Bite-to-hospital time and morbidity in victims of viper bite in a rural hospital in Nigeria

Abstract

BackgroundMortality amongst in-hospital patients bitten by carpet viper in northern Nigeria has reduced, related to use of a monospecific ovine Fab snake antivenom. However, many victims survive with temporary or permanent morbidity.ObjectivesStudy objectives were to: (1) determine and score the morbidity caused by carpet viper bite; and (2) find the relationship between bite-to-hospital time and morbidity amongst victims of carpet viper bite.MethodA prospective study was conducted in a rural hospital in north-central Nigeria. The morbidities scored were oedema, tenderness, prolonged whole-blood clotting time, blister, ulcer, need for blood transfusion, coma, hypotension, convulsion, length of hospital stay, need for disarticulation, and need for skin graft. A score of one was given to each objective sign. The bite-to-hospital time of 233 subjects was obtained. Descriptive and inferential statistical analysis was done.ResultsMost of the subjects (150 or 64%) came to the hospital within 6 hours of the snake bite, with 2 (1%) arriving within 1 hour. The median bite-to-hospital time was 5 hours, with a range of 0.5–216 hours. Major morbidities were oedema, seen in 212 (91.0%; 95% CI 86.6–94.3%); incoagulable blood, seen in 205 (88%; 95% CI 83.1–91.9%), and tenderness, seen in 201 (86.3%; 95% CI 81.2–90.4%). The mean morbidity score was 8 ± 4. For every unit increase in logged bite-to-hospital time, the morbidity score increased by 1.85 (p < 0.001).ConclusionMorbidity caused by carpet viper bite is high in Zamko, north-central Nigeria, and correlates with increasing bite-to-hospital time.

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

“…large vipers) avoid such human-trafficked areas which pose great human-detection risks. As in the majority of West African studies, and as recorded from all sections of our study population, three snake species were by far the commonest snakebite culprits; Carpet Viper, Night Adder Causus maculatus and Black-necked Spitting Cobra [16, 23, 26, 35, 40, 43, 45, 46]. These three species were also the commonest found in our study area, as shown by extensive ecological censuses [59].…”

“…Long delays in antivenom treatment often lead to severe cases of morbidity (e.g. amputations) or death, even if such treatment is administered correctly [22, 42, 44, 45]. It is therefore important to ascertain the extent of both untreated and delayed treatments in order to address these clinical and epidemiological shortcomings in the management of snakebites in remote rural parts of Ghana and sub-Saharan Africa [2, 13, 15, 40, 42].…”

“…Such factors also result in the poikilothermic snakes seeking warm areas during morning hours and shade in the hot midday and early afternoons. Nocturnal snakebites were mostly confined to homes and roads, a pattern found in many other rural areas of Africa, and attributed to walking barefoot, or inappropriate footwear and poor domestic lighting conditions [25, 31, 45, 51].…”

Effectiveness of Rapid Transport of Victims and Community Health Education on Snake Bite Fatalities in Rural Nepal

“…We are convinced that this intervention should be replicated and its efficacy evaluated in other parts of southern Asia and elsewhere (e.g., Africa), where available transports are limited and where morbidity and mortality from snake bites are associated with increased bite-to-hospital time. 28,29 Cost-effectiveness analysis of the intervention would also help policy makers. In addition, other types of medical emergencies may also benefit from a community-based approach involving motorcycle volunteers.…”

Older Age and Time to Medical Assistance Are Associated with Severity and Mortality of Snakebites in the Brazilian Amazon: A Case-Control Study

“…In the same country, patients admitted with symptoms of neurotoxicity and vomiting [ 22 , 24 ], coagulopathy and leukocytosis [ 23 ], hypertension, albuminuria, changes in bleeding and prothrombin time [ 25 ] were more likely to develop severe outcomes. The delay in antivenom administration was also a risk factor for severity in Nigeria [ 27 ]. Capillary leak syndrome, bleeding and respiratory paralysis were risk factors for mortality in patients who received snake antivenom in Nigeria and Korea [ 28 , 29 ].…”