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Afroz A, Siddiquea BN, Chowdhury HA, Jackson TNW, Watt AD. Snakebite envenoming: A systematic review and meta-analysis of global morbidity and mortality. PLoS Negl Trop Dis 2024; 18:e0012080. [PMID: 38574167 PMCID: PMC11020954 DOI: 10.1371/journal.pntd.0012080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/16/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Snakebite envenoming represents a significant and often neglected public health challenge, particularly in rural communities across tropical and subtropical regions. An estimated 1.2-5.5 million people are envenomed by snakebites annually. More than 125,000 of these bites are fatal, and 3-4 times as many results in disability/disfigurement. Despite its prevalence, collecting accurate epidemiological data on snakebite is challenging. This systematic review and meta-analysis collates global epidemiology data on snakebite morbidity and mortality. METHODS Medline, Embase, Cochrane and CINAHL Plus databases were searched for articles published between 2001-2022. Pooled incidence and mortality were obtained using random effects modelling, heterogeneity (I2) was tested, and sensitivity analyses performed. Newcastle-Ottawa Scale assessed study quality. RESULTS Out of the four databases, 5,312 articles were found. After removing duplicates, 3,953 articles were screened by title and abstract and 65 articles containing information on snakebite epidemiology, encompassing 663,460 snakebites, were selected for analysis. The people most at risk for snakebite were men (59%), engaged in agricultural labour (27.5%), and residing in rural areas (66.7%). More than half (57%) of the reported bites resulted in envenoming. Incidents occurred frequently in the summer season (38.5%), during daytime (56.7%), and bites were most often to the lower limb (56.4%). Envenoming severity was frequently mild (46.7%), treated in hospital (68.3%), and was treated with anti-venom (64.7%). The pooled global incidence and mortality was 69.4 /100,000 population (95%CI: 36.8 to 101.9) and 0.33/100,000 population (95%CI, 0.14 to 0.52) per year, respectively. Stratified by continents, Asia had the highest incidence of 130.7/100,000 population (95%CI: 48.3 to 213.1) while Europe has the lowest with 0.7/100,000 population (95%CI: -0.2 to 1.5). The highest mortality was reported in Asia at 0.96/100,000 population (95% CI: 0.22 to 1.70), and Africa 0.44/100,000 population (95%CI: -0.03 to 0.84). Incidence was highest among inhabitants of lower-middle-income countries 132.7/100,000 population (95%CI: 55.4 to 209.9) while mortality was highest in low-income countries at 0.85/100,000 population (95% CI: -0.06 to 2.31). CONCLUSION Incidence and mortality rates noted here highlight the global impact of snakebite and underscore the critical need to address the burden of snakebite envenoming. It also reveals that while reported snakebite incidence was higher in lower-middle-income countries, the burden of mortality was greatest among inhabitants of low-income countries, again emphasising the need for greater efforts to tackle this neglected tropical disease.
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Affiliation(s)
- Afsana Afroz
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Hasina Akhter Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Timothy NW Jackson
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Andrew D. Watt
- Australian Venom Research Unit, Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Benhammou D, Chippaux JP, Ntone R, Madec Y, Amta P, Noel G, Karl FN, Perilhou A, Matchim L, Sanchez M, Ndifon M, Clauteaux P, Eteki L, Boum Y, Nkwescheu AS, Taieb F. Snakebites in Cameroon: Tolerance of a Snake Antivenom (Inoserp™ PAN-AFRICA) in Africa in Real-Life Conditions. Toxins (Basel) 2024; 16:165. [PMID: 38668590 PMCID: PMC11053651 DOI: 10.3390/toxins16040165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/29/2024] Open
Abstract
Snakebite envenomation (SBE) is a public health issue in sub-Saharan countries. Antivenom is the only etiological treatment. Excellent tolerance is essential in managing SBE successfully. This study aimed to evaluate tolerance of InoserpTM PAN-AFRICA (IPA). It was conducted on fourteen sites across Cameroon. IPA was administered intravenously and repeated at the same dose every two hours if needed. Early and late tolerance was assessed by the onset of clinical signs within two hours and at a visit two weeks or more after the first IPA administration, respectively. Over 20 months, 447 patients presenting with a snakebite were included. One dose of IPA was administered to 361 patients and repeated at least once in 106 patients. No significant difference was shown between the proportion of adverse events in patients who received IPA (266/361, 73.7%) and those who did not (69/85, 81.2%) (p = 0.95). Adverse reactions, probably attributable to IPA, were identified in four (1.1%) patients, including one severe (angioedema) and three mild. All these reactions resolved favorably. None of the serious adverse events observed in twelve patients were attributed to IPA. No signs of late intolerance were observed in 302 patients. Tolerance appears to be satisfactory. The availability of effective and well-tolerated antivenoms would reduce the duration of treatment and prevent most disabilities and/or deaths.
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Affiliation(s)
- David Benhammou
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris Cité University, F-75015 Paris, France; (D.B.)
| | - Jean-Philippe Chippaux
- MERIT Unit, Institut de Recherche pour le Développement, Paris Cité University, F-75006 Paris, France
| | - Rodrigue Ntone
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris Cité University, F-75015 Paris, France; (D.B.)
| | - Pierre Amta
- Tokombere Hospital, Tokombere, Mora BP 74, Cameroon;
| | - Gaëlle Noel
- Institut Pasteur, Translational Research Center, Paris Cité University, F-75015 Paris, France; (G.N.); (P.C.)
| | - Fai Njuwa Karl
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Anaïs Perilhou
- Institut Pasteur, Clinical Research Coordination Center, Paris Cité University, F-75015 Paris, France;
| | - Lucrece Matchim
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Marie Sanchez
- Institut Pasteur, Data Management Core Facility, Paris Cité University, F-75015 Paris, France;
| | - Mark Ndifon
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Pedro Clauteaux
- Institut Pasteur, Translational Research Center, Paris Cité University, F-75015 Paris, France; (G.N.); (P.C.)
