Snakebite victim profiles and treatment-seeking behaviors in two regions of Kenya: results from a health demographic surveillance system

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.

Social adjustment and rehabilitation in international competitors with spinal injuries sustained in military service

One hundred and eighteen competitors, with spinal injuries, attending the First International Ex-Service Wheelchair Games, held in July 1993, were interviewed. Athletes from 17 countries attended. Sixteen competitors were tetraplegic and 102 paraplegic, their injuries are detailed below. The injuries had occurred on average 14.0 years previously: 35 injuries were war injuries a further 10 due to combat training. The paraplegic athletes had spent 9.6 months and the tetraplegic 12.3 months in hospital. Fifty-five spinal stabilizations had been performed, and this was associated with a reduced inpatient stay for the paraplegic athletes (7.7 months vs 11.3 months). Spinal fixation did not affect later employment. Thirty-one athletes worked, and the amount of pension had no significant bearing on the numbers working. There was a mean delay of 38.3 months from injury until return to sport, and only 11.8% of competitors took up sport in the initial rehabilitation period. The differences between operative treatment, inpatient stay and numbers working from the different countries are compared. Financing of attendance and training seemed to be informal, with just over half of the athletes financed by their governments. The role of sport in rehabilitation of those patients with spinal injuries, and specifically those injured whilst serving in the armed forces, is discussed.

Skin lesions occurring in clients with reflex sympathetic dystrophy syndrome

A study was conducted of 198 clients with reflex sympathetic dystrophy syndrome (RSDS) to gather demographic and descriptive data related to the occurrence of skin lesions. Participants ranged in age from 18-78 years, were predominantly women and represented all three stages of RSDS. Findings indicated that clients with RSDS develop distinctive skin lesions in addition to the cutaneous changes described in the literature. Skin lesions occur in the first and second stages of the syndrome. Skin lesions reportedly worsened in 135 clients (68%) when their pain became more severe, and correspondingly, seemed to improve as the pain decreased.

Reflex sympathetic dystrophy syndrome: a longitudinal study

Reflex sympathetic dystrophy syndrome is a multi-symptom, multi-system syndrome which affects all age groups with the common, overriding complaint of severe, unrelenting, burning pain. Affecting millions worldwide, the illness trajectory is poorly understood. A large longitudinal patient study has yielded important preliminary findings, which have implications for nurses caring for a variety of patients in pain.

New thoughts on reflex sympathetic dystrophy syndrome

Chronic pain caused by a sympathetic nervous system aberration must be considered separately from chronic pain resulting from carcinoma, arthritis, neuropathies and other delineated pathology. Because the pathophysiology of these conditions and their associated pain can be explained, treatment modalities can be planned specific to the affected individual and targeted toward the altered physiology. If the pathophysiology is not clearly defined or understood, as is the case in reflex sympathetic dystrophy and other idiopathic pain conditions, then prescription and remediation become a challenge for the healthcare professional and client. New thoughts on the clinical findings, pathogenesis, diagnosis and prognosis are evolving, with inherent implications for neuroscience nursing.

Reflex sympathetic dystrophy syndrome: pain that doesn't stop

This article describes reflex sympathetic dystrophy syndrome and how the nurse's role in early identification of the syndrome can help break the vicious pain cycle these patients experience. Nursing care plans must be directed toward providing emotional support and encouragement, maintaining and/or restoring mobility, and establishing adequate pain control.

Osteitis deformans in the South African negro. A report of 3 cases

Osteitis deformans is a relatively common disease in Caucasians, but rare in the indigenous people in Africa. Three cases of Paget's disease occuring in South African Negroes are reported here. Gene marker studies confirmed the absence of Caucasoid genes in these patients.

Hepatoma presenting as a bone tumour: a case report

Osseous metastases from hepatoma are rare. One patient who had a lesion in the upper humerus is presented.