Abstract
In the Brazilian Amazon, long distances, low healthcare coverage, common use of ineffective or deleterious self-care practices, and resistance to seeking medical assistance have an impact on access to antivenom treatment. This study aimed to estimate snakebite underreporting, and analyze barriers that prevent victims from obtaining healthcare in communities located in 15 municipalities on the banks of the Solimões, Juruá and Purus Rivers, in the remote Western Brazilian Amazon. Information on the participants' demographics, previous snakebites, access to healthcare, time taken to reach medical assistance, use of self-care practices, and the reason for not accessing healthcare were collected through semi-structured interviews. In the case of deaths, information was collected by interviewing parents, relatives or acquaintances. A total of 172 participants who reported having suffered snakebites during their lifetime were interviewed. A total of 73 different treatment procedures was reported by 65.1% of the participants. Participants living in different river basins share few self-care procedures that use traditional medicine, and 91 (52.9%) participants reported that they had access to healthcare. Living in communities along the Juruá River [OR = 12.6 (95% CI = 3.2-49.7; p<0.001)] and the use of traditional medicine [OR = 11.6 (95% CI = 3.4-39.8; p<0.001)] were variables that were independently associated to the lack of access to healthcare. The main reasons for not accessing healthcare were the pprioritization of traditional treatments (70.4%), and the failure to recognize the situation as being potentially severe (50.6%). Four deaths from complications arising from the snakebite were reported, and three of these were from communities on the banks of the Juruá River. Only one of these received medical assistance. We found an unexpectedly high underreporting of snakebite cases and associated deaths. Snakebite victims utilized three main different healing systems: 1) self-care using miscellaneous techniques; 2) official medical healthcare generally combined with traditional practices; and 3) self-care using traditional practices combined with Western medicines. To mitigate snakebite burden in the Brazilian Amazon, an innovative intervention that would optimize timely delivery of care, including antivenom distribution among existing community healthcare centers, is needed.
Highlights
Snakebite envenomings occur through the inoculation of toxins by several species of snakes, and lead to local and systemic manifestations, as well as potential physical and psychological disabilities, which can have enormous social and economic repercussions
The Brazilian government has implemented some organizational arrangements to improve the health care of the riverine population, when it comes to the need for immediate attention, as in the case of snakebite, these policies still seem to be insufficient to avoid complications, sequelae, and deaths
There is a growing body of literature on the treatment practices of snakebite victims who have not consulted any healing specialist for their illness, and it appears as if most cases are initially treated at home using traditional medicines or pharmaceuticals and a great proportion of these cases never comes to the attention of a medical practitioner
Summary
Snakebite envenomings occur through the inoculation of toxins by several species of snakes, and lead to local and systemic manifestations, as well as potential physical and psychological disabilities, which can have enormous social and economic repercussions. Envenomings caused by snakes occur mostly in rural areas, which have low human socioeconomic indexes, poor housing and sanitation conditions, and lack of comprehensive healthcare [3,4]. Rural populations with these risk characteristics face serious difficulties in order to receive adequate treatment since access to healthcare units often involves long journeys, combined with a low availability of means of transportation and significant geographical barriers. Deficiencies in the availability of antivenoms and lack of adequate training of health professionals are factors that compromise patient care, favoring the occurrence of severe cases and deaths due to snakebite envenomations [1,2]
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