Retrospective study on the incidence of envenomation and accessibility to antivenom in Burkina Faso

Abstract

BackgroundSnakebite is a common neglected public health issue, especially in poor rural areas of sub-Saharan Africa, Asia and Latin America. Passive immunotherapy with safe and effective antivenom is the only approved treatment for it. This study aimed to determine the incidence of snakebites, and to assess the availability and accessibility of antivenoms, from 2010 to 2014, in Burkina Faso.MethodsThe assessment of snakebite cases managed in all health facilities from 2010 to 2014 was performed from the Statistical Yearbook of the Ministry of Health. Antivenom consumption data were collected from the drug wholesalers established in Burkina Faso.ResultsSnakebites are among the five leading causes of consultations in health districts. From 2010 to 2014, 114,126 envenomation cases occurred in Burkina Faso, out of which 62,293 (54.6 %) victims have been hospitalized resulting in 1,362 (2 %) deaths. The annual incidence and mortality were respectively 130 bites and 1.75 deaths per 100,000 inhabitants. The amount of antivenom sold by wholesalers were 5,738 vials with a total cost of US$ 539,055 (annual average = US$ 107,811). The high cost of these antivenoms (between US$ 42 and 170 per dose according to brand) limited their use by rural people, the main victims of snakebites, whose income is insufficient. Thus, only 4 % of patients received antivenom treatment over the past five years. The price of antivenom was reduced in 2015 to US$ 3.4 by a public drug wholesaler.ConclusionThe study confirmed the high burden of snakebites in Burkina Faso. To better manage envenomation, Burkina Faso implemented a strategy consisting in seeking affordable sources of antivenom supply of good quality and innovative mechanisms of subsidy.

Epidemiology, ecology and human perceptions of snakebites in a savanna community of northern Ghana

“…We consistently found that young to middle-aged men (age group = 15-44 years) were most at risk of snakebites, corroborating similar findings from Ghana [22, 23, 24], other parts of West Africa [15, 25, 26, 27, 44, 46, 47] and Africa in general [30, 34, 48, 49, 50]. Adolescent and young men in their twenties are among the most active and adventurous, albeit least cautious, section of rural African people [24, 27, 44, 51]. They expose themselves to snake encounters by risky behaviour during land clearing, harvesting, bush and charcoal burning, hunting and commuting on foot during dark or early morning hours with impaired visibility in dim light and dense vegetation [24, 47, 50].…”

“…With a large sample size of 1,024 respondents covering both dry and wet seasons, and a retrospective 10-year bivariate data sample of snakebite incidences and rainfall patterns, our study represents an important contribution to epidemiological snakebite studies for this region. Previous epidemiological studies have largely been limited to short-term data series with lower sample sizes of predominantly retrospective hospital records for Ghana [22, 23, 24] and sub-Saharan Africa [25, 26, 27, 28, 29], where complementary or nationwide long-term published studies remain scarce [1, 16, 30, 31]. Estimates of regional or national snakebite burdens based exclusively on hospital records inevitably neglect many snakebite cases treated at home or by TMPs [1, 4, 16, 30].…”

“…Snake density is related to habitat type and human disturbance, as well as food sources and hiding places. It is also inversely related to human density in many parts of sub-Saharan Africa [27, 30, 46], and therefore directly related to both destruction of suitable habitats as well as human persecution, especially in most African cultures with great dislike of snakes. Snakebite prevalence is lower in urban centres devoid of natural vegetation, and where snakes are at higher risk of being detected and killed [30].…”

Snakebite envenomation turns again into a neglected tropical disease!

“…In Asia, some data exist in India, for example [ 8 ], but they do not suffice to bring a consistent view of the situation. Analyses of African data have indicated that the problem there is of much underestimated magnitude [ 9 ], and this is largely being confirmed by the first epidemiological analyses from national health registries [ 10 ].…”

Priority Actions and Progress to Substantially and Sustainably Reduce the Mortality, Morbidity and Socioeconomic Burden of Tropical Snakebite

“…Data from studies conducted in India [11,14], Bangladesh [15], Sri Lanka [16,17], Nigeria [12,18], Burkina Faso [19], Kenya [20] and Senegal [21], amongst others, provide evidence of an increasing capability of acquiring snakebite epidemiology data that need to be adopted and promoted more widely. The workshop was informed of hospital-based and community survey projects being undertaken or planned in several countries represented by the recently established African Society of Venimology and in Southeast Asia.…”