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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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Schurer JM, Admasu MT, Bonaventure M, Hakizimana D, Murara E, MacDonald LE, Rafferty E. "I sold my towel and shoes to pay the traditional healer": Care-seeking costs and productivity losses among snakebite victims in Eastern Province, Rwanda. PLoS Negl Trop Dis 2023; 17:e0011768. [PMID: 37983274 PMCID: PMC10695369 DOI: 10.1371/journal.pntd.0011768] [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: 07/18/2023] [Revised: 12/04/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
Snakebite envenomation (SBE) is endemic to sub-Saharan Africa and generally over-represented in rural, remote, and impoverished agricultural communities. While poverty is an established risk factor, little research has been done to investigate the economic consequences of SBE. This cross-sectional, quantitative study aimed to measure out-of-pocket spending and lost income when a household member was bitten by a snake. In 2020, 732 snakebite survivors from Eastern Province (Rwanda) agreed to complete a survey administered by telephone. The survey focused on participant demographics, income, direct medical and non-medical costs, care-seeking decisions, and lost work during convalescence. Our results suggested that patients incurred the highest mean expenses when they sought care from hospitals (11 307 RWF or 12 USD) or traditional healers (5 836 RWF or 6 USD) but that the highest maximum cost was incurred from traditional healers (300 000 RWF or 313 USD). Across all victims, the total amount paid to traditional healers (3.4 million RWF or 3 537 USD) was 4.7 times higher than all other care providers combined. On average, families lost 111 814 RWF (117 USD) per snakebite in direct treatment costs and indirect productivity losses. Many victims sought care from traditional healers despite being eligible for free medical care. Altogether, this study serves as a reminder of the serious physical and financial consequences associated with SBE and provides justification for new investments into SBE prevention and care.
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Affiliation(s)
- Janna M. Schurer
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, United States of America
| | | | - Mihigo Bonaventure
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | - Dieudonne Hakizimana
- University of Washington, Department of Global Health, Seattle, Washington state, United States of America
| | - Elijah Murara
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | | | - Ellen Rafferty
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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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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Schurer JM, Murara E, van Oirschot J, Ooms G. Antivenom for sale? Availability and affordability of snakebite medicines across public and private health facilities in Rwanda. Toxicon 2023; 234:107292. [PMID: 37734455 DOI: 10.1016/j.toxicon.2023.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
Antivenom is considered the safest and most effective treatment against snake envenomation (SBE); however, global shortages mean that many low-income countries struggle to meet demand. In Rwanda, chronic shortages of essential medicines are an important barrier to robust healthcare delivery and discourage snakebite victims from seeking hospital care. The aim of this retrospective, cross-sectional study was to evaluate the availability and affordability of commodities to treat SBE at hospitals and health centers. In total, our team interviewed pharmacy managers at 111 public and 31 private health facilities (N = 142) to complete a validated quantitative questionnaire, entering data electronically through KoBoCollect. Commodity prices were collected in 2023RWF and for the lowest cost item across any category. A commodity was considered affordable if a treatment regimen cost less than one day's wages, using the international poverty line to approximate a low-income worker's wages. Across all health facilities, mean availability of SBE commodities was relatively good (77.1%). Snake antivenom was only available at public hospitals and was concentrated in urban rather than rural areas. Two snake antivenom types were observed, one of which was not appropriate for treating envenomation by East African snakes. Overall, this meant that only 4.2% of facilities stocked safe and effective antivenom. Black stones, an ineffective traditional treatment, were sold by 5.6% of health providers. Moreover, antivenom did not meet the minimum threshold for affordability, costing on average 10 days of work for a single dose among uninsured individuals. Altogether, this study highlights serious performance gaps among pharmacies responsible for procuring and supplying SBE commodities and helps to explain the widespread belief that SBE treatment is unaffordable at hospitals and health centers. Urgent action is needed to ensure that all hospital and health center pharmacies located in high-risk areas stock appropriate antivenom and that re-stocking time for essential medicines is reduced.
