BackgroundSnakebite is an important public health problem in tropical regions of the world. Although devastating effects of envenoming such as kidney failure, tissue necrosis, bleeding diathesis, and neurotoxicity are well known in the acute stage following a snakebite, the long-term effects of snake envenoming have not been adequately studied.Materials and methodsA population-based study was conducted among 8707 residents in a rural district in Sri Lanka to assess the long-term sequelae following snakebite. Health-related complaints that snakebite victims had developed immediately or within 4 weeks of the bite and persisted for more than 3 months, were assessed by interviewer-administered questionnaire and in-depth interviews, and further evaluated by physical examination and relevant investigations.ResultsOf the 816 participants who were identified as ever snakebite victims, 112 (13.7%) presented with at least one snakebite-related long-term health complication. Among them, “migraine-like-syndrome” characterized by headache vertigo, and photosensitivity to sunlight was found in 46 (5.6%); musculoskeletal disorders such as pain, local swelling, muscle weakness, deformities, contractures, and amputations were found in 26 (3.2%); visual impairment in 21 (2.6%); acute kidney injury in 4 (0.5%); skin blisters at the bite site in 5 (0.6%); psychological distress in 2 (0.2%); hemiplegia in 1 (0.1%); right-side facial nerve palsy in 1 (0.1%); paresthesia over bite site in 1 (0.1%); generalized shivering in 1 (0.1%); and chronic nonhealing ulcer in 1 (0.1%). Interestingly, 31 (3.8%) reported nonspecific somatic symptoms such as abdominal colic, chest tightness, wheezing, receding gums, excessive hair loss, and lassitude with body aches following the bite. The average duration of symptoms since snakebite was 12.7 years (SD=11.7).ConclusionThis study highlights that a significant proportion of snakebite victims suffer disabling chronic health sequelae. There is a need to place systems to address these unmet health needs.

BackgroundSnakebite is a major public health problem in agricultural communities in the tropics leading to acute local and systemic impairments with resultant disabilities. Snakebite related long-term musculoskeletal disabilities have been a neglected area of research. We conducted a population-based, cross-sectional study in an agricultural community to describe the chronic musculoskeletal disabilities of snake envenoming.Methodology/Principal FindingsA sample representative of residents of a single district in a region of high incidence of snake envenoming was recruited to identify ever snakebite victims. They were evaluated for chronic musculoskeletal disabilities that had developed immediately or within four weeks after the snakebite and persisted over three months. In-depth interviews, validated musculoskeletal functional assessment criteria and specialists’ examinations were utilised. Among the 816 victims, 26 (3.2%, 95% confidence interval: 2.2–4.6%) had musculoskeletal disabilities, persisting on average for 13.4 years (SD = 14.4). The disabilities were mostly in lower limbs (61.5%) and ranged from swelling (34.6%), muscle wasting (46.1%), reduced motion (61.5%), reduced muscle power (50%), impaired balance (26.9%), chronic non-healing ulcers (3.85%), abnormal gait (3.85%), fixed deformities (19.2%) to amputations (15.4%). Based on disability patterns, six snakebite-related musculoskeletal syndromes were recognised. The offending snakes causing disabilities were cobra (30.8%), Russell’s viper (26.9%) and hump-nosed viper (7.7%). Cobra bites manifested muscle wasting (87.5%), reduced muscle power (87.5%), joint stiffness (62.5%) and deformities (37.5%) while viper bites manifested impaired balance (42.8%), pain (71.4%) and swelling (71.4%).Conclusions/SignificanceSnakebite envenoming is associated with considerable long-term musculoskeletal disabilities. Facilities for specialized care and rehabilitation need to be established in high risk areas.

Background The burden of snakebite remains poorly characterised because of the paucity of population-based data. Further, factors determining the vulnerability of individuals within rural communities to snakebite have been rarely investigated. We undertook a population-based study to determine the prevalence, vulnerability and epidemiological characteristics of snakebite in rural Sri Lanka. Methods and findings A population-based cross-sectional study was conducted among 8707 current residents in the district of Ampara, representing typical rural Sri Lanka. The sample was recruited using multi-stage cluster sampling with probability proportionate-to-size. Snakebite victims were identified using the WHO criteria. Data were collected using a pre-tested interviewer-administered questionnaire. Each household had on average 3.8 persons; mean age 28.3 years (SD = 18.2); 51.3% males. The one-year point prevalence of snakebites was 17.6 per 1000 residents (95% CI: 15–20.6) and 6.12 per 100 households (95% CI: 5.25–7.13), while the lifetime prevalence was 9.4 per 100 residents (95% CI: 8.8–10.0) and 30.5 per 100 households (95% CI: 28.6–32.2) with a case fatality ratio of 0.033. Venomous snakebites accounted for 28.1%; snakes were unidentified among 30.1%. Compared to the non-snakebite victims, being single, males, of Sinhala ethnicity, aged >19 years, low education and socioeconomic status, engaging in farming or unskilled outdoor occupations denoted vulnerability to snakebites. Outdoor bites (77.8%) were more common among males; during daytime; mostly while walking; within the rural terrains and home gardens; on lower limbs; mostly by hump-nosed and Russell viper. Indoor bites were more common among females; during night-time; while sleeping and barefooted; on lower limbs; mostly by hump-nosed vipers, kraits and non-venomous snakes. Conclusions The burden of snakebite is considerably high among rural populations. The concept of vulnerability can be useful in healthcare decision-making and resource allocation.

Introduction: The complete routine neonatal examination before discharge of the newborn baby is the simplest and earliest way to identify possible heart lesions. Objective: The aim of this study was to ascertain the clinical significance of precordial murmurs heard on routine neonatal examination Design: Descriptive, cross sectional study design was applied at routine neonatal examination before discharge of the neonate Method: All consecutive 4,804 live born neonates (excluding those dying before neonatal evaluation) at non-university units of the De Soysa Hospital for Women (DSHW) during a ten month period from 15.05.2013 were screened within 24 hours of birth for precordial murmurs and those with audible murmurs were then referred for echocardiography Results: Prevalence of murmurs and CHD at routine neonatal examination was 16 per 1,000 live births and 15 per 1,000 live births respectively. The most common lesions found in echocardiographic evaluation were atrial septal defect (62%), patent ductus arteriosus (26%), ventricular septal defect (19%) and cyanotic heart with multiple lesions (12%). Conclusions: At routine neonatal examination, prevalence of murmurs was 1.6% and the prevalence of CHD was 15 per 1,000 live births. If a murmur was heard, there was a 96% chance that the neonate could have CHD.

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