Abstract
BackgroundSnakebite envenoming causes 81,000–138,000 annual human deaths and pain, terror, or disability in 4.5–5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon.MethodsWe conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using probability-proportional-to-size, 20 villages were randomly selected, then, all inhabited households were systematically selected. Annual incidence and adjusted odds-ratio for predictors were estimated.FindingsAmong the 9,924 participants, 66 suffered a snakebite during the past year: the resulting incidence is 665 (95%CI: 519–841) per 100,000 inhabitants per year. Victims were aged 5-75y (median: 34y), 53% were male and 57% farmer-cultivators. Two children died (case-fatality rate: 3%); 39 (59%) presented severity signs, including 2 (3%) neurotoxic syndromes, 20 (30%) systemic digestive syndromes, and 17 (26%) severe cytotoxic syndromes. Non-severe cases included 20 (30%) mild cytotoxic syndromes and 7 (11%) dry bites. Only two victims (3%) received antivenom. 59 (89%) used family traditional practices, 25 (38%) traditional healers, and 31 (47%) consulted health facilities. Median delays to these three care-options were 5, 45, and 60 minutes, respectively. Traditional treatments included incisions (n = 57; 86%), tourniquets (n = 51; 77%) and black-stones (n = 44; 67%). The two last procedures were also used in health facilities (n = 18). Consulting traditional healers was associated with severity (adjusted-OR: 19.6 (2.5–156), p = 0.005) and complications (aOR: 17.3, 2.4–123, p = 0.004). Long-term disabilities were subjective psychological trauma (n = 47; 71%), finger amputation (n = 1; 2%), ankylosis (n = 1; 2%) and chronic pain (n = 1; 2%).ConclusionsWe observed alarming levels of snakebite incidence, mortality, antivenom scarcity, and use of traditional medicine. It could represent several thousands of victims at national level. We suggested conducting a country-wide study, and improving antivenom supply, first-aid training, for traditional healers and health professionals.
Highlights
Snakebite envenoming is increasingly recognized as a major, deadly tropical disease of public health importance
We suggested conducting a country-wide study, and improving antivenom supply, first-aid training, for traditional healers and health professionals
The elapids endemic to this area are neurotoxic cobras and mambas (e.g. Naja melanoleuca and Dendroaspis jamesoni), whose venoms cause a flaccid paralysis of the cranial nerves, rapidly extending downwards to the respiratory muscles [6]
Summary
Snakebite envenoming is increasingly recognized as a major, deadly tropical disease of public health importance. Snakebite was re-included in the World Health Organization’s (WHO) list of Neglected Tropical Diseases (NTDs) in June 2017 [1,2], highlighting the lack of (i) epidemiological awareness, (ii) adequate prevention and medical training, and (iii) safe, affordable and polyvalent antivenoms in many regions. WHO estimates that yearly 4.5–5.4 million people are bitten by a snake, of which 1.8–2.7 million are envenomed [3,4], leading to about 400,000 amputations or lifelong disabilities, and 81,000–138,000 deaths. Snakebite envenoming causes 81,000–138,000 annual human deaths and pain, terror, or disability in 4.5–5.4 million victims. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon
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