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Faust A, Ray N. Consequences of geographical accessibility to post-exposure treatment for rabies and snakebite in Africa: a mini review. FRONTIERS IN HEALTH SERVICES 2024; 4:1309692. [PMID: 38873089 PMCID: PMC11169726 DOI: 10.3389/frhs.2024.1309692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
Introduction Rabies and snakebite envenoming are two zoonotic neglected tropical diseases (NTDs) transmitted to humans by animal bites, causing each year around 179,000 deaths and are most prevalent in Asia and Africa. Improving geographical accessibility to treatment is crucial in reducing the time from bite to treatment. This mini review aims to identify and synthesize recent studies on the consequences of distance and travel time on the victims of these diseases in African countries, in order to discuss potential joint approaches for health system strengthening targeting both diseases. Methods A literature review was conducted separately for each disease using Pubmed, Google Scholar, and snowball searching. Eligible studies, published between 2017 and 2022, had to discuss any aspect linked to geographical accessibility to treatments for either disease in Africa. Results Twenty-two articles (8 on snakebite and 14 on rabies) were eligible for data extraction. No study targeted both diseases. Identified consequences of low accessibility to treatment were classified into 6 categories: (1) Delay to treatment; (2) Outcome; (3) Financial impacts; (4) Under-reporting; (5) Compliance to treatment, and (6) Visits to traditional healers. Discussion and conclusion Geographical access to treatment significantly influences the burden of rabies and snakebite in Africa. In line with WHO's call for integrating approaches among NTDs, there are opportunities to model disease hotspots, assess population coverage, and optimize geographic access to care for both diseases, possibly jointly. This could enhance the management of these NTDs and contribute to achieving the global snakebite and rabies roadmaps by 2030.
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Affiliation(s)
- Aurélia Faust
- GeoHealth Group, Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- GeoHealth Group, Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
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Bisneto PF, Frazão L, Ceron K, Sachett J, Monteiro WM, Kaefer IL, Guedes TB. The challenge in detecting risk areas of snakebite when case rates are low: the case of Amazonian coral snakes. AN ACAD BRAS CIENC 2023; 95:e20230565. [PMID: 38088733 DOI: 10.1590/0001-3765202320230565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/17/2023] [Indexed: 12/18/2023] Open
Abstract
Identifying risk areas for envenomation by animals is relevant for public health, such as strategic distribution of antivenoms. Coral snakes are highly diverse in the Amazon, inhabit natural and human-modified environments, and the outcome of the cases tends to be serious and potentially lethal due to their neurotoxic venom. By integrating species' geographical records and environmental variables, we used species distribution modeling to predict the distribution of coral snake species in the Brazilian Amazonia. We analyzed the relationship between the predicted distribution of coral snake species, along with envenomation data in the region, to propose actions to reduce the number of cases and to provide tools for a better policy of public health. We conclude that the entire Amazon shows high environmental suitability for coral snakes, and such suitability explains little about the incidence of cases. This is probably due to the low human density in the Amazon and to coral snake traits such as secretive habits and non-agressive behavior. Differently from other venomous snakes, the scenario regarding coral snakebites precludes the detection of prominent geographical areas of concern and demands a broad and equitable availability of health centers throughout Amazonia and along other areas of occurrence of the genus Micrurus.