| | - Lucrèce Eteki
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Yap Boum
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
- Institut Pasteur de Bangui, Bangui BP 923, Central African Republic
- Faculté de Médecine et de Sciences Biomédicales, Yaounde I University, Yaounde BP 1364, Cameroon
| | | | - Fabien Taieb
- Institut Pasteur Medical Center, Paris Cité University, F-75015 Paris, France
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Méndez-Molina R, Villela-Oriza AK, Espinosa-Couoh AA, Huchim-Lara O. Snakebites epidemiology in Mexico: a 13-year ecological analysis. Trans R Soc Trop Med Hyg 2024; 118:118-126. [PMID: 37746875 DOI: 10.1093/trstmh/trad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/30/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Globally, snakebites have a significant impact on public health and represent substantial costs for health services. Their severity is particularly relevant in developing countries due to the lack of resources and accessibility to health facilities. Additionally, the number of cases may be underestimated, highlighting the urgent need for improved prevention measures. METHODS An observational ecological study was undertaken using the records identified with X200-X209 codes registered in the Ministry of Health injuries database during 2010-2022. Variables included information related to the patient, the snakebite and the healthcare provided. Statistical analysis was carried out with STATA 16 and Microsoft Excel 2020. RESULTS A total of 10 420 snakebites were registered. The average number of cases per year was 788 (IQR 615, 875) and 82.74% occurred during the rainy season. The median age was 35 (IQR 19, 52) y and early adulthood was the most affected age group; bites were most common on the hand and in the living place. The Eastern region of Mexico registered the highest number of cases, with 3496 (33.71%) of snakebites. The lethality rate was 18.23 per 10 000. CONCLUSIONS Snakebites are a significant health problem in Mexico. Most injuries occur among men in early adulthood, in households and in the upper extremities.
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Padidar S, Monadjem A, Litschka-Koen T, Thomas B, Shongwe N, Baker C, Mmema L, Sithole T, Murray J, Casewell NR, Pons J, Lalloo DG, Harrison RA, Stienstra Y, Dlamini WM. Snakebite epidemiology, outcomes and multi-cluster risk modelling in Eswatini. PLoS Negl Trop Dis 2023; 17:e0011732. [PMID: 37948462 PMCID: PMC10664941 DOI: 10.1371/journal.pntd.0011732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/22/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Halving snakebite morbidity and mortality by 2030 requires countries to develop both prevention and treatment strategies. The paucity of data on the global incidence and severity of snakebite envenoming causes challenges in prioritizing and mobilising resources for snakebite prevention and treatment. In line with the World Health Organisation's 2019 Snakebite Strategy, this study sought to investigate Eswatini's snakebite epidemiology and outcomes, and identify the socio-geographical factors associated with snakebite risk. METHODOLOGY Programmatic data from the Ministry of Health, Government of Eswatini 2019-2021, was used to assess the epidemiology and outcomes of snakebite in Eswatini. We developed a snake species richness map from the occurrence data of all venomous snakes of medical importance in Eswatini that was subjected to niche modelling. We formulated four risk indices using snake species richness, various geospatial datasets and reported snakebites. A multivariate cluster modelling approach using these indices was developed to estimate risk of snakebite and the outcomes of snakebite in Eswatini. PRINCIPAL FINDINGS An average of 466 snakebites was recorded annually in Eswatini. Bites were recorded across the entire country and peaked in the evening during summer months. Two cluster risk maps indicated areas of the country with a high probability of snakebite and a high probability of poor snakebite outcomes. The areas with the highest rate of snakebite risk were primarily in the rural and agricultural regions of the country. SIGNIFICANCE These models can be used to inform better snakebite prevention and treatment measures to enable Eswatini to meet the global goal of reducing snakebite morbidity and mortality by 50% by 2030. The supply chain challenges of antivenom affecting southern Africa and the high rates of snakebite identified in our study highlight the need for improved snakebite prevention and treatment tools that can be employed by health care workers stationed at rural, community clinics.
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Affiliation(s)
- Sara Padidar
- Department of Biological Sciences, University of Eswatini, Kwaluseni, Eswatini
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - Ara Monadjem
- Department of Biological Sciences, University of Eswatini, Kwaluseni, Eswatini
- Mammal Research Institute, Department of Zoology & Entomology, University of Pretoria, Hatfield, Pretoria, South Africa
| | - Thea Litschka-Koen
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - Brent Thomas
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nondusimo Shongwe
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - Clare Baker
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lindelwa Mmema
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | | | - James Murray
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - Nicholas R. Casewell
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jonathan Pons
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - David G. Lalloo
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Robert A. Harrison
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ymkje Stienstra
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands
| | - Wisdom M. Dlamini
- Department of Geography, Environmental Science and Planning, University of Eswatini, Kwaluseni, Eswatini
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Chippaux JP, Ntone R, Benhammou D, Madec Y, Noël G, Perilhou A, Karl F, Amta P, Sanchez M, Matchim L, Clauteaux P, Eteki L, Ndifon M, Boum Y, Nkwescheu AS, Taieb F. Real life condition evaluation of Inoserp PAN-AFRICA antivenom effectiveness in Cameroon. PLoS Negl Trop Dis 2023; 17:e0011707. [PMID: 37939111 PMCID: PMC10659212 DOI: 10.1371/journal.pntd.0011707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 11/20/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Snakebites is a serious public health issue but remains a neglected tropical disease. Data on antivenom effectiveness are urgently needed in Africa. We assessed effectiveness of Inoserp PAN-AFRICA (IPA), the recommended antivenom available in Cameroon. METHODOLOGY/PRINCIPAL FINDINGS We enrolled 447 patients presenting with snakebite in 14 health facilities across Cameroon. At presentation, cytotoxicity, coagulation troubles and neurotoxicity were graded. We administered two to four vials of antivenom to patients based on hemotoxic or neurotoxic signs. We renewed antivenom administration to patients with persistence of bleedings or neurotoxicity 2 hours after each injection. We defined early improvement as a reduction of the grade of envenomation symptoms 2 hours after first injection. Medium-term effectiveness was investigated looking at disappearance of symptoms during hospitalization. After hospital discharge, a home visit was planned to assess long-term outcomes. Between October 2019 and May 2021, we enrolled 447 (93.7%), including 72% from the savannah regions. The median [IQR] age was 25 [14-40]. Envenomation was diagnosed in 369 (82.6%) participants. The antivenom was administered to 356 patients (96.5%) of whom 256 (71.9%) received one administration. Among these patients, cytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxicity in 23 (6.5%) participants. Two hours after the first administration of antivenom, we observed a decrease in coagulation disorders or neurotoxicity in 75.2% and 39.1% of patients, respectively. Complete cessation of bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively. Sequelae have been observed in 9 (3%) patients at the home visit 15 days after hospital admission and 11 (3%) died including one before antivenom injection. CONCLUSIONS/SIGNIFICANCE We confirmed good effectiveness of the IPA and highlighted the rapid improvement in bleeding or neurotoxicity after the first administration. Sequential administrations of low doses of antivenom, rigorously assessed at short intervals for an eventual renewal, can preserve patient safety and save antivenom. TRIAL REGISTRATION NCT03326492.
