snakebites.bib

@article{Gomez-Betancur2019,
abstract = {Snakebite envenomation is a life-threatening disease that was recently re-included as a neglected tropical disease (NTD), affecting millions of people in tropical and subtropical areas of the world. Improvement in the therapeutic approaches to envenomation is required to palliate the morbidity and mortality effects of this NTD. The specific therapeutic treatment for this NTD uses snake antivenom immunoglobulins. Unfortunately, access to these vital drugs is limited, principally due to their cost. Different ethnic groups in the affected regions have achieved notable success in treatment for centuries using natural sources, especially plants, to mitigate the effects of snake envenomation. The ethnopharmacological approach is essential to identify the potential metabolites or derivatives needed to treat this important NTD. Here, the authors describe specific therapeutic snakebite envenomation treatments and conduct a review on different strategies to identify the potential agents that can mitigate the effects of the venoms. The study also covers an increased number of literature reports on the ability of natural sources, particularly plants, to treat snakebites, along with their mechanisms, drawbacks and future perspectives.},
author = {G{\'{o}}mez-Betancur, Isabel and Gogineni, Vedanjali and Salazar-Ospina, Andrea and Le{\'{o}}n, Francisco},
doi = {10.3390/molecules24183276},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/G{\'{o}}mez-Betancur et al. - 2019 - Perspective on the Therapeutics of Anti-Snake Venom.pdf:pdf},
issn = {1420-3049},
journal = {Molecules (Basel, Switzerland)},
keywords = {Anti-venom,medicinal plants,plant constituents,snake venom,snakebite treatment},
language = {eng},
month = {sep},
number = {18},
pages = {3276},
pmid = {31505752},
title = {{Perspective on the Therapeutics of Anti-Snake Venom.}},
url = {https://www.mdpi.com/1420-3049/24/18/3276 http://www.ncbi.nlm.nih.gov/pubmed/31505752 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC6767026},
volume = {24},
year = {2019}
}
@article{Quintana-Castillo2020,
abstract = {BACKGROUND: Snakebite is an often-neglected event with a high rate of mortality and is concentrated in poor areas. We aimed to assess the economic impact and health effects of the implementation of interventions for snakebites through a systematic review of the scientific literature. METHODS: Thirty search strategies were conducted in seven databases, applying PRISMA's identification, screening, selection, and inclusion phases. The reproducibility of the selection of studies and the extraction of information were guaranteed. The methodological quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards. Qualitative synthesis and meta-analysis were performed for determining the average cost-effectiveness (ACE) for each death and disability-adjusted life years (DALY) avoided. RESULTS: Six cost-effectiveness studies were included for the supply of antivenom (AV), taken as outcomes on days of hospitalization or in ICU, death and DALYs avoided. All studies only included institutional costs, and majority of them did not specify the analytical model or economic evaluation parameters and did not perform uncertainty analyses. The management protocol standardization with interdisciplinary attention improves ACE of AV. Cost-effectiveness ratio (CER) of treatment with AV was USD 1253 (constant value for the year 2017, adjusted by purchasing power parity) for each death avoided and USD 51 per DALY avoided. CONCLUSION: High cost-effectiveness of the AV treatment for snakebites was evidenced, which shows that the allocation of resources for this event should be a healthcare priority in addition to implementation of strategies that improve the access to, opportunity, and quality of hospital and pre-hospital care and reduce the cost of AV.},
author = {Quintana-Castillo, Juan Carlos and Estrada-G{\'{o}}mez, Sebasti{\'{a}}n and Cardona-Arias, Jaiberth Antonio},
doi = {10.2147/CEOR.S259426},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Quintana-Castillo, Estrada-G{\'{o}}mez, Cardona-Arias - 2020 - Economic Evaluations of Interventions for Snakebites A Systematic Review.pdf:pdf},
issn = {1178-6981},
journal = {ClinicoEconomics and Outcomes Research},
language = {eng},
month = {sep},
pages = {547--554},
pmid = {32982344},
title = {{Economic Evaluations of Interventions for Snakebites: A Systematic Review}},
url = {https://www.dovepress.com/economic-evaluations-of-interventions-for-snakebites-a-systematic-revi-peer-reviewed-article-CEOR},
volume = {Volume 12},
year = {2020}
}
@article{Schioldann2018,
abstract = {BACKGROUND: Snakebite is a major public health problem in many developing countries. Farmers are particularly exposed to snakes, and due to their rural location often experience delays in accessing formal healthcare. The reasons to use traditional healers may include difficulties in accessing formal healthcare, certain beliefs about snakes and snake venom, tradition, and trust in the capacity of traditional healers. Traditional healing, however, may have serious consequences in terms of delays or added complications. There is little in-depth current information about the reasons for its continued use for snakebite. As part of a health services development project to improve health outcomes for snakebite patients, community attitudes to the use of traditional healers were explored in the Mandalay region of Myanmar. METHODOLOGY & FINDINGS: With the objective of learning from local communities, information was generated in three communities using participatory appraisal methods with the communities, and focus group discussions with the local healthcare staff. Many snakebite victims in these communities use traditional healing. Reasons include transport difficulties, low cost for traditional healing, inadequacy of anti-snake venom in the formal healthcare sector, and traditional beliefs, as traditional healing practices are rooted in many cultural and traditional factors. The communities reported that even if access to medical care were improved, traditional healing would continue to be used. CONCLUSION: These findings point to the need for working with traditional healers for prevention, appropriate first aid and timely access to effective treatment for snakebite.},
author = {Schioldann, Eliza and Mahmood, Mohammad Afzal and Kyaw, Mya Myitzu and Halliday, Dale and Thwin, Khin Thida and Chit, Nyein Nyein and Cumming, Robert and Bacon, David and Alfred, Sam and White, Julian and Warrell, David and Peh, Chen Au},
doi = {10.1371/journal.pntd.0006299},
editor = {Chippaux, Jean-Philippe},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Schioldann et al. - 2018 - Why snakebite patients in Myanmar seek traditional healers despite availability of biomedical care at hospita.pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
keywords = {Adolescent,Adult,Attitudes,Child,East Asian Traditional,Female,First Aid,Health Knowledge,Health Services Accessibility,Humans,Male,Medicine,Middle Aged,Myanmar,Neglected Diseases,Patient Acceptance of Health Care,Population Groups,Practice,Rural Population,Snake Bites,Socioeconomic Factors,Surveys and Questionnaires,Young Adult,complications,economics,therapy},
language = {eng},
month = {feb},
number = {2},
pages = {e0006299},
pmid = {29489824},
title = {{Why snakebite patients in Myanmar seek traditional healers despite availability of biomedical care at hospitals? Community perspectives on reasons}},
url = {https://dx.plos.org/10.1371/journal.pntd.0006299},
volume = {12},
year = {2018}
}
@article{Tochie2017,
abstract = {OBJECTIVES Snakebite is an underestimated medical and surgical emergency in developing countries responsible for a high disease burden. Optimal management of snake envenomation in these resource-limited settings is precluded by several public health challenges. In this review, we discuss the disease burden of snakebites in Cameroon and the public health challenges of its management in view of making recommendations essential for policy-making. MEDLINE, African Journals Online and Google Scholar were searched from January 1990 to February 2017 for studies addressing snakebite in Cameroon. Our search extended to include grey literature from book chapters, conference proceedings, theses and documents from organizations. RESULTS Our results suggest that snakebites pose a significant health and economic burden in Cameroon. A composite of factors contributes to the challenge of managing snakebites in Cameroon and include: inadequate disease surveillance; poor health-seeking behaviours of patients; under-production and scarcity of anti-venom serum and the relatively high cost of anti-venom serum. There is an urgent need to revamp the current health policies through health education, promotion and building of sustainable health systems. Disease surveillance and management can be improved by providing refresher courses for healthcare providers and subsidization of the prices of anti-venom serum in pharmacies in the country.},
author = {Tochie, Joel Noutakdie and Temgoua, Mazou N. and Njim, Tsi and Celestin, Danwang and Tankeu, Ronni and Nkemngu, Njinkeng J.},
doi = {10.1186/s13104-017-2718-2},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Tochie et al. - 2017 - The neglected burden of snakebites in Cameroon a review of the epidemiology, management and public health challen.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Tochie et al. - 2017 - The neglected burden of snakebites in Cameroon a review of the epidemiology, management and public health chal(2).pdf:pdf},
issn = {1756-0500},
journal = {BMC research notes},
keywords = {,Anti-venom serum,Cameroon,Envenomation,Public health challenges,Snakebite},
language = {eng},
month = {dec},
number = {1},
pages = {405},
pmid = {28807018},
publisher = {BioMed Central},
title = {{The neglected burden of snakebites in Cameroon: a review of the epidemiology, management and public health challenges}},
url = {http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-017-2718-2 http://www.ncbi.nlm.nih.gov/pubmed/28807018 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5557567},
volume = {10},
year = {2017}
}
@article{Kasturiratne2017,
abstract = {BACKGROUND Snakebite is a major problem affecting the rural poor in many of the poorest countries in the tropics. However, the scale of the socio-economic burden has rarely been studied. We undertook a comprehensive assessment of the burden in Sri Lanka. METHODS Data from a representative nation-wide community based household survey were used to estimate the number of bites and deaths nationally, and household and out of pocket costs were derived from household questionnaires. Health system costs were obtained from hospital cost accounting systems and estimates of antivenom usage. DALYs lost to snakebite were estimated using standard approaches using disability weights for poisoning. FINDINGS 79% of victims suffered economic loss following a snakebite with a median out of pocket expenditure of $11.82 (IQR 2-28.57) and a median estimated loss of income of $28.57 and $33.21 for those in employment or self-employment, respectively. Family members also lost income to help care for patients. Estimated health system costs for Sri Lanka were $ 10,260,652 annually. The annual estimated total number of DALYS was 11,101 to 15,076 per year for envenoming following snakebite. INTERPRETATION Snakebite places a considerable economic burden on the households of victims in Sri Lanka, despite a health system which is accessible and free at the point of care. The disability burden is also considerable, similar to that of meningitis or dengue, although the relatively low case fatality rate and limited physical sequelae following bites by Sri Lankan snakes means that this burden may be less than in countries on the African continent.},
author = {Kasturiratne, Anuradhani and Pathmeswaran, Arunasalam and Wickremasinghe, A. Rajitha and Jayamanne, Shaluka F. and Dawson, Andrew and Isbister, Geoff K. and de Silva, Hithanadura Janaka and Lalloo, David G.},
doi = {10.1371/journal.pntd.0005647},
editor = {Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kasturiratne et al. - 2017 - The socio-economic burden of snakebite in Sri Lanka.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kasturiratne et al. - 2017 - The socio-economic burden of snakebite in Sri Lanka(2).pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kasturiratne et al. - 2017 - The socio-economic burden of snakebite in Sri Lanka(3).pdf:pdf},
issn = {1935-2735},
journal = {PLoS neglected tropical diseases},
keywords = {,Animals,Antivenins,Body weight,Global health,Health Care Costs,Health economics,Humans,Income,Poisoning,Public and occupational health,Snake Bites,Snakebite,Socioeconomic aspects of health,Sri Lanka,economics,epidemiology,therapeutic use,therapy},
language = {eng},
month = {jul},
number = {7},
pages = {e0005647},
pmid = {28683119},
publisher = {Public Library of Science},
title = {{The socio-economic burden of snakebite in Sri Lanka.}},
url = {https://dx.plos.org/10.1371/journal.pntd.0005647 https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005647 http://www.ncbi.nlm.nih.gov/pubmed/28683119 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5500261},
volume = {11},
year = {2017}
}
@article{White2019,
abstract = {Snakebite is predominantly an occupational disease affecting poor rural farmers in tropical regions and was recently added to the World Health Organisation list of Neglected Tropical Diseases (NTD). We document an overview of methodologies developed and deployed in the Myanmar Snakebite Project, a foreign aid project largely funded by the Australian Government, with the core aim to "improve outcomes for snakebite patients". A multidisciplinary team of experts was assembled that worked in a collaborative manner with colleagues in Myanmar, first to identify problems related to managing snakebite and then develop interventions aimed to improve selected problem areas. A broad approach was adopted, covering antivenom production, antivenom distribution and health system management of snakebite. Problems identified in antivenom production included poor snake husbandry resulting in poor survival of captive specimens, lack of geographical diversity; poor horse husbandry, resulting in high mortality, inadequate stock acquisition protocols and data collection, and inappropriate immunisation and bleeding techniques; and inadequate production capacity for freeze dried antivenoms and quality control systems. These problems were addressed in various ways, resulting in some substantial improvements. Antivenom distribution is being reorganised to achieve better availability and utilisation of stock. Health system management of snakebite was assessed across all levels within the area selected for the study, in Mandalay region. A comprehensive community survey indicated that hospital statistics substantially underestimated the snakebite burden, and that access to care by local villagers was delayed by transport and cost issues compounded by lack of antivenom at the most peripheral level of the health service. A health system survey confirmed under-resourcing at the local village level. Prospective case data collection initiated at tertiary hospitals indicated the extent of the snakebite burden on health resources. Interventions initiated or planned include training of health staff, development of a core of senior trainers who can "train the trainers" nationwide in a sustainable way, development and deployment of management guidelines and algorithms for snakebite and a distribution of solar powered fridges to remote health facilities to allow storage of antivenom and prompt treatment of snakebite cases before transfer to major hospitals, thereby reducing the "bite to needle" time.},
