Protocol and monitoring to improve snake bite outcomes in rural Ghana

Abstract

A study was conducted in Mathias Hospital, Yeji, an area of Ghana, where snake bite cases are an important cause of morbidity and mortality, with a case fatality rate of 11% (8/72). Case management difficulties included uncertainty about the assessment of the severity of envenoming, the dosage of antivenom, and the response to treatment. An intervention with several components was introduced: development of a treatment protocol, staff training, monitoring of compliance and patient education. During a 33-month post-intervention period there was excellent protocol compliance, fewer snake bite complications, and a fall in mortality rate to 1.3% (3/238) compared with a 15-month baseline review. There was a 50% increase in snake bite admissions and fewer delays. To improve snake bite outcomes in comparable settings, particularly if inexperienced staff are involved in care, we recommend a similar quality assurance project, involving case review and use of a treatment protocol with monitoring of compliance to sustain an improved approach.

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

“…The population of Savelugu-Nanton District was ∼130,000, constituting ∼6% of the population of the Northern Region of Ghana in 2008 [17], so we conservatively estimate about 1,700-12,500 envenomations with about 50-350 fatalities annually (mortality rate of ∼3%) in this part of the country. This figure makes up about 20-95% of a Ghana national estimate of about 250-375 [40], and is within the range of current available estimates for the sub-region [1, 9] and other estimates from northern [23] and central [22, 42] Ghana, but 5-10 times higher than southwest Ghana [24].…”

“…With a large sample size of 1,024 respondents covering both dry and wet seasons, and a retrospective 10-year bivariate data sample of snakebite incidences and rainfall patterns, our study represents an important contribution to epidemiological snakebite studies for this region. Previous epidemiological studies have largely been limited to short-term data series with lower sample sizes of predominantly retrospective hospital records for Ghana [22, 23, 24] and sub-Saharan Africa [25, 26, 27, 28, 29], where complementary or nationwide long-term published studies remain scarce [1, 16, 30, 31]. Estimates of regional or national snakebite burdens based exclusively on hospital records inevitably neglect many snakebite cases treated at home or by TMPs [1, 4, 16, 30].…”

“…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].…”

Snakebite in north-eastern South Africa: clinical characteristics and risks for severity

“…Outcomes in snakebite have repeatedly been shown to be positively influenced by increased knowledge of snakebite amongst local practitioners. 34,35 …”

Shortcomings in snake bite management in rural Cameroon: a case report

“…Their importance must not be under-estimated even in the presence of adequate amounts of specific anti-venoms [1]. In a study in Ghana, the institution of an intervention package for snake bite management, comprising: treatment protocol, staff training, monitoring of compliance and patient education, saw a 50% increase in snake bite admissions and a 90% decrease in mortality from snake bites, over a 15 month period [32]. A similar intervention could be expected to have a similar effect in our setting.…”