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Affiliation(s)
- Jean-Philippe Chippaux
- Université Paris Cité, Institut de Recherche pour le développement, MERIT, Paris, France
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | | | - David Benhammou
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology unit, Paris, France
| | - Yoann Madec
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology unit, Paris, France
| | - Gaëlle Noël
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | - Anais Perilhou
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | - Fai Karl
- Epicentre Yaoundé, Yaoundé, Cameroon
| | | | - Marie Sanchez
- Institut Pasteur, Université Paris Cité, Data management core facility, Paris, France
| | | | - Pedro Clauteaux
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | | | | | - Yap Boum
- Epicentre Yaoundé, Yaoundé, Cameroon
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Francis MF, Vianney SJM, Heitz-Tokpa K, Kreppel K. Risks of snakebite and challenges to seeking and providing treatment for agro-pastoral communities in Tanzania. PLoS One 2023; 18:e0280836. [PMID: 36763599 PMCID: PMC9916632 DOI: 10.1371/journal.pone.0280836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Continuous occurrence of snakebite incidences and the vulnerability of some communities remain a critical problem in sub-Saharan Africa. Despite causing permanent disability to almost half a million people annually and numerous deaths, snakebite and associated complications are still largely neglected. This study aimed at elucidating risk factors associated with snakebite cases, treatment availability and case management practices for vulnerable agro-pastoralist communities in Northern Tanzania. METHODS Data was collected in the Monduli (Arusha region) and the Simanjiro (Manyara region) districts in Tanzania. Interviews with 101 snakebite victims or their guardians and 13 health professionals from 3 health centers in the districts were conducted. Additionally, case records of patients admitted between 2007 and 2019 to the Meserani Snakebite Clinic were obtained. RESULTS This study showed that appropriate treatment for snakebite including anti-venom, is difficult to access and that snakebite incidences were significantly linked to factors such as gender, age, socio-economic activity, season of the year, and whether being at home or out in the fields. Anti-venom and trained health professionals were only available at the Meserani Snake Park Clinic. Men were bitten most often (χ2 = 62.08, df = 4, p-value < 0.0001). Overall, adults between the ages of 18 and 60 years (χ2 = 62.08, df = 4, p-value < 0.0001) received most bites, usually while outdoors herding cattle in the dry season. A significant majority of victims looked for traditional treatment first (52.7%, χ2 = 29.541, df = 2, p-value = 0.0001). The results of this study present crucial information on what is needed to improve the accessibility to appropriate treatment after a snakebite among agro-pastoral communities. CONCLUSION The situation regarding morbidity and mortality due to the inaccessibility of common treatment for snakebite in northern Tanzania is challenging. Reliance on traditional medicine exacerbates the situation. There is dire need to involve affected communities, researchers, the government, clinicians and the public in general, to work together and take part in the global snakebite initiative. Communities and health professionals recognise the underlying challenges and have valuable suggestions on how to improve the situation.
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Affiliation(s)
- Monica Fredrick Francis
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bio-Engineering, Nelson Mandela - African Institution of Science and Technology, Arusha, Tanzania
- * E-mail:
| | - Sr. John-Mary Vianney
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bio-Engineering, Nelson Mandela - African Institution of Science and Technology, Arusha, Tanzania
| | - Kathrin Heitz-Tokpa
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Katharina Kreppel
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bio-Engineering, Nelson Mandela - African Institution of Science and Technology, Arusha, Tanzania
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Bravo-Vega C, Renjifo-Ibañez C, Santos-Vega M, León Nuñez LJ, Angarita-Sierra T, Cordovez JM. A generalized framework for estimating snakebite underreporting using statistical models: A study in Colombia. PLoS Negl Trop Dis 2023; 17:e0011117. [PMID: 36745647 PMCID: PMC9934346 DOI: 10.1371/journal.pntd.0011117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/16/2023] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Snakebite envenoming is a neglected tropical disease affecting deprived populations, and its burden is underestimated in some regions where patients prefer using traditional medicine, case reporting systems are deficient, or health systems are inaccessible to at-risk populations. Thus, the development of strategies to optimize disease management is a major challenge. We propose a framework that can be used to estimate total snakebite incidence at a fine political scale. METHODOLOGY/PRINCIPAL FINDINGS First, we generated fine-scale snakebite risk maps based on the distribution of venomous snakes in Colombia. We then used a generalized mixed-effect model that estimates total snakebite incidence based on risk maps, poverty, and travel time to the nearest medical center. Finally, we calibrated our model with snakebite data in Colombia from 2010 to 2019 using the Markov-chain-Monte-Carlo algorithm. Our results suggest that 10.19% of total snakebite cases (532.26 yearly envenomings) are not reported and these snakebite victims do not seek medical attention, and that populations in the Orinoco and Amazonian regions are the most at-risk and show the highest percentage of underreporting. We also found that variables such as precipitation of the driest month and mean temperature of the warmest quarter influences the suitability of environments for venomous snakes rather than absolute temperature or rainfall. CONCLUSIONS/SIGNIFICANCE Our framework permits snakebite underreporting to be estimated using data on snakebite incidence and surveillance, presence locations for the most medically significant venomous snake species, and openly available information on population size, poverty, climate, land cover, roads, and the locations of medical centers. Thus, our algorithm could be used in other countries to estimate total snakebite incidence and improve disease management strategies; however, this framework does not serve as a replacement for a surveillance system, which should be made a priority in countries facing similar public health challenges.
