Outcome Of Snake Bite Research Articles

Impact of tourniquet use on severity of snakebite envenoming in Chongqing, China: a single-center retrospective study.

To identify risk factors associated with snakebite severity and determine whether tourniquet use can affect the severity and outcome of snakebites. The clinical data of patients who sustained limb snakebites from 1 March 2021 to 31 October 2022 were reviewed. The patients were divided into three groups according to snakebite severity: mild (517 cases), moderate (112 cases), and severe (8 cases). We compared the clinical data of mild versus moderate to severe snakebites. Multivariate logistic regression was used to determine the independent risk factors for moderate to severe snakebites. The study involved 637 patients. There were statistically significant differences in age, tourniquet use, onset time, white blood cell increase, platelet decrease, creatine kinase (CK) increase, activated partial thromboplastin time shortening, and length of stay between patients with mild snakebites and those with moderate to severe snakebites. Multivariate logistic regression analysis showed that age, tourniquet use, and CK increase were independent risk factors for moderate to severe snakebites. The overall severity of snakebites in Chongqing is mild, and the prognosis is good. Age, tourniquet use, and CK increase are independent risk factors for the severity of snakebites. We do not recommend tourniquet use after snakebites in Chongqing.

Snakebite epidemiology, outcomes and multi-cluster risk modelling in Eswatini.

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. 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. 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. 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.

Clinical profile and outcome of snake bite in children at a tertiary care centre in South India

The Journal is the primary organ of Continuing Paediatric Medical Education in Sri Lanka. The journal also has a website. Free full text access is available for all readers.The Sri Lanka Journal of Child Health is now indexed in SciVerse Scopus (Source Record ID 19900193609), Index Medicus for South-East Asia Region (IMSEAR), CABI (Centre for Agriculture and Bioscience International Global Health Database), DOAJ and is available in Google, as well as Google Scholar.The policies of the journal are modelled on the Committee on Publication Ethics (COPE) Guidelines on Principles of Transparency and Best Practice in Scholarly Publishing. Sri Lanka Journal of Child Health is recognised by the International Committee of Medical Journal Editors (ICMJE) as a publication following the ICMJE Recommendations.

English

BACKGROUND The clinical profile and outcome of snake bite varies from place to place and depends on a number of factors including the type of snake bite, place of snake bite, time of bite, season, and duration of presentation after bite. The clinical profile, factors affecting the outcome and the outcome have not been previously well studied. METHODS This is a cross-sectional observational study conducted for a duration of six months from January 2021 to June 2021. Subjects meeting inclusion criteria were enrolled in the study group after obtaining written consent. Patients were evaluated based on the standard pro-forma with detailed history and clinical examination. All relevant investigations to assess systemic envenomation, treatment and outcome were documented in all the patients. RESULTS In the study, 204 (68 %) were male patients and 96 (32 %) were female patients. 108 (36 %) were admitted with venomous snake bite and 192 (64 %) were with non-poisonous snake bite. 52 patients had snake bite on the upper extremities, 234 had snake bite on the lower extremities, 8 patients had snake bite on the trunk whereas 6 patients had bite on other areas of the body. 202 patients had swelling at the bite site, 222 had pain at the site of bite, 86 patients had oozing of blood and 6 patients had vague somatic symptoms. 132 patients had local oedema, 148 had local tenderness, 66 patients had skin necrosis and 16 patients developed blisters at the site of bite. 124 patients had systemic manifestations of which 24 patients had vomiting, 12 patients developed abdominal pain, 10 patients developed anuria/oliguria, 14 patients developed hypotension, 12 patients developed bleeding manifestations, 10 patients developed neurological symptoms and 2 snakebite patients had syncope. Complications and mortality in poisonous snake bite due to renal failure was observed in 38 patients with a mortality of 1 patient, 10 patients developed intravascular haemolysis, 8 patients developed unexplained hypotension, 18 patients developed secondary infection, 4 patients developed intra-cerebral bleeding and 15 patients developed neurotoxity with a mortality of 2 patients. CONCLUSIONS Snake bite is a common problem encountered in tertiary care centres and the most common encountered type of snakebite was haemotoxic bite. Pain at the bite site was the commonest symptom and tenderness at bite site was the commonest sign in patients with snake bite. Mortality in venomous bite was 3.7%. Prolonged bite to needle time, development of renal failure, leukocytosis, neurotoxicity and severe degree of coagulopathy were factors associated with adverse outcome. KEYWORDS Clinical Profile, Outcome, Snake Bite, Tertiary Care Centre