author = {White, Julian and Mahmood, Mohammad Afzal and Alfred, Sam and Thwin, Khin Thida and Kyaw, Khin Maung and Zaw, Aung and Warrell, David and Cumming, Robert and Moody, John and Eagles, Debbie and Ragas, Keiran and Dunstan, Nathan and Bacon, David and Hurtado, Plinio and Peh, Chen Au},
doi = {10.1016/j.toxcx.2018.100001},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/White et al. - 2019 - A comprehensive approach to managing a neglected, neglected tropical disease The Myanmar Snakebite Project (MSP).pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/White et al. - 2019 - A comprehensive approach to managing a neglected, neglected tropical disease The Myanmar Snakebite Project (MSP(2).pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/White et al. - 2019 - A comprehensive approach to managing a neglected, neglected tropical disease The Myanmar Snakebite Project (MSP(3).pdf:pdf},
issn = {25901710},
journal = {Toxicon: X},
keywords = {,Antivenom,Community evaluation,Health services development,Prospective clinical studies,Snakebite,Training},
language = {eng},
month = {jan},
pages = {100001},
pmid = {32831344},
title = {{A comprehensive approach to managing a neglected, neglected tropical disease; The Myanmar Snakebite Project (MSP)}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S2590171018300018 http://www.ncbi.nlm.nih.gov/pubmed/32831344 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC7285917},
volume = {1},
year = {2019}
}
@article{Gampini2016,
abstract = {{\textcopyright} 2016 Gampini et al. Background: Snakebite is a common neglected public health issue, especially in poor rural areas of sub-Saharan Africa, Asia and Latin America. Passive immunotherapy with safe and effective antivenom is the only approved treatment for it. This study aimed to determine the incidence of snakebites, and to assess the availability and accessibility of antivenoms, from 2010 to 2014, in Burkina Faso. Methods: The assessment of snakebite cases managed in all health facilities from 2010 to 2014 was performed from the Statistical Yearbook of the Ministry of Health. Antivenom consumption data were collected from the drug wholesalers established in Burkina Faso. Results: Snakebites are among the five leading causes of consultations in health districts. From 2010 to 2014, 114,126 envenomation cases occurred in Burkina Faso, out of which 62,293 (54.6 %) victims have been hospitalized resulting in 1,362 (2 %) deaths. The annual incidence and mortality were respectively 130 bites and 1.75 deaths per 100,000 inhabitants. The amount of antivenom sold by wholesalers were 5,738 vials with a total cost of US$ 539,055 (annual average = US$ 107,811). The high cost of these antivenoms (between US$ 42 and 170 per dose according to brand) limited their use by rural people, the main victims of snakebites, whose income is insufficient. Thus, only 4 % of patients received antivenom treatment over the past five years. The price of antivenom was reduced in 2015 to US$ 3.4 by a public drug wholesaler. Conclusion: The study confirmed the high burden of snakebites in Burkina Faso. To better manage envenomation, Burkina Faso implemented a strategy consisting in seeking affordable sources of antivenom supply of good quality and innovative mechanisms of subsidy.},
author = {Gampini, Sandrine and Nassouri, Sonia and Chippaux, Jean-Philippe Philippe and Semde, Rasman{\'{e}}},
doi = {10.1186/s40409-016-0066-7},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Gampini et al. - 2016 - Retrospective study on the incidence of envenomation and accessibility to antivenom in Burkina Faso(3).pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Gampini et al. - 2016 - Retrospective study on the incidence of envenomation and accessibility to antivenom in Burkina Faso.pdf:pdf},
issn = {1678-9199},
journal = {Journal of Venomous Animals and Toxins including Tropical Diseases},
keywords = {,Antivenom,Burkina Faso,Envenomation,Snakebite},
language = {eng},
month = {dec},
number = {1},
pages = {10},
pmid = {26985188},
publisher = {BioMed Central Ltd.},
title = {{Retrospective study on the incidence of envenomation and accessibility to antivenom in Burkina Faso}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26985188 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4793557 http://www.jvat.org/content/22/1/10},
volume = {22},
year = {2016}
}
@article{Herzel2018,
abstract = {The cost-effectiveness of the standard of care for snakebite treatment, antivenom, and supportive care has been established in various settings. In this study, based on data from South Indian private health-care providers, we address an additional question: “For what cost and effectiveness values would adding adjunct-based treatment strategies to the standard of care for venomous snakebites be cost-effective?” We modeled the cost and performance of potential interventions (e.g., pharmacologic or preventive) used adjunctively with antivenom and supportive care for the treatment of snakebite. Because these potential interventions are theoretical, we used a threshold cost-effectiveness approach to explore this forward-looking concept. We examined economic parameters at which these interventions could be cost-effective or even cost saving. A threshold analysis was used to examine the addition of new interventions to the standard of care. Incremental cost-effectiveness ratios were used to compare treatment strategies. One-way, scenario, and probabilistic sensitivity analyses were conducted to analyze parameter uncertainty and define cost and effectiveness thresholds. Our results suggest that even a 3% reduction in severe cases due to an adjunct strategy is likely to reduce the cost of overall treatment and have the greatest impact on cost-effectiveness. In this model, for example, an investment of $10 of intervention that reduces the incidence of severe cases by 3%, even without changing antivenom usage patterns, creates cost savings of $75 per individual. These findings illustrate the striking degree to which an adjunct intervention could improve patient outcomes and be cost-effective or even cost saving.},
author = {Herzel, Benjamin J. and Samuel, Stephen P. and Bulfone, Tommaso C. and Raj, C. Soundara and Lewin, Matthew and Kahn, James G. and {Soundara Raj}, C. and Lewin, Matthew and Kahn, James G. and Raj, C. Soundara and Lewin, Matthew and Kahn, James G.},
doi = {10.4269/ajtmh.17-0922},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Herzel et al. - 2018 - Snakebite An Exploratory Cost-Effectiveness Analysis of Adjunct Treatment Strategies.pdf:pdf},
issn = {0002-9637},
journal = {The American Journal of Tropical Medicine and Hygiene},
month = {aug},
number = {2},
pages = {404--412},
pmid = {29869597},
publisher = {American Society of Tropical Medicine and Hygiene},
title = {{Snakebite: An Exploratory Cost-Effectiveness Analysis of Adjunct Treatment Strategies}},
url = {http://www.ajtmh.org/content/journals/10.4269/ajtmh.17-0922},
volume = {99},
year = {2018}
}
@article{Michael2018,
abstract = {Background: Snakebite envenoming causes considerable morbidity and mortality in northern Nigeria. The clinician's knowledge of snakebite impacts outcome. We assessed clinicians' knowledge of snakebite envenoming to highlight knowledge and practice gaps for possible intervention to improve snakebite outcomes. Methods: This was a cross-sectional multicentre study of 374 doctors selected from the accident and emergency, internal medicine, family medicine/general outpatient, paediatrics and surgery departments of nine tertiary hospitals in northern Nigeria using a multistage sampling technique. A self-administered questionnaire was used to assess their sociodemographics, knowledge of common venomous snakes, snakebite first aid, snake antivenom treatment and prevention. Results: The respondents' mean age was 35.6±5.8 y. They were predominantly males (70.6%) from urban hospitals (71.9%), from the northwest region (35.3%), in family medicine/general outpatient departments (33.4%), of < 10 years working experience (66.3%) and had previous experience in snakebite management (78.3%). Although their mean overall knowledge score was 70.2±12.6%, only 52.9% had an adequate overall knowledge score. Most had adequate knowledge of snakebite clinical features (62.3%), first aid (75.7%) and preventive measures (97.1%), but only 50.8% and 25.1% had adequate knowledge of snake species that caused most injuries/deaths and anti-snake venom treatment, respectively. Overall knowledge predictors were ≥10 y working experience (odd ratio [OR] 1.72 [95% confidence interval (CI) 1.07 to 2.76]), urban hospital setting (OR 0.58 [95% CI 0.35 to 0.96]), surgery department (OR 0.44 [95% CI 0.24 to 0.81]), northwest/north-central region (OR 2.36 [95% CI 1.46 to 3.82]) and previous experience in snakebite management (OR 2.55 [95% CI 1.49 to 4.36]). Conclusions: Overall knowledge was low. Improvements in overall knowledge may require clinicians' exposure to snakebite management and training of accident and emergency clinicians in the region.},
author = {Michael, Godpower C. and Grema, Bukar A. and Aliyu, Ibrahim and Alhaji, Mohammed A. and Lawal, Teslim O. and Ibrahim, Haliru and Fikin, Aminu G. and Gyaran, Fatima S. and Kane, Kennedy N. and Thacher, Thomas D. and Badamasi, Abba K. and Ogwuche, Emmanuel},
doi = {10.1093/trstmh/try028},
issn = {0035-9203},
journal = {Transactions of The Royal Society of Tropical Medicine and Hygiene},
keywords = {,Clinicians,Knowledge,Nigeria,Snakebite,Tertiary hospitals},
month = {feb},
number = {2},
pages = {47--56},
pmid = {29617989},
publisher = {Oxford University Press},
title = {{Knowledge of venomous snakes, snakebite first aid, treatment, and prevention among clinicians in northern Nigeria: a cross-sectional multicentre study}},
url = {https://academic.oup.com/trstmh/article/112/2/47/4956545},
volume = {112},
year = {2018}
}
@article{Harrison2009,
abstract = {Background: Most epidemiological and clinical reports on snake envenoming focus on a single country and describe rural communities as being at greatest risk. Reports linking snakebite vulnerability to socioeconomic status are usually limited to anecdotal statements. The few reports with a global perspective have identified the tropical regions of Asia and Africa as suffering the highest levels of snakebite-induced mortality. Our analysis examined the association between globally available data on snakebite-induced mortality and socioeconomic indicators of poverty. Methodology/Principal Findings: We acquired data on (i) the Human Development Index, (ii) the Per Capita Government Expenditure on Health, (iii) the Percentage Labour Force in Agriculture and (iv) Gross Domestic Product Per Capita from publicly available databases on the 138 countries for which snakebite-induced mortality rates have recently been estimated. The socioeconomic datasets were then plotted against the snakebite-induced mortality estimates (where both datasets were available) and the relationship determined. Each analysis illustrated a strong association between snakebite-induced mortality and poverty. Conclusions/Significance: This study, the first of its kind, unequivocally demonstrates that snake envenoming is a disease of the poor. The negative association between snakebite deaths and government expenditure on health confirms that the burden of mortality is highest in those countries least able to deal with the considerable financial cost of snakebite. {\textcopyright} 2009 Harrison et al.},
author = {Harrison, Robert A. and Hargreaves, Adam and Wagstaff, Simon C. and Faragher, Brian and Lalloo, David G.},
doi = {10.1371/journal.pntd.0000569},
editor = {White, Julian},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Harrison et al. - 2009 - Snake envenoming A disease of poverty.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Harrison et al. - 2009 - Snake envenoming A disease of poverty(2).pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Harrison et al. - 2009 - Snake envenoming A disease of poverty(3).pdf:pdf},
issn = {1935-2735},
journal = {PLoS Neglected Tropical Diseases},
month = {dec},
number = {12},
pages = {e569},
pmid = {20027216},
title = {{Snake envenoming: A disease of poverty}},
url = {https://dx.plos.org/10.1371/journal.pntd.0000569},
volume = {3},
year = {2009}
}
@article{Chippaux2016,
abstract = {{\textcopyright} 2016 Chippaux et al. During the 6th International Conference on Envenomation by Snakebites and Scorpion Stings in Africa held in Abidjan, from 1 to 5 June 2015, the measures for the management of envenomation were discussed and new recommendations were adopted by the participants. The high incidence and severity of this affliction were confirmed by several studies conducted in African countries. The poor availability of antivenom, particularly because of the cost, was also highlighted. Some experiences have been reported, mainly those regarding the financial support of antivenom in Burkina Faso (more than 90 %) and Togo (up to 60 %) or the mandatory reporting of cases in Cameroon. Key recommendations concerned: improvement of epidemiological information based on case collection; training of health workers in the management of envenomation; policy to promote the use of effective and safe antivenom; and antivenom funding by sharing its costs with stakeholders in order to improve antivenom accessibility for low-income patients.},
author = {Chippaux, Jean Philippe and Akaffou, Marc Hermann and Allali, Bernard Kouadio and Dosso, Mireille and Massougbodji, Achille and Barraviera, Benedito},
doi = {10.1186/s40409-016-0062-y},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Chippaux et al. - 2016 - The 6th international conference on envenomation by Snakebites and Scorpion Stings in Africa A crucial step for.pdf:pdf},
issn = {16789199},
journal = {Journal of Venomous Animals and Toxins Including Tropical Diseases},
keywords = {Africa,Antivenom,Drug policy,Envenomation,Epidemiology},
month = {mar},
number = {1},
publisher = {BioMed Central Ltd.},
title = {{The 6th international conference on envenomation by Snakebites and Scorpion Stings in Africa: A crucial step for the management of envenomation}},
volume = {22},
year = {2016}
}
@article{Ediriweera2016,
abstract = {Background: There is a paucity of robust epidemiological data on snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of snakebite in Sri Lanka. Methodology/Principal Findings: The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country's population) were surveyed. The crude overall community incidence of snakebite, envenoming and mortality were 398 (95% CI: 356–441), 151 (130–173) and 2.3 (0.2–4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. Conclusions/Significance: This study provides community based incidence rates of snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region.},
author = {Ediriweera, Dileepa Senajith and Kasturiratne, Anuradhani and Pathmeswaran, Arunasalam and Gunawardena, Nipul Kithsiri and Wijayawickrama, Buddhika Asiri and Jayamanne, Shaluka Francis and Isbister, Geoffrey Kennedy and Dawson, Andrew and Giorgi, Emanuele and Diggle, Peter John and Lalloo, David Griffith and de Silva, Hithanadura Janaka},
doi = {10.1371/journal.pntd.0004813},
editor = {Raso, Giovanna},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ediriweera et al. - 2016 - Mapping the Risk of Snakebite in Sri Lanka - A National Survey with Geospatial Analysis.pdf:pdf},
issn = {19352735},
journal = {PLoS Neglected Tropical Diseases},
month = {jul},
number = {7},
pages = {e0004813},
title = {{Mapping the Risk of Snakebite in Sri Lanka - A National Survey with Geospatial Analysis}},
url = {https://dx.plos.org/10.1371/journal.pntd.0004813},
volume = {10},
year = {2016}
}
@article{Pandey2016,