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Affiliation(s)
- Carlos Bravo-Vega
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
- * E-mail:
| | | | - Mauricio Santos-Vega
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Leonardo Jose León Nuñez
- Observatorio de Salud Pública y epidemiología "José Felix Patiño", Universidad de los Andes, Bogotá, Colombia
| | - Teddy Angarita-Sierra
- Grupo de investigación Biodiversidad para la sociedad, Universidad Nacional de Colombia sede de La Paz, Cesar, Colombia
| | - Juan Manuel Cordovez
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
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A Comparative Study of Asymptomatic Malaria in a Forest Rural and Depleted Forest Urban Setting during a Low Malaria Transmission and COVID-19 Pandemic Period. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2545830. [PMID: 36281461 PMCID: PMC9587908 DOI: 10.1155/2022/2545830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/22/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
The global malaria morbidity and mortality witnessed an increase from 2019 to 2020 partly due to disruptions in control programs' activities imposed by the COVID-19 pandemic. Therefore, there is still a significant burden of malaria in Cameroon which needs attention from all fronts to attain elimination goals. It is normally expected that a typical forest ecology that has undergone urbanization and subjected to high rates of ecological instabilities should also have a shift from characteristic perennial malaria transmission and a shift in the type of malaria endemicity plaguing such distorted forest ecology. In this observational comparative study, we randomly enrolled participants from rural and urban settings of a forest zone during a low malaria transmission period, which coincided with the onset of COVID-19 pandemic. An optimized structured questionnaire was employed, to collect socio-demographic data and associated risk factors. The CareStart™ Malaria HRP2 antigen test was performed on participants from both settings to determine the prevalence of community asymptomatic malaria. Of 307 participants, 188 (61.0%) were from the rural, while 119 (38.8%) from the urban community. The overall prevalence of asymptomatic malaria (27.0%) detected Plasmodium falciparum antigen in 83 participants. The urban community's prevalence was 4.2% (5 positives) while the rural community's was 41.5% (78 positives). In simple logistic regression models, rural forest community and farm around the house were statistically significant predictors of testing positive (coefficient 2.8, 95% CI 1.8-3.7, p value<0.001) and (coefficient 3.1, 95% CI 1.1-5.1, p value =0.003), respectively. In the multivariate model, the strongest predictor of testing positive was living in a rural community, with p < 0.001 and odds ratio of 10.9 (95% CI, 3.8-31.8). These results indicate that during a low transmission period, the prevalence of asymptomatic malaria differs between depleted urban and rural forested settings, suggesting a need for strategic target intervention for the control of asymptomatic malaria.
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Farooq H, Bero C, Guilengue Y, Elias C, Massingue Y, Mucopote I, Nanvonamuquitxo C, Marais J, Faurby S, Antonelli A. Snakebite incidence in rural sub-Saharan Africa might be severely underestimated. Toxicon 2022; 219:106932. [PMID: 36181779 DOI: 10.1016/j.toxicon.2022.106932] [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: 06/06/2022] [Revised: 08/24/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
Abstract
Snakebites in sub-Saharan Africa account for 20,000 to 32,000 annual deaths. But since most data is retrieved from hospital or incomplete central databases, and many victims do not seek hospital treatment or prefer traditional remedies, the current numbers are likely underestimated. In order to reduce snakebite incidence by 50% by 2030 as targeted by World Health Organization, it is crucial to accurately quantify and understand the current rates of snakebite incidence, which can only be reliably measured through household surveys. In this study, we interviewed 1037 households in nine communities in Cabo Delgado, northern Mozambique. Our aim was to quantify true snakebite incidence and under-reporting, by comparing the total number of snakebites reported to our team during household surveys with the subset of reports that reached health centers. We additionally quantified snakebite incidence in terms of species, location of the attack, type of treatment, season, and gender of the victims. These data allow us to propose conservative extrapolations of snakebite incidence and mortality for the province of Cabo Delgado and for Mozambique. Of all snakebites reported in the surveys (N = 296), most incidents were treated exclusively by traditional doctors (N = 174; 59%) and 25% were not seen by any doctor. Most bites occurred on farms and during the rainy season. Using a conservative estimation where we assume our results to be extrapolatable for the whole of rural Mozambique, but considering snakebites in urban areas to be inexistent, we propose that in Cabo Delgado, every year at least 6124 people are victims of snakebites, of which at least 791 result in deaths. In Mozambique, we extrapolated that every year at least 69,261 people are victims of snakebite, of which at least 8950 result in death (one in eight snakebites is fatal). Our estimates are the first for Mozambique based on data retrieved in the country, and despite being an underestimation they increase snakebite incidence levels ten-fold and the number of deaths by 30-fold. Urgent and widespread surveys are needed to further assess the full extent of snakebites in sub-Saharan Africa, explore regional patterns and develop mitigation plans.
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Affiliation(s)
- Harith Farooq
- Gothenburg Global Biodiversity Centre, Göteborg, Sweden; Department of Biological and Environmental Sciences, University of Gothenburg, Göteborg, Sweden; Faculty of Natural Sciences, Lúrio University, Cabo Delgado, Mozambique.