Prevalence and Outcome of Snake Bites Among Children Admitted in the Emergency Pediatric Unit, Federal Medical Centre, Birnin Kebbi, Nigeria.

IntroductionSnakebites are common and constitute an important health problem in many countries of the world, with the greatest burden occurring in rural areas of Asia and Sub-Saharan Africa. They were classified by the World Health Organization as category A of neglected tropical diseases. Most studies on snake envenoming in Nigeria were among adult populations with few among children. This study assessed the prevalence and outcome of snakebite among children in Federal Medical Centre, Birnin Kebbi.MethodsThis was a four-year retrospective study in which the medical records of patients with managed snakebite were reviewed. A study proforma was used to obtain information on socio-demographic characteristics, site of the bite, features of envenoming, pre-hospitalization intervention, hospital treatment, length of hospitalization, and outcome of treatment of the patients.ResultsThere were 19 snakebite cases out of 5,195 admissions during the period under review, giving a prevalence of 0.0037 (3.7/1000) with a male:female ratio of 2:1. The majority (66.7%) of the children were aged between 11 and 15 years and the mean (± SD) age of the study population was 10.5 (± 3.3) years. The lower limb was the site of bite in 10 (55.6%) of the patients and clinical features included local pain (100%), local swelling of varying magnitude (16 (88.9%)), spontaneous bleeding eight (44.4%) among others. Ten (55.65%) patients presented after four hours of bite and the mean (±SD) duration of hospitalization was 2.11 (±0.58) days. Most (77.8%) received at least one form of pre-hospital care while only 66.7% received polyvalent anti-snake venin. The case fatality rate was 5.6% while 55.6% of patients signed against medical advice.ConclusionThere was a low hospital prevalence of snakebite in children in the present study location with associated low mortality but a high rate of discharge against medical advice. Most of the patients had a pre-hospital intervention and anti-snake venin is not readily accessible.

Snakebite Outcome Study in Far west Provincial Hospital Of Nepal

Introduction: Snakebite is well known medical emergencies and cause of hospital admission with significant mortality in our country. Objective of this study is to find out the status and outcome of snake bites envenoming management.
 Methods: This is prospective observational study from 15th April 2018 to 14th April 2019.Data collected all snake bites presented this hospital and observed till discharged, death or referred. Case management was done as per the WHO guideline for the management of snake bite 2016. Permission for study was taken from Medical Superintendent of Seti provincial hospital and informed consent was taken. The data were entered in Microsoft Excel 2007 and analyzed using latest version of SPSS version and appropriate descriptive statistical tools.
 Results: A total of 362 snakebites were landed in the emergency of this hospital during one year period among them 71% non-poisonous and 29% poisonous snake bites. There were 17 deaths (case fatality rate 12%). Among poisonous Krait 36 % were identified snakes and half could not. Major features of envenoming were ptosis,nausea,vomiting and pain abdomen, parotid tenderness, numbness and blister and bleeding in bitten parts. Almost all 86% poisonous bites got 100ml snake venom antiserum. Few cases required additional 10 vials (100ml) and 13.5% required ventilation for respiratory paralysis. There was no mortality in Intensive Care Unit and ward.
 Conclusions: Snake bite is the seasonal life-threatening emergency public health problem; significant numbers of snakebite and mortality but timely intervention has excellent outcome. Community awareness and strengthening health systems are major activities to be done.