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Affiliation(s)
- Pedro Ferreira Bisneto
- Universidade Federal do Amazonas, Programa de Pós-Graduação em Zoologia, Avenida General Rodrigo Otávio, Coroado I, 69067-005 Manaus, AM, Brazil
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Av. Pedro Teixeira, s/n, Dom Pedro, 69040-000 Manaus, AM, Brazil
| | - Luciana Frazão
- University of Coimbra, Centre for Functional Ecology - Science for People & the Planet, Department of Life Sciences, Faculty of Sciences and Technology, Paço das Escolas, 3000-456, Coimbra, Portugal
| | - Karoline Ceron
- Universidade Estadual de Campinas, Instituto de Biologia, Departamento de Biologia Animal, Cidade Universitária Zeferino Vaz - Barão Geraldo, 13083-872 Campinas, SP, Brazil
| | - Jacqueline Sachett
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Av. Pedro Teixeira, s/n, Dom Pedro, 69040-000 Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001 Manaus, AM, Brazil
- Fundação Alfredo da Matta, Diretoria de Ensino e Pesquisa, Av. Codajás, 24, Cachoeirinha, 69065-130 Manaus, AM, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, s/n, Dom Pedro, 69040-000 Manaus, AM, Brazil
| | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Av. Pedro Teixeira, s/n, Dom Pedro, 69040-000 Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Av. Carvalho Leal, 1777, Cachoeirinha, 69065-001 Manaus, AM, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Diretoria de Ensino e Pesquisa, Av. Pedro Teixeira, s/n, Dom Pedro, 69040-000 Manaus, AM, Brazil
| | - Igor Luis Kaefer
- Universidade Federal do Amazonas, Programa de Pós-Graduação em Zoologia, Avenida General Rodrigo Otávio, Coroado I, 69067-005 Manaus, AM, Brazil
| | - Thaís B Guedes
- Universidade Estadual de Campinas (UNICAMP), Departamento de Biologia Animal, Instituto de Biologia, Rua Monteiro Lobato, 255, Bloco P1, Cidade Universitária, 13083-862 Campinas, SP, Brazil
- University of Gothenburg, Gothenburg Global Biodiversity Center and Department of Biological and Environmental Sciences, Box 461, SE-405-30, Göteborg, Sweden
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Oluoch GO, Otundo D, Nyawacha S, Ongeri D, Smith M, Meta V, Trelfa A, Ahmed S, Harrison RA, Lalloo DG, Stienstra Y, Tianyi FL. Conducting epidemiological studies on snakebite in nomadic populations: A methodological paper. PLoS Negl Trop Dis 2023; 17:e0011792. [PMID: 38153942 PMCID: PMC10754435 DOI: 10.1371/journal.pntd.0011792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Research on snakebite has mostly been conducted on settled populations and current risk factors and potential interventions are therefore most suited for these populations. There is limited epidemiological data on mobile and nomadic populations, who may have a higher risk of snakebite. METHODS AND RESULTS We conducted a scoping review to gather evidence on survey methods used in nomadic populations and compared them with contemporary survey methods used for snakebite research. Only 16 (10.5%) of 154 articles reportedly conducted on pastoralist nomadic populations actually involved mobile pastoralists. All articles describing snakebite surveys (n = 18) used multistage cluster designs on population census sampling frames, which would not be appropriate for nomadic populations. We used geospatial techniques and open-source high-resolution satellite images to create a digital sampling frame of 50,707 households and used a multistage sampling strategy to survey nomadic and semi-nomadic populations in Samburu County, Kenya. From a sample of 900 geo-located households, we correctly identified and collected data from 573 (65.4%) households, of which 409 were in their original locations and 164 had moved within 5km of their original locations. We randomly sampled 302 (34.6%) households to replace completely abandoned and untraceable households. CONCLUSION Highly mobile populations require specific considerations in selecting or creating sampling frames and sampling units for epidemiological research. Snakebite risk has a strong spatial component and using census-based sampling frames would be inappropriate in nomadic populations. We propose using open-source satellite imaging and geographic information systems to improve the conduct of epidemiological research in these populations.