| | - Cláudio Bero
- Faculty of Natural Sciences, Lúrio University, Cabo Delgado, Mozambique
| | - Yolanda Guilengue
- Faculty of Natural Sciences, Lúrio University, Cabo Delgado, Mozambique
| | - Clementina Elias
- Faculty of Natural Sciences, Lúrio University, Cabo Delgado, Mozambique
| | - Yasalde Massingue
- Faculty of Natural Sciences, Lúrio University, Cabo Delgado, Mozambique
| | - Ivo Mucopote
- Faculty of Natural Sciences, Lúrio University, Cabo Delgado, Mozambique
| | | | - Johan Marais
- African Snakebite Institute, Pretoria, South Africa
| | - Søren Faurby
- Gothenburg Global Biodiversity Centre, Göteborg, Sweden; Department of Biological and Environmental Sciences, University of Gothenburg, Göteborg, Sweden
| | - Alexandre Antonelli
- Gothenburg Global Biodiversity Centre, Göteborg, Sweden; Department of Biological and Environmental Sciences, University of Gothenburg, Göteborg, Sweden; Royal Botanic Gardens, Kew, Surrey, UK; Department of Plant Sciences, University of Oxford, Oxford, UK
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10
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Dookeeram D, Bidaisee S, Hatcher C, Nguyen N, Maharaj S. Assessment of Risk Factors, Prehospital Measures and Clinical Needs of Patients Admitted With Snake Envenomation at a Rural Hospital in Trinidad and Tobago. Cureus 2022; 14:e29616. [PMID: 36321057 PMCID: PMC9603065 DOI: 10.7759/cureus.29616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: This study assessed the risk factors for sustaining a snake bite, the prehospital measures employed, and the clinical needs of patients admitted with confirmed envenomation. Methodology: Data was collected at a single center, a rural secondary care hospital in Trinidad and Tobago. A cross-sectional method was used that enrolled all consenting patients requiring admission following clinical confirmation of snake envenomation during the period 2017-2019. Data collection involved a review of the patient record from the emergency room and hospital admission to establish the clinical need during the time of admission which was defined as the administration of medication, need for surgery, and critical care intervention. Data collection also involved a patient interview to establish demographics, prehospital measures employed, and assessment of the risk factors associated with sustaining the snake bite. Results: 29 patients were admitted for snakebite envenomation during 2017-2019 and all patients consented to enrolment. Of these patients, 22 were male and most commonly were within the age range of 18-40 years old. 34.5% of patients were farmers and 68.9% of patients identified being bitten by the Mapepire Balsain snake. 65.5% of patients reported being unaware of the risk of snake bites and 82.8% were not wearing boots, with the lower limb being the most common bite site among 55.2%. 41.4% of bites were sustained during work-related activity while 34.5% of bites were sustained during recreational activity. Prehospital measures were employed by 18 of the 29 patients with the most common types being irrigation (10.3%), cutting (6.9%), tourniquets (44.8%), pressure immobilization (6.9%), topical applications (3.4%), and ingestion of a substance (6.9%). 34.5% received hospital care within 1 hour of the bite while 55.2% arrived at the hospital between 1 and 4 hours of being bitten. The clinical challenges of these patients included local reactions (82.8%), coagulopathy (72.4%), compartment syndrome (17.2%), cellulitis (3.4%), and dislocated shoulder (3.4%). The clinical needs of these patients included vitamin K (13.8%), antibiotics (93.1%), tetanus shots (17.2%), analgesia (6.8%), and anti-venom (82.7%). 10.3% of patients required debridement and 3.4% required a fasciotomy. The average stay in the hospital was 3.8 days. There were no documents of deaths or need for critical care. Conclusion: Persons are most likely to be envenomated by the M. Balsain in Trinidad. These patients are commonly males ranging anywhere from 18 to 40 years presenting local reactions and coagulopathy needing admittance to the hospital. While the majority of patients requiring admission performed some type of prehospital measure, very few did so with pressure immobilization. Furthermore, the majority of patients had a prolonged time before presenting to the hospital; this is a potential area for improvement in the health system through education and sensitization. There was a significant utilization of resources on these patients when taking into consideration their clinical needs, medication, and hospital stay; primary prevention should be a focus through the education of groups who are at higher risk for a venomous snake encounter.
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11
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Soga M, Gaston KJ. The dark side of nature experience: Typology, dynamics and implications of negative sensory interactions with nature. PEOPLE AND NATURE 2022. [DOI: 10.1002/pan3.10383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masashi Soga
- Graduate School of Agricultural and Life Sciences The University of Tokyo Bunkyo Tokyo Japan
| | - Kevin J. Gaston
- Environment and Sustainability Institute University of Exeter Penryn UK
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12
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Bamogo R, Thiam M, Nikièma AS, Somé FA, Mané Y, Sawadogo SP, Sow B, Diabaté A, Diatta Y, Dabiré RK. Snakebite frequencies and envenomation case management in primary health centers of the Bobo-Dioulasso health district (Burkina Faso) from 2014 to 2018. Trans R Soc Trop Med Hyg 2021; 115:1265-1272. [PMID: 34581814 PMCID: PMC8560633 DOI: 10.1093/trstmh/trab146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/25/2021] [Accepted: 09/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background Snakebite envenomation is a significant public health problem in Burkina Faso. Our study describes the epidemiological and therapeutic aspects of snakebite cases at primary health centers in Houet Province, which is located in the western area of Burkina Faso. Methods We conducted a retrospective study of 664 snakebite cases occurring at 10 primary health centers in Houet Province from January 2014 to December 2018. Data were collected from the patient consultation recording database registry system. Results Affected individuals had a male/female ratio of 1.31. The lowest annual incidences (0.02 [95% CI –0.01 to 0.05] and 0.24 [95% CI 0.05 to 0.43]) were observed in the urban primary health centers of Bolomakoté and Sarfalao, respectively. Rural primary health centers in Nasso in 2016 and in Soumousso in 2014 had the highest annual incidence (13.80 [95% CI 7.59 to 20.00] and 3.92 [95% CI 2.99 to 4.86], respectively). Of the 664 registered snakebite victims, none received antivenom immunotherapy treatment. Conclusion Our study shows that snakebite envenomation incidents are common at the 10 primary health centers in Houet Province. Furthermore, despite the lack of antivenom and often inadequate treatment at these primary health centers, they remain the first point of care for snakebite victims.
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Affiliation(s)
- Rabila Bamogo
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso.,Université Cheikh Anta Diop, Ecole Doctorale en Sciences de la Vie, de la Santé et de l'Environnement, Faculté des Sciences et Techniques BP : 5005, Dakar, Sénégal.,Université Cheikh Anta Diop, Institut Fondamental d'Afrique Noire (IFAN), Laboratoire de Zoologie et des Vertébrés terrestres de Dakar, BP 206, Dakar, Sénégal
| | - Massamba Thiam
- Université Cheikh Anta Diop, Institut Fondamental d'Afrique Noire (IFAN), Laboratoire de Zoologie et des Vertébrés terrestres de Dakar, BP 206, Dakar, Sénégal
| | - Achille Sindimbasba Nikièma
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Fabrice Anyirekun Somé
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Youssouph Mané
- Institut de Recherche pour le Développement (IRD) de Dakar, BP 1386 CP 18524, Dakar, Sénégal
| | - Simon Péguédwindé Sawadogo
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Bazoumana Sow
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Abdoulaye Diabaté
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
| | - Youssouph Diatta
- Université Cheikh Anta Diop, Institut Fondamental d'Afrique Noire (IFAN), Laboratoire de Zoologie et des Vertébrés terrestres de Dakar, BP 206, Dakar, Sénégal
| | - Roch Kounbobr Dabiré
- Institut de Recherche en Sciences de la Santé (IRSS), Direction Régionale de l'Ouest, BP 545 Bobo Dioulasso 01, Burkina Faso
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13
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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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14
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Yusuf AJ, Aleku GA, Bello UR, Liman DU. Prospects and Challenges of Developing Plant-Derived Snake Antivenin Natural Products: A Focus on West Africa. ChemMedChem 2021; 16:3635-3648. [PMID: 34585514 DOI: 10.1002/cmdc.202100478] [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: 07/06/2021] [Revised: 09/23/2021] [Indexed: 11/06/2022]
Abstract
Snakebite envenomation (SBE) is an important public health issue that is now receiving renewed attention following its reclassification as a Neglected Tropical Disease (NTD). Most incidences occur in rural areas of resource-limited countries, as such, timely and appropriate medical care for SBE is often inaccessible. The administration of anti-snake venom serum (ASV) is the only effective definitive treatment of SBE, but treatment failure to available ASVs is not uncommon. Emerging evidence highlights the potential of small-molecule compounds as inhibitors against toxins of snake venom. This presents an encouraging prospect to develop an alternative therapeutic option for the treatment SBE, that may be amenable for use at the point of care in resource-constraint settings. In view of the pivotal role of natural products in modern drug discovery programmes, there is considerable interest in ethno-pharmacological mining of medicinal plants and plant-derived medicinal compounds toward developing novel snake venom-neutralising therapeutics. In this review, we compile a collection of medicinal plants used in the treatment of SBE in West Africa and highlight their promise as potential botanical drugs or as sources of novel small-molecule compounds for the treatment of SBE. The challenges that must be surmounted to bring this to fruition including the need for (sub) regional collaboration have been discussed.
