A generalized framework for estimating snakebite underreporting using statistical models: A study in Colombia

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 and 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.

Serpentes envolvidas em acidentes ofídicos em duas comunidades no Acre, oeste da Amazônia brasileira

“…O envenenamento por picada de serpente é considerado pela Organização Mundial da Saúde (OMS) uma doença tropical negligenciada e em 2019 a OMS lançou uma estratégia ambiciosa visando cortar pela metade as taxas de mortalidade e incapacidade causadas por picadas de serpente até o ano de 2030 (Who, 2019;Schneider et al, 2021). Essa estratégia global recomenda, entre outras ações, o fortalecimento dos sistemas de vigilância e a melhoria na coleta e análise de dados sobre o envenenamento por serpentes (Bravo-Vega et al, 2023). A implementação dessa diretriz demonstra o compromisso da comunidade internacional em abordar de forma efetiva este desafio de saúde pública, adaptando soluções às especificidades locais e melhorando o acesso ao tratamento e à prevenção em áreas afetadas (Williams et al, 2019).…”