Snakebites in “Invisible Populations”: A cross-sectional survey in riverine populations in the remote western Brazilian Amazon

Abstract

In the Brazilian Amazon, long distances, low healthcare coverage, common use of ineffective or deleterious self-care practices, and resistance to seeking medical assistance have an impact on access to antivenom treatment. This study aimed to estimate snakebite underreporting, and analyze barriers that prevent victims from obtaining healthcare in communities located in 15 municipalities on the banks of the Solimões, Juruá and Purus Rivers, in the remote Western Brazilian Amazon. Information on the participants’ demographics, previous snakebites, access to healthcare, time taken to reach medical assistance, use of self-care practices, and the reason for not accessing healthcare were collected through semi-structured interviews. In the case of deaths, information was collected by interviewing parents, relatives or acquaintances. A total of 172 participants who reported having suffered snakebites during their lifetime were interviewed. A total of 73 different treatment procedures was reported by 65.1% of the participants. Participants living in different river basins share few self-care procedures that use traditional medicine, and 91 (52.9%) participants reported that they had access to healthcare. Living in communities along the Juruá River [OR = 12.6 (95% CI = 3.2–49.7; p<0.001)] and the use of traditional medicine [OR = 11.6 (95% CI = 3.4–39.8; p<0.001)] were variables that were independently associated to the lack of access to healthcare. The main reasons for not accessing healthcare were the pprioritization of traditional treatments (70.4%), and the failure to recognize the situation as being potentially severe (50.6%). Four deaths from complications arising from the snakebite were reported, and three of these were from communities on the banks of the Juruá River. Only one of these received medical assistance. We found an unexpectedly high underreporting of snakebite cases and associated deaths. Snakebite victims utilized three main different healing systems: 1) self-care using miscellaneous techniques; 2) official medical healthcare generally combined with traditional practices; and 3) self-care using traditional practices combined with Western medicines. To mitigate snakebite burden in the Brazilian Amazon, an innovative intervention that would optimize timely delivery of care, including antivenom distribution among existing community healthcare centers, is needed.

Treatment of a Snakebite Injury With Secondary Bacterial Infection

“…Sixteen days after the snakebite, she returned for a dressing change; assessment of the wound revealed red nodules and perilesional calor (heat) in the posterior area of the left leg. A complete blood cell count demonstrated the following: erythrocytes, 3.9 ×10 6 /mm 3 ; hematocrit, 30.64%; hemoglobin, 10.11 g/dL; and platelets, 578,000/mm 3. These findings indicated reduction in the risk of local bleeding and signs of secondary infection.…”

“…2 However, we recognize that the official number of cases, and even deaths, is underestimated due to the challenges related to the remote nature of area where these bites often occur and the need to seek care at centers located far from where the bite occurs. 3 The main challenges arise from the need to travel great geographic distances for health care and the prohibitive costs of air travel. Over a period of 6 years (2010-2015), a descriptive study that focused on snakebite envenomation in the Brazilian Amazon reported 9386 cases; 81% were caused by Bothrops species (a genus of venomous pit vipers).…”

Building an explanatory model for snakebite envenoming care in the Brazilian Amazon from the indigenous caregivers’ perspective

“…However, contact between different health systems often leads to some kind of conflict or competition [ 40 ]. Regarding SBEs, the use of folk medicine and traditional self-care practices are often recorded around the world as the cause of late medical assistance and poor prognosis [ 41 – 44 ]. Our results do not support the simplistic thought that the belief in the efficacy of traditional practices delays the decision to seek the health service in indigenous villagers, as indigenous caregivers are not against transporting patients to the hospital; on the contrary, they recommend referral in these cases.…”

“Two Cultures in Favor of a Dying Patient”: Experiences of Health Care Professionals Providing Snakebite Care to Indigenous Peoples in the Brazilian Amazon

“…Given the great diversity of indigenous ethnicities, the current literature is not comprehensive, but it does provide some information on how indigenous peoples in the Brazilian Amazon care for themselves and seek traditional care for snakebites [ 10 , 17 , 18 ]. Minimal research, however, has been conducted on how indigenous peoples access and utilize the health system for snakebite treatment [ 9 ].…”