. This review indicates that the increase of snakebite incidence due to flooding has been repeatedly observed all over the world. This phenomenon could be exacerbated because of climate change, which is expected to increase the overall magnitude and frequency of flooding. However, it could also be mitigated by the role the Internet, mobile communications, and social media could play in snakebite prevention and human and animal rescue strategies during flooding.
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Bhaumik S, Norton R, Jagnoor J. Burden and risk factors for snakebite in India: protocol for a systematic review. F1000Res 2020; 9:25. [PMID: 32399199 PMCID: PMC7194469 DOI: 10.12688/f1000research.21924.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 03/29/2024] Open
Abstract
Introduction: Snakebites are a neglected tropical disease with a high burden in South and South-East Asia and sub-Saharan Africa. In 2019, the World Health Organization (WHO) released a roadmap which aims for a 50% reduction in death and disability due to snakebite globally by 2030. It is estimated that India has the highest number of snakebite deaths in the world. Objective: To synthesize evidence on the burden (incidence/ prevalence, mortality, morbidity, health facility and economic), and risk factors for snakebite in India. Methods: We will search for peer-reviewed literature and grey literature in six electronic databases (MEDLINE, EMBASE, Global Health, PsychInfo, CENTRAL, SafetyLit) and hand-search IndMed, conference abstracts, relevant websites and citation tracking. Two reviewers will screen and extract data independently with a third reviewer acting as an arbiter for any inconsistencies. Quality of the included studies will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. For burden, data from facility based and community-based studies will be synthesised and reported separately, except in the case of studies conducted concurrently. We will conduct narrative analyses with the aim of understanding patterns in data through tabulation for both burden and risk factors evidence synthesis. The PROGRESS Plus lens will be used to explore equity pertaining to burden of snakebites. Analyses for each individual risk factor-outcome pair will be conducted and reported separately. If appropriate, meta-analyses will be conducted as per JBI guidelines, assessing heterogeneity using Tau-squared, Cochran's Q test and Chi-squared (p > 0.05) tests. We plan to conduct sub-group analyses based on setting, study design, sex/gender, age-groups, tribal people and occupation. A funnel plot will be generated if there are more than nine studies included in a specific meta-analysis, to assess publication bias. Asymmetry of the funnel plot will be adjudged using the Egger, Begg and Harbord tests.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
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17
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Bhaumik S, Norton R, Jagnoor J. Burden and risk factors for snakebite in India: protocol for a systematic review. F1000Res 2020; 9:25. [PMID: 32399199 PMCID: PMC7194469 DOI: 10.12688/f1000research.21924.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Snakebite is a neglected tropical disease with a high burden in South and South-East Asia and sub-Saharan Africa. In 2019, the World Health Organization (WHO) released a roadmap which aims for a 50% reduction in death and disability due to snakebite globally by 2030. It is estimated that India has the highest number of snakebite deaths in the world. Objective: To synthesize evidence on the burden (incidence/ prevalence, mortality, morbidity, health facility and economic), and risk factors for snakebite in India. Methods: We will search for peer-reviewed literature and grey literature in six electronic databases (MEDLINE, EMBASE, Global Health, PsychInfo, CENTRAL, SafetyLit) and hand-search IndMed, conference abstracts, relevant websites and citation tracking. Two reviewers will screen and extract data independently with a third reviewer acting as an arbiter for any inconsistencies. Quality of the included studies will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. For burden, data from facility based and community-based studies will be synthesised and reported separately, except for studies conducted concurrently. We will conduct meta-analysis for community-based studies at state-level for incidence/prevalence, mortality and morbidity , if appropriate. The PROGRESS Plus lens will be used to explore equity . Analyses for each individual risk factor-outcome pair will be conducted and reported separately. If appropriate, meta-analyses will be conducted as per JBI guidelines, assessing heterogeneity using Tau-squared, Cochran's Q test and Chi-squared (p > 0.05) tests. We plan to conduct sub-group analyses based on pre-specific parameters. A funnel plot will be generated if there are more than nine studies included in a specific meta-analysis, to assess publication bias When meta-analysis is not appropriate, structured tabulation of results across studies and/or by vote counting based on the direction of effect as per guidelines in the Cochrane Handbook.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
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18