Clinical profile and outcome of snake bite in children admitted in a tertiary care institute in the metropolitan city of Karnataka, India

Background: Snake bite is a major medical and public health problem in tropical agricultural world. A high incidence of snake bite envenomation has been reported from rural India, many times the incidence is underestimated due to lack of epidemiological information. The present study analyses the age, mode of presentation, seasonal variation, clinical profile, management and outcome of patients with snake bite in below 18 years of age group of a metropolitan city, India.Methods: This study is a retrospective single centre study conducted in government referral hospital in Bangalore from January 2016 to January 2020 including 53 patients, who presented with a history of snake bite. Clinical data about age, sex, clinical manifestations, complications, management and outcome were analysed.Results: In our study including of 53 patients, maximum snake bites incidents were noted in age group of 6-10 years (47.16%) of the rural population with male predominance (83.01%). Most of the bites occurred during monsoon season (54.71%) in evening time. Bite marks were observed mainly on lower limbs in 71.69% of patients. Tourniquet was the commonly used first aid care (67.92%). Most of the bites were vasculotoxic in (75.47%) followed by neuroparalytic in 15 patients (9.43%) and maximum cases responded to 20 vials of ante venom. Mortality was nil.Conclusions: Snake bite is a life-threatening emergency. The key in minimizing mortality and severe morbidity is aggressive management of sick patient and timely as well as judicious administration of ante snake venom. There is a requirement to sensitize the general public and healthcare personnel on preventive measures, emergency care and treatment of snake bites. The serious clinical features of snake bite warrant early referral and management in tertiary care centers.

Clinical spectrum and out comes of snake bite patients admitted in a tertiary care hospital , A prospective observational hospital based study

Background: Snakebite is a major public health problem and its prevalence is high in India. Insufficient epidemiological data and global neglect of this condition prompted the World Health organization to recognize it as a ‘‘neglected tropical disease’’
 Objective: To study demographic characteristics of snakebite victims, to see clinical symptoms of bite and outcomes of snakebite.
 Methods: A prospective observational hospital-based study carried out from November 2016 to October 2017, in patients with a history of snakebite.
 Results:Total 300 patients were included in this study,170 (56.67%) were bitten by heamotoxic snakes and 130 (43.33%) were bitten by neurotoxic snakes. Majority of patients were in the age group of 20-39 years ( n=153; 51%). Men outnumbered women( n=190; 63.33%), with male to female ratio of 1.7: 1. Higher incidence of snake bite was found in July – September (n=135;45.00 %) followed by April to June( n=124; 41.33%).Majority of patients were farmers in rural areas ( n=242; 80.80%).Out of 300 patients,80required ICU care.In patients with neuroparalytic snake bites, clinical features were; ptosis (n=126; 96.92%),ophthalmoplegia (n=98; 75.38%),respiratory paralysis (n=60; 46.15%),bulbar weakness ( n=74; 56.92%) andabdomen pain(n=25; 19.23%).Clinical features in patients of haemotoxic snake bites were ; bleeding from bite site(n=110; 65.29%) , cellulitis(n=100; 58.82%), gum bleed(n=53; 31.18%), ecchymosis(n=49; 28.82%),epistaxis(n=27; 15.82%),gastrointestinal bleeding(n=25; 14.71%) andhaemoptysis(n=19; 11.18%). Complications observed were acute kidney injury ( n=62; 20.67%) , respiratory failure ( n=51; 17.00%) , DIC( n=7; 2.33%) and ARDS( n=5; 1.67%) . Out of 170 hemotoxic snake bite patients, 157 (92.35%) patients recovered and 13 (7.65%) patients died and out of 130 neurotoxic snake bites, 124 (95.39%) patients recovered and 6 (4.61%) patients died, overall mortality was 6.3%. In our study, bite to needle time was less than 1 hour in 47 patients (15.66%), less than 6 hrs in 120 patients (40%) and more than 24 hours in 45 (15%).
 Conclusion: Snakebite is common in adult males between 20 to 50 years and the commonest site is the lower limb. The majority of the victims are farmers who work in fields. A maximum number of cases presented within 1-6 hours of bite using a tourniquet on the affected limb as first aid. The complications and mortality of snakebite are high.

