This study compares two antivenoms used to treat Echis ocellatus snake bite patients at Mathias Hospital, Yeji, central Ghana. FAV-Afrique antivenom (Aventis Pasteur) was given to 278 patients during 2001--2003, whilst Asna Antivenom C (Bharat Serum and Vaccines Ltd) was used in 2004 to treat 66 patients. The two groups had comparable patient attributes, time from snake bite to treatment and staff adherence to the tested treatment protocol. The antivenom C group required more repeat doses and twice the amount of antivenom to treat coagulopathy. Of greater concern, the antivenom C mortality rate was 12.1%, a marked rise from the 1.8% rate in the earlier FAV-Afrique antivenom group. In this study, antivenom C was ineffective as treatment for West African E. ocellatus snake venom. This illustrates the absolute need for regional pilot tests to assess the effectiveness of a new antivenom against local snake venoms before its sole and general distribution in a region is initiated.

A study was conducted in Mathias Hospital, Yeji, an area of Ghana, where snake bite cases are an important cause of morbidity and mortality, with a case fatality rate of 11% (8/72). Case management difficulties included uncertainty about the assessment of the severity of envenoming, the dosage of antivenom, and the response to treatment. An intervention with several components was introduced: development of a treatment protocol, staff training, monitoring of compliance and patient education. During a 33-month post-intervention period there was excellent protocol compliance, fewer snake bite complications, and a fall in mortality rate to 1.3% (3/238) compared with a 15-month baseline review. There was a 50% increase in snake bite admissions and fewer delays. To improve snake bite outcomes in comparable settings, particularly if inexperienced staff are involved in care, we recommend a similar quality assurance project, involving case review and use of a treatment protocol with monitoring of compliance to sustain an improved approach.

Background African countries are working to achieve rapid reductions in maternal and child mortality and meet their targets for the Millennium Development Goals (MDGs). Partners in the Catalytic Initiative to Save One Million Lives (CI) are assisting them by providing funding and technical assistance to increase and accelerate coverage for proven interventions. Here we describe how the Lives Saved Tool (LiST) was used as part of an early assessment of the expected impact of CI plans in Malawi, Burkina Faso and Ghana.Methods LiST builds on country-specific demographic and cause-of-death profiles, and models the effect of changes in coverage for proven interventions on future levels of mortality among children less than 5 years of age. We worked with representatives of Ministries of Health and their development partners to apply LiST to assess the potential impact of CI plans and coverage targets, generating a short list of the highest-priority interventions for additional scale-up to achieve rapid reductions in under-5 mortality.Results The results show that in each country, achieving national coverage targets for just four or five high-impact interventions could reduce under-5 mortality by at least 20% by 2011, relative to 2006 levels. Even greater gains could be obtained in Burkina Faso and Ghana by scaling up these high-impact interventions to 80%.Discussion LiST can contribute to the development of stronger programmes by identifying the highest-impact interventions in a given epidemiological setting. The quality of LiST estimates is dependent on the available data on coverage levels and causes of death, and assumes that the target levels of coverage are feasible in a given context while maintaining service quality. Further experience is needed in the feasibility and usefulness of LiST as part of the program planning process at district and subdistrict levels.