Introduction Snakebites are a major cause of permanent injury and death among poor, rural populations in developing countries, including those in East Africa. This research characterizes snakebite incidence, risk factors, and subsequent health-seeking behaviors in two regions of Kenya using a mixed methods approach. Methods As a part of regular activities of a health demographic surveillance system, household-level survey on snakebite incidence was conducted in two areas of Kenya: Kwale along the Kenyan Coast and Mbita on Lake Victoria. If someone in the home was reported to have been bitten in the 5 years previous to the visit, a survey instrument was administered. The survey gathered contextual information on the bite, treatment-seeking behavior and clinical manifestations. To obtain deeper, contextual information, respondents were also asked to narrate the bite incident, subsequent behavior and outcomes. Results 8775 and 9206 households were surveyed in Kwale and Mbita, respectively. Out of these, 453 (5.17%) and 92 (1.00%) households reported that at least one person had been bitten by a snake in the past 5 years. Deaths from snakebites were rare (4.04%), but patterns of treatment seeking varied. Treatment at formal care facilities were sought for 50.8% and at traditional healers for 53.3%. 18.4% sought treatment from both sources. Victims who delayed receiving treatment from a formal facility were more likely to have consulted a traditional healer (OR 8.8995% CI [3.83, 20.64]). Delays in treatment seeking were associated with significantly increased odds of having a severe outcome, including death, paralysis or loss of consciousness (OR 3.47 95% CI [1.56; 7.70]). Conclusion Snakebite incidence and outcomes vary by region in Kenya, and treatment-seeking behaviors are complex. Work needs to be done to better characterize the spatial distribution of snakebite incidence in Kenya and efforts need to be made to ensure that victims have sufficient access to effective treatments to prevent death and serious injury.

Due to climate change, extreme weather events are increasing, and extreme heat days are expected to warm by 3°C in the mid-latitudes by mid-century Intergovernmental Panel on Climate Change. 1 The impacts of extreme weather events, e.g., temperatures or precipitation amounts that were observed less than 1% of the time in a historical period, such as 1981-2010, 2 disproportionately fall on vulnerable communities. These vulnerable communities include persons of color, who are more likely to live in lower quality homes and neighborhoods with fewer resources due to racially discriminatory mortgage lending practices, and individuals with low incomes, who often lack extreme temperature mitigation methods or may limit energy usage to minimize utility costs. 3 Of U.S. cities, Detroit, Michigan may be particularly vulnerable. This city of 670 000 people American Community Survey 4 lies in the Koppen climate classification group "hot summer continental

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