abstract = {Background: Venomous snakebite and its effects are a source of fear for people living in southern Nepal. As a result, people have developed a negative attitude towards snakes, which can lead to human-snake conflicts that result in killing of snakes. Attempting to kill snakes increases the risk of snakebite, and actual killing of snakes contributes to loss of biodiversity. Currently, snake populations in southern Nepal are thought to be declining, but more research is needed to evaluate the conservation status of snakes. Therefore, we assessed attitudes, knowledge, and awareness of snakes and snakebite by Chitwan National Park's (CNP) buffer zone (BZ) inhabitants in an effort to better understand challenges to snake conservation and snakebite management. The results of this study have the potential to promote biodiversity conservation and increase human health in southern Nepal and beyond. Methods: We carried out face-to-face interviews of 150 randomly selected CNP BZ inhabitants, adopting a cross-sectional mixed research design and structured and semi-structured questionnaires from January-February 2013. Results: Results indicated that 43 % of respondents disliked snakes, 49 % would exterminate all venomous snakes, and 86 % feared snakes. Farmers were the most negative and teachers were the most ambivalent towards snakes. Respondents were generally unable to identify different snake species, and were almost completely unaware of the need of conserve snakes and how to prevent snakebites. Belief in a snake god, and the ability of snakes to absorb poisonous gases from the atmosphere were among many superstitions that appeared to predispose negativity towards snakes of BZ residents. Conclusion: People with predisposed negativity towards snakes were not proponents of snake conservation. Fear, negativity, ambivalence towards, and ignorance about, snakes and the need for snake conservation were strong indicators of the propensity to harm or kill snakes. It seems that if wanton killing of snakes continues, local snake populations will decline, and rare and endangered snake species may even become locally extirpated. Moreover, inappropriate perception and knowledge about snakes and snakebites may put BZ people at increased risk of venomous snakebite. Therefore, intensive, pragmatic educational efforts focused on natural history and ecology of snakes and prevention of snakebite should be undertaken in communities and at schools and universities.},
author = {Pandey, Deb Prasad and {Subedi Pandey}, Gita and Devkota, Kamal and Goode, Matt},
doi = {10.1186/s13002-016-0092-0},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Pandey et al. - 2016 - Public perceptions of snakes and snakebite management implications for conservation and human health in southern.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Pandey et al. - 2016 - Public perceptions of snakes and snakebite management Implications for conservation and human health in southe(2).pdf:pdf},
issn = {1746-4269},
journal = {Journal of Ethnobiology and Ethnomedicine},
keywords = {Conservation,Ecosystem health,Ethno-ophiology,Key stone species,Snake identification,Snake species diversity,Snake worship,Snakebite},
month = {dec},
number = {1},
pages = {22},
pmid = {27255454},
publisher = {BioMed Central Ltd.},
title = {{Public perceptions of snakes and snakebite management: Implications for conservation and human health in southern Nepal}},
url = {http://ethnobiomed.biomedcentral.com/articles/10.1186/s13002-016-0092-0},
volume = {12},
year = {2016}
}
@article{Williams2019a,
abstract = {Snakebite envenoming (SBE) is a priority neglected tropical disease, which kills in excess of 100,000 people per year. Additionally, many millions of survivors also suffer through disabilities and long-term health consequences. The only treatment for SBE, antivenom, has a number of major associated problems, not least, adverse reactions and limited availability. This emphasises the necessity for urgent improvements to the management of this disease. Administration of antivenom is too frequently based on symptomatology, which results in wasting crucial time. The majority of SBE-affected regions rely on broad-spectrum polyvalent antivenoms that have a low content of case-specific efficacious immunoglobulins. Research into small molecular therapeutics such as varespladib/methyl-varespladib (PLA2 inhibitors) and batimastat/marimastat (metalloprotease inhibitors) suggest that such adjunctive treatments could be hugely beneficial to victims. Progress into toxin-specific monoclonal antibodies as well as alternative binding scaffolds such as aptamers hold much promise for future treatment strategies. SBE is not implicit during snakebite, due to venom metering. Thus, the delay between bite and symptom presentation is critical and when symptoms appear it may often already be too late to effectively treat SBE. The development of reliable diagnostical tools could therefore initiate a paradigm shift in the treatment of SBE. While the complete eradication of SBE is an impossibility, mitigation is in the pipeline, with new treatments and diagnostics rapidly emerging. Here we critically review the urgent necessity for the development of diagnostic tools and improved therapeutics to mitigate the deaths and disabilities caused by SBE.},
author = {Williams and Layfield and Vallance and Patel and Bicknell and Trim and Vaiyapuri},
doi = {10.3390/toxins11060363},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Williams et al. - 2019 - The Urgent Need to Develop Novel Strategies for the Diagnosis and Treatment of Snakebites.pdf:pdf},
issn = {2072-6651},
journal = {Toxins},
keywords = {Diagnostics,Neglected tropical disease,Snakebite envenoming (SBE),Therapeutics,Toxin neutralisation,Venom},
month = {jun},
number = {6},
pages = {363},
title = {{The Urgent Need to Develop Novel Strategies for the Diagnosis and Treatment of Snakebites}},
url = {https://www.mdpi.com/2072-6651/11/6/363},
volume = {11},
year = {2019}
}
@article{Harrison2019,
author = {Harrison, Robert A and Williams, David J},
doi = {10.1093/trstmh/trz096},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Harrison, Williams - 2019 - Outlining progress since the first International Snakebite Awareness Day and some key challenges for next ye.pdf:pdf},
issn = {0035-9203},
journal = {Transactions of The Royal Society of Tropical Medicine and Hygiene},
month = {oct},
number = {10},
pages = {577--578},
publisher = {Oxford University Press (OUP)},
title = {{Outlining progress since the first International Snakebite Awareness Day and some key challenges for next year}},
url = {https://academic.oup.com/trstmh/article/113/10/577/5569788},
volume = {113},
year = {2019}
}
@misc{TheLancet2019,
author = {{The Lancet}},
booktitle = {The Lancet},
doi = {10.1016/S0140-6736(19)31232-2},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/The Lancet - 2019 - Snakebite—emerging from the shadows of neglect.pdf:pdf},
issn = {1474547X},
month = {jun},
number = {10187},
pages = {2175},
publisher = {Lancet Publishing Group},
title = {{Snakebite—emerging from the shadows of neglect}},
volume = {393},
year = {2019}
}
@article{Dehghani2012,
abstract = {BACKGROUND: Snake bites are one of the significant health problems in the tropical and subtropical regions. Snake bite is a common medical emergency in Iran, and the epidemiological features and management of such cases vary from region to region.\n\nOBJECTIVES: This present research study was conducted to obtain new information about the epidemiology of snake bites in the region of Kashan, located in the central part of Iran.\n\nPATIENTS AND METHODS: This research was a descriptive retrospective study. Data from 2004 to 2011 of snakebite cases were collected from case reports. Information included; age and sex of the victim, district, month of incident, mortality, and time of bite.\n\nRESULTS: The results of this study showed that the majority of snake bite patients were male (96%). The age distribution of patients indicated that the greatest rate of snake bites occurred among the 15-24 year old group. Data collected in this study revealed that the highest incidence of snake bite cases took place in summer (60%) and the lowest number occurred in winter, with no snake bite cases being recorded. The peak number of snakebite cases was seen during June-September.\n\nCONCLUSIONS: It was concluded that snake bite cases in Kashan are similar to other areas in Iran from an epidemiological point of view, including; age distribution rates, gender and site of the bites. The existence of Macrov ipera lebetina, a dangerous venomous snake, can cause a range of clinical effects among residents in central parts of Iran, such as Kashan area.},
author = {Dehghani, Rouhullah and Rabani, DavarKhah and {Panjeh Shahi}, Morteza and Jazayeri, Mehrdad and {Sabahi Bidgoli}, Mohammd},
doi = {10.5812/atr.6445},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Dehghani et al. - 2012 - Incidence of Snake Bites in Kashan, Iran During an Eight Year Period (2004-2011).pdf:pdf},
issn = {2251-953X},
journal = {Archives of Trauma Research},
keywords = {Bites and Stings,Snakes,Venoms},
month = {aug},
number = {2},
pages = {67--71},
pmid = {24396746},
publisher = {Kowsar Medical Institute},
title = {{Incidence of Snake Bites in Kashan, Iran During an Eight Year Period (2004-2011)}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24396746 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3876526 http://archtrauma.kaums.ac.ir/article_62098.html},
volume = {1},
year = {2012}
}
@techreport{WHO2017,
author = {WHO},
booktitle = {WHO},
keywords = {asthma [subject],bronchial asthma,injuries [subject],neglected tropical disease [subject],nurses,nursing [subject],trauma care,tropical disease [subject]},
publisher = {World Health Organization},
title = {{WHO | Improving treatment for snakebite patients}},
url = {http://www.who.int/snakebites/treatment/improving_treatment_for_snakebite_patients/en/},
year = {2017}
}
@article{Brown2012,
abstract = {Background: The worldwide neglect of immunotherapeutic products for the treatment of snakebite has resulted in a critical paucity of effective, safe and affordable therapy in many Third World countries, particularly in Africa. Snakebite ranks high among the most neglected global health problems, with thousands of untreated victims dying or becoming permanently maimed in developing countries each year because of a lack of antivenom-a treatment that is widely available in most developed countries. This paper analyses the current status of antivenom production for sub-Saharan African countries and provides a snapshot of the global situation. Methods: A global survey of snake antivenom products was undertaken in 2007, involving 46 current and former antivenom manufacturers. Companies producing antivenom for use in sub-Saharan Africa were re-surveyed in 2010 and 2011. Results: The amount of antivenom manufactured for sub-Saharan Africa increased between 2007 and 2010/11, however output and procurement remained far below that required to treat the estimated 300,000-500,000 snakebite victims each year. Variable potency and inappropriate marketing of some antivenoms mean that the number of effective treatments available may be as low as 2.5% of projected needs. Five companies currently market antivenom for sale in Africa; three others have products in the final stages of development; and since 2007 one has ceased production indefinitely. Most current antivenom producers possess a willingness and capacity to raise output. However inconsistent market demand, unpredictable financial investment and inadequate quality control discourage further production and threaten the viability of the antivenom industry. Conclusion: Financial stimulus is urgently needed to identify and develop dependable sources of high-grade antivenoms, support current and emerging manufacturers, and capitalise on existing unutilised production capacity. Investing to ensure a consistent and sustainable marketplace for efficacious antivenom products will drive improvements in quality, output and availability, and save thousands of lives each year. {\textcopyright} 2012 Brown.},
author = {Brown, Nicholas I.},
doi = {10.1371/journal.pntd.0001670},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Brown - 2012 - Consequences of neglect Analysis of the sub-saharan african snake antivenom market and the global context.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Brown - 2012 - Consequences of neglect Analysis of the sub-saharan african snake antivenom market and the global context(2).pdf:pdf},
issn = {19352727},
journal = {PLoS Neglected Tropical Diseases},
keywords = {Africa South of the Sahara,Antivenins / administration & dosage*,Biological Products / administration & dosage*,Biological Products / supply & distribution*,Drug Industry / trends,Health Services Accessibility / statistics & numer,Humans,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,Neglected Diseases / therapy*,Nicholas I Brown,Non-U.S. Gov't,PMC3367979,PubMed Abstract,Research Support,Snake Bites / therapy*,doi:10.1371/journal.pntd.0001670,pmid:22679521},
month = {jun},
number = {6},
pmid = {22679521},
title = {{Consequences of neglect: Analysis of the sub-saharan african snake antivenom market and the global context}},
url = {https://pubmed.ncbi.nlm.nih.gov/22679521/ /pmc/articles/PMC3367979/?report=abstract https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3367979/},
volume = {6},
year = {2012}
}
@article{Chippaux2017,
abstract = {Jean-Philippe Chippaux discusses the implications and limitations of a new study on the global burden of snakebite.},
author = {Chippaux, Jean Philippe},
doi = {10.1371/journal.pmed.0050221},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Chippaux - 2017 - Snakebite envenomation turns again into a neglected tropical disease!.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Chippaux - 2017 - Snakebite envenomation turns again into a neglected tropical disease!(2).pdf:pdf},
issn = {15491277},
journal = {PLoS Medicine},
month = {nov},
number = {11},
pages = {1538--1539},
publisher = {BioMed Central Ltd.},
title = {{Snakebite envenomation turns again into a neglected tropical disease!}},
volume = {5},
year = {2017}
}
@article{Hamza2016,
abstract = {Background: Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa. Methods: We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (Echis species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs. Results: The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240) for Benin Republic to $281 ($159–457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1—way sensitivity analyses. In addition, the PSA showed that in the majority of iterations ranging from 97.3% in Liberia to 100% in Cameroun, Guinea Bissau, Mali, Nigeria and Senegal, our model results yielded an ICER that fell below the threshold of one time per capita GDP, thus, indicating a high degree of confidence in our results. Conclusions: Therapy for SBE with AV in countries of WA is highly cost-effective at commonly accepted thresholds. Broadening access to effective AVs in rural communities in West Africa is a priority.},
author = {Hamza, Muhammad and Idris, Maryam A. and Maiyaki, Musa B. and Lamorde, Mohammed and Chippaux, Jean Philippe and Warrell, David A. and Kuznik, Andreas and Habib, Abdulrazaq G.},
doi = {10.1371/journal.pntd.0004568},
editor = {de Silva, H Janaka},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Hamza et al. - 2016 - Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa.pdf:pdf},
issn = {19352735},
journal = {PLoS Neglected Tropical Diseases},
month = {mar},
number = {3},
pages = {e0004568},
publisher = {Public Library of Science},
title = {{Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa}},
url = {https://dx.plos.org/10.1371/journal.pntd.0004568},
volume = {10},
year = {2016}
}
@article{Ram2019,
