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Snakebite envenoming

2019; Elsevier BV; Volume: 393; Issue: 10167 Linguagem: Inglês

10.1016/s0140-6736(18)32762-4

1474-547X

Christian J. Hunter, Karl-Heinz Piechazek, Peter M Nyarango, Timothy Rennie,

Rabies epidemiology and control

Joshua Longbottom and colleagues (July 12, 2018, p 673)1Longbottom J Shearer FM Devine M et al.Vulnerability to snakebite envenoming: a global mapping of hotspots.Lancet. 2018; 392: 673-684Summary Full Text Full Text PDF PubMed Scopus (166) Google Scholar published modelling data that support the assertion that snake envenoming is a major health issue affecting remote and rural tropical regions. As pointed out in the accompanying Comment,2Isbister GK Silva A Addressing the global challenge of snake envenoming.Lancet. 2018; 392: 619-620Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar the major limitation of the study is that actual snakebites are not reported. Here, we report the number of snakebite injuries in 1 year at Namibia's major referral hospital. Despite the frequent encounters between snakes and humans in southern Africa, there are few data that show the burden of injury caused by snakebite.3Buys PJ Buys PJC Snakes of Namibia. Gamsberg MacMillan, Namibia2002Google Scholar, 4Muller GJ Modler H Wium CA Marks CJ Veale DJ Snake bite in southern Africa: diagnosis and management.Continuing Medical Education. 2012; 30: 362-382Google Scholar Namibia is a vast and arid country that is sparsely populated, and most of the population lives in rural areas (villages and farms). These factors lead to clinical services being sparsely distributed and to a centralisation of speciality medical services. More than 85 snake species can be found in Namibia, and 11 of them are considered extremely dangerous.3Buys PJ Buys PJC Snakes of Namibia. Gamsberg MacMillan, Namibia2002Google Scholar After receiving permission from the Ministry of Health and Social Services, Windhoek, Namibia, we did a prospective study of snakebites at Namibia's only general referral hospital—Katutura State Hospital, Windhoek, Namibia. We recorded all patients who presented to the casualty department, or were referred to the surgical services from outside the health facilities. De-identified data were recorded when patients presented to the hospital. From August, 2015, to July, 2016, there were 721 snakebites recorded, with a peak in December (figure). Of these, 372 resulted in serious injury. 569 bites happened in regions outside the city, and the patients were transferred to Katutura State Hospital after stabilisation. 123 injured people were children younger than 5 years, 120 injured people were aged 6–18 years old, and 133 injured people were older than 19 years. Children younger than 6 years were affected more by the bites than older children and adults. Of the 33 deaths recorded, 21 were children younger than 6 years. There were probably other patients with snakebites treated at local clinics and health centres that did not require a transfer to the hospital or who died at the location. Deaths outside of the hospital or before the patients were transferred to it were not recorded. The distinct seasonal pattern of the snakebites might be related to the temperature and rainfall changes. 116 (18%) of 721 patients were treated with polyvalent or monovalent antivenom, and 30 (26%) of these patients died. The low administration of antivenom therapy could be a result of supply line deficiency, insufficient knowledge of clinical providers, or other factors. Further studies are needed to understand the burden of snakebite injury in Namibia and other regions where snakes and humans come into contact frequently. We declare no competing interests. Vulnerability to snakebite envenoming: a global mapping of hotspotsIdentifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease. Full-Text PDF Open AccessSnakebite envenomingJoshua Longbottom and colleagues1 addressed snakebite envenoming, which is a major heath issue that affects remote and rural regions of tropical countries. It is a neglected disease that mainly affects people of a lower socioeconomic status. Full-Text PDF