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Affiliation(s)
- Janna M Schurer
- Center for One Health, University of Global Health Equity, Butaro, Rwanda; Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine at Tufts University, North Grafton, USA.
| | - Elijah Murara
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | | | - Gaby Ooms
- Health Action International, Amsterdam, the Netherlands; Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.
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Salim A, Williams J, Abdel Wahab S, Adeshokan T, Almeida JR, Williams HF, Vaiyapuri R, Senthilkumaran S, Thirumalaikolundusubramanian P, Patel K, Baksh MF, Lewin MR, Vaiyapuri S. Identifying key factors contributing to treatment costs for snakebite envenoming in private tertiary healthcare settings in Tamil Nadu, India. PLoS Negl Trop Dis 2023; 17:e0011699. [PMID: 37844081 PMCID: PMC10602377 DOI: 10.1371/journal.pntd.0011699] [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: 06/23/2023] [Revised: 10/26/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND India suffers ~58,000 annual deaths due to snakebites. The 'Big Four' snakes (Russell's viper, Indian cobra, common krait, and saw-scaled viper) that are responsible for most bites cause diverse clinical effects. Delayed treatment increases the risk of serious complications and treatment costs. Although government hospitals offer free treatment for snakebites in India, most patients opt for private healthcare, which is an out-of-pocket expense as they often lack health insurance coverage. This study aims to analyse snakebite treatment costs in private tertiary care hospitals in Tamil Nadu, India and identifies the key factors contributing to treatment costs. METHODOLOGY/PRINCIPAL FINDINGS The treatment cost details for 913 snakebite victims were collected from 10 private tertiary care hospitals across Tamil Nadu. The data were classified into hospital, pharmacy, investigation, and laboratory costs, and analysed to determine various factors that contribute to the costs. The results demonstrate that the average treatment costs vary widely for different snakes. The hospital and pharmacy costs are higher than investigation and laboratory costs for all snakebites. Notably, Russell's viper bites cost significantly more than the bites from other snakes. Overall, the type of snake, nature of complications, specialist treatments required, and arrival time to hospitals were identified as some of the key factors for higher treatment costs. CONCLUSIONS/SIGNIFICANCE These data demonstrate that ~80% of snakebite patients can be treated with INR 100,000 (~GBP 1000 or USD 1200) or less. This study emphasises the urgent need to improve rural medical care by providing appropriate training for healthcare professionals and essential resources to facilitate early assessment of patients, administer the initial dose of antivenom and refer the patients to tertiary care only when needed. Moreover, the outcome of this study forms a basis for developing appropriate policies to regulate snakebite treatment costs and provide affordable medical insurance for vulnerable communities.
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Affiliation(s)
- Anika Salim
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - Jarred Williams
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | - Tade Adeshokan
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | - José R. Almeida
- School of Pharmacy, University of Reading, Reading, United Kingdom
| | | | | | | | | | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - M. Fazil Baksh
- Department of Mathematics and Statistics, University of Reading, Reading, United Kingdom
| | - Matthew R. Lewin
- California Academy of Sciences, San Francisco, California, United States of America
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Bhaumik S, Norton R, Jagnoor J. Structural capacity and continuum of snakebite care in the primary health care system in India: a cross-sectional assessment. BMC PRIMARY CARE 2023; 24:160. [PMID: 37563556 PMCID: PMC10416377 DOI: 10.1186/s12875-023-02109-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND In 2019, the World Health Organization, set a target to halve the burden of snakebite, by 2030, and identified 'health systems strengthening' as a key pillar of action. In India, the country with most snakebite deaths, the Union Government identified (in September 2022) training of health workers as a priority action area. In this policy context, we provide empirical evidence by analysing the most recent nationwide survey data (District Level Household and Facility Survey - 4), to assess structural capacity and continuum of snakebite