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Affiliation(s)
- Amina J Yusuf
- Department of Pharmaceutical & Medicinal Chemistry, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Godwin A Aleku
- Department of Biochemistry, University of Cambridge, Cambridge, CB2 1GA, UK
| | - Usman Rabiu Bello
- Biotechnology unit, Department of Life Sciences, Mewar University, Gangrar, Chittorgarh, Rajasthan, India
| | - Dahiru Umar Liman
- Department of Pharmaceutical & Medicinal Chemistry, Usmanu Danfodiyo University, Sokoto, Nigeria
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15
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Duda R, Monteiro WM, Giles-Vernick T. Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation. Toxicon X 2021; 11:100077. [PMID: 34381993 PMCID: PMC8334740 DOI: 10.1016/j.toxcx.2021.100077] [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: 04/20/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
The WHO has identified the goal of halving deaths and disability from snakebite envenomation (SBE) by 2030 through a four-pillar program that promotes accessible and affordable treatments, strengthens health systems, promotes community and multi-level engagement, and mobilizes partnerships, coordination and resources to advocate for global action. This initiative could accelerate multi-disciplinary research and action in central Africa, a “hotspot” for SBE, but it offers little specific guidance about anthropological research to be conducted. This commentary develops that research agenda. It surveys anthropological, ethnohistorical investigations in the central African forest to elaborate the socio-cultural and historical significance and practices around snakes and snakebites. It draws from south and southeast Asian and Latin American literatures to illustrate anthropological contributions to SBE research. It then outlines a Central African research agenda employing ethnobiological investigation of snake ecologies, participatory evaluations of humans-snake contacts, and interviews and participant-observation of local prevention and treatment practices and knowledge. This research will co-develop policies and practices with forest communities and leaders and regional and national authorities to reduce the burden of SBE. Central African forests are a hotspot for snakebite envenomation. SBE research in central Africa has not mobilized anthropological literatures or methodologies. Policies to reduce SBE burden in central Africa should build on participatory research. Policies to reduce SBE burden should be co-developed with local and national stakeholders.
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Affiliation(s)
- Romain Duda
- Anthropology & Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
| | - Wuelton M Monteiro
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil.,Department of Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Tamara Giles-Vernick
- Anthropology & Ecology of Disease Emergence Unit, Institut Pasteur, Paris, France
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16
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Ooms GI, van Oirschot J, Waldmann B, Okemo D, Mantel-Teeuwisse AK, van den Ham HA, Reed T. The Burden of Snakebite in Rural Communities in Kenya: A Household Survey. Am J Trop Med Hyg 2021; 105:828-836. [PMID: 34280130 PMCID: PMC8592359 DOI: 10.4269/ajtmh.21-0266] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/25/2021] [Indexed: 11/07/2022] Open
Abstract
Annually, about 2.7 million snakebite envenomings occur worldwide, primarily affecting those living in rural regions. Effective treatment exists but is scarce, and traditional treatments are commonly used. To inform context-specific policies in Kenya, this study aimed to determine the health-seeking behavior and the health, social, and economic burden of snakebites in rural communities. Nonprobability sampling was used to survey 382 respondents from four snakebite-endemic counties, from February to August 2020, using a structured questionnaire. Descriptive statistics, Fisher's exact tests, binary logistic regressions, and Mantel-Haenszel tests were used for analysis. Life-time experience with snakebites included 13.1% of respondents who reported being personally bitten and 37.4% who reported knowing of a community member being bitten. Respondents reported death after a snakebite in 9.1% of bitten community members and in 14.6% of bitten family members. Risk of snakebite was not significantly associated with sex, educational level, or occupation. Snakebite victims were most often walking (38%) or farming (24%) when bitten. Of those bitten, 58% went to a health facility, 30% sought traditional treatment, and 12% first went to a traditional healer before visiting a facility. Significant differences existed in perceptions on the financial consequences of snakebites among those who had been personally bitten and those who had observed a snakebite. Most commonly mentioned preventive measures were wearing shoes and carrying a light in the dark. Community engagement, including engagement with traditional healers, is needed to reduce snakebites. This should be done through education and sensitization to improve used preventive measures and effective health-seeking behavior.
