Intensive-care management of snakebite victims in rural sub-Saharan Africa: An experience from Uganda

Abstract

Approximately 5.4 million people are bitten by snakes annually, with up to half of these victims experiencing signs of envenomation. This results in an estimated 138 000 deaths per year. [1] Only limited data exist on the long-term morbidity of snakebites, but one study suggested that between 5 900 and 14 600 amputations per year may be attributed to snakebites in sub-Saharan Africa (sSA) alone. [2] However, accuracy of epidemiological data is limited owing to under-reporting, patients' poor access to healthcare facilities and many victims attending traditional healers rather than health centres or hospitals. [1][2][3] The burden of snakebites is unevenly distributed across the globe, with 95% of cases encountered in low-and middle-income countries in Africa and Asia. [4,5] Even in those areas, the health effects of snakebites are disproportional, with the poorest of the poor generally experiencing poor outcomes. [6,7] Rural sSA is specifically vulnerable owing to limited availability of healthcare services. In 2017, the World Health Organization (WHO) recognised snakebite envenoming as a neglected tropical disease. [7] Accordingly, snakebite antivenoms are included in the WHO's list of essential medicines. [8] Common acute medical conditions arising from snakebites depend on the species, but include neurotoxicity, coagulation failure accompanied by shock or organ dysfunction, and local tissue destruction. [9] Multiple factors, including delayed presentation to healthcare facilities, adversely affect the management and outcome of snakebite victims. [2] Inadequate regulatory frameworks that result in ineffective or unsafe antivenom products being available, restricted access and high costs are crucial challenges limiting the use of antivenoms, particularly in sSA. [10,11] Supportive measures are often the only therapeutic options for patients presenting with snakebite envenoming in sSA.In this study, we report the intensive care unit (ICU) management and outcomes of 174 snakebite victims who were treated mainly with basic intensive-care interventions (e.g. mechanical ventilation) in a rural sSA hospital where adequate doses of antivenom were not available.

Identifying key factors contributing to treatment costs for snakebite envenoming in private tertiary healthcare settings in Tamil Nadu, India

“…It is often inevitable to arrive at late night due to the nature of SBE (e.g., common krait bites at night times), and therefore, clinicians and hospitals should consider charging the same amount even for patients who are arriving at late night as SBE mainly affects poor rural communities. The use of intensive care units is also critical and indeed, some patients can be managed with only supportive measures such as ventilation support in such units even in the absence of antivenoms [ 23 ]. Therefore, the hospitals should consider reducing the charges for intensive care units for SBE.…”

“…Although antivenom is essential for treating SBE patients, it is not the only treatment that can save lives [18][19][20]. For example, airway and respiratory compromise in SBE patients suffering from neurotoxic envenomings can be managed almost entirely by mechanical ventilation where no antivenom is available or the antivenom is not effective [20][21][22][23]. Tissue necrosis around the bite site may require operative interventions such as local debridement and fasciotomy along with possible amputation where attempts at limb salvage are not viable or successful [18,19].…”

Barriers and opportunities for improving management of snakebites: Perspectives of healthcare workers in Northern Uganda

“…In Uganda, snakebite affects 101 out of every 100,0000 people annually, with the Northern region being one of the high-incidence areas due to its tropical location and diverse snake fauna [ 10 , 11 ]. However, the disease burden and the social and economic impacts of snakebite are difficult to estimate because of poor data collection, limited access to health care, and low awareness among affected communities [ 2 ].…”