care in primary health care system in India. METHODOLOGY We evaluated structural capacity for snakebite care under six domains: medicines, equipment, infrastructure, human resources, governance and finance, and health management information systems (HMIS). We categorised states (aspirant, performer, front-runner, achiever) based on the proportion of primary health centres (PHC) and community health centres (CHC), attaining highest possible domain score. We assessed continuum of snakebite care, district-wise, under five domains (connectivity to PHC, structural capacity of PHC, referral from PHC to higher facility, structural capacity of CHC, referral from CHC to higher facility) as adequate or not. RESULTS No state excelled ( front-runner or achiever) in all six domains of structural capacity in PHCs or CHCs. The broader domains (physical infrastructure, human resources for health, HMIS) were weaker compared to snakebite care medicines in most states/UTs, at both PHC and CHC levels. CHCs faced greater concerns regarding human resources and equipment availability than PHCs in many states. Among PHCs, physical infrastructure and HMIS were aspirational in all 29 assessed states, while medicines, equipment, human resources, and governance and finance were aspirational in 8 (27.6%), 2 (6.9%), 17 (58.6%), and 12 (41.4%) states respectively. For CHCs, physical infrastructure was aspirational in all 30 assessed states/UTs, whereas HMIS, medicines, equipment, human resources, and governance and finance were aspirational in 29 (96.7%), 11 (36.7%), 27 (90%), 26 (86.7%), and 3 (10%) states respectively. No district had adequate continuum of snakebite care in all domains. Except for transport availability from CHC to higher facilities (48% of districts adequate) and transport availability from PHC to higher facilities (11% of districts adequate), fewer than 2% of districts were adequate in all other domains. CONCLUSION Comprehensive strengthening of primary health care, across all domains, and throughout the continuum of care, instead of a piece-meal approach towards health systems strengthening, is necessitated to reduce snakebite burden in India, and possibly other high-burden nations with weak health systems. Health facility surveys are necessitated for this purpose.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
- Injury Division, The George Institute for Global Health, New Delhi, India.
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Imperial College, London, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Okot DF, Namukobe J, Vudriko P, Anywar G, Heydenreich M, Omowumi OA, Byamukama R. In Vitro Anti-Venom Potentials of Aqueous Extract and Oils of Toona ciliata M. Roem against Cobra Venom and Chemical Constituents of Oils. Molecules 2023; 28:molecules28073089. [PMID: 37049851 PMCID: PMC10096364 DOI: 10.3390/molecules28073089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
There are high mortality and morbidity rates from poisonous snakebites globally. Many medicinal plants are locally used for snakebite treatment in Uganda. This study aimed to determine the in vitro anti-venom activities of aqueous extract and oils of Toona ciliata against Naja melanoleuca venom. A mixture of venom and extract was administered intramuscularly in rats. Anticoagulant, antiphospholipase A2 (PLA2) inhibition assay, and gel electrophoresis for anti-venom activities of oils were done. The chemical constituents of the oils of ciliata were identified using Gas chromatography-tandem mass spectroscopy (GC-MS/MS). The LD50 of the venom was 0.168 ± 0.21 µg/g. The venom and aqueous extract mixture (1.25 µg/g and 3.5 mg/g) did not cause any rat mortality, while the control with venom only (1.25 µg/g) caused death in 1 h. The aqueous extract of T. ciliata inhibited the anticoagulation activity of N. melanoleuca venom from 18.58 min. to 4.83 min and reduced the hemolytic halo diameter from 24 to 22 mm. SDS-PAGE gel electrophoresis showed that oils completely cleared venom proteins. GC-MS/MS analysis showed that the oils had sesquiterpene hydrocarbons (60%) in the volatile oil (VO) and oxygenated sesquiterpenes (48.89%) in the non-volatile oils (NVO). Some major compounds reported for the first time in T. ciliata NVOs were: Rutamarin (52.55%), β-Himachalol (9.53%), Girinimbine (6.68%) and Oprea1 (6.24%). Most compounds in the VO were reported for the first time in T. ciliata, including the major ones Santalene (8.55%) and Himachal-7-ol (6.69%). The result showed that aqueous extract and oils of T. ciliata have anti-venom/procoagulant activities and completely neutralized the venom. We recommend a study on isolation and testing the pure compounds against the same venom.