abstract = {BACKGROUND: Snakestone (blackstone) is known to be useful in the treatment of snakebites in different parts of the world for centuries. So far, no empirical study examined its usefulness in snakebite. This study was conducted to know the efficacy of snakestone in snakebite. METHODS: This was a clinic based cross-sectional observational study. Fifty-six consecutive individuals with different snakebites who underwent snakestone treatment were recruited and assessed with demographic clinical pro forma and clinical assessment was done for recovery from snakebite. STATISTICAL ANALYSIS USED: Descriptive and inferential statistics (Kruskal–Wallis test) were used. RESULTS: The mean score on age was 34 years, 8 h since the bite, and 278 stones were used. Number of stone used for treatment varied significantly based on postbite symptom (P P P CONCLUSIONS: Snakestone treatment may be effective in snakebite. Further study is needed to replicate the finding.},
author = {Ram and Jancy, Christy},
doi = {10.4103/IJHAS.IJHAS_45_19},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ram, Jancy - 2019 - Treatment of snakebite with snakestone – A preliminary observational study.pdf:pdf},
issn = {2278-344X},
journal = {International Journal of Health & Allied Sciences},
number = {3},
pages = {155},
publisher = {Medknow Publications and Media Pvt. Ltd.},
title = {{Treatment of snakebite with snakestone – A preliminary observational study}},
url = {http://www.ijhas.in/article.asp?issn=2278-344X;year=2019;volume=8;issue=3;spage=155;epage=158;aulast=Ram},
volume = {8},
year = {2019}
}
@misc{GlobalSnakebiteInitiative,
author = {{Global Snakebite Initiative}},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Global Snakebite Initiative - Unknown - The Antivenom Crisis in Africa.html:html},
title = {{The Antivenom Crisis in Africa |}},
url = {http://www.snakebiteinitiative.org/?page_id=696},
urldate = {2019-10-16}
}
@article{Vongphoumy2015,
abstract = {Background The Lao PDR (Laos) is one of the least developed countries in Asia with an estimated 25% of the population living in poverty. It is the habitat of some highly venomous snakes and the majority of the population earns their living from agricultural activities. Under these circumstances the incidence of snakebites is expected to be high. Methods Two cross-sectional, community-based surveys were performed in Champone and Phin district, Savannakhet province, Lao PDR to estimate snakebite incidence. Multistage random sampling was used. In the first stage approximately 40% of all villages in each district were randomly selected. In the second stage 33% of all households in each village were randomly chosen. Members of the selected households were interviewed about snakebites during the previous 12 months. Results Thirty-five of 9856 interviewees reported a snakebite in a 12 month period in Champone district and 79 of 7150 interviewees in Phin district. The estimated incidence is 355 snakebites per 100,000 persons per year and 1105 per 100,000 in Champone and Phin district respectively. All snakebite victims received treatment by traditional healers or self-treatment at home and nobody went to a hospital. Incidence of snakebites, calculated on the basis of hospital records of 14 district hospitals and Savannakhet provincial hospital, ranged from 3 to 14 cases per 100,000 persons per year between 2012 and 2014. Conclusion Incidence of snakebites is high in rural communities in Laos with significant regional differences. Poverty most likely contributes significantly to the higher number of snakebites in Phin district. Hospital statistics profoundly underestimates snakebite incidence, because the majority of snakebite victims receive only treatment by traditional healers or self-treatment in their village. There is an urgent need to train medical staff and students in management of snakebite patients and make snake antivenom available to cope effectively with this important public health problem in order to prevent fatalities and disabilities.},
author = {Vongphoumy, Inthanomchanh and Phongmany, Panom and Sydala, Sengdao and Prasith, Nouda and Reintjes, Ralf and Blessmann, Joerg},
doi = {10.1371/journal.pntd.0003887},
editor = {Chippaux, Jean-Philippe},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Vongphoumy et al. - 2015 - Snakebites in two rural districts in Lao PDR Community-based surveys disclose high incidence of an invisible.pdf:pdf},
issn = {19352735},
journal = {PLoS Neglected Tropical Diseases},
month = {jun},
number = {6},
pages = {e0003887},
title = {{Snakebites in two rural districts in Lao PDR: Community-based surveys disclose high incidence of an invisible public health problem}},
url = {https://dx.plos.org/10.1371/journal.pntd.0003887},
volume = {9},
year = {2015}
}
@misc{Chippaux1991,
abstract = {The causes and implications of venom variability are discussed with a review of the literature. Venom variability may have an impact on both primary venom research and management of snakebite, including selection of antivenoms and selection of specimens for antivenom production. Choice of venom is reviewed, including venom collection, maintenance, and pooled venom versus venom milked from individual specimens, the latter being more reliable in many applications. Intraspecific variability resulting in clinical variability of envenomation occurs and is reviewed. Venom variability is considered at several levels; interfamily, intergenus, interspecies, intersubspecies and intraspecies, geographical variation, between individual specimens, and in individual specimens, due to seasonal variation, diet, habitat, age-dependent change, and sexual dimorphism. It is concluded that venom researchers must be aware of venom variability both in selecting their sources of venom and in interpretation of results. Producers of antivenom must utilize an understanding of such variability in selecting sources of venom for antivenom production to ensure representation of all venom types required within each antivenom. Furthermore, clinicians treating snakebite should understand the influence of venom variability on both the presentation of envenomation and the treatment implications. {\textcopyright} 1991.},
author = {Chippaux, J. P. and Williams, V. and White, J.},
booktitle = {Toxicon},
doi = {10.1016/0041-0101(91)90116-9},
issn = {00410101},
keywords = {Animals,J P Chippaux,J White,MEDLINE,NCBI,NIH,NLM,National Center for Biotechnology Information,National Institutes of Health,National Library of Medicine,PubMed Abstract,Review,Snake Venoms / chemistry*,Snake Venoms / immunology,Snake Venoms / toxicity,Snakes / physiology*,Species Specificity,V Williams,doi:10.1016/0041-0101(91)90116-9,pmid:1814005},
number = {11},
pages = {1279--1303},
pmid = {1814005},
publisher = {Toxicon},
title = {{Snake venom variability: methods of study, results and interpretation}},
url = {https://pubmed.ncbi.nlm.nih.gov/1814005/},
volume = {29},
year = {1991}
}
@article{Habib2003,
abstract = {Background: There is inequality in vaccination coverage, and adult farmers in tropical rural communities could have missed tetanus toxoid as campaigns target children. Snakebite is not uncommon and partly because of lack of effective antivenom, management in inaccessible areas could be complicated with tetanus in unimmunized victims. Patients and results: Four snakebite victims who developed tetanus were seen in northern Nigeria. Three were bitten while farming and patients took 10-25 days before presenting to hospital. All patients had incised bite sites and applied local medicinal herbs and in one case, a black 'snake' stone. Bites were by the cobra (Naja nigricollis) and carpet viper (Echis ocellatus) in the extremities and victims had swollen limbs and bleeding with incoagulable blood. Three of the patients were given anti-tetanus serum (ATS) after development of tetanus symptoms in a primary facility and only one recalled receipt of one dose of tetanus toxoid prior to bite. Patients had trismus, rigidity, backache, spasms and one had autonomic dysfunction and was managed with antispasmodics, ATS, wound care, antibiotics and supportive measures. Two patients with envenoming and severe tetanus received antivenom, but died. One of the two surviving patients developed osteomyelitis with prolonged hospital stay, while the other recovered with residual disability. Conclusion: Tetanus could follow snakebite in inaccessible rural agricultural communities with inadequate health care provision. Clinical presentation is typical but late and is confounded by snakebite complications leading to considerable morbidity and mortality. The cases highlight the triple problems of inadequacy, inaccessibility and inequality in health care and calls for measures aimed at improvement. {\textcopyright} 2002 Elsevier Science B.V. All rights reserved.},
author = {Habib, A.G.},
doi = {10.1016/S0001-706X(02)00234-6},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib - 2003 - Tetanus complicating snakebite in northern Nigeria.pdf:pdf},
issn = {0001706X},
journal = {Acta Tropica},
keywords = {Northern Nigeria,Snakebite,Tetanus,Tetanus toxoid,Vaccination},
month = {jan},
number = {1},
pages = {87--91},
title = {{Tetanus complicating snakebite in northern Nigeria:}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0001706X02002346},
volume = {85},
year = {2003}
}
@article{Kshirsagar2013,
abstract = {OBJECTIVE A high incidence of snake bite envenomation has been reported from rural India. Due to inadequate epidemiological data, the incidence is underestimated. This study analyses the pattern of snake bite and their management in children in rural areas of Maharashtra, India. To determine the age, mode of presentation, seasonal variation, clinical profile and outcome of patients with snake bite less than 15 years of age. METHODS This study is a retrospective, descriptive study including 162 patients, who presented with history of snake bite. Clinical data about age, sex, clinical manifestations, complications and outcome were obtained from case records and were analyzed. FINDINGS Out of the 162 patients 98 (60.49%) were males. The bites were vasculotoxic in 147 (90.74%) and neuroparalytic in 15 (9.25%) patients. Mainly bites occurred from July to September with 84 (51.85%) bites. Bites were more common in males in age more than 5 years (89%) with bite marks mainly on lower limbs in 120 (74.04%) patients. Deaths were reported in patients who reported late to the hospital with a mortality rate of 1.85%. CONCLUSION Snake bite is a life threatening emergency. The key to minimizing mortality and severe morbidity is aggressive management of the ABC's of resuscitation, and timely and judicious administration of adequate dose of anti-venom.},
author = {Kshirsagar, Vinayak Y. and Ahmed, Minhajuddin and Colaco, Sylvia M.},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kshirsagar, Ahmed, Colaco - 2013 - Clinical profile of snake bite in children in rural India.pdf:pdf},
issn = {2008-2142},
journal = {Iranian journal of pediatrics},
keywords = {Children,Neuroparalytic,Outcome Assessment,Snake Bite,Snake Envenomation,Vasculotoxic},
month = {dec},
number = {6},
pages = {632--6},
pmid = {24910739},
publisher = {Kowsar Medical Publishing Company},
title = {{Clinical profile of snake bite in children in rural India.}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24910739 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4025118},
volume = {23},
year = {2013}
}
@misc{Wedasingha2020,
abstract = {Venom-induced consumption coagulopathy is the most important systemic effect of snake envenoming. Coagulation tests are helpful to accurately and promptly diagnose venom-induced consumption coagulopathy and administer antivenom, which is the only specific treatment available. However, bedside clotting tests play a major role in diagnosing coagulopathy in low-income settings, where the majority of snakebites occur. We conducted a literature search in MEDLINE{\textregistered} from 1946 to 30 November 2019, looking for research articles describing clinical studies on bedside coagulation tests in snakebite patients. Out of 442 articles identified, 147 articles describing bedside clotting assays were included in the review. Three main bedside clotting tests were identified, namely the Lee–White clotting test, 20-min whole blood clotting time and venous clotting time. Although the original Lee–White clotting test has never been validated for snake envenoming, a recently validated version has been used in some South American countries. The 20-min whole blood clotting time test is the most commonly used test in a wide range of settings and for taxonomically diverse snake species. Venous clotting time is almost exclusively used in Thailand. Many validation studies have methodological limitations, including small sample size, lack of case-authentication, the inclusion of a heterogeneous mix of snakebites and inappropriate uses of gold standard tests. The observation times for bedside clotting tests were arbitrary, without proper scientific justification. Future research needs to focus on improving the existing 20-min whole blood clotting test, and also on looking for alternative bedside coagulation tests which are cheap, reliable and quicker.},
author = {Wedasingha, Supun and Isbister, Geoffrey and Silva, Anjana},
booktitle = {Toxins},
doi = {10.3390/toxins12090583},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Wedasingha, Isbister, Silva - 2020 - Bedside Coagulation Tests in Diagnosing Venom-Induced Consumption Coagulopathy in Snakebite.pdf:pdf},
issn = {20726651},
keywords = {Bedside,Clotting test,Envenoming,Snakebite,Venom-induced consumption coagulopathy},
month = {sep},
number = {9},
pmid = {32927702},
publisher = {MDPI AG},
title = {{Bedside Coagulation Tests in Diagnosing Venom-Induced Consumption Coagulopathy in Snakebite}},
volume = {12},
year = {2020}
}
@article{Tchoffo2019,
abstract = {Background: In Cameroon, since the first epidemiological week held in 2015, snakebites have been registered among Potential Epidemic Diseases (PED). In the Centre Region, the most densely populated of the country, weekly reports of snakebites are generated at health districts level for monthly data updates. Methods: To contribute to the better management of snakebite cases, an observational study was conducted to assess the snakebite reporting rate in the Centre Region of Cameroon. The results of this retro-prospective survey were confronted to those of the weekly epidemiological surveillance system, recorded in the PED regional data base. Results: The incidence of bites was relatively high (36.6 bites per 100,000 inhabitants), as well as the general attack rate (about 49 envenomations per 100 victims). The lethality recorded was 2.5% and the mortality was about 1 death per 100,000 inhabitants a year. The sex ratio was largely female biased (61.6%). The bites occurred mostly during the rainy season (73.0%). Bitten victims were mainly farmers (47.4%), and agriculture was the main risk factor. The comparative analysis of the data suggested a high non-reporting rate of snakebite cases (67.8%). Conclusion: Snakebite is an endemic condition in the Centre Region of Cameroon. Because of the high rate of non-reporting of cases, the collection of information from the registers of the health facilities only appears not enough to assess the real importance of envenomation in this Region.},
author = {Tchoffo, D{\'{e}}sir{\'{e}} and Kamgno, Joseph and Kekeunou, S{\'{e}}vilor and Yadufashije, Callixte and {Nana Djeunga}, Hugues C. and Nkwescheu, Armand S{\'{e}}raphin},
doi = {10.1186/s12889-019-7363-3},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Tchoffo et al. - 2019 - High snakebite underreporting rate in the Centre Region of Cameroon An observational study.pdf:pdf},
issn = {14712458},
journal = {BMC Public Health},
keywords = {Cameroon,Centre region,Epidemiological profile,Snakebites,Underreporting},
month = {dec},
number = {1},
pages = {1040},
title = {{High snakebite underreporting rate in the Centre Region of Cameroon: An observational study}},
url = {https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7363-3},
volume = {19},
year = {2019}
}
@article{Warrell2008,