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Affiliation(s)
- Gaby I. Ooms
- Health Action International, Amsterdam, The Netherlands
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Aukje K. Mantel-Teeuwisse
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Hendrika A. van den Ham
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Tim Reed
- Health Action International, Amsterdam, The Netherlands
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17
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Bolon I, Babo Martins S, Ochoa C, Alcoba G, Herrera M, Bofia Boyogueno HM, Sharma BK, Subedi M, Shah B, Wanda F, Sharma SK, Nkwescheu AS, Ray N, Chappuis F, Ruiz de Castañeda R. What is the impact of snakebite envenoming on domestic animals? A nation-wide community-based study in Nepal and Cameroon. Toxicon X 2021; 9-10:100068. [PMID: 34179766 PMCID: PMC8214143 DOI: 10.1016/j.toxcx.2021.100068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 12/26/2022] Open
Abstract
Snakebite envenoming is a life-threatening disease in humans and animals and a major public health issue in rural communities of South-East Asia and sub-Saharan Africa. Yet the impact of snakebite on domestic animals has been poorly studied. This study aimed to describe the context, clinical features, treatment, and outcomes of snakebite envenoming in domestic animals in Nepal and Cameroon. Primary data on snakebite in animals were recorded from a community-based nation-wide survey on human and animal snakebite in Nepal and Cameroon (Snake-byte project). Mobile teams collected data on snakebite in humans and animals in 13,879 and 10,798 households in Nepal and Cameroon respectively from December 2018 to June 2019. This study included 405 snakebite cases (73 in Nepal and 332 in Cameroon) in multiple types of animals. An interview with a structured questionnaire collected specific information about the animal victims. Snake bites in animals took place predominantly inside and around the house or farm in Nepal (92%) and Cameroon (71%). Other frequent locations in Cameroon were field or pasture (12%). A large diversity of clinical features was reported in all types of envenomed animals. They showed either a few clinical signs (e.g., local swelling, bleeding) or a combination of multiple clinical signs. Only 9% of animal victims, mainly cattle and buffaloes and less frequently goats, sheep, and dogs, received treatment, predominantly with traditional medicine. The overall mortality of snakebite was 85% in Nepal and 87% in Cameroon. Results from this nationwide study show an important impact of snakebite on animal health in Nepal and Cameroon. There is a need for cost-effective prevention control strategies and affordable snakebite therapies in the veterinary field to save animal lives and farmer livelihood in the poorest countries of the world. The WHO global strategy to prevent and control snakebite envenoming supports a One Health approach, which may help develop integrated solutions to the snakebite problem taking into account human and animal health.
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Affiliation(s)
- Isabelle Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des mines 9, 1202, Geneva, Switzerland
| | - Sara Babo Martins
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des mines 9, 1202, Geneva, Switzerland
| | - Carlos Ochoa
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des mines 9, 1202, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, 66 boulevard Carl-Vogt, 1205, Geneva, Switzerland
| | - Gabriel Alcoba
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des mines 9, 1202, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Department of Community Health and Medicine, Faculty of Medicine, 24 rue Micheli-du-Crest, Geneva 14, 1211, Switzerland
- Médecins Sans Frontières (MSF), Rue de Lausanne 78, 1202, Geneva, Switzerland
| | - María Herrera
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, 11501-2060, Costa Rica
| | - Henri Magloire Bofia Boyogueno
- Ministère de l'Elevage, des Pêches et des Industries Animales (MINEPIA), Direction des Services Vétérinaires, Yaoundé, Cameroon
| | - Barun Kumar Sharma
- Ministry of Agriculture and Livestock Development, Singhadurbar, Kathmandu, Nepal
| | - Manish Subedi
- B.P. Koirala Institute of Health Sciences (BPKIHS), Buddha Road, Dharan, 56700, Nepal
| | - Bhupendra Shah
- B.P. Koirala Institute of Health Sciences (BPKIHS), Buddha Road, Dharan, 56700, Nepal
| | - Franck Wanda
- Centre International de Recherche, d'Enseignement et de Soins en Milieu Tropical (CIRES), BP 11 Akonolinga, Cameroon
| | - Sanjib Kumar Sharma
- B.P. Koirala Institute of Health Sciences (BPKIHS), Buddha Road, Dharan, 56700, Nepal
| | - Armand Seraphin Nkwescheu
- Cameroon Society of Epidemiology (CaSE), P.O.Box 1411, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Science, University of Yaoundé 1, Yaoundé, Cameroon
| | - Nicolas Ray
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des mines 9, 1202, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, 66 boulevard Carl-Vogt, 1205, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Department of Community Health and Medicine, Faculty of Medicine, 24 rue Micheli-du-Crest, Geneva 14, 1211, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des mines 9, 1202, Geneva, Switzerland
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Chuat M, Alcoba G, Eyong J, Wanda F, Comte E, Nkwescheu A, Chappuis F, Hudelson P. Dealing with snakebite in rural Cameroon: A qualitative investigation among victims and traditional healers. Toxicon X 2021; 9-10:100072. [PMID: 34337385 PMCID: PMC8313737 DOI: 10.1016/j.toxcx.2021.100072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Snakebite is a neglected tropical disease (NTD) affecting rural and remote populations globally, who are additionally burdened by poverty and the lack of effective healthcare systems. Delayed healthcare and use of traditional treatments are very frequent. The purpose of our study was to explore perceptions of snakes, impact of snakebite, and knowledge and opinions of different snakebite treatments with the aim of identifying opportunities for improving snakebite management. METHODS This is a qualitative descriptive study based on semi-structured interviews with 21 snakebite victims and 4 traditional healers in 4 villages of Akonolinga health district, Center Region, Cameroon. Analysis focused on describing participants' perceptions of snakes, the impact of snakebite on the victims' lives, and their opinions of different treatment options. RESULTS Respondents were fearful of snakes and knowledgeable about envenoming symptoms and treatments. The experience of snakebite led to increased vigilance and avoidance behaviours, which sometimes resulted in financial loss for the victims. A range of traditional treatments were described, including tourniquets, black-stone application and medicinal plant decoctions. However, opinions were ambivalent regarding their efficacy, depending especially on previous personal experiences. Still, traditional treatments were said to be more available and cheaper than hospital care, and in particular, than antivenom. Nevertheless, most victims preferred hospital treatment if the financial and transportation barriers were lifted. Both snakebite victims and traditional healers were of the opinion that collaboration between health services and traditional healers could help to improve snakebite management and outcomes. CONCLUSION Our study shows that snakebite victims are in favour of using antivenom for the treatment of snakebite and would welcome better access to it. However, its current unavailability and high cost pushes them to turn to traditional treatments. On the other hand, traditional healers are in favour of collaborating with health facilities. These results are very encouraging for the improvement of snakebite management in Cameroon along the lines of the WHO Snakebite Envenoming Strategy for Prevention and Control: ensuring access to safe and effective treatment, and increasing partnership and coordination between communities, traditional healers, and conventional caregivers.