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Affiliation(s)
- David Fred Okot
- Department of Chemistry, Makerere University, Kampala P.O. Box 7062, Uganda
- Centre for Snakebites and Venom Research, Department of Chemistry, Gulu University, Gulu P.O. Box 166, Uganda
| | - Jane Namukobe
- Department of Chemistry, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Patrick Vudriko
- Research Centre for Tropical Diseases and Vector Control, Department of Veterinary Pharmacy, Clinics and Comparative Medicine, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Godwin Anywar
- Department of Plant Sciences, Microbiology & Biotechnology, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Matthias Heydenreich
- Institute of Chemistry, University of Potsdam, Karl-Liebknecht-Str. 24-25, D-14476 Potsdam, Germany
| | - Oyedeji Adebola Omowumi
- Department of Chemical & Physical Sciences, Faculty of Natural Sciences, Walter Sisulu University, Private Bag X1, Mthatha 5099, South Africa
| | - Robert Byamukama
- Department of Chemistry, Makerere University, Kampala P.O. Box 7062, Uganda
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Francis MF, Vianney SJM, Heitz-Tokpa K, Kreppel K. Risks of snakebite and challenges to seeking and providing treatment for agro-pastoral communities in Tanzania. PLoS One 2023; 18:e0280836. [PMID: 36763599 PMCID: PMC9916632 DOI: 10.1371/journal.pone.0280836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Continuous occurrence of snakebite incidences and the vulnerability of some communities remain a critical problem in sub-Saharan Africa. Despite causing permanent disability to almost half a million people annually and numerous deaths, snakebite and associated complications are still largely neglected. This study aimed at elucidating risk factors associated with snakebite cases, treatment availability and case management practices for vulnerable agro-pastoralist communities in Northern Tanzania. METHODS Data was collected in the Monduli (Arusha region) and the Simanjiro (Manyara region) districts in Tanzania. Interviews with 101 snakebite victims or their guardians and 13 health professionals from 3 health centers in the districts were conducted. Additionally, case records of patients admitted between 2007 and 2019 to the Meserani Snakebite Clinic were obtained. RESULTS This study showed that appropriate treatment for snakebite including anti-venom, is difficult to access and that snakebite incidences were significantly linked to factors such as gender, age, socio-economic activity, season of the year, and whether being at home or out in the fields. Anti-venom and trained health professionals were only available at the Meserani Snake Park Clinic. Men were bitten most often (χ2 = 62.08, df = 4, p-value < 0.0001). Overall, adults between the ages of 18 and 60 years (χ2 = 62.08, df = 4, p-value < 0.0001) received most bites, usually while outdoors herding cattle in the dry season. A significant majority of victims looked for traditional treatment first (52.7%, χ2 = 29.541, df = 2, p-value = 0.0001). The results of this study present crucial information on what is needed to improve the accessibility to appropriate treatment after a snakebite among agro-pastoral communities. CONCLUSION The situation regarding morbidity and mortality due to the inaccessibility of common treatment for snakebite in northern Tanzania is challenging. Reliance on traditional medicine exacerbates the situation. There is dire need to involve affected communities, researchers, the government, clinicians and the public in general, to work together and take part in the global snakebite initiative. Communities and health professionals recognise the underlying challenges and have valuable suggestions on how to improve the situation.
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Affiliation(s)
- Monica Fredrick Francis
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bio-Engineering, Nelson Mandela - African Institution of Science and Technology, Arusha, Tanzania
- * E-mail:
| | - Sr. John-Mary Vianney
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bio-Engineering, Nelson Mandela - African Institution of Science and Technology, Arusha, Tanzania
| | - Kathrin Heitz-Tokpa
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Katharina Kreppel
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bio-Engineering, Nelson Mandela - African Institution of Science and Technology, Arusha, Tanzania
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Schurer JM, Hirwa EM, Masimbi O, Nduwayezu R. Knowledge, attitudes, and practices: a quantitative assessment of hospital physicians and medical interns treating snakebite envenomation in Rwanda. Trans R Soc Trop Med Hyg 2022; 116:645-654. [DOI: 10.1093/trstmh/trab187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Snakebite envenomation (SBE) is a serious and potentially life-threatening condition that most often targets rural, subsistence-based farmers in sub-Saharan Africa. Rwanda is home to 13 venomous and medically important snake species. Those bitten are known to seek care from traditional healers and/or formal health facilities. No information is available on patient management at government health facilities.