A Study of Clinical Profile and Outcome of Snake Bite at Tertiary Care Centre in South Rajasthan

A Study of Clinical Profile and Outcome of Snake Bite at Tertiary Care Centre in South Rajasthan

Clinical profile and outcome of snake bite in children

Background: Snake bite is generally considered to be a rural problem and has been linked with environmental and occupational condition is a neglected public health problem. This study was conducted to ascertain clinical profile, complication and outcome of snake bite in pediatric population. Methods: Retrospective observational study was done in Paediatrics wards and Paediatric Intensive care unit of tertiary care institute. A medical record files of 200 patients of snakebite, between the periods of January 2013 to August 2018 were recovered from Medical Record and Statistics Section of Institute. Files were analyzed for demographic data; variables included site of bite, time of bite, type of primary treatment and treatment provider, and type of snake poison, common symptoms suggestive of hematotoxicity, myotoxicity and neurotoxicity. Results: Out of total 200 patients, 59.0% were male and most of snake bites were seen in age group of 6-12 years. All bites were nonprovocative and in 57.5% lower limb was the commonest site of bite. A 81.5% patient were primarily treated by medical personnel, 56.5% patients were received treatment within 1 hour of bite and hospitalized within 6 hours of bite. Cellulitis was commonest complication (39.0%) followed by vasculotoxicity (30%) and neuroparalysis in (27.5%), followed by respiratory paralysis in (19.0%),coagulation (17.0%). Renal replacement therapy was required in 6.5%, blood/blood product transfusion in 11% patients and case fatality rate was 11.5%. Conclusions: The most vulnerable to snake bites are boys aged more than 5 years. There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.

Maternal and Perinatal Outcome, a Case Report of Disseminated Intravascular Coagulation Following Snakebite after Treatment with Polyvalent Anti-snake Bites

Snakebite is not common during pregnancy, but the obstetric consequences are severe and associated with the severity of envenomation. Early stages of pregnancy and treatment delay are risk factors for the poor prognosis. A 20-year-old pregnant woman in 16 weeks of the first pregnancy referred to Zabol Amir Hospital on August 13, 2015, with the history of snakebite on the right foot. Intravenous fluid, 2 units of packed cells and 4 units of fresh frozen plasma (FFP) were administered, however, the coagulopathy and hematuria remained. Polyvalent anti-snakebite serum was injected. At first, 3 vials (30 mg) were injected and due to lack of improvement, four extra doses (40 mg) of polyvalent anti-snakebite serum were administered; then, at the 5th day she was discharged with a good general condition. The follow up was performed on a regular basis including periodic examination, PT and PTT check. Snakebite during pregnancy can lead to a dangerous condition for the mother and fetus. However, early treatment with polyvalent anti-snake serum and appropriate management improved the outcome of snakebite in pregnancy

Clinical profile and outcome of snake bite in children

Background: Snake bite is generally considered to be a rural problem and has been linked with environmental and occupational condition is a neglected public health problem. This study was conducted to ascertain clinical profile, complication and outcome of snake bite in pediatric population. Methods:Retrospective observational study was done in paediatrics wards and Paediatric Intensive care unit of tertiary care institute. A medical record files of 80 patients of snakebite, between the periods of January 2011 to February 2016 were recovered from Medical Record and Statistics Section of Institute. Files were analyzed for demographic data; variables included site of bite, time of bite, type of primary treatment and treatment provider, and type of snake poison, common symptoms suggestive of hematotoxicity, myotoxicity and neurotoxicity.Results: Out of total 80 patients, 58.75% were male and most of snake bites were seen in age group of 6-12 years. Clinically 57.5% patients were presented with signs and symptoms of envenomation and most of them were bitten during the months of June to September. All bites were nonprovocative and in 57.5% lower limb was the commonest site of bite. A 77.5% patient were primarily treated by medical personnel, 56.25% patients were received treatment within 1 hour of bite and hospitalized within 6 hours of bite. Coagulation failure was commonest complication (58.33%) followed by hypotension (25%) in vasculotoxic snake bite and respiratory paralysis (68.18%) in neuroparalytic bites. Renal replacement therapy was required in 5%, blood/blood product transfusion in 11% patients and case fatality rate was 11.25%.Conclusions: The most vulnerable to snake bites are boys aged more than 5 years. There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.

