Abstract
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. 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. 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.
Highlights
Access to snakebite care is problematic in Kenya and seemed to have worsened during COVID-19
Efforts should focus on ensuring availability at both lowerand higher-level facilities, and improving the supply chain to reduce stock-outs
Snakebite has been recognised by the World Health Organization (WHO) as a neglected tropical disease (NTD) that seriously impacts people living in rural areas in Africa, Asia, Central and South America, and Oceania
Summary
Snakebite has been recognised by the World Health Organization (WHO) as a neglected tropical disease (NTD) that seriously impacts people living in rural areas in Africa, Asia, Central and South America, and Oceania. It is estimated that each year, about 2.7 million snakebite envenomings occur [1]. Envenomation takes place following the bite of a venomous snake, when a mixture of toxins (venom) is injected during the bite, and can only be effectively treated with high-quality antivenom [1]. Patients usually require further care to treat the symptoms of envenoming and side effects of antivenom administration, such as anaphylactoid reactions and serum sickness [3]. About 2.7 million snakebite envenomings occur globally. Patients usually require additional care to treat envenoming symptoms and antivenom side effects. This study, investigated the availability, affordability, and stock-outs of antivenom and commodities for supportive snakebite care in health facilities across Kenya
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