Ethno-knowledge and attitudes regarding snakebites in the Alto Juruá region, Western Brazilian Amazonia

Silva, Ageane Mota da; Colombini, Mônica; Moura-da-Silva, Ana Maria; Souza, Rodrigo Medeiros de; Monteiro, Wuelton Marcelo; Bernarde, Paulo Sérgio

doi:10.1016/j.toxicon.2019.10.238

Cited by 26 publications

(38 citation statements)

References 52 publications

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“…Previous studies carried out in the Brazilian Amazon region have demonstrated the effect of delays in the treatment of snakebites as a risk factor for complications and even death [3,12]. The delay in treatment is usually attributed to the great distances to be traveled by patients in order to reach a healthcare unit where antivenom is available [3,12], or is attributed to cultural factors that would cause patients to choose traditional treatment [14]. In this study, we found that these reasons are plausible, but they only partially explain the processes by which individuals chose their paths to reach a reference hospital for snakebite treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The professional component of the system is usually located in the urban area of the municipalities, where antivenoms and ancillary treatment is available. In the case of snakebite envenomation in the Brazilian Amazon, even when these official therapeutic resources are accessible to the populations, traditional therapies are not fully replaced [14].…”

Section: Therapeutic Itinerariesmentioning

confidence: 99%

“…In the Brazilian Amazon, first aid measures that would not be medically effective for the victim's recovery are commonly utilized [14]. In the self-care practices reported by the study participants, many procedures that can contribute to the worsening of the local clinical picture of the envenomation are observed.…”

Section: Self-care Subjective Domains and Itinerary Choicesmentioning

confidence: 99%

“…In fact, traditional healing practices are common in many cultures, and some communities report that even with access to medical care, traditional healing practices are still used [64]. Use of these ineffective or even deleterious self-care practices are recorded across the world as being the cause of late medical assistance and poor prognosis in snakebites [14,63,65]. Interestingly, however, some participants who had a previous experience of snakebite in the family, or had previously been bitten, decided not to use traditional measures, as they had been discouraged to do so by health professionals on previous occasions.…”

Section: Self-care Subjective Domains and Itinerary Choicesmentioning

confidence: 99%

“…Some of these therapies include harmful procedures that can lead to snakebite complications, such as secondary bacterial infections in the affected limb [14], necrosis and compartment syndrome, which may lead to temporary or permanent functional losses in affected patients. Amputation, scarring, and muscular atrophy, which all affect mobility, are potential chronic outcomes.…”

Section: Introductionmentioning

confidence: 99%

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A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)

et al. 2021

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Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient’s admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Therapeutic Itinerariesmentioning

confidence: 99%

Section: Self-care Subjective Domains and Itinerary Choicesmentioning

confidence: 99%

Section: Self-care Subjective Domains and Itinerary Choicesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)

et al. 2021

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Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox

Carvalho,

Souza,

Melo

et al. 2024

JAMA Intern Med

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ImportanceBothrops venom acts almost immediately at the bite site and causes tissue damage.ObjectiveTo investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations.Design, Setting, and ParticipantsThis was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022.InterventionThe intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point.Main Outcomes and MeasuresFeasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients’ acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients’ discharge. P values for outcomes were adjusted with Bonferroni correction.ResultsA total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P &lt; .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed.Conclusions and RelevanceThe data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations.Trial RegistrationBrazilian Registry of Clinical Trials Identifier: RBR-4qw4vf

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Bothrops atrox, the most important snake involved in human envenomings in the amazon: How venomics contributes to the knowledge of snake biology and clinical toxinology

et al. 2020

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Ethno-knowledge and attitudes regarding snakebites in the Alto Juruá region, Western Brazilian Amazonia

Cited by 26 publications

References 52 publications

A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)

A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)

Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox

Bothrops atrox, the most important snake involved in human envenomings in the amazon: How venomics contributes to the knowledge of snake biology and clinical toxinology

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