A hospital based study on snake bite poisoning in adults in the western region of Nepal

Snake bite poisoning is an emergency condition with significant morbidity and mortality. It is more prevalent in Terai and Inner Terai regions of Nepal especially during monsoon season. There is no study on snake bite poisoning in adults in this part of the country after the introduction of national snake bite management guideline in 2003. This retrospective study was conducted to evaluate the clinico-epidemiological profile, amount of anti-snake venom used and outcome of snake bites. Six hundred and thirty eight cases of snake bite poisoning above the age of 15 years admitted in emergency department of the hospital, over a period of 6 years from 2004/2005 to 2009/2010 were evaluated retrospectively. The study showed almost equal numbers of bites in males and females (50.3% vs 49.7%) with two third of victims of 15 to 45 years of age. Most of the poisonings (68%) was seen during June, July and August months corresponding to the monsoon season in Nepal. Majority of the victims could not identify the snakes (45 %).Fingers & hands were bitten in majority cases (43 %). Ptosis was observed in all cases of snake bite poisoning. About 21% of the adults had respiratory distress needing respiratory support. Average ASV used was 21.3 vials. Case fatality rate (CFR) was 11.9% with more fatality on those with respiratory distress. As mortality due to snakebite poisoning and consumption of antisnake venom is still high with the use of national protocol 2003, further study to evaluate alternate protocol is recommended.

Epidemiology and fatal outcomes of snakebite in the union territory of Dadra and Nagar Haveli

Background: Snakebite is one of the most neglected public health issues in the tropical and subtropical countries; India, being one of them. It is a medical emergency requiring immediate medical attention issues in poor tribal communities living in the forest area. Objectives: The indigenous factors of any geographical region are unique, and it contributes to the incidence of the snakebite and the outcome. It is necessary to consider the indigenous factors in the preventive and curative policies. The study was conducted to understand the epidemiological, geographical, and demographical aspect of snakebite in the union territory (UT) of Dadra and Nagar Haveli. Materials and Methods: Information concerning incident of venomous snakebite on weekly basis from all government health-care providers as presumptive surveillance. Furthermore, the victim’s demographic information, age, sex, addresses, biting site, and the outcome of the snakebite victims were recorded through Integrated Hospital Management System. Result: The crude incidence rate of snakebites was 21.65/10000, and annual age-standardized mortality rates per 100,000 were 1.1. The males were outnumbered on females. The male and female ratio was observed 1.4:1. Conclusion: The fatal outcomes of snakebite can be reduced in high risk area with implementation of a systematic behaviors change communication and mobilization of victims to the hospital, along with prompt administration of anti-snake venom serum (ASVS).

Effect of distance and delay in access to care on outcome of snakebite in rural north-eastern Nigeria

Snakebite envenoming is a major cause of morbidity and mortality in rural areas of the tropics. Timely administration of effective antivenom remains the mainstay of management. The study was a quantitative descriptive study aimed at exploring the causes and effects of delay, distance and time taken to access care on snakebite outcomes in Nigeria. All prospective snakebite victims reporting to Kaltungo General Hospital were enrolled. Data on demography, date and time bitten, date and time admitted, site of bite, circumstances of snakebite, responsible snake, clinical features, 20-minute whole-blood clotting test, antivenom administered and outcome were recorded. Delay arising from use of traditional first aid (TFA), time elapsed from snakebite to presentation and the shortest distance from bite location to the hospital was calculated or obtained using a global positioning system. The association between delay before hospital presentation and poor outcome was not statistically significant, even though there was a 2% higher likelihood of poor outcome among those with a 1-hour delay compared to those without delay (odds ratio 1.02, 95% confidence interval 1.00-1.03). There was no difference in distance from bite location to hospital between those with a poor outcome (74) compared to those with a good outcome (325). Those with a poor outcome had more severe envenomation requiring more antivenoms and longer hospital stays. Given poor access to antivenom therapy at distant locations ≥100 km, victims were more likely to use TFA such as black 'snake' stone, with consequent prolonged delays. Antivenoms should be more readily available at distant places. Community education on avoiding potentially harmful TFA and prompt access to care is recommended. There is a need to provide snakebite care to multiple peripheral, relatively more rural inaccessible areas.

