Antivenom for sale? Availability and affordability of snakebite medicines across public and private health facilities in Rwanda

Schurer, Janna M.; Murara, Elijah; van Oirschot, Janneke; Ooms, Gaby

doi:10.1016/j.toxicon.2023.107292

Cited by 5 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Snakebite prevention in Rwanda could include community sensitization programs encouraging high risk populations to use bed nets, patch holes where snakes could enter homes, practice rodent control, use torches when travelling at night, wear closed-toed shoes, and to seek formal care immediately when bitten by a snake [ 4 ]. At the systems level, improved procurement and distribution of appropriate SAV among Rwandese health facilities in addition to the inclusion of SBE management in medical curricula, are likely to meaningfully improve patient outcomes [ 10 , 16 , 31 ]. Easing the burden of transportation could encourage more victims to seek immediate care from formal health facilities.…”

Section: Discussionmentioning

confidence: 99%

“…The formal health system has a well-organized hierarchy of care starting with Community Health Workers (CHWs) at the village level who refer patients to nurses at health posts/centers, who in turn might refer patients to physicians at district, provincial or referral hospitals [ 15 ]. Snake-antivenom (SAV) appropriate against African snakebites is available at 4.2% of health facilities but is not considered affordable according to World Health Organization standards [ 16 ]. Only physicians are authorized to administer SAV.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

“I sold my towel and shoes to pay the traditional healer”: Care-seeking costs and productivity losses among snakebite victims in Eastern Province, Rwanda

Schurer,

Admasu,

Bonaventure

et al. 2023

PLoS Negl Trop Dis

Self Cite

View full text Add to dashboard Cite

Snakebite envenomation (SBE) is endemic to sub-Saharan Africa and generally over-represented in rural, remote, and impoverished agricultural communities. While poverty is an established risk factor, little research has been done to investigate the economic consequences of SBE. This cross-sectional, quantitative study aimed to measure out-of-pocket spending and lost income when a household member was bitten by a snake. In 2020, 732 snakebite survivors from Eastern Province (Rwanda) agreed to complete a survey administered by telephone. The survey focused on participant demographics, income, direct medical and non-medical costs, care-seeking decisions, and lost work during convalescence. Our results suggested that patients incurred the highest mean expenses when they sought care from hospitals (11 307 RWF or 12 USD) or traditional healers (5 836 RWF or 6 USD) but that the highest maximum cost was incurred from traditional healers (300 000 RWF or 313 USD). Across all victims, the total amount paid to traditional healers (3.4 million RWF or 3 537 USD) was 4.7 times higher than all other care providers combined. On average, families lost 111 814 RWF (117 USD) per snakebite in direct treatment costs and indirect productivity losses. Many victims sought care from traditional healers despite being eligible for free medical care. Altogether, this study serves as a reminder of the serious physical and financial consequences associated with SBE and provides justification for new investments into SBE prevention and care.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“I sold my towel and shoes to pay the traditional healer”: Care-seeking costs and productivity losses among snakebite victims in Eastern Province, Rwanda

Schurer,

Admasu,

Bonaventure

et al. 2023

PLoS Negl Trop Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in SSA. The survey on the availability of anaesthesia commodities was part of a larger project in Rwanda on access to essential medicines for the management and treatment of snakebites [ 32 ]. In this study, 34 commodities were surveyed, including four commodities that are used in anaesthesia care (ketamine, thiopental, inhalational agents, and propofol).…”

Section: Methodsmentioning

confidence: 99%

“…on access to essential medicines for the management and treatment of snakebites [32]. In this study, 34 commodities were surveyed, including four commodities that are used in anaesthesia care (ketamine, thiopental, inhalational agents, and propofol).…”

Section: Methodsmentioning

confidence: 99%

The impact of scheduling ketamine as an internationally controlled substance on anaesthesia care in Sub-Saharan Africa: a case study and key informant interviews

Ooms,

Usman,

Reed

et al. 2024

BMC Health Serv Res

View full text Add to dashboard Cite

Background Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled. Methods This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach. Results The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants. Conclusion Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.

show abstract

“…34 Challenge doses were three times the previously determined median lethal dose (LD 50 ) for the venoms of N. nigricollis (3× LD 50 =55.2 µg/mouse) 35 and D. polylepis (3× LD 50 =1.14 µg/mouse) 36 and five times for the venom of B. arietans (5× LD 50 =110 µg/mouse). 37 The rationale for using 3× LD 50 challenge doses for N. nigricollis and D. polylepis, rather than the conventional 5× LD 50 , was a refinement due to experience with these particular venoms demonstrating the use of 5× LD 50 resulted in poor resolution of dose groups outcomes. The number of resulting deaths was recorded at 6 hours.…”

Section: Neutralisation Of Lethality Assessmentmentioning

confidence: 99%

African polyvalent antivenom can maintain pharmacological stability and ability to neutralise murine venom lethality for decades post-expiry: evidence for increasing antivenom shelf life to aid in alleviating chronic shortages

Solano,

Cunningham,

Edge

et al. 2024

BMJ Glob Health

View full text Add to dashboard Cite

IntroductionAntivenom is a lifesaving medicine for treating snakebite envenoming, yet there has been a crisis in antivenom supply for many decades. Despite this, substantial quantities of antivenom stocks expire before use. This study has investigated whether expired antivenoms retain preclinical quality and efficacy, with the rationale that they could be used in emergency situations when in-date antivenom is unavailable.MethodsUsing WHO guidelines and industry test requirements, we examined the in vitro stability and murine in vivo efficacy of eight batches of the sub-Saharan African antivenom, South African Institute for Medical Research polyvalent, that had expired at various times over a period of 30 years.ResultsWe demonstrate modest declines in immunochemical stability, with antivenoms older than 25 years having high levels of turbidity. In vitro preclinical analysis demonstrated all expired antivenoms retained immunological recognition of venom antigens and the ability to inhibit key toxin families. All expired antivenoms retained comparable in vivo preclinical efficacy in preventing the lethal effects of envenoming in mice versus three regionally and medically important venoms.ConclusionsThis study provides strong rationale for stakeholders, including manufacturers, regulators and health authorities, to explore the use of expired antivenom more broadly, to aid in alleviating critical shortages in antivenom supply in the short term and the extension of antivenom shelf life in the longer term.

show abstract

Antivenom for sale? Availability and affordability of snakebite medicines across public and private health facilities in Rwanda

Cited by 5 publications

References 21 publications

“I sold my towel and shoes to pay the traditional healer”: Care-seeking costs and productivity losses among snakebite victims in Eastern Province, Rwanda

“I sold my towel and shoes to pay the traditional healer”: Care-seeking costs and productivity losses among snakebite victims in Eastern Province, Rwanda

The impact of scheduling ketamine as an internationally controlled substance on anaesthesia care in Sub-Saharan Africa: a case study and key informant interviews

African polyvalent antivenom can maintain pharmacological stability and ability to neutralise murine venom lethality for decades post-expiry: evidence for increasing antivenom shelf life to aid in alleviating chronic shortages

Contact Info

Product

Resources

About