abstract = {Snake bite envenoming, mainly caused by the saw-scaled or carpet viper (Echis ocellatus), is a neglected disease of West Africa. Specific antivenoms can save life and limb but, for various reasons, supply of these essential drugs to Africa has dwindled to less than 2% of estimated requirements. Other problems include maldistribution, inadequate conservation and inappropriate clinical use of antivenoms. In the face of this crisis, several promising new antivenoms have been developed. However, some dangerously inappropriate products of Indian origin are being marketed by unscrupulous manufacturers or distributors in Africa and Papua New Guinea, with disastrous results. A major source of confusion is labelling antivenom with ambiguous snake names that fail to distinguish the Asian species whose venoms are used in their production from the local snakes whose venoms are antigenically dissimilar. {\textcopyright} 2007 Royal Society of Tropical Medicine and Hygiene.},
author = {Warrell, David A.},
doi = {10.1016/j.trstmh.2007.12.005},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Warrell - 2008 - Unscrupulous marketing of snake bite antivenoms in Africa and Papua New Guinea choosing the right product-'What's in a.pdf:pdf},
issn = {00359203},
journal = {Transactions of the Royal Society of Tropical Medicine and Hygiene},
keywords = {Antivenom,Echis ocellatus,Oxyuranus scutellatus canni,Papua New Guinea,Snake bite,Snake taxonomy,West Africa},
month = {may},
number = {5},
pages = {397--399},
title = {{Unscrupulous marketing of snake bite antivenoms in Africa and Papua New Guinea: choosing the right product-'What's in a name?'}},
volume = {102},
year = {2008}
}
@article{Stock2007,
abstract = {To reduce unacceptably high death rates from snakebite envenomation, sub-Saharan Africa must adopt not only a new generation of multivalent biotech antivenoms, but also an infrastructure to deliver them. {\textcopyright} 2007 Nature Publishing Group.},
author = {Stock, Roberto P. and Massougbodji, Achille and Alag{\'{o}}n, Alejandro and Chippaux, Jean-Philippe Philippe},
doi = {10.1038/nbt0207-173},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Stock et al. - 2007 - Bringing antivenoms to Sub-Saharan Africa(2).pdf:pdf},
issn = {1087-0156},
journal = {Nature Biotechnology},
keywords = {Agriculture,Bioinformatics,Biomedical Engineering/Biotechnology,Biomedicine,Biotechnology,Life Sciences,general},
month = {feb},
number = {2},
pages = {173--177},
publisher = {Nature Publishing Group},
title = {{Bringing antivenoms to Sub-Saharan Africa}},
url = {http://www.nature.com/articles/nbt0207-173},
volume = {25},
year = {2007}
}
@article{Chippaux2015,
abstract = {The strategy recommended by the African Society of Toxinology,7 founded 3 years ago, addresses three basic points: better region-specific antivenom development and distribution needs accurate epidemiological studies; medical staff need training to optimise product selection and use; and purchasing support programmes should standardise charges on behalf of stakeholders (governments and private employers, especially agricultural firms, health insurance providers, etc) to mutualise the costs equitably.},
author = {Chippaux, Jean-Philippe and Massougbodji, Achille and Diouf, Amadou and Bald{\'{e}}, Cellou M. and Boyer, Leslie V.},
doi = {10.1016/S0140-6736(15)01104-6},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Chippaux et al. - 2015 - Snake bites and antivenom shortage in Africa.pdf:pdf},
issn = {01406736},
journal = {The Lancet},
month = {dec},
number = {10010},
pages = {2252--2253},
publisher = {Lancet Publishing Group},
title = {{Snake bites and antivenom shortage in Africa}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0140673615011046},
volume = {386},
year = {2015}
}
@article{Leon2018,
abstract = {Snake antivenoms are formulations of animal immunoglobulins used in the treatment of snakebite envenomation. The general scheme for producing snake antivenoms has undergone few changes since its development more than a century ago; however, technological innovations have been introduced in the manufacturing process. These medicines must comply with identity, purity, safety and efficacy profiles, as requested by the current Good Manufacturing Practices (GMPs) applied to modern biopharmaceutical drugs. Industrial production of snake antivenoms comprises several stages, such as: 1) production of reference venom pools, 2) production of hyperimmune plasma, 3) purification of the antivenom immunoglobulins, 4) formulation of the antivenom, 5) stabilization of the formulation, and 6) quality control of in-process and final products. In this work, a general review of the existing technology used for the industrial manufacture of snake antivenoms is presented.},
author = {Le{\'{o}}n, Guillermo and Vargas, Mari{\'{a}}ngela and Segura, {\'{A}}lvaro and Herrera, Mar{\'{i}}a and Villalta, Mauren and S{\'{a}}nchez, Andr{\'{e}}s and Solano, Gabriela and G{\'{o}}mez, Aar{\'{o}}n and S{\'{a}}nchez, Melvin and Estrada, Ricardo and Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a},
doi = {10.1016/j.toxicon.2018.06.084},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Le{\'{o}}n et al. - 2018 - Current technology for the industrial manufacture of snake antivenoms.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Antivenom,Envenomation,Industrial biotechnology,Snake,Venoms},
month = {sep},
pages = {63--73},
publisher = {Elsevier Ltd},
title = {{Current technology for the industrial manufacture of snake antivenoms}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010118302952},
volume = {151},
year = {2018}
}
@article{Pandey2016a,
abstract = {Snakebite envenomation affects thousands of people annually in Nepal. Published hospital-based studies of snakebite treatment in Nepal are scarce. Here we present the results of the first prospective, cross-sectional study of hospitalized envenomed snakebite cases in southcentral Nepal, a region characterized by poor pre-hospital care of snakebites, limited supply and excessive use of antivenom, and a high case/fatality ratio. We seek to identify clinical management problems and suggest potential interventions to improve treatment of snakebites. Out of the 342 patients presented with snakebites to an urban emergency department in the Terai region of Nepal between April and September of 2007, 39 patients were enrolled based on development of ptosis or swelling of bitten body parts. We collected patient demographic information and documented circumstances of snakebite, prehospital care, hospital care, and development of complications. Among 39 envenomated patients admitted to Bharatpur Hospital enrolled in the study 34 (92%) exhibited features of clinically significant neurotoxicity and were treated with antivenom. Antivenom use ranged from 4 to 98 vials of Polyspecific Indian Antivenom per patient. Each of victims (n=34) received antivenom an average of 4.3 (median) ±0.73 (standard error of mean) hours after receiving the snakebite. The overall case fatality rate was 21%. Neurotoxicity developed up to 25.8hr after suspected elapid snakebites. This was not observed for viperid snake bites. No enrolled patients received any of the currently recommended first aid for snake bite. The prevalence of nocturnal elapid snake bites, the practice of inappropriate first aid measures and highly variable administration of antivenom were identified as major challenges to appropriate care in this study. To address these issues we suggest development of a comprehensive checklist for identification of snake species, management of envenomation, and an educational program which teaches proper care at all stages of snakebite treatment.},
author = {Pandey, Deb P and Vohra, Rais and Stalcup, Philip and Shrestha, Bhola R},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Pandey et al. - 2016 - A season of snakebite envenomation presentation patterns, timing of care, anti-venom use, and case fatality rates.pdf:pdf},
issn = {2044-0324},
journal = {Journal of venom research},
pages = {1--9},
pmid = {26998219},
title = {{A season of snakebite envenomation: presentation patterns, timing of care, anti-venom use, and case fatality rates from a hospital of southcentral Nepal.}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26998219 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4776021 http://www.ncbi.nlm.nih.gov/pubmed/26998219%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4776021},
volume = {7},
year = {2016}
}
@misc{Fry2018,
abstract = {Many issues and complications in treating snakebite are a result of poor human social, economic and clinical intervention and management. As such, there is scope for significant improvements for reducing incidence and increasing patient outcomes. Snakes do not target humans as prey, but as our dwellings and farms expand ever farther and climate change increases snake activity periods, accidental encounters with snakes seeking water and prey increase drastically. Despite its long history, the snakebite crisis is neglected, ignored, underestimated and fundamentally misunderstood. Tens of thousands of lives are lost to snakebites each year and hundreds of thousands of people will survive with some form of permanent damage and reduced work capacity. These numbers are well recognized as being gross underestimations due to poor to non-existent record keeping in some of the most affected areas. These underestimations complicate achieving the proper recognition of snakebite's socioeconomic impact and thus securing foreign aid to help alleviate this global crisis. Antivenoms are expensive and hospitals are few and far between, leaving people to seek help from traditional healers or use other forms of ineffective treatment. In some cases, cheaper, inappropriately manufactured antivenom from other regions is used despite no evidence for their efficacy, with often robust data demonstrating they are woefully ineffective in neutralizing many venoms for which they are marketed for. Inappropriate first-aid and treatments include cutting the wound, tourniquets, electrical shock, immersion in ice water, and use of ineffective herbal remedies by traditional healers. Even in the developed world, there are fundamental controversies including fasciotomy, pressure bandages, antivenom dosage, premedication such as adrenalin, and lack of antivenom for exotic snakebites in the pet trade. This review explores the myriad of human-origin factors that influence the trajectory of global snakebite causes and treatment failures and illustrate that snakebite is as much a sociological and economic problem as it is a medical one. Reducing the incidence and frequency of such controllable factors are therefore realistic targets to help alleviate the global snakebite burden as incremental improvements across several areas will have a strong cumulative effect.},
author = {Fry, Bryan G.},
booktitle = {Toxins},
doi = {10.3390/toxins10040170},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Fry - 2018 - Snakebite When the human touch becomes a bad touch(2).pdf:pdf},
issn = {20726651},
keywords = {Antivenom,Envenomation,Snakebite,Venom},
month = {apr},
number = {4},
pages = {170},
title = {{Snakebite: When the human touch becomes a bad touch}},
url = {http://www.mdpi.com/2072-6651/10/4/170},
volume = {10},
year = {2018}
}
@article{Friedrich2018,
abstract = {The World Health Assembly adopted a resolution during its 71st meeting to make snakebite envenoming a high priority. The measure aims to ensure that countries develop a common plan of action to improve access to safe, effective, and affordable treatment for individuals bitten by venomous snakes. Last year, snakebite envenoming was added to the World Health Organization's (WHO's) list of neglected tropical diseases.},
author = {Friedrich, M. J.},
doi = {10.1001/jama.2018.9118},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Friedrich - 2018 - Efforts to Address Snakebite.pdf:pdf},
issn = {15383598},
journal = {JAMA},
month = {jul},
number = {3},
pages = {227},
pmid = {30027253},
title = {{Efforts to Address Snakebite}},
url = {https://jamanetwork.com/journals/jama/article-abstract/2687872 http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2018.9118 http://www.ncbi.nlm.nih.gov/pubmed/30027253},
volume = {320},
year = {2018}
}
@article{Jayawardana2018,
abstract = {Background: Snakebite is an important public health problem in tropical regions of the world. Although devastating effects of envenoming such as kidney failure, tissue necrosis, bleeding diathesis, and neurotoxicity are well known in the acute stage following a snakebite, the long-term effects of snake envenoming have not been adequately studied. Materials and methods: A population-based study was conducted among 8707 residents in a rural district in Sri Lanka to assess the long-term sequelae following snakebite. Health-related complaints that snakebite victims had developed immediately or within 4 weeks of the bite and persisted for more than 3 months, were assessed by interviewer-administered questionnaire and in-depth interviews, and further evaluated by physical examination and relevant investigations. Results: Of the 816 participants who were identified as ever snakebite victims, 112 (13.7%) presented with at least one snakebite-related long-term health complication. Among them, “migraine-like-syndrome” characterized by headache vertigo, and photosensitivity to sunlight was found in 46 (5.6%); musculoskeletal disorders such as pain, local swelling, muscle weakness, deformities, contractures, and amputations were found in 26 (3.2%); visual impairment in 21 (2.6%); acute kidney injury in 4 (0.5%); skin blisters at the bite site in 5 (0.6%); psychological distress in 2 (0.2%); hemiplegia in 1 (0.1%); right-side facial nerve palsy in 1 (0.1%); paresthesia over bite site in 1 (0.1%); generalized shivering in 1 (0.1%); and chronic nonhealing ulcer in 1 (0.1%). Interestingly, 31 (3.8%) reported nonspecific somatic symptoms such as abdominal colic, chest tightness, wheezing, receding gums, excessive hair loss, and lassitude with body aches following the bite. The average duration of symptoms since snakebite was 12.7 years (SD=11.7). Conclusion: This study highlights that a significant proportion of snakebite victims suffer disabling chronic health sequelae. There is a need to place systems to address these unmet health needs.},
author = {Jayawardana, Subashini and Arambepola, Carukshi and Chang, Thashi and Gnanathasan, Ariaranee},
doi = {10.2147/JMDH.S126648},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Jayawardana et al. - 2018 - Long-term health complications following snake envenoming.pdf:pdf},
issn = {11782390},
journal = {Journal of Multidisciplinary Healthcare},
keywords = {Long-term health complications Sri Lanka,Population-based study,Snakebite},
month = {jun},
pages = {279--285},
title = {{Long-term health complications following snake envenoming}},
url = {https://www.dovepress.com/long-term-health-complications-following-snake-envenoming-peer-reviewed-article-JMDH},
volume = {11},
year = {2018}
}
@article{Xu2003,
abstract = {Background: Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. Yet catastrophic expenditure is not rare. We investigated the extent of catastrophic health expenditure as a first step to developing appropriate policy responses. Methods: We used a cross-country analysis design. Data from household surveys in 59 countries were used to explore, by regression analysis, variables associated with catastrophic health expenditure. We defined expenditure as being catastrophic if a household's financial contributions to the health system exceed 40% of income remaining after subsistence needs have been met. Findings: The proportion of households facing catastrophic payments from out-of-pocket health expenses varied widely between countries. Catastrophic spending rates were highest in some countries in transition, and in certain Latin American countries. Three key preconditions for catastrophic payments were identified: the availability of health services requiring payment, low capacity to pay, and the lack of prepayment or health insurance. Interpretation: People, particularly in poor households, can be protected from catastrophic health expenditures by reducing a health system's reliance on out-of-pocket payments and providing more financial risk protection. Increase in the availability of health services is critical to improving health in poor countries, but this approach could raise the proportion of households facing catastrophic expenditure; risk protection policies would be especially important in this situation.},