An epidemiological study of snakebites from rural Haryana

Background: Snakebite is a frequently encountered medical emergency faced mainly by rural populations. It is a significant public health problem in many parts of the world, especially in South Asian countries. Aims: This study aimed to analyze the epidemiological aspects of snakebite among human snakebite victims admitted to the emergency ward of a tertiary care teaching hospital between 2010 and 2012 in rural Haryana. Additional objectives were to study other factors that have a bearing on the outcome of snakebite. Methods: In this cross-sectional study, lists of addresses and contact numbers were prepared for all the snakebite cases admitted to the emergency ward of Maharishi Markandeshwar Institute of Medical Science & Research (MMIMSR), Mullana, Haryana, between June 2010 and May 2012. The subjects eligible for the study were then interviewed to gather epidemiological information. Necessary clinical data were obtained from records. Results: The majority or 49.4% of the victims were in the age group of 31-45 years, followed by 32.91% in the age group of 16-30 years. Of the victims, 20.3% were illiterates. A majority (48.1%) of the victims were manual laborers and farmers. The foot was the most commonly (62.03%) involved part of the body. Most (48.10%) of the snakebite incidents occurred while the victims were doing agricultural work. Further, 64.56% cases were reported during the monsoon season and 41.77% victims were bitten in the bush. Among the subjects, 60.76% received first aid at the site of incident, and 20.25% of them sought hospital care after consulting the traditional healers (ozhas). Time lapsed for seeking hospital treatment was less than 4 h in 55.69% of the cases. The overwhelming majority (83.54%) of snakebite victims recovered after the treatment. Conclusion: This study highlights the need for improving community education, prompt transport of bitten patients to medical care, capacity-building of medical staff at all levels, and availability of anti-snake venom in rural health facilities to reduce snakebite deaths.

Neurotoxic Manifestation of Snake Bite in Bangladesh

Introduction: Snake bite is a potentially life threatening emergency situation physician has to encounter in rural areas of tropical countries in South-East Asia including Bangladesh. Among the venomous snakes in Bangladesh, Neurotoxic snakes like Cobra and Krait are the commonest. In this study neurotoxic manifestation of venomous snakes are clinically observed. Methods: In this series a total 35 snakebite patients with neurological features from May 1999 to June 2001 were included and preexisting neurological cases were excluded. Results: Among the 537 total snake bite cases, the neurotoxic snake bite was 10% with 51 cobra bite and 12 kraits bite. The victims age are in the range of 3.5 years to 85 years with 70% cases are under 30 years of old. There is slight male preponderence with almost same number of bite at home and outside. The common clinical neurotoxic features are ptosis, (100%) external ophthalmoplegia, dysphagia, dysphonia and broken neck sign. The chest movements were reduced in 20 % cases. All 35 cases (100%) were treated with Haffkine polyvalent anti snake venom with 8.6% cases needed 2nd dose. All 35 cases with neurotoxic features were also treated with anti cholinesterses (100%) and among them 14.2% needed ventilatory support. Anti-snake venom reaction was very common in the with pyrogenic reaction (80.64%) and anaphylactic reaction (64.51%). The outcome of snake bite was excellent with 97% recovery with one residual neurological deficit and no fatality. Conclusion: The neurotoxic snake bite has definite characteristics neurological sign and symptoms which could lead to fatality with respiratory paralysis.