Methods
This quantitative evaluation aimed to characterize knowledge, attitudes and practices related to snakebite management in Rwanda. Target respondents included physicians working at hospitals with the highest SBE caseload and medical interns. Respondents were asked to complete questionnaires on paper or online through Qualtrics.
Results
Overall, 105 physicians and 171 interns agreed to participate. Our findings suggest that overall knowledge scores were low for both groups (mean 49.4%, minimum–maximum 31.3–70.8%). Respondents were keen to receive SBE training but often lacked essential supplies needed to adhere to recommended guidelines for SBE management. One-third of respondents (34.8%) believed that traditional healers could manage SBE successfully and two-thirds (66.3%) felt that black stone therapy was an appropriate first aid practice.
Conclusions
These findings indicate a clear need for improved curricula related to SBE, enhanced supply chain management and practical mechanisms for supporting clinicians.
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Affiliation(s)
- Janna M Schurer
- Center for One Health, University of Global Health Equity , Kigali, Rwanda
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine at Tufts University , North Grafton, MA, USA
| | - Elise M Hirwa
- Center for One Health, University of Global Health Equity , Kigali, Rwanda
| | - Ornella Masimbi
- Educational Development and Quality Center, University of Global Health Equity , Kigali, Rwanda
| | - Richard Nduwayezu
- School of Medicine and Pharmacy, University of Rwanda , Kigali, Rwanda
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“At the hospital they do not treat venom from snakebites”: A qualitative assessment of health seeking perspectives and experiences among snakebite victims in Rwanda. Toxicon X 2022; 14:100100. [PMID: 35243331 PMCID: PMC8885568 DOI: 10.1016/j.toxcx.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/29/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
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Larson PS, Ndemwa M, Thomas AF, Tamari N, Diela P, Changoma M, Mohamed A, Larson MC, Ketenci KC, Goto K, Kaneko S. Snakebite victim profiles and treatment-seeking behaviors in two regions of Kenya: results from a health demographic surveillance system. Trop Med Health 2022; 50:31. [PMID: 35488352 PMCID: PMC9052588 DOI: 10.1186/s41182-022-00421-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Snakebites are a major cause of permanent injury and death among poor, rural populations in developing countries, including those in East Africa. This research characterizes snakebite incidence, risk factors, and subsequent health-seeking behaviors in two regions of Kenya using a mixed methods approach. METHODS As a part of regular activities of a health demographic surveillance system, household-level survey on snakebite incidence was conducted in two areas of Kenya: Kwale along the Kenyan Coast and Mbita on Lake Victoria. If someone in the home was reported to have been bitten in the 5 years previous to the visit, a survey instrument was administered. The survey gathered contextual information on the bite, treatment-seeking behavior and clinical manifestations. To obtain deeper, contextual information, respondents were also asked to narrate the bite incident, subsequent behavior and outcomes. RESULTS 8775 and 9206 households were surveyed in Kwale and Mbita, respectively. Out of these, 453 (5.17%) and 92 (1.00%) households reported that at least one person had been bitten by a snake in the past 5 years. Deaths from snakebites were rare (4.04%), but patterns of treatment seeking varied. Treatment at formal care facilities were sought for 50.8% and at traditional healers for 53.3%. 18.4% sought treatment from both sources. Victims who delayed receiving treatment from a formal facility were more likely to have consulted a traditional healer (OR 8.8995% CI [3.83, 20.64]). Delays in treatment seeking were associated with significantly increased odds of having a severe outcome, including death, paralysis or loss of consciousness (OR 3.47 95% CI [1.56; 7.70]). CONCLUSION Snakebite incidence and outcomes vary by region in Kenya, and treatment-seeking behaviors are complex. Work needs to be done to better characterize the spatial distribution of snakebite incidence in Kenya and efforts need to be made to ensure that victims have sufficient access to effective treatments to prevent death and serious injury.