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Affiliation(s)
- George O. Oluoch
- Kenya Snakebite Research and Intervention Centre, Kenya Institute of Primate Research, Ministry of Health, Karen, Nairobi, Kenya
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Pembroke Place, Liverpool, United Kingdom
| | - Denis Otundo
- Kenya Snakebite Research and Intervention Centre, Kenya Institute of Primate Research, Ministry of Health, Karen, Nairobi, Kenya
| | | | | | | | | | - Anna Trelfa
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Pembroke Place, Liverpool, United Kingdom
| | - Sayem Ahmed
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Pembroke Place, Liverpool, United Kingdom
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Robert A. Harrison
- Kenya Snakebite Research and Intervention Centre, Kenya Institute of Primate Research, Ministry of Health, Karen, Nairobi, Kenya
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Pembroke Place, Liverpool, United Kingdom
| | - David G. Lalloo
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Pembroke Place, Liverpool, United Kingdom
| | - Ymkje Stienstra
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Pembroke Place, Liverpool, United Kingdom
- University of Groningen, University Medical Centre Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands
| | - Frank-Leonel Tianyi
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Pembroke Place, Liverpool, United Kingdom
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Padidar S, Monadjem A, Litschka-Koen T, Thomas B, Shongwe N, Baker C, Mmema L, Sithole T, Murray J, Casewell NR, Pons J, Lalloo DG, Harrison RA, Stienstra Y, Dlamini WM. Snakebite epidemiology, outcomes and multi-cluster risk modelling in Eswatini. PLoS Negl Trop Dis 2023; 17:e0011732. [PMID: 37948462 PMCID: PMC10664941 DOI: 10.1371/journal.pntd.0011732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/22/2023] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Halving snakebite morbidity and mortality by 2030 requires countries to develop both prevention and treatment strategies. The paucity of data on the global incidence and severity of snakebite envenoming causes challenges in prioritizing and mobilising resources for snakebite prevention and treatment. In line with the World Health Organisation's 2019 Snakebite Strategy, this study sought to investigate Eswatini's snakebite epidemiology and outcomes, and identify the socio-geographical factors associated with snakebite risk. METHODOLOGY Programmatic data from the Ministry of Health, Government of Eswatini 2019-2021, was used to assess the epidemiology and outcomes of snakebite in Eswatini. We developed a snake species richness map from the occurrence data of all venomous snakes of medical importance in Eswatini that was subjected to niche modelling. We formulated four risk indices using snake species richness, various geospatial datasets and reported snakebites. A multivariate cluster modelling approach using these indices was developed to estimate risk of snakebite and the outcomes of snakebite in Eswatini. PRINCIPAL FINDINGS An average of 466 snakebites was recorded annually in Eswatini. Bites were recorded across the entire country and peaked in the evening during summer months. Two cluster risk maps indicated areas of the country with a high probability of snakebite and a high probability of poor snakebite outcomes. The areas with the highest rate of snakebite risk were primarily in the rural and agricultural regions of the country. SIGNIFICANCE These models can be used to inform better snakebite prevention and treatment measures to enable Eswatini to meet the global goal of reducing snakebite morbidity and mortality by 50% by 2030. The supply chain challenges of antivenom affecting southern Africa and the high rates of snakebite identified in our study highlight the need for improved snakebite prevention and treatment tools that can be employed by health care workers stationed at rural, community clinics.
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Affiliation(s)
- Sara Padidar
- Department of Biological Sciences, University of Eswatini, Kwaluseni, Eswatini
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - Ara Monadjem
- Department of Biological Sciences, University of Eswatini, Kwaluseni, Eswatini
- Mammal Research Institute, Department of Zoology & Entomology, University of Pretoria, Hatfield, Pretoria, South Africa
| | - Thea Litschka-Koen
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - Brent Thomas
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nondusimo Shongwe
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - Clare Baker
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lindelwa Mmema
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | | | - James Murray
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - Nicholas R. Casewell
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jonathan Pons
- Eswatini Antivenom Foundation, Simunye, Eswatini
- Eswatini Snakebite Research and Intervention Centre, Simunye, Eswatini
| | - David G. Lalloo
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Robert A. Harrison
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ymkje Stienstra
- Centre for Snakebite Research and Interventions, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine/Infectious Diseases, Groningen, The Netherlands
| | - Wisdom M. Dlamini
- Department of Geography, Environmental Science and Planning, University of Eswatini, Kwaluseni, Eswatini
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Gutiérrez JM, Bolon I, Borri J, Ruiz de Castañeda R. Broadening the research landscape in the field of snakebite envenoming: Towards a holistic perspective. Toxicon 2023; 233:107279. [PMID: 37659665 DOI: 10.1016/j.toxicon.2023.107279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Abstract
Snakebite envenoming (SBE) is a neglected tropical disease that kills and maims hundreds of thousands of people yearly, particularly in impoverished rural settings of the Global South. Understanding the complexity of SBE and tackling this disease demands a transdisciplinary, One Health approach. There is a long-standing research tradition on SBE in toxinology and human medicine. In contrast, other disciplines, such as veterinary medicine or social sciences, still need to be better developed in this field, especially in countries with a high incidence of SBE. Broadening the disciplinary landscape, connecting various research approaches, methods, and data across disciplines and sectors, and engaging with communities affected by SBE in implementing evidence-based solutions are needed. This review summarizes areas that require strengthening to better understand the complexity of SBE and to generate a robust body of knowledge to be translated into effective public health interventions.