archivePrefix = {arXiv},
arxivId = {arXiv:hep-th/9912205},
author = {Xu, Ke and Evans, David B. and Kawabata, Kei and Zeramdini, Riadh and Klavus, Jan and Murray, Christopher J.L. JL J.L. JL L},
doi = {10.1016/S0140-6736(03)13861-5},
eprint = {9912205},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Xu et al. - 2003 - Household catastrophic health expenditure A multicountry analysis.pdf:pdf},
isbn = {1474-547X (Electronic)\r0140-6736 (Linking)},
issn = {01406736},
journal = {Lancet},
month = {jul},
number = {9378},
pages = {111--117},
pmid = {12867110},
primaryClass = {arXiv:hep-th},
publisher = {Elsevier},
title = {{Household catastrophic health expenditure: A multicountry analysis}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0140673603138615 http://www.ncbi.nlm.nih.gov/pubmed/12867110},
volume = {362},
year = {2003}
}
@article{Hasan2012,
abstract = {The present study aims to assess the different types of costs for treatment of snake bite patients, to quantify household economic impact and to understand the coping mechanisms required to cover the costs for snake bite patients in Bangladesh. The patients admitted to four tertiary level hospitals in Bangladesh were interviewed using structured questionnaires including health-care-related expenditures and the way in which the expenditures were covered. Of the snakes which bit the patients, 54.2% were non-venomous, 45.8% were venomous and 42.2% of the patients were given polyvalent antivenom. The total expenditure related to snake bite varies from US$4 (US$1 = Taka 72) to US$2294 with a mean of US$124 and the mean income loss was US$93. Expenditure for venomous snake bite was US$231, which is about seven times higher than non-venomous snake bite (US$34). The treatment imposes a major economic burden on affected families, especially in venomous snake bite cases. {\textcopyright} 2012, SAGE Publications. All rights reserved.},
author = {Hasan, S. M.K. K and Basher, A and Molla, A. A. and Sultana, N. K. and Faiz, M. A.},
doi = {10.1258/td.2011.110137},
issn = {17581133},
journal = {Tropical Doctor},
month = {jan},
number = {1},
pages = {41--43},
pmid = {22223726},
title = {{The impact of snake bite on household economy in Bangladesh}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22223726},
volume = {42},
year = {2012}
}
@article{Mills2014,
abstract = {O ver the past 10 years, debates on global health have paid increasing attention to the importance of health care systems, which encompass the institutions, organizations, and resources (physical, financial, and human) assembled to deliver health care services that meet population needs. It has become especially important to emphasize health care systems in low-and middle-income countries because of the substantial external funding provided for disease-specific programs, especially for drugs and medical supplies, and the relative under-funding of the broader health care infrastructures in these countries. 1 A function ing health care system is fundamental to the achievement of universal coverage for health care, which has been the focus of recent statements by advocacy groups and other organizations around the globe, including a declaration by the United Nations in 2012. 2 Recent analyses have drawn attention to the weaknesses of health care systems in low-and middle-income countries. For example, in the 75 countries that account for more than 95% of maternal and child deaths, the median proportion of births attended by a skilled health worker is only 62% (range, 10 to 100%), and women without money or coverage for this service are much less likely to receive it than are women with the means to pay for it. 3 Lack of financial protection for the costs of health care means that approximately 100 million people are pushed below the poverty line each year by payments for health care, 4 and many more will not seek care because they lack the necessary funds. In response to such deficiencies in the health care system, a number of countries and their partners in development have been introducing new approaches to financing , organizing, and delivering health care. This article briefly reviews the main weaknesses of health care systems in low-and middle-income countries, lists the most common responses to those weaknesses, and then presents three of the most popular responses for further review. These responses, which have attracted considerable controversy, involve the questions of whether to pay for health care through general taxation or contributory insurance funds to improve financial protection for specific sections of the population, whether to use financial incentives to increase health care utilization and improve health care quality, and whether to make use of private entities to extend the reach of the health care system. This review draws on what is now quite an extensive literature on the deficiencies of health care systems 1 and on the Health Systems Evidence database. 5 However , the poor quality and uneven coverage of evidence on the strengthening of health care systems means that evidence of deficiencies is stronger than evidence of remedies. Moreover, the specific circumstances of individual countries strongly influence both decisions about which approaches might be relevant and their success , so any generalizations made from health systems research in particular countries must be carefully considered. 6 It is unlikely that there is one single blueprint},
author = {Mills, Anne},
doi = {10.1056/NEJMra1110897},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Mills - 2014 - Health Care Systems in Low- and Middle-Income Countries.pdf:pdf},
issn = {0028-4793},
journal = {New England Journal of Medicine},
month = {feb},
number = {6},
pages = {552--557},
publisher = {Massachussetts Medical Society},
title = {{Health Care Systems in Low- and Middle-Income Countries}},
url = {http://www.nejm.org/doi/10.1056/NEJMra1110897},
volume = {370},
year = {2014}
}
@article{Sarkhel2017,
abstract = {Objective Snakebite is a serious medical problem in Paschim Medinipur district, West Bengal, India. In the present study, hospital based data on snakebite cases and deaths were collected from 10 blocks of the district to obtain a picture of this neglected public health issue. Methods Retrospective data of snakebite and deaths from 2012 to 2016 was collected from the 5 Rural hospitals (RH) and 5 Block level Primary Health Centres(BPHC) of the ten blocks of Paschim Medinipur district in a prescribed format addressing issues including the demographic factors regarding the victims, seasonal pattern, history of snakebite in previous 5 years, outcome of the bite, any reporting of death. Results A total number of 1633 snakebites were reported in the study during the period of 2012–2016. The hospital data from the ten blocks reported 17 deaths due to snakebite in the given period. It was found that about 34% of the snake bites occurred from June to September. The age-wise distribution of snakebite cases show that majority of snakebite affected cases were within the age of 21–45 years. Males(62%) suffered more than the females(38%). The case fatality rate reported from the hospital based data was 1.04%. 60% of the snakebites occurred during morning to noon hours. The clinical manifestation of snakebite included regional edema in the affected limb, hypotension, malaise, vomiting, abdominal pain and diarrhea. The bite to hospital time was found to be 120 ± 6.5 mins(n = 750 cases) and bite to ASV injection time was found to be 270 ± 3.5 mins(n = 750 cases). Conclusion Snakebite is a neglected health issue in Paschim Medinipur district. Lack of snakebite data is due to under reporting. In the present study we have attempted to investigate the official data available on snakebite from 10 blocks of Paschim Medinipur district which has been identified for high snakebite incidence.},
author = {Sarkhel, Sumana and Ghosh, Rituparna and Mana, Koushik and Gantait, Kripasindhu},
doi = {10.1016/j.toxrep.2017.07.007},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Sarkhel et al. - 2017 - A hospital based epidemiological study of snakebite in Paschim Medinipur district, West Bengal, India.pdf:pdf},
issn = {22147500},
journal = {Toxicology Reports},
keywords = {Paschim Medinipur,Snakebite,hospital -based data},
pages = {415--419},
title = {{A hospital based epidemiological study of snakebite in Paschim Medinipur district, West Bengal, India}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S2214750017300501},
volume = {4},
year = {2017}
}
@misc{Gerardo2019,
abstract = {Importance: Venomous snakebite severity ranges from an asymptomatic dry bite to severe envenomation and death. The clinical evaluation aids in prognosis and is essential to determine the risks and potential benefits of antivenom treatment. Objectives: To identify historical features, clinical examination findings, basic laboratory testing, and clinical grading scales that will risk-stratify patients with pit viper snake envenomation for severe systemic envenomation, severe tissue injury, and/or severe hematologic venom effects. Data Sources: We conducted a structured search of PubMed (1966-October 3, 2017) and Embase database (1980-October 3, 2017) to identify English-language studies that evaluated clinical features predictive of severe envenomation. Study Selection: We included studies that evaluated the test performance of at least 1 clinical finding with an acceptable reference standard of severe envenomation for venomous snakes of the Western Hemisphere. Only studies involving the most common subfamily, Crotalinae (pit vipers), were evaluated. Seventeen studies with data were available for abstraction. Data Extraction and Synthesis: The clinical features assessed and severity outcome measures were extracted from each original study. We assessed severity in 3 categories: systemic toxicity, tissue injury, and hematologic effects. Differences were resolved by author consensus. Results: The pooled prevalence of severe systemic envenomation was 14% (95% CI, 9%-21%). The pooled prevalence of severe tissue injury and severe hematologic venom effects were 14% (95% CI, 12%-16%) and 18% (95% CI, 8%-27%), respectively. Factors increasing the likelihood of severe systemic envenomation included the time from bite to care of 6 or more hours (likelihood ratio [LR], 3.4 [95% CI, 1.1-6.4]), a patient younger than 12 years (LRs, 3.2 [95% CI, 1.5-7.1] and 2.9 [95% CI, 1.3-6.2]), large snake size (LR, 3.1 [95% CI, 1.5-5.7]), and ptosis (LRs, 1.4 [95% CI, 1.0-2.1] and 3.8 [95% CI, 1.8-8.3]). Envenomation by the genus Agkistrodon (copperhead and cottonmouth), as opposed to rattlesnakes, decreased the likelihood of severe systemic envenomation (LR, 0.28 [95% CI, 0.10-0.78]). Initial hypofibrinogenemia (LR, 5.1 [95% CI, 1.7-15.0]) and thrombocytopenia (LR, 3.7 [95% CI, 1.9-7.3]) increased the likelihood of severe hematologic venom effects. Other clinical features from history, physical examination, or normal laboratory values were not discriminative. Conclusions: Clinical features can identify patients at increased risk of severe systemic envenomation and severe hematologic venom effects, but there are few features that are associated with severe tissue injury or can confidently exclude severe envenomation. Physicians should monitor patients closely and be wary of progression from nonsevere to a severe envenomation and have a low threshold to escalate therapy as needed.},
author = {Gerardo, Charles J. and Vissoci, Jo{\~{a}}o R.N. and Evans, C. Scott and Simel, David L. and Lavonas, Eric J.},
booktitle = {JAMA Surgery},
doi = {10.1001/jamasurg.2018.5069},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Gerardo et al. - 2019 - Does This Patient Have a Severe Snake Envenomation The Rational Clinical Examination Systematic Review.pdf:pdf},
issn = {21686254},
month = {apr},
number = {4},
pages = {346--354},
pmid = {30758508},
publisher = {American Medical Association},
title = {{Does This Patient Have a Severe Snake Envenomation?: The Rational Clinical Examination Systematic Review}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/30758508},
volume = {154},
year = {2019}
}
@misc{Ardayfio2020,
author = {Ardayfio, Rosemary and Della, Ocloo Russell},
booktitle = {Graphic Communications Group Ltd},
pages = {3--11},
title = {{Ghana records average of 9,600 snakebites a year}},
url = {https://www.graphic.com.gh/news/health/ghana-records-average-of-9-600-snakebites-a-year.html},
urldate = {2020-07-30},
year = {2020}
}
@misc{WorldHealthOrganisationWHO,
author = {{World Health Organisation (WHO)}},
title = {{Snakebite}},
url = {https://www.who.int/health-topics/snakebite#tab=tab_1},
urldate = {2020-04-06}
}
@article{JPChippauxAMassougbodjiRPStock2007,
author = {{JP Chippaux, A Massougbodji, RP Stock}, A Alag{\'{o}}n},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/JP Chippaux, A Massougbodji, RP Stock - 2007 - Investigators of African Antivipmyn in Benin. Clinical trial of a F(ab')2 polyvalent equi.pdf:pdf},
journal = {Am J Trop Med Hyg},
number = {3},
pages = {538--46},
title = {{Investigators of African Antivipmyn in Benin. Clinical trial of a F(ab')2 polyvalent equine antivenom for African snakebites in Benin}},
volume = {77},
year = {2007}
}
@article{Lam2016,
abstract = {{\textcopyright} 2016 Lam et al. Background: Although considered a public health issue in Senegal, the actual incidence and mortality from snakebite are not known. In the present study, an epidemiological survey was carried out in K{\'{e}}dougou region, southeastern Senegal, where envenomations, particularly by Echisocellatus, are frequent and severe. Methods: Three sources of data were used: records from health centers and reports by health professionals; traditional healers; and household surveys. Results: The annual incidence and mortality provided by health centers were 24.4 envenomations and 0.24 deaths per 100,000 population, respectively. The annual incidence recorded by traditional healers was 250 bites per 100,000 inhabitants, but the number of deaths was unknown. Finally, the household surveys reported an annual incidence of 92.8 bites per 100,000 inhabitants and an annual mortality rate of 2.2 deaths per 100,000 inhabitants. The differences in incidence and mortality between the different methods were explained by significant bias, resulting in particular from the complex patient's healthcare-seeking behavior. The incidence provided by health records should be used to specify the immediate quantitative requirements of antivenoms and places where they should be available first. Conclusion: Mandatory reporting of cases would improve the management of envenomation by simplifying epidemiological surveys. Patients' preference for traditional medicine should prompt health authorities to urge traditional healers to refer patients to health centers according to defined clinical criteria (mainly edema and bleeding or neurotoxic symptoms). Finally, household surveys were likely to reflect the actual epidemiological situation. Poison Control Center of Senegal should continue its work to sensitize stakeholders and train health staff.},
author = {Lam, Absa and Camara, Bouna and Kane, Oumar and Diouf, Amadou and Chippaux, Jean Philippe},
doi = {10.1186/s40409-016-0064-9},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Lam et al. - 2016 - Epidemiology of snakebites in K{\'{e}}dougou region (eastern Senegal) Comparison of various methods for assessment of inci.pdf:pdf},
issn = {16789199},
journal = {Journal of Venomous Animals and Toxins Including Tropical Diseases},