Presentation, management, and outcome of snake-bite in two district hospitals in Ghana

INTRODUCTION: the burden of disease represented by snakebites is widely underestimated and often neglected public health problem in the tropics. There is insufficient epidemiological data to guide distribution of antivenin and proper management of venomous snakebites. We describe the presentation, management and outcome of snakebites in two district hospitals in Ghana. METHODS: using data collection sheet, we prospectively documented information on all snakebite victims presenting at two Ghanaian district hospitals from 1st January 2011 to 31st December 2011. RESULTS: 163 snakebites representing incidence of 92/100,000 were recorded with mean age of 24 (16SD) years. 62.0% were males and 41.7% were farmers. Most bites occurred in April (14.3%), June (12.4%) and November (12.4%) and had occurred when victims were involved in farm-related activities (50.3%). Average time of presentation after snakebite was 3.6 (1.0 SD) hours and commonest clinical presentations were pain (93.0%), swelling (84.0%) and bleeding (51%). Of the total cases 76.7% were given antivenon, 96.3% were given antibiotics, 91.4% corticosteroids and 58.3% antihistamines. No mortality was recorded. CONCLUSION: provision of protocols and their strict adherence in the management of snakebites is required to limit unwarranted use of antibiotics and steroids in the management of snakebite. We recommend evaluation of all antivenins imported for management of snakebites to ascertain their effectiveness so as to reduce morbidity and mortality associated with snakebites in this region.

Clinical Features, Management and Outcome of Snake Bite in Children in Manipal Teaching Hospital

Background: Snake bite is a widely distributed and neglected condition with a significant mortality. Medically significant snakes are: Elapidae, which are mainly neurotoxic and Viperidae, which are hemotoxic. Most studies on snake bites are done in Terai belt of Nepal and this is a first study of its kind in children in western region of Nepal. Methods: This was a 7 year retrospective study in Pediatric unit of Manipal Teaching Hospital, Pokhara, Nepal. Relevant data from all cases of snake bite in children up to 18 years of age was collected in a structured proforma and analyzed. Results: Among the 39 cases of Snake bites; it was more in boys (M: F=1.16:1), from rural areas (62%) and was more common during monsoon (64%). The commonest site of bite was foot (64%). Snakes were identifiable in only 23% of the cases. Local swelling (77%) and pain (74%) were common clinical features. Coagulation profile was deranged in 80% of the patients, hematuria was observed in 13% patients and 15% patients had thrombocytopenia. Most of the snakes were hemotoxic (77%) and only 1 case (2.5%) was neurotoxic. Only 44% of the patients received polyvalent anti-snake venom and blood products were required in 51% of the patients. Most patients improved (75%) and the case fatality rate was 2.5%. Conclusion: Most snakes found in mountainous region of Nepal are hemotoxic and lead to deranged coagulation profile. Mortality is low in hemotoxic as compared to neurotoxic envenomations. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 119-124 DOI: http://dx.doi.org/10.3126/njms.v2i2.8954

Presentation and outcome of snake bite among children in Sokoto, North-Western Nigeria

Background: Snake bite with envenomation is a medical emergency. Children are at risk of severe manifestations due to small body mass. Unlike adult population, there is limited data on snake bite among children in Sokoto, North-Western Nigeria. We described the presentation and outcome of snake bite in children presenting to the Emergency Pediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods: Case records of all children managed for snake bites from 1 st January 2003 to 31 st December 2012 were retrospectively reviewed. Demographic and other relevant information were retrieved and data analyzed using Microsoft Excel. Results: Out of 23,570 Pediatric admissions, 36 children had snake bites giving prevalence of 0.0015 (1.5/1000). Male: Female ratio was 1.6:1, with a mean (standard deviation) age of 9.6 ± 2.8 years (range = 1-14 years). Snakebites involved the lower limbs in 52.8%; and at home in 69.4%, and during the night in 58.3% of patients. The highest prevalence of bite was between April and July. Features of envenomation included local swelling (100%), prolonged clotting time (61.1%) and spontaneous hemorrhage (epistaxis and hematemesis) in 11.1%. One patient (2.8%) had seizure which may be incidental, though common causes such as hypoglycemia, malaria and meningitis were excluded by laboratory investigations. Polyvalent anti-snake venom was administered in 29 (80.6%) children, with adverse reaction observed in 13.8% (4/29) of the patients. Thirteen patients (36.1%) signed against medical advice while the remaining 23 (63.9%) were discharged home. Conclusion: Snake envenomation is associated with low morbidity and mortality in our study. Measures aimed at eliminating snake habitats around residential areas should be encouraged.