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Affiliation(s)
- José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
| | - Isabelle Bolon
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Rafael Ruiz de Castañeda
- Institute of Global Health, Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Bhaumik S, Zwi AB, Norton R, Jagnoor J. How and why snakebite became a global health priority: a policy analysis. BMJ Glob Health 2023; 8:e011923. [PMID: 37604596 PMCID: PMC10445399 DOI: 10.1136/bmjgh-2023-011923] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Snakebite was added to the WHO neglected tropical disease (NTD) list in 2017, followed by a World Health Assembly resolution in 2018, and an explicit global target being set to reduce the burden in 2019. We aimed to understand how and why snakebite became a global health priority. METHODS We conducted a policy case study, using in-depth interviews, and documents (peer-reviewed and grey literature) as data sources. We drew on Shiffman et al's framework on global health network to guide the analysis. RESULTS We conducted 20 interviews and examined 91 documents. The prioritisation of snakebite occurred in four phases: pre-crescendo, crescendo, de-crescendo and re-crescendo. The core snakebite network consisted of academics, which expanded during the re-crescendo phase to include civil society organisations and state actors. The involvement of diverse stakeholders led to better understanding of WHO processes. The use of intersecting and layered issue framing, framing solutions around snake antivenoms, in a background of cross-cultural fascination and fear of snakes enabled prioritisation in the re-crescendo phase. Ebbs and flows in legitimacy of the network and reluctant acceptance of snakebite within the NTD community are challenges. CONCLUSION Our analyses imply a fragile placement of snakebite in the global agenda. We identify two challenges, which needs to be overcome. The study highlights the need to review the WHO criteria for classifying diseases as NTD. We propose that future prioritisation analysis should consider identifying temporal patterns, as well as integrating legitimacy dimensions, as in our study.
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Affiliation(s)
- Soumyadeep Bhaumik
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India
| | - Anthony B Zwi
- School of Social Sciences, UNSW, Sydney, New South Wales, Australia
| | - Robyn Norton
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, Imperial College, London, UK
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
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Yousefi M, Yousefkhani SH, Grünig M, Kafash A, Rajabizadeh M, Pouyani ER. Identifying high snakebite risk area under climate change for community education and antivenom distribution. Sci Rep 2023; 13:8191. [PMID: 37210435 DOI: 10.1038/s41598-023-35314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
Snakebite is one of the largest risks from wildlife, however little is known about venomous snake distribution, spatial variation in snakebite risk, potential changes in snakebite risk pattern due to climate change, and vulnerable human population. As a consequence, management and prevention of snakebite is hampered by this lack of information. Here we used habitat suitability modeling for 10 medically important venomous snakes to identify high snakebite risk area under climate change in Iran. We identified areas with high snakebite risk in Iran and showed that snakebite risk will increase in some parts of the country. Our results also revealed that mountainous areas (Zagros, Alborz, Kopet-Dagh mountains) will experience highest changes in species composition. We underline that in order to improve snakebite management, areas which were identified with high snakebite risk in Iran need to be prioritized for the distribution of antivenom medication and awareness rising programs among vulnerable human population.
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Affiliation(s)
- Masoud Yousefi
- Department of Animal Science, School of Biology, Damghan University, Damghan, Iran.