keywords = {Envenomation,Epidemiology,Incidence,Senegal,Snakebite},
month = {mar},
number = {1},
publisher = {BioMed Central Ltd.},
title = {{Epidemiology of snakebites in K{\'{e}}dougou region (eastern Senegal): Comparison of various methods for assessment of incidence and mortality}},
volume = {22},
year = {2016}
}
@article{Pathmeswaran2006,
abstract = {The outcome of snakebite is related to the biting species but it is often difficult to identify the biting snake, particularly in community settings. We have developed a clinical scoring system suitable for use in epidemiological surveys, with the main aim of identifying the presumed biting species in those with systemic envenoming who require treatment. The score took into account ten features relating to bites of the five medically important snakes in Sri Lanka, and an algorithm was developed applying different weightings for each feature for different species. A systematically developed artificial data set was used to fine tune the score and to develop criteria for definitive identification. The score was prospectively validated using 134 species-confirmed snakebites. It correctly differentiated the bites caused by the three snakes that commonly cause major clinical problems (Russell's viper (RV), kraits and cobra) from other snakes (hump-nosed viper (HNV) and saw-scaled viper (SSV)) with 80% sensitivity and 100% specificity. For individual species, sensitivity and specificity were, respectively: cobra 76%, 99%; kraits 85%, 99%; and RV 70%, 99%. As anticipated, the score was insensitive in the identification of bites due to HNV and SSV. {\textcopyright} 2005 Royal Society of Tropical Medicine and Hygiene.},
author = {Pathmeswaran, A and Kasturiratne, A and Fonseka, M and Nandasena, S and Lalloo, D G and de Silva, H J},
doi = {10.1016/j.trstmh.2005.10.003},
issn = {00359203},
journal = {Transactions of the Royal Society of Tropical Medicine and Hygiene},
keywords = {Epidemiology,Snakebite,Sri Lanka},
month = {sep},
number = {9},
pages = {874--878},
pmid = {16412486},
title = {{Identifying the biting species in snakebite by clinical features: an epidemiological tool for community surveys}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16412486},
volume = {100},
year = {2006}
}
@article{Jayawardana2016,
abstract = {Background: Snakebite is a major public health problem in agricultural communities in the tropics leading to acute local and systemic impairments with resultant disabilities. Snakebite related long-term musculoskeletal disabilities have been a neglected area of research. We conducted a population-based, cross-sectional study in an agricultural community to describe the chronic musculoskeletal disabilities of snake envenoming. Methodology/Principal Findings: A sample representative of residents of a single district in a region of high incidence of snake envenoming was recruited to identify ever snakebite victims. They were evaluated for chronic musculoskeletal disabilities that had developed immediately or within four weeks after the snakebite and persisted over three months. In-depth interviews, validated musculoskeletal functional assessment criteria and specialists' examinations were utilised. Among the 816 victims, 26 (3.2%, 95% confidence interval: 2.2–4.6%) had musculoskeletal disabilities, persisting on average for 13.4 years (SD = 14.4). The disabilities were mostly in lower limbs (61.5%) and ranged from swelling (34.6%), muscle wasting (46.1%), reduced motion (61.5%), reduced muscle power (50%), impaired balance (26.9%), chronic non-healing ulcers (3.85%), abnormal gait (3.85%), fixed deformities (19.2%) to amputations (15.4%). Based on disability patterns, six snakebite-related musculoskeletal syndromes were recognised. The offending snakes causing disabilities were cobra (30.8%), Russell's viper (26.9%) and hump-nosed viper (7.7%). Cobra bites manifested muscle wasting (87.5%), reduced muscle power (87.5%), joint stiffness (62.5%) and deformities (37.5%) while viper bites manifested impaired balance (42.8%), pain (71.4%) and swelling (71.4%). Conclusions/Significance: Snakebite envenoming is associated with considerable long-term musculoskeletal disabilities. Facilities for specialized care and rehabilitation need to be established in high risk areas.},
author = {Jayawardana, Subashini and Gnanathasan, Ariaranee and Arambepola, Carukshi and Chang, Thashi},
doi = {10.1371/journal.pntd.0005103},
editor = {de Silva, Janaka},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {nov},
number = {11},
pages = {e0005103},
pmid = {27814368},
title = {{Chronic Musculoskeletal Disabilities following Snake Envenoming in Sri Lanka: A Population-Based Study}},
url = {https://dx.plos.org/10.1371/journal.pntd.0005103},
volume = {10},
year = {2016}
}
@misc{Tasoulis2017,
abstract = {Advances in the last decade combining transcriptomics with established proteomics methods have made possible rapid identification and quantification of protein families in snake venoms. Although over 100 studies have been published, the value of this information is increased when it is collated, allowing rapid assimilation and evaluation of evolutionary trends, geographical variation, and possible medical implications. This review brings together all compositional studies of snake venom proteomes published in the last decade. Compositional studies were identified for 132 snake species: 42 from 360 (12%) Elapidae (elapids), 20 from 101 (20%) Viperinae (true vipers), 65 from 239 (27%) Crotalinae (pit vipers), and five species of non-front-fanged snakes. Approximately 90% of their total venom composition consisted of eight protein families for elapids, 11 protein families for viperines and ten protein families for crotalines. There were four dominant protein families: phospholipase A2s (the most common across all front-fanged snakes), metalloproteases, serine proteases and three-finger toxins. There were six secondary protein families: cysteine-rich secretory proteins,L-amino acid oxidases, kunitz peptides, C-type lectins/snaclecs, disintegrins and natriuretic peptides. Elapid venoms contained mostly three-finger toxins and phospholipase A2s and viper venoms metalloproteases, phospholipase A2s and serine proteases. Although 63 protein families were identified, more than half were present in <5% of snake species studied and always in low abundance. The importance of these minor component proteins remains unknown.},
author = {Tasoulis, Theo and Isbister, Geoffrey K.},
booktitle = {Toxins},
doi = {10.3390/toxins9090290},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Tasoulis, Isbister - 2017 - A review and database of snake venom proteomes.pdf:pdf},
issn = {20726651},
keywords = {Elapid,Proteomics,Snakes,Toxins,Venom,Viper},
month = {sep},
number = {9},
pages = {290},
title = {{A review and database of snake venom proteomes}},
url = {http://www.mdpi.com/2072-6651/9/9/290},
volume = {9},
year = {2017}
}
@article{Yanez-Arenas2016,
abstract = {Snakebite envenoming is an important public health concern worldwide. In the Americas, $\sim$300,000 bites occur annually, leaving 84,110–140,981 envenomings and 652–3466 deaths. Here, we modeled current and future snakebite risk using ecological niche models (ENMs) of 90 venomous snake taxa. Current snakebite risk predictions were corroborated by incidence data from eight regions/periods with different characteristics. Detailed projections of potential future range shifts on distributions of the medically most relevant species indicated that North American species' ranges are likely to increase in the future, but mixed results were obtained for Latin American snakes. A likely expansion of overall risk area and an increase of rural population at risk were observed from a consensus model among future scenarios. Our study highlights the capacity of ENMs to provide detailed information on current and future potential distributions of venomous snakes, as well as useful perspectives on snakebite risk, at least broad scales.},
author = {Ya{\~{n}}ez-Arenas, Carlos and {Townsend Peterson}, A. and Rodr{\'{i}}guez-Medina, Karla and Barve, Narayani},
doi = {10.1007/s10584-015-1544-6},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ya{\~{n}}ez-Arenas et al. - 2016 - Mapping current and future potential snakebite risk in the new world.pdf:pdf},
issn = {0165-0009},
journal = {Climatic Change},
month = {feb},
number = {4},
pages = {697--711},
title = {{Mapping current and future potential snakebite risk in the new world}},
url = {http://link.springer.com/10.1007/s10584-015-1544-6},
volume = {134},
year = {2016}
}
@article{Musah2019,
abstract = {BACKGROUND Worldwide, snakebite envenomations total $\sim$2.7 million reported cases annually with $\sim$100,000 fatalities. Since 2009, snakebite envenomation has intermittently been classified as a very important 'neglected tropical disease' by the World Health Organisation. Despite this emerging awareness, limited efforts have been geared towards addressing the serious public health implications of snakebites, particularly in sub-Saharan Africa, where baseline epidemiological and ecological data remain incomplete. Due to poverty as well as limited infrastructure and public health facilities, people in rural Africa, including Ghana, often have no other choice than to seek treatment from traditional medical practitioners (TMPs). The African 'snakebite crisis' is highlighted here using regionally representative complementary data from a community-based epidemiological and ecological study in the savanna zone of northern Ghana. METHODOLOGY AND FINDINGS Our baseline study involved two data collection methods in the Savelugu-Nanton District (in 2019 the district was separated into Savelugu and Nanton districts) in northern Ghana, comprising a cross-sectional study of 1,000 residents and 24 TMPs between December 2008 and May 2009. Semi-structured interviews, as well as collection of retrospective snakebite and concurrent rainfall records from the Savelugu-Nanton District Hospital and Ghana Meteorological Authority respectively over 10-years (1999-2008) were used in the study. Variables tested included demography, human activity patterns, seasonality, snake ecology and clinical reports. Complementary data showed higher snakebite prevalence during the rainy season, and a hump-shaped correlation between rainfall intensity and snakebite incidences. Almost 6% of respondents had experienced a personal snakebite, whereas $\sim$60% of respondents had witnessed a total of 799 snakebite cases. Out of a total of 857 reported snakebite cases, 24 ($\sim$2.8%) died. The highest snakebite prevalence was recorded for males in the age group 15-44 years during farming activities, with most bites occurring in the leg/foot region. The highest snakebite rate was within farmlands, most severe bites frequently caused by the Carpet viper (Echis ocellatus). CONCLUSION The relatively high community-based prevalence of $\sim$6%, and case fatality ratio of $\sim$3%, indicate that snakebites represent an important public health risk in northern Ghana. Based on the high number of respondents and long recording period, we believe these data truly reflect the general situation in the rural northern savanna zone of Ghana and West Africa at large. We recommend increased efforts from both local and international health authorities to address the current snakebite health crisis generally compromising livelihoods and productivity of rural farming communities in West Africa.},
author = {Musah, Yahaya and Ameade, Evans P. K. and Attuquayefio, Daniel K. and Holbech, Lars H.},
doi = {10.1371/journal.pntd.0007221},
editor = {Chippaux, Jean-Philippe},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Musah et al. - 2019 - Epidemiology, ecology and human perceptions of snakebites in a savanna community of northern Ghana.pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {aug},
number = {8},
pages = {e0007221},
publisher = {Public Library of Science (PLoS)},
title = {{Epidemiology, ecology and human perceptions of snakebites in a savanna community of northern Ghana}},
url = {http://dx.plos.org/10.1371/journal.pntd.0007221},
volume = {13},
year = {2019}
}
@misc{Gutierrez2017,
abstract = {Snakebite envenoming is a neglected tropical disease that kills >100,000 people and maims >400,000 people every year. Impoverished populations living in the rural tropics are particularly vulnerable; snakebite envenoming perpetuates the cycle of poverty. Snake venoms are complex mixtures of proteins that exert a wide range of toxic actions. The high variability in snake venom composition is responsible for the various clinical manifestations in envenomings, ranging from local tissue damage to potentially life-threatening systemic effects. Intravenous administration of antivenom is the only specific treatment to counteract envenoming. Analgesics, ventilator support, fluid therapy, haemodialysis and antibiotic therapy are also used. Novel therapeutic alternatives based on recombinant antibody technologies and new toxin inhibitors are being explored. Confronting snakebite envenoming at a global level demands the implementation of an integrated intervention strategy involving the WHO, the research community, antivenom manufacturers, regulatory agencies, national and regional health authorities, professional health organizations, international funding agencies, advocacy groups and civil society institutions.},
author = {Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a and Calvete, Juan J. and Habib, Abdulrazaq G. and Harrison, Robert A. and Williams, David J. and Warrell, David A.},
booktitle = {Nature reviews. Disease primers},
doi = {10.1038/nrdp.2017.63},
isbn = {9783319045764},
issn = {2056676X},
month = {dec},
number = {1},
pages = {17063},
pmid = {28905944},
title = {{Snakebite envenoming}},
url = {http://www.nature.com/articles/nrdp201763},
volume = {3},
year = {2017}
}
@article{Ochola2018,
abstract = {Introduction: Snake bites are a silent public health problem in Kenya. Previous studies on snake bites in the country have mainly focused on identifying offending snake species, assessing the severity of envenomation and testing the efficacy of antivenom. Factors associated with snake bites in the country are yet to be fully understood. The aim of this work was to determine pharmaco-epidemiological factors associated with snake bites in areas of Kenya where incidence, severity and species responsible for snake bites have been reported. Methods: Kakamega provincial hospital, Kabarnet, Kapenguria and, Makueni district hospitals were selected as study sites based on previous findings on incidence, severity and species responsible for snake bites in catchment areas of these hospitals. Persistent newspaper reports of snake bites in these areas and distribution of snakes in Kenya were also considered. Cases of snake bites reported between 2007-2009 were retrospectively reviewed and data on incidence, age, site of the bites, time of bite and antivenom use was collected. Results: 176 bites were captured, 91 of which occurred in 2009. Individual incidence was between 2.7/100,000/year and 6.7/100,000/year. Bites peaked in the 1-15 year age group while 132/176 bites were in the lower limb area and 49/176 victims received antivenom. Most bites occurred during the dry season, in the bush and in the evening. Overall mortality was 2.27%. Conclusion: There is a need to sensitize the Kenyan public and healthcare personnel on preventive measures, first aid and treatment of snake bites.},
author = {Ochola, Francis Okumu and Okumu, Mitchel Otieno and Muchemi, Gerald Mwangi and Mbaria, James Mucunu and Gikunju, Joseph Kangangi},
doi = {10.11604/pamj.2018.29.217.15366},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ochola et al. - 2018 - Epidemiology of snake bites in selected areas of Kenya.pdf:pdf},
issn = {1937-8688},
journal = {Pan African Medical Journal},
keywords = {Epidemiology,Kenya,Neglected emergency,Snake antivenom,Snake bite},
