The Current State of Snakebite Care in Kenya, Uganda, and Zambia: Healthcare Workers’ Perspectives and Knowledge, and Health Facilities’ Treatment Capacity

Abstract

Snakebites continue to be a public health concern in sub-Saharan Africa, where availability of appropriate medical treatment is rare, even though death and disability can be prevented with timely intervention. A challenge is the lack of sociopolitical studies to inform health policies. This study aimed to identify snakebite patient profiles, healthcare workers’ (HCWs) knowledge of snakebite, and facilities’ snakebite treatment capacity in Kenya, Uganda, and Zambia to inform interventions to improve access to appropriate treatment. The research comprised a cross-sectional key informant survey among HCWs from health facilities in Kenya (n = 145), Uganda (n = 144), and Zambia (n = 108). Data were collected between March 2018 and November 2019. Most of the HCWs suggested that the number of snakebite incidents was similar between the genders, that most patients were aged 21–30 years, and most people were bitten when farming or walking. Overall, only 12% of HCWs had received formal training in snakebite management. Only about 20% of HCWs in each country said their health facility had the medicines needed to treat snakebites, with antivenom available in 0–34% of facilities across the sectors and countries, and snakebites were not systematically recorded. This research shows that an integrative approach through policies to increase resource allocation for health system strengthening, including community education, HCW training, and improved access to snakebite treatment, is needed. Part of this approach should include regulations that ensure antivenoms available in health facilities meet quality control standards and that snakebites are accommodated into routine reporting systems to assess progress.

Snakebite incidents, prevention and care during COVID-19: Global key-informant experiences

“…While global awareness has increased, health systems in many snakebite endemic countries are still not equipped to respond adequately. Lack of expertise, equipment and access to medical commodities, specifically effective antivenom, are common issues at health facilities, while timely access to care and effective health-seeking behaviour are challenges at the community level ( Fry, 2018 ; Ooms et al, 2021 ; Williams, 2015 ). Then, in early 2020, coronavirus disease 2019 (COVID-19) started to have an unprecedented impact on societies and health systems across the world.…”

Delays, fears and training needs: Perspectives of health workers on clinical management of snakebite revealed by a qualitative study in Kitui County, Kenya

“…Our study adds to the existing evidence that some health workers in sub-Saharan Africa believe in the effectiveness of traditional remedies ( Ooms et al, 2020 ; Taieb et al, 2018 ; Michael et al, 2018 ). Such remedies are advised against in International and Kenyan guidelines for snakebite management ( World Health Organization Regional Office for Africa, 2010 ; Kenya Ministry of Health Neglected Tropical Diseases Program, 2019 ).…”

“…Evidence from high and upper-middle income settings is that patient factors, including socioeconomic status, attitudes and adherence to treatment, may also influence health workers' decision making ( Hajjaj et al, 2010 ; Mckinlay et al, 1996 ; Bernheim et al, 2008 ). There is no evidence on whether, or how, these or other factors influence health workers' approach to snakebite management as existing research in sub-Saharan Africa has focussed on health worker knowledge of snakebite ( Michael et al, 2018 ; Ooms et al, 2020 ; Taieb et al, 2018 ).…”

Availability, affordability and stock-outs of commodities for the treatment of snakebite in Kenya

“…Even if antivenom and supportive commodities to manage adverse reactions are adequately available, the question remains whether healthcare workers have the skills to properly manage the patient. Research in Kenya has shown, for example, that only 12.4% of healthcare workers had received training on snakebite management [ 12 ]. In line with this, we found that the 20-minute whole blood clotting test (20WBCT), which is a simple test using a glass tube to test for coagulability to identify hemotoxic envenomings, was indicated to be available at only 7.5% of Kenyan facilities [ 4 ].…”

“…Most studies on antivenom availability have been estimating the availability compared to the needs; it is estimated that the number of effective treatments available in sub-Saharan Africa may be as low as 2.5% of what is needed [7]. However, to date, in very few countries in sub-Saharan Africa has the availability of antivenoms in health facilities been methodically studied, while the availability of supportive treatment has rarely been studied in any country globally [12][13][14]. Further, studies on antivenom costs in sub-Saharan Africa primarily focus on wholesale prices, not on patient (out-of-pocket) prices or patient affordability [7,13].…”