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Affiliation(s)
- Peter S Larson
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, Kenya, Nagasaki, Nagasaki, Japan. .,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA. .,University of Michigan Institute for Social Research, Ann Arbor, MI, USA.
| | - Morris Ndemwa
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, Kenya, Nagasaki, Nagasaki, Japan
| | - Aleksandra F Thomas
- University of Michigan, Literature, Science and the Arts, Ann Arbor, MI, USA
| | - Noriko Tamari
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, Kenya, Nagasaki, Nagasaki, Japan
| | - Paul Diela
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, Kenya, Nagasaki, Nagasaki, Japan
| | - Mwatasa Changoma
- Nagasaki University Institute of Tropical Medicine-Kenya Medical Research Institute (NUITM-KEMRI) Project, Kenya, Nagasaki, Nagasaki, Japan.,Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Kaan Cem Ketenci
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Kensuke Goto
- Division of Health and Safety Sciences Education, Osaka Kyoiku University, Osaka, Japan
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Yusuf AJ, Aleku GA, Bello UR, Liman DU. Prospects and Challenges of Developing Plant-Derived Snake Antivenin Natural Products: A Focus on West Africa. ChemMedChem 2021; 16:3635-3648. [PMID: 34585514 DOI: 10.1002/cmdc.202100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/23/2021] [Indexed: 11/06/2022]
Abstract
Snakebite envenomation (SBE) is an important public health issue that is now receiving renewed attention following its reclassification as a Neglected Tropical Disease (NTD). Most incidences occur in rural areas of resource-limited countries, as such, timely and appropriate medical care for SBE is often inaccessible. The administration of anti-snake venom serum (ASV) is the only effective definitive treatment of SBE, but treatment failure to available ASVs is not uncommon. Emerging evidence highlights the potential of small-molecule compounds as inhibitors against toxins of snake venom. This presents an encouraging prospect to develop an alternative therapeutic option for the treatment SBE, that may be amenable for use at the point of care in resource-constraint settings. In view of the pivotal role of natural products in modern drug discovery programmes, there is considerable interest in ethno-pharmacological mining of medicinal plants and plant-derived medicinal compounds toward developing novel snake venom-neutralising therapeutics. In this review, we compile a collection of medicinal plants used in the treatment of SBE in West Africa and highlight their promise as potential botanical drugs or as sources of novel small-molecule compounds for the treatment of SBE. The challenges that must be surmounted to bring this to fruition including the need for (sub) regional collaboration have been discussed.