- LIB, Museum Koenig, Bonn, Leibniz Institute for the Analysis of Biodiversity Change, Adenauerallee 127, 53113, Bonn, Germany.
| | | | - Marc Grünig
- Ecosystem Dynamics and Forest Management Group, School of Life Sciences, Technical University of Munich (TUM), 85354, Freising, Germany
| | - Anooshe Kafash
- Department of Environmental Science, Faculty of Natural Resources, University of Tehran, Karaj, Iran
| | - Mahdi Rajabizadeh
- Department of Biodiversity, Institute of Science and High Technology and Environmental Sciences, Graduate University of Advanced Technology, Kerman, 7631133131, Iran
- AI.Nature Team, INRIA Startup Studio, 2 Rue Simone IFF, 75012, Paris, France
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Halliru N, Badamasi MM, Tudunwada IY, Dajel TB, Abubakar SB, Hamza AS, Oluwashola SB, Nalado NK, Dahiru M, Na’abdu I, Saleh UN, Daiyab AM, Mohammed SA, Iliyasu G, Muhammad H, Habib AG. Epidemiologic and spatiotemporal study on access to snakebite care in Northern Nigeria. TOXIN REV 2023. [DOI: 10.1080/15569543.2023.2177873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Naziru Halliru
- Geo-Referenced Infrastructure and Demographic Data for Development (GRID3) Nigeria, CIESIN, Columbia Climate School, Columbia University, New York, NY, USA
| | - Murtala M. Badamasi
- Geographic Information Systems (GIS) Lab, Center for Dryland Agriculture, Bayero University Kano, Kano, Nigeria
| | | | - Titus B. Dajel
- Comprehensive Health Center Zamko, Jos University Teaching Hospital, Langtang, Plateau state, Nigeria
| | | | | | | | - Nasiru K. Nalado
- Zonal Advanced Space Technology Applications Laboratory, Kano, Nigeria
| | - Muhammad Dahiru
- Zonal Advanced Space Technology Applications Laboratory, Kano, Nigeria
| | - Ibrahim Na’abdu
- Geographic Information Systems (GIS) Lab, Center for Dryland Agriculture, Bayero University Kano, Kano, Nigeria
| | - Umar N. Saleh
- Geographic Information Systems (GIS) Lab, Center for Dryland Agriculture, Bayero University Kano, Kano, Nigeria
| | | | | | - Garba Iliyasu
- Infectious & Tropical Diseases Unit, Bayero University Kano, Kano, Nigeria
| | - Hamza Muhammad
- Infectious & Tropical Diseases Unit, Bayero University Kano, Kano, Nigeria
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Ochoa C, Rai M, Babo Martins S, Alcoba G, Bolon I, Ruiz de Castañeda R, Sharma SK, Chappuis F, Ray N. Vulnerability to snakebite envenoming and access to healthcare in the Terai region of Nepal: a geospatial analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 9:100103. [PMID: 37383041 PMCID: PMC10306013 DOI: 10.1016/j.lansea.2022.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 06/30/2023]
Abstract
Background Snakebite envenoming is a neglected tropical disease that mainly affects poor populations in rural areas. In hyperendemic regions, prevention could partially reduce the constant risk, but the population still needs timely access to adequate treatment. In line with WHO's snakebite roadmap, we aim to understand snakebite vulnerability through modelling of risk and access to treatment, and propose plausible solutions to optimise resource allocation. Methods We combined snakebite-risk distribution rasters with travel-time accessibility analyses for the Terai region of Nepal, considering three vehicle types, two seasons, two snakebite syndromes, and uncertainty intervals. We proposed localised and generalised optimisation scenarios to improve snakebite treatment coverage for the population, focusing on the neurotoxic syndrome. Findings In the Terai, the neurotoxic syndrome is the main factor leading to high snakebite vulnerability. For the most common scenario of season, syndrome, and transport, an estimated 2.07 (15.3%) million rural people fall into the high vulnerability class. This ranges between 0.3 (2.29%) and 6.8 (50.43%) million people when considering the most optimistic and most pessimistic scenarios, respectively. If all health facilities treating snakebite envenoming could optimally treat both syndromes, treatment coverage of the rural population could increase from 65.93% to 93.74%, representing a difference of >3.8 million people. Interpretation This study is the first high-resolution analysis of snakebite vulnerability, accounting for uncertainties in both risk and travel speed. The results can help identify populations highly vulnerable to snakebite envenoming, optimise resource allocation, and support WHO's snakebite roadmap efforts. Funding Swiss National Science Foundation.
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Affiliation(s)
- Carlos Ochoa
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
| | | | - Sara Babo Martins
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gabriel Alcoba
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Médecins Sans Frontières (MSF), Neglected Tropical Diseases Working Group, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Isabelle Bolon
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
- Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
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