Snakebite epidemiology and health-seeking behavior in Akonolinga health district, Cameroon: Cross-sectional study

Abstract

Background Snakebite envenoming causes 81,000-138,000 annual human deaths and pain, terror, or disability in 4.5-5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon. Methods We conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using probability-proportionalto-size, 20 villages were randomly selected, then, all inhabited households were systematically selected. Annual incidence and adjusted odds-ratio for predictors were estimated. Findings Among the 9,924 participants, 66 suffered a snakebite during the past year: the resulting incidence is 665 (95%CI: 519-841) per 100,000 inhabitants per year. Victims were aged 5-75y (median: 34y), 53% were male and 57% farmer-cultivators. Two children died (casefatality rate: 3%); 39 (59%) presented severity signs, including 2 (3%) neurotoxic syndromes, 20 (30%) systemic digestive syndromes, and 17 (26%) severe cytotoxic syndromes. Non-severe cases included 20 (30%) mild cytotoxic syndromes and 7 (11%) dry bites. Only two victims (3%) received antivenom. 59 (89%) used family traditional practices, 25 (38%) traditional healers, and 31 (47%) consulted health facilities. Median delays to these three care-options were 5, 45, and 60 minutes, respectively. Traditional treatments included incisions (n = 57; 86%), tourniquets (n = 51; 77%) and black-stones (n = 44; 67%).

Snakebites in Rural Areas of Brazil by Race: Indigenous the Most Exposed Group

“…The Ministry of Health in Brazil has been distributing around 230,000 ampoules of antivenom to approximately 2000 hospitals free of charge annually [16], which is likely one of the reasons for the low mortality rates associated with snakebites in Brazil found in this and prior studies [9,16,[28][29][30]41]. Brazil's case-fatality rate for snakebites of around 0.4%, found in our study and the previous study by Bochner [9], is particularly low if compared with studies in other countries, such as the reported case-fatality rate of 3% in a recent district-level study in Cameroon [42], and an estimated case-fatality rate of 3.2% for in-hospital cases of snakebite envenoming in India [43]. According to Chippaux [44], the model that exists in Brazil regarding antivenom distribution, as well as existing infrastructure that ensures treatment for many people, is a good model for other low-and middle-income countries, including those in Africa and Asia.…”

Chronic health effects and cost of snakebite

“…Depressive symptoms and post-traumatic stress disorder are the most common psychological conditions reported following snakebite ( Khosrojerdi and Amini, 2013 ; Williams et al, 2011 ). Non-specific somatic manifestations of psychological problems resulting from the experience of snakebite, which may be related to socio-cultural beliefs that promote a sick role are also described in the literature (Rodríguez and Gutiérrez, 2019; Alcoba et al, 2020 ).…”

A scoping review of current practices on community engagement in rural East Africa: Recommendations for snakebite envenoming

“…This study collected data about who delivered the engagement to the communities; no publications mentioned the involvement of traditional healers, yet the key role that they play in the traditional management of SBE in many communities is well known ( Alcoba et al, 2020 ; Sloan et al, 2007 ). Although it can be challenging and time-consuming, the NTD community must seek ways to work with traditional healers and community and religious leaders, who hold trusted and influential positions within their communities and thus are key in driving behavioural change ( Awah et al, 2018 ; Kadam et al, 2021 ).…”