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Affiliation(s)
- Manon Chuat
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206, Genève, Geneva, Switzerland
| | - Gabriel Alcoba
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Geneva, Switzerland
- Medical Department, Médecins Sans Frontières, Rue de Lausanne 78, 1211, Genève, Geneva, Switzerland
| | - Justin Eyong
- Centre International de Recherches, D'Enseignements et de Soins en Milieu Tropical (CIRES), CIRES BP 11, Akonolinga, Akonolinga, Cameroon
- Cameroon Society of Epidemiology (CaSE), Yaoundé, BP, 1411, Yaoundé, Cameroon
| | - Franck Wanda
- Centre International de Recherches, D'Enseignements et de Soins en Milieu Tropical (CIRES), CIRES BP 11, Akonolinga, Akonolinga, Cameroon
| | - Eric Comte
- Centre International de Recherches, D'Enseignements et de Soins en Milieu Tropical (CIRES), CIRES BP 11, Akonolinga, Akonolinga, Cameroon
| | - Armand Nkwescheu
- Cameroon Society of Epidemiology (CaSE), Yaoundé, BP, 1411, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Science, University of Yaoundé 1, Melen, Yaoundé, BP, 1364, Yaoundé, Yaoundé, Cameroon
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Primary Care, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Geneva, Switzerland
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Ooms GI, van Oirschot J, Waldmann B, von Bernus S, van den Ham HA, Mantel-Teeuwisse AK, Reed T. The Current State of Snakebite Care in Kenya, Uganda, and Zambia: Healthcare Workers' Perspectives and Knowledge, and Health Facilities' Treatment Capacity. Am J Trop Med Hyg 2020; 104:774-782. [PMID: 33236717 DOI: 10.4269/ajtmh.20-1078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/08/2020] [Indexed: 11/07/2022] Open
Abstract
Snakebites continue to be a public health concern in sub-Saharan Africa, where availability of appropriate medical treatment is rare, even though death and disability can be prevented with timely intervention. A challenge is the lack of sociopolitical studies to inform health policies. This study aimed to identify snakebite patient profiles, healthcare workers' (HCWs) knowledge of snakebite, and facilities' snakebite treatment capacity in Kenya, Uganda, and Zambia to inform interventions to improve access to appropriate treatment. The research comprised a cross-sectional key informant survey among HCWs from health facilities in Kenya (n = 145), Uganda (n = 144), and Zambia (n = 108). Data were collected between March 2018 and November 2019. Most of the HCWs suggested that the number of snakebite incidents was similar between the genders, that most patients were aged 21-30 years, and most people were bitten when farming or walking. Overall, only 12% of HCWs had received formal training in snakebite management. Only about 20% of HCWs in each country said their health facility had the medicines needed to treat snakebites, with antivenom available in 0-34% of facilities across the sectors and countries, and snakebites were not systematically recorded. This research shows that an integrative approach through policies to increase resource allocation for health system strengthening, including community education, HCW training, and improved access to snakebite treatment, is needed. Part of this approach should include regulations that ensure antivenoms available in health facilities meet quality control standards and that snakebites are accommodated into routine reporting systems to assess progress.
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Affiliation(s)
- Gaby I Ooms
- Health Action International, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Hendrika A van den Ham
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Tim Reed
- Health Action International, Amsterdam, The Netherlands
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Snakebite epidemiology and health-seeking behavior in Akonolinga health district, Cameroon: Cross-sectional study. PLoS Negl Trop Dis 2020; 14:e0008334. [PMID: 32584806 PMCID: PMC7343182 DOI: 10.1371/journal.pntd.0008334] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 07/08/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Snakebite envenoming causes 81,000–138,000 annual human deaths and pain, terror, or disability in 4.5–5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon. Methods We conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using probability-proportional-to-size, 20 villages were randomly selected, then, all inhabited households were systematically selected. Annual incidence and adjusted odds-ratio for predictors were estimated. Findings Among the 9,924 participants, 66 suffered a snakebite during the past year: the resulting incidence is 665 (95%CI: 519–841) per 100,000 inhabitants per year. Victims were aged 5-75y (median: 34y), 53% were male and 57% farmer-cultivators. Two children died (case-fatality rate: 3%); 39 (59%) presented severity signs, including 2 (3%) neurotoxic syndromes, 20 (30%) systemic digestive syndromes, and 17 (26%) severe cytotoxic syndromes. Non-severe cases included 20 (30%) mild cytotoxic syndromes and 7 (11%) dry bites. Only two victims (3%) received antivenom. 59 (89%) used family traditional practices, 25 (38%) traditional healers, and 31 (47%) consulted health facilities. Median delays to these three care-options were 5, 45, and 60 minutes, respectively. Traditional treatments included incisions (n = 57; 86%), tourniquets (n = 51; 77%) and black-stones (n = 44; 67%). The two last procedures were also used in health facilities (n = 18). Consulting traditional healers was associated with severity (adjusted-OR: 19.6 (2.5–156), p = 0.005) and complications (aOR: 17.3, 2.4–123, p = 0.004). Long-term disabilities were subjective psychological trauma (n = 47; 71%), finger amputation (n = 1; 2%), ankylosis (n = 1; 2%) and chronic pain (n = 1; 2%). Conclusions We observed alarming levels of snakebite incidence, mortality, antivenom scarcity, and use of traditional medicine. It could represent several thousands of victims at national level. We suggested conducting a country-wide study, and improving antivenom supply, first-aid training, for traditional healers and health professionals. On a global scale, snakebite envenoming causes more than 100,000 human deaths annually, as well as pain, terror, or serious disabilities in about 5 million victims, as reported by the World Health Organization. However, accurate data from community-based surveys are lacking, especially in Sub-Saharan Africa. Our aim was to assess the burden of snakebite in Akonolinga health district in Centre Region, Cameroon. We conducted a cross-sectional household survey in 20 randomly selected villages. Our study shows that about 6.6 victims per 1,000 inhabitants are bitten by a snake yearly, and that 3% of those victims die. The two victims who died in our survey were children who did not receive antivenom. Among all victims, 59% presented with severe symptoms, but only 3% received antivenom, and the majority used some traditional treatment. Consulting traditional healers was associated with clinical severity and medical complications. In summary, we found three main problems: a high burden in terms of incidence, severity and death; a lack of access to antivenoms; and the common use of potentially harmful traditional practices (causing delay and complications). This could represent tens of thousands of victims on a national level. We suggest conducting a country-wide representative study.
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