Snakebite envenoming in humanitarian crises and migration: A scoping review and the Médecins Sans Frontières experience

Abstract

Snakebite envenoming is a public health concern in many countries affected by humanitarian crises. Its magnitude was recognized internationally but associations between snakebite peaks and humanitarian crises were never clearly established or analysed. This scoping review searched any available evidence of this hypothesized association between snakebite types of crises, through PubMed/Medline by two researchers. The search also included hand searching, and reports from humanitarian organizations working in this area. The scoping review yielded 41 results. None described a robust epidemiological link or evidence of causality. There is an evidence gap regarding our research question. Several publications however point or hint towards the occurrence of snakebite outbreaks during conflict, displacement, floods, and migration of impoverished agricultural workers. Non-systematic screening yielded another 11 publications (52 in total). We found Médecins Sans Frontières routine reports showing that 6469 patients were admitted in 2019 throughout its projects in 17 countries. The impact of snakebite was the highest in four countries particularly affected by humanitarian crises, South Sudan, Ethiopia, Central African Republic, and Yemen, with some hospitals receiving more than 1000 annual admissions. Time correlations with conflict and events are shown in Figures. We found no published epidemiological data formally showing any associations between humanitarian crises and snakebite incidence. However, the search publications showing peaks during crises, and monitoring curves in four countries point towards an increased risk during humanitarian crises. We call for urgent population-based studies and surveillance. Stakeholders should consider upgrading snakebite care and antivenom supply during humanitarian crises in snakebite-endemic countries.

Snakebite case management: a cohort study in Northwest Ethiopia, 2012-2020

“…The Ethiopian national epidemiological survey reports 949 cases within a 10 month period [10]. In areas where MSF is operating, the routinely collected data show that annual snakebite cases in Ethiopia and South Sudan has increased from a few hundreds to more than a thousand [26]. Similarly, in Kenya snakebite was reported in 13.1% of the respondents in a community while in Sudan 12623 snakebite cases were seen annually [27].…”

Global mortality of snakebite envenoming between 1990 and 2019

“…Sub-Saharan Africa faces many of the same problems as South Asia, such as health system capacity shortcomings and the use of traditional healers as primary providers, as well as problems like an inadequate production of antivenom for the continent’s endemic snakes and high rates of conflict and humanitarian crisis 21 , 22 . We estimated Sub-Saharan Africa had the second greatest mortality with 6790 deaths (95% UI 5040–10,100) and 314,000 YLLs (219,000–521,000), equivalent to age-standardized rates of 1.2 deaths (0.9–1.6) per 100,000 and 36.9 YLLs (27.3–54.6) per 100,000.…”

“…The supply of antivenom is inadequate in sub-Saharan Africa and the cost for a dose is often prohibitively expensive, leaving victims of snakebite envenomation without treatment options 22 . Many of the countries with the highest burden of snakebite envenoming in sub-Saharan Africa are also those recently or currently in the midst of conflicts and humanitarian crises that increase outdoor exposure and disrupt the health system’s capacity for surveillance and treatment 21 , 23 . For example, Somalia (4.5 deaths per 100,000), Central African Republic (3.4 deaths per 100,000), Eritrea (2.9 deaths per 100,000), Chad (2.6 per 100,000), and South Sudan (2.3 deaths per 100,000) have some of the highest mortality rates globally.…”

“…For example, Somalia (4.5 deaths per 100,000), Central African Republic (3.4 deaths per 100,000), Eritrea (2.9 deaths per 100,000), Chad (2.6 per 100,000), and South Sudan (2.3 deaths per 100,000) have some of the highest mortality rates globally. Human displacement from conflict likely leads to increased human-wildlife conflicts and decreased access to antivenom and other necessary medical care 14 , 21 . Our estimates corroborate previous reports that populations in the middle of humanitarian, migration, and environmental crises are at high risk and surveillance efforts should be scaled up targeting these populations 21 .…”

“…Human displacement from conflict likely leads to increased human-wildlife conflicts and decreased access to antivenom and other necessary medical care 14 , 21 . Our estimates corroborate previous reports that populations in the middle of humanitarian, migration, and environmental crises are at high risk and surveillance efforts should be scaled up targeting these populations 21 .…”