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Affiliation(s)
- Amina J Yusuf
- Department of Pharmaceutical & Medicinal Chemistry, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Godwin A Aleku
- Department of Biochemistry, University of Cambridge, Cambridge, CB2 1GA, UK
| | - Usman Rabiu Bello
- Biotechnology unit, Department of Life Sciences, Mewar University, Gangrar, Chittorgarh, Rajasthan, India
| | - Dahiru Umar Liman
- Department of Pharmaceutical & Medicinal Chemistry, Usmanu Danfodiyo University, Sokoto, Nigeria
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Carey TA. Solving the Puzzle of Global Health Inequity: Completing the Picture Piece by Piece by Piece. ACTA ACUST UNITED AC 2021; 1:195-208. [PMID: 34622214 PMCID: PMC8397854 DOI: 10.1007/s43477-021-00022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
Achieving health equity is an ongoing priority for the global community. Understanding, supporting, and addressing the challenges that face health workers is a critical component of the solution to this problem. The University of Global Health Equity (UGHE) in Rwanda has established the Institute of Global Health Equity Research (IGHER) to contribute to the generation of new knowledge through high-quality research and research training that seeks to improve our understanding of the important issues that influence the distribution of health and healthcare globally. With an unrelenting emphasis on increased impact by prioritizing implementation research, IGHER is particularly interested in amassing a compendium of important research lessons to increase the likelihood that effective implementation strategies will be employed to enhance healthcare service provision. IGHER organizes research according to five foundational research questions, which address different elements that are pivotal to a comprehensive approach to appreciating the nuanced realities of effective healthcare service provision. UGHE outputs for 2020 indicate that: appropriate resourcing of healthcare services is critical for the eradication of global health inequities; policy reform is required for many healthcare innovations and initiatives to be implemented adequately; and high-quality research that is applicable to different contexts is essential for eradicating global health inequities. Furthermore, reimagining healthcare delivery will benefit from an intentional, ongoing, bidirectional influence between evidence-based pedagogy (methods and practices of teaching, education, and instruction) and supporting research activity such that education and instruction inform the research conducted and research findings are fed back to the classroom to help improve education and instruction. As IGHER continues to grow, the valuable insights afforded by high-impact implementation research will increase. These insights will help to inform the development and use of evidence-based implementation strategies for the adoption, scaling, and sustainability of equitable, effective, and efficient health services globally.
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Affiliation(s)
- Timothy A Carey
- Institute of Global Health Equity Research, University of Global Health Equity, PO Box 6955, Kigali, 20093 Rwanda
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Ooms GI, van Oirschot J, Okemo D, Waldmann B, Erulu E, Mantel-Teeuwisse AK, van den Ham HA, Reed T. Availability, affordability and stock-outs of commodities for the treatment of snakebite in Kenya. PLoS Negl Trop Dis 2021; 15:e0009702. [PMID: 34398889 PMCID: PMC8389522 DOI: 10.1371/journal.pntd.0009702] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/26/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Annually, about 2.7 million snakebite envenomings occur globally. Alongside antivenom, patients usually require additional care to treat envenoming symptoms and antivenom side effects. Efforts are underway to improve snakebite care, but evidence from the ground to inform this is scarce. This study, therefore, investigated the availability, affordability, and stock-outs of antivenom and commodities for supportive snakebite care in health facilities across Kenya. METHODOLOGY/PRINCIPAL FINDINGS This study used an adaptation of the standardised World Health Organization (WHO)/Health Action International methodology. Data on commodity availability, prices and stock-outs were collected in July-August 2020 from public (n = 85), private (n = 36), and private not-for-profit (n = 12) facilities in Kenya. Stock-outs were measured retrospectively for a twelve-month period, enabling a comparison of a pre-COVID-19 period to stock-outs during COVID-19. Affordability was calculated using the wage of a lowest-paid government worker (LPGW) and the impoverishment approach. Accessibility was assessed combining the WHO availability target (≥80%) and LPGW affordability (<1 day's wage) measures. Overall availability of snakebite commodities was low (43.0%). Antivenom was available at 44.7% of public- and 19.4% of private facilities. Stock-outs of any snakebite commodity were common in the public- (18.6%) and private (11.7%) sectors, and had worsened during COVID-19 (10.6% versus 17.0% public sector, 8.4% versus 11.7% private sector). Affordability was not an issue in the public sector, while in the private sector the median cost of one vial of antivenom was 14.4 days' wage for an LPGW. Five commodities in the public sector and two in the private sector were deemed accessible. CONCLUSIONS Access to snakebite care is problematic in Kenya and seemed to have worsened during COVID-19. To improve access, efforts should focus on ensuring availability at both lower- and higher-level facilities, and improving the supply chain to reduce stock-outs. Including antivenom into Universal Health Coverage benefits packages would further facilitate accessibility.
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Affiliation(s)
- Gaby Isabelle Ooms
- Health Action International, Amsterdam, The Netherlands
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | - Aukje K Mantel-Teeuwisse
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Hendrika A van den Ham
- Utrecht Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Tim Reed
- Health Action International, Amsterdam, The Netherlands
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