Facial human bites. Vision on STMMs in Africa

Abstract

Objectives: Human bites of the face are a frequent and serious health issue as they often compromise patients function and aesthetics as well as lead to further complications. The aim of the study is to review human bites of the face referred to our team during 112 short-term medical missions (STMMs) in Sub-Saharan Africa over the past 20 years and to discuss the epidemiology, appearance, management and outcome, including the most common complications. Methods: A retrospective medical documentation review was carried out examining all human bites of the face operated by our team during 112 STMMs from 2000 to 2019 in different countries of Sub-Saharan Africa. Results: Out of about 5500 patients medical charts 51 patients were selected due to history of human bite. Patients’ age range was 15-65 years, female to male ratio was 1, 55:1, the most often involved parts were: lips, ear and nose. Various surgical procedures were carried out including local flaps and free grafts. Infection and graft necrosis were the most common reported complication (n=4, 9,3 %). Conclusion: Human bites injuries are a serious health problem in some African populations because of their frequency and possible severity. The treatment is particularly challenging due to their potential to cause local infections, the risk they pose for transmission of systemic diseases as well as their demanding surgical management.

Management of Human Bites in a Rural Kenyan Setting

“…Our study describes greater frequency of bite injuries in men than women. While this concords with findings in the West, which show greater rates of biting among males, it differs from other literature on human bites in African settings, such as Nigeria, Tanzania, and Ghana, which have often shown female predominance 6,7,16–18 . Given that many of human bites in our cohort occur in the setting of intoxication, the predominance of males could be explained, in part, by higher rates of alcohol use among males in our local population 19 …”

“…The treatment of human bites is a common issue facing healthcare practitioners in the low-resource countries of Sub-Saharan Africa where expert reports note it as a growing public health concern 6 . Social tensions, which are often at the root of this form of interpersonal violence, continue to be amplified by on-going economic depression, competition for limited resources, and alcohol abuse 7 . In addition, improvements in transportation, healthcare facility development, and a rising trust in medical professionals have allowed patients in Africa's rural areas to seek treatment to which they would not have previously had access 8,9 .…”

“…Unfortunately, the infrastructure, equipment, medical storage, infection control, and surgical personnel, which typifies available healthcare facilities for the majority of patients in Sub-Saharan Africa, do not meet the World Health Organizations minimum standards 10 . Given that adequate medical and surgical management for patients with human bites is often lacking, this population is especially vulnerable to experiencing poor surgical outcomes and postoperative infections, which will negatively affect both the patient's physical and psychosocial functioning 7,11,12 . There is a need for further characterization of human bite presentation, management, and expected outcome in rural, underresourced settings.…”

“…6 Social tensions, which are often at the root of this form of interpersonal violence, continue to be amplified by on-going economic depression, competition for limited resources, and alcohol abuse. 7 In addition, improvements in transportation, healthcare facility development, and a rising trust in medical professionals have allowed patients in Africa's rural areas to seek treatment to which they would not have previously had access. 8,9 The desired outcomes from surgical management are generally healing, function, and aesthetics.…”

“…10 Given that adequate medical and surgical management for patients with human bites is often lacking, this population is especially vulnerable to experiencing poor surgical outcomes and postoperative infections, which will negatively affect both the patient's physical and psychosocial functioning. 7,11,12 There is a need for further characterization of human bite presentation, management, and expected outcome in rural, underresourced settings.…”