Availability, affordability and stock-outs of commodities for the treatment of snakebite in Kenya

Abstract

Background Annually, about 2.7 million snakebite envenomings occur globally. Alongside antivenom, patients usually require additional care to treat envenoming symptoms and antivenom side effects. Efforts are underway to improve snakebite care, but evidence from the ground to inform this is scarce. This study, therefore, investigated the availability, affordability, and stock-outs of antivenom and commodities for supportive snakebite care in health facilities across Kenya. Methodology/principal findings This study used an adaptation of the standardised World Health Organization (WHO)/Health Action International methodology. Data on commodity availability, prices and stock-outs were collected in July-August 2020 from public (n = 85), private (n = 36), and private not-for-profit (n = 12) facilities in Kenya. Stock-outs were measured retrospectively for a twelve-month period, enabling a comparison of a pre-COVID-19 period to stock-outs during COVID-19. Affordability was calculated using the wage of a lowest-paid government worker (LPGW) and the impoverishment approach. Accessibility was assessed combining the WHO availability target (≥80%) and LPGW affordability (<1 day’s wage) measures. Overall availability of snakebite commodities was low (43.0%). Antivenom was available at 44.7% of public- and 19.4% of private facilities. Stock-outs of any snakebite commodity were common in the public- (18.6%) and private (11.7%) sectors, and had worsened during COVID-19 (10.6% versus 17.0% public sector, 8.4% versus 11.7% private sector). Affordability was not an issue in the public sector, while in the private sector the median cost of one vial of antivenom was 14.4 days’ wage for an LPGW. Five commodities in the public sector and two in the private sector were deemed accessible. Conclusions Access to snakebite care is problematic in Kenya and seemed to have worsened during COVID-19. To improve access, efforts should focus on ensuring availability at both lower- and higher-level facilities, and improving the supply chain to reduce stock-outs. Including antivenom into Universal Health Coverage benefits packages would further facilitate accessibility.

Differential effects of the venoms of Russell’s viper and Indian cobra on human myoblasts

“…Usually, these life-saving medicines are not readily available in rural high-risk areas where incidences occur frequently. The time delay in receiving antivenom treatment following SBE often results in extensive local tissue damage that can lead to permanent disabilities 45 , 46 . As a result, there is an urgent need to develop better, more efficacious, and affordable treatments for SBE.…”

Integrating PrEP in maternal and child health clinics in Kenya: analysis of a service availability and readiness assessment (SARA) survey

“…While this question was intended to reflect stockouts over the past 30 days including today, misinterpretations may have led to data reporting inconsistencies. Literature on commodity availability across several health topics have included measures of stockouts over varying time periods; the WHO SARA reference manual also includes measures of both current availability and past stockouts for the same commodities ( 55 – 58 ). These findings suggest that both measures should be included in future SARA surveys to avoid underestimation of commodity stockouts.…”

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

“…As described, many studies have demonstrated retained efficacy of expired antivenoms, [17][18][19] and it is important to consider whether existing antivenom stocks could be used more efficiently, 16 particularly given the lack of access to these products in low and middle-income settings. [49][50][51] Reports suggest that clinicians are already using expired antivenom products due to lack of availability of in-date products, 25 and the South-East Asia regional office WHO guidelines for managing snakebite endorse this in certain circumstances: 'in patients with severe envenoming, recently expired antivenoms may be used if there is no alternative'. 22 However, we must emphasise that while we and others have demonstrated retained preclinical efficacy of expired antivenoms in mouse models, the clinical efficacy and safety of these antivenoms cannot be confirmed from these assays.…”