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Adjusting for spatial variation when assessing individual-level risk: A case-study in the epidemiology of snake-bite in Sri Lanka. PLoS One 2019; 14:e0223021. [PMID: 31581273 PMCID: PMC6776347 DOI: 10.1371/journal.pone.0223021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/11/2019] [Indexed: 12/04/2022] Open
Abstract
Background Health outcomes and causality are usually assessed with individual level sociodemographic variables. Studies that consider only individual-level variables can suffer from residual confounding. This can result in individual variables that are unrelated to risk behaving as proxies for uncaptured information. There is a scarcity of literature on risk factors for snakebite. In this study, we evaluate the individual-level risk factors of snakebite in Sri Lanka and highlight the impact of spatial confounding on determining the individual-level risk effects. Methods Data was obtained from the National Snakebite Survey of Sri Lanka. This was an Island-wide community-based survey. The survey sampled 165,665 individuals from all 25 districts of the country. We used generalized linear models to identify individual-level factors that contribute to an individual’s risk of experiencing a snakebite event. We fitted separate models to assess risk factors with and without considering spatial variation in snakebite incidence in the country. Results Both spatially adjusted and non-adjusted models revealed that middle-aged people, males, field workers and individuals with low level of education have high risk of snakebites. The model without spatial adjustment showed an interaction between ethnicity and income levels. When the model included a spatial adjustment for the overall snakebite incidence, this interaction disappeared and income level appeared as an independent risk factor. Both models showed similar effect sizes for gender and age. HEmployment and education showed lower effect sizes in the spatially adjusted model. Conclusions Both individual-level characteristics and local snakebite incidence are important to determine snakebite risk at a given location. Individual level variables could act as proxies for underling residual spatial variation when environmental information is not considered. This can lead to misinterpretation of risk factors and biased estimates of effect sizes. Both individual-level and environmental variables are important in assessing causality in epidemiological studies.
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Snakebite in domestic animals: First global scoping review. Prev Vet Med 2019; 170:104729. [PMID: 31421490 DOI: 10.1016/j.prevetmed.2019.104729] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 06/21/2019] [Accepted: 07/07/2019] [Indexed: 11/22/2022]
Abstract
Snakebite is a Neglected Tropical Disease estimated to cause more than 100,000 human deaths and disable more than 400,000 victims each year. It primarily affects poor agricultural workers, farmers, and cattle herders living in rural areas of developing countries. It is thus an occupational disease. However, the impact of snakebite on these rural communities could be even higher if a One Health approach is taken to consider the direct impact on domestic animals and indirect impact on the livelihood of affected communities. To explore this hypothesis we developed the first scoping review to identify and characterize the global literature on snakebite in domestic animals. Three bibliographic databases (PubMed, Web of Science and Agricola) were searched using terms related to snake, snakebite and domestic animals for publications up to December 31st, 2016. Two independent reviewers screened publications applying inclusion/exclusion criteria to select relevant material. Relevant information was then extracted from the selected literature. The global literature on snakebite in domestic animals (n = 143 observational studies, reviews and letters) mainly represented North America, Europe and Australia (69%) with less information from Central and South America, Asia and Africa (31%). Observational studies (n = 119) mostly concerned pets (78%) and to a lesser extent livestock (22%). Thirty-four snake species were reported as responsible for bites in domestic animals. WHO's Medically Important Venomous Snakes were more frequently involved. The social-ecological determinants of snakebite were poorly documented but the reviewed literature suggested a strong seasonality and a diversity of habitat. Snakebite in animals caused neurotoxic, cytotoxic and hemotoxic envenomation syndromes similar to humans and death. Half of publications on envenomed livestock reported a fatality rate above 47%. There was no literature on the indirect impact of snakebite on livelihood caused by animal morbidity and mortality. The results of this scoping review suggest a high and under-reported burden in terms of mortality in animals and a potential economic impact of snakebite in terms of losses in livelihood of affected communities. However, major knowledge gaps with respect to impact of snakebite on livestock and livelihood were identified. Filling these gaps is necessary for a full understanding of the impact of snakebite and to raise scientific, political and public awareness on this neglected issue.
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