title = {{Epidemiology of snake bites in selected areas of Kenya}},
url = {http://www.panafrican-med-journal.com/content/article/29/217/full/},
volume = {29},
year = {2018}
}
@article{Gutierrez2006,
abstract = {Envenoming resulting from snake bites is an important public health hazard in many regions of the world, yet public health authorities have given little attention to the problem.},
author = {Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a and Theakston, R. David G and Warrell, David A},
doi = {10.1371/journal.pmed.0030150},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Guti{\'{e}}rrez, Theakston, Warrell - 2006 - Confronting the Neglected Problem of Snake Bite Envenoming The Need for a Global Partnership.pdf:pdf},
issn = {1549-1676},
journal = {PLoS Medicine},
month = {jun},
number = {6},
pages = {e150},
title = {{Confronting the Neglected Problem of Snake Bite Envenoming: The Need for a Global Partnership}},
url = {http://dx.plos.org/10.1371/journal.pmed.0030150},
volume = {3},
year = {2006}
}
@article{Ediriweera2017,
abstract = {Introduction: Sri Lanka has a population of 21 million and about 80,000 snakebites occur annually. However, there are limited data on health seeking behavior following bites. We investigated the effects of snakebite and envenoming on health seeking behavior in Sri Lanka. Methods: In a community-based island-wide survey conducted in Sri Lanka 44,136 households were sampled using a multistage cluster sampling method. An individual who reported experiencing a snakebite within the preceding 12 months was considered a case. An interviewer-administered questionnaire was used to obtain details of the bite and health seeking behavior among cases. Results: Among 165,665 individuals surveyed, there were 695 snakebite victims. 682 (98.1%) had sought health care after the bite; 381 (54.8%) sought allopathic treatment and 301 (43.3%) sought traditional treatment. 323 (46.5%) had evidence of probable envenoming, among them 227 (70.3%) sought allopathic treatment, 94 (29.1%) sought traditional treatment and 2 did not seek treatment. There was wide geographic variation in the proportion of seeking allopathic treatment from <20% in the Western province to > 90% in the Northern province. Multiple logistic regression analysis showed that seeking allopathic treatment was independently associated with being systemically envenomed (Odds Ratio = 1.99, 95% CI: 1.36–2.90, P < 0.001), distance to the healthcare facility (OR = 1.13 per kilometer, 95% CI: 1.09 to 1.17, P < 0.001), time duration from the bite (OR = 0.49 per day, 95% CI: 0.29–0.74, P = 0.002), and the local incidence of envenoming (OR = 1.31 for each 50 per 100,000, 95% CI: 1.19–1.46, P < 0.001) and snakebite (OR = 0.90 for each 50 per 100,000, 95% CI: 0.85–0.94, P < 0.001) in the relevant geographic area. Conclusions: In Sri Lanka, both allopathic and traditional treatments are sought following snakebite. The presence of probable envenoming was a major contribution to seeking allopathic treatment.},
author = {Ediriweera, Dileepa Senajith and Kasturiratne, Anuradhani and Pathmeswaran, Arunasalam and Gunawardena, Nipul Kithsiri and Jayamanne, Shaluka Francis and Lalloo, David Griffith and de Silva, Hithanadura Janaka},
doi = {10.1371/journal.pntd.0006073},
editor = {Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ediriweera et al. - 2017 - Health seeking behavior following snakebites in Sri Lanka Results of an island wide community based survey.pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {nov},
number = {11},
pages = {e0006073},
title = {{Health seeking behavior following snakebites in Sri Lanka: Results of an island wide community based survey}},
url = {https://dx.plos.org/10.1371/journal.pntd.0006073},
volume = {11},
year = {2017}
}
@article{Akani2013,
abstract = {BACKGROUND: Venomous snakes are among the most serious health hazards for rural people in tropical regions of the world. Herein we compare the monthly activity patterns of eight venomous snake species (Elapidae and Viperidae) with those of rural people in the Niger Delta area of southern Nigeria, in order to identify the periods of highest potential risk for persons, and the human group actually at greater risk of snakebite. RESULTS: We documented that above-ground activity of all venomous snakes peaked in the wet season, and that high snake activity and high human activity were most highly correlated between April and August. In addition, we documented that women and teenagers were at relatively higher risk of encountering a venomous snake than adult males, despite they are less often in the field than men. CONCLUSIONS: Our results suggest that future programs devoted to mitigate the social and health effects of snakebites in the Niger Delta region should involve especially women and teenagers, with ad-hoc education projects if appropriate. We urge that international organizations working on social and health problems in the developing world, such as IRD, DFID, UNDP, should provide advice through specific programs targeted at especially these categories which have been highlighted in comparatively potential higher threat from snakebites than adult men.},
author = {Akani, Godfrey C. and Ebere, Nwabueze and Franco, Daniel and Eniang, Edem A. and Petrozzi, Fabio and Politano, Edoardo and Luiselli, Luca},
doi = {10.1186/1678-9199-19-2},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Akani et al. - 2013 - Correlation between annual activity patterns of venomous snakes and rural people in the Niger Delta, southern Nige.pdf:pdf},
issn = {16789180},
journal = {Journal of Venomous Animals and Toxins Including Tropical Diseases},
keywords = {Monthly activity,Nigeria,Rural people,Venomous snakes},
month = {feb},
number = {1},
title = {{Correlation between annual activity patterns of venomous snakes and rural people in the Niger Delta, southern Nigeria}},
volume = {19},
year = {2013}
}
@article{Magalhaes2019a,
abstract = {Snakebite envenomation in the Brazilian Amazon is a recognized public health problem that does not receive the appropriate attention from key stakeholders. The morbidity rate is relevant, but still underestimated. Thus, the present study updates the current state of knowledge on snakebite envenomation in the Brazilian Amazon. It follows a descriptive method and contributes new knowledge about the dynamics of snakebites and the associated morbidity and mortality reported in the Brazilian Amazon. The study is based on information from cases registered and retrieved from the Brazilian Information System for Notifiable Diseases (Sistema de Informa{\c{c}}{\~{a}}o de Agravos de Notifica{\c{c}}{\~{a}}o-SINAN). The registers we studied covers a period of six years, 2010-2015. Most snakebites occurred in the states of Par{\'{a}} (30 693 cases, 43.34%) and Amazonas (9386 cases, 13.25%), with a higher prevalence in males of an economically active age. The main genus involved in bites was Bothrops sp. The mortality rate was 0.24 per hundred thousand and the case fatality rate was 0.51%. Although low case fatality and mortality rates were observed, much can still be done to prevent snakebites as they continue to be a serious public health problem considering the severity and potentially high economic impact for the individual and to society.},
author = {Magalh{\~{a}}es, Samara Freire Valente and Peixoto, Henry Maia and Moura, Noely and Monteiro, Wuelton Marcelo and {De Oliveira}, Maria Regina Fernandes},
doi = {10.1093/trstmh/try121},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Magalh{\~{a}}es et al. - 2019 - Snakebite envenomation in the Brazilian Amazon A descriptive study.pdf:pdf},
issn = {18783503},
journal = {Transactions of the Royal Society of Tropical Medicine and Hygiene},
keywords = {Envenoming,Epidemiology,Information systems,Public health,Snake venom,Snakebites},
month = {mar},
number = {3},
pages = {143--151},
title = {{Snakebite envenomation in the Brazilian Amazon: A descriptive study}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S1080603215004299 https://academic.oup.com/trstmh/article/113/3/143/5204422},
volume = {113},
year = {2019}
}
@article{Ediriweera2018,
abstract = {Background: Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. Methods: A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165 665 individuals living in 44 136 households and recorded all recalled snakebite events that had occurred during the preceding year. Log-linear models were fitted to describe the expected number of snakebites occurring in each month, taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and of recall bias amongst survey respondents. Results: Snakebite events showed a clear seasonal variation. Typically, snakebite incidence is highest during November–December followed by March–May and August, but this can vary between years due to variations in relative humidity, which is also a risk factor. Low relative-humidity levels are associated with high snakebite incidence. If current climate-change projections are correct, this could lead to an increase in the annual snakebite burden of 31.3% (95% confidence interval: 10.7–55.7) during the next 25–50 years. Conclusions: Snakebite in Sri Lanka shows seasonal variation. Additionally, more snakebites can be expected during periods of lower-than-expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.},
author = {Ediriweera, Dileepa Senajith and Diggle, Peter John and Kasturiratne, Anuradhani and Pathmeswaran, Arunasalam and Gunawardena, Nipul Kithsiri and Jayamanne, Shaluka Francis and Isbister, Geoffrey Kennedy and Dawson, Andrew and Lalloo, David Griffith and {De Silva}, Hithanadura Janaka},
doi = {10.1093/ije/dyy188},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ediriweera et al. - 2018 - Evaluating temporal patterns of snakebite in Sri Lanka The potential for higher snakebite burdens with climat.pdf:pdf},
issn = {14643685},
journal = {International Journal of Epidemiology},
keywords = {Global climate change,Relative humidity,Seasonal variation,Snakebite,Sri Lanka,Weather},
month = {dec},
number = {6},
pages = {2049--2058},
pmid = {30215727},
title = {{Evaluating temporal patterns of snakebite in Sri Lanka: The potential for higher snakebite burdens with climate change}},
url = {https://academic.oup.com/ije/article/47/6/2049/5094971},
volume = {47},
year = {2018}
}
@misc{Blaylock2005,
abstract = {(2005). The identification and syndromic management of snakebite in South Africa. South African Family Practice: Vol. 47, No. 9, pp. 48-53.},
author = {Blaylock, Roger S.},
booktitle = {South African Family Practice},
doi = {10.1080/20786204.2005.10873288},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Blaylock - 2005 - The identification and syndromic management of snakebite in South Africa.pdf:pdf},
issn = {20786204},
keywords = {Antivenom,Snake bite},
number = {9},
pages = {48--53},
publisher = {Medpharm Publications},
title = {{The identification and syndromic management of snakebite in South Africa}},
url = {https://www.tandfonline.com/doi/abs/10.1080/20786204.2005.10873288},
volume = {47},
year = {2005}
}
@article{Taieb2018,
abstract = {BACKGROUND: Snakebite has only recently been recognized as a neglected tropical disease by the WHO. Knowledge regarding snakebites and its care is poor both at the population level, and at the health care staff level. The goal of this study was to describe the level of knowledge and clinical practice regarding snakebite among health care staff from Cameroon. METHODS: A two-day training dedicated to snakebite and its care was organized in 2015 in Yaound{\'{e}}, capital city of Cameroon. A total of 98 health care staff from all over Cameroon attended the training. Prior to and after the training, an evaluation quantified the attendees' level of knowledge. Pre- and post-training evaluations were compared to assess knowledge improvement. RESULTS: Overall, prior to the training knowledge regarding snakebite and care was poor, and wrong beliefs that "pierre noire" or tourniquet were useful in case of snakebite were common. Knowledge was statistically improved after the training. CONCLUSION: Trainings dedicated to all type of health care staff towards snakebite to improve care are needed, this training must take into consideration the context and the targeted population.},
author = {Taieb, Fabien and Dub, Timoth{\'{e}}e and Madec, Yoann and Tondeur, Laura and Chippaux, Jean Philippe and Lebreton, Matthew and Medang, Raphael and Foute, Fran{\c{c}}oise Ngnedjou Nwabufo and Tchoffo, D{\'{e}}sir{\'{e}} and Potet, Julien and Alcoba, Gabriel and Comte, Eric and Einterz, Ellen M. and Nkwescheu, Armand S.},
doi = {10.1371/journal.pntd.0006716},
editor = {Habib, Abdulrazaq G.},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Taieb et al. - 2018 - Knowledge, attitude and practices of snakebite management amongst health workers in Cameroon Need for continuous t.pdf:pdf},
issn = {19352735},
journal = {PLoS neglected tropical diseases},
month = {oct},
number = {10},
pages = {e0006716},
title = {{Knowledge, attitude and practices of snakebite management amongst health workers in Cameroon: Need for continuous training and capacity building}},
url = {http://dx.plos.org/10.1371/journal.pntd.0006716},
volume = {12},
year = {2018}
}
@article{Visser2008,
abstract = {This study compares two antivenoms used to treat Echis ocellatus snake bite patients at Mathias Hospital, Yeji, central Ghana. FAV-Afrique™ antivenom (Aventis Pasteur) was given to 278 patients during 2001-2003, whilst Asna Antivenom C (Bharat Serum and Vaccines Ltd) was used in 2004 to treat 66 patients. The two groups had comparable patient attributes, time from snake bite to treatment and staff adherence to the tested treatment protocol. The antivenom C group required more repeat doses and twice the amount of antivenom to treat coagulopathy. Of greater concern, the antivenom C mortality rate was 12.1%, a marked rise from the 1.8% rate in the earlier FAV-Afrique™ antivenom group. In this study, antivenom C was ineffective as treatment for West African E. ocellatus snake venom. This illustrates the absolute need for regional pilot tests to assess the effectiveness of a new antivenom against local snake venoms before its sole and general distribution in a region is initiated. {\textcopyright} 2007 Royal Society of Tropical Medicine and Hygiene.},
author = {Visser, L. E. and Kyei-Faried, S. and Belcher, D. W. and Geelhoed, D. W. and van Leeuwen, J. Schagen and van Roosmalen, J.},
doi = {10.1016/j.trstmh.2007.11.006},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Visser et al. - 2008 - Failure of a new antivenom to treat Echis ocellatus snake bite in rural Ghana the importance of quality surveilla.pdf:pdf},
issn = {00359203},
journal = {Transactions of the Royal Society of Tropical Medicine and Hygiene},
keywords = {Antivenom,Carpet viper,Envenomation,Evaluation,Ghana,Snake bite},
month = {may},
number = {5},
pages = {445--450},
pmid = {18190937},
title = {{Failure of a new antivenom to treat Echis ocellatus snake bite in rural Ghana: the importance of quality surveillance}},
url = {https://academic.oup.com/trstmh/article-lookup/doi/10.1016/j.trstmh.2007.11.006},
volume = {102},
year = {2008}
}
@article{Harrison2017,
abstract = {Background: Antivenom is the treatment of choice for snakebite, which annually kills an estimated 32,000 people in sub-Saharan Africa and leaves approximately 100,000 survivors with permanent physical disabilities that exert a considerable socioeconomic burden. Over the past two decades, the high costs of the most polyspecifically-effective antivenoms have sequentially reduced demand, commercial manufacturing incentives and production volumes that have combined to create a continent-wide vacuum of effective snakebite therapy. This was quickly filled with new, less expensive antivenoms, many of which are of untested efficacy. Some of these successfully marketed antivenoms for Africa are inappropriately manufactured with venoms from non-African snakes and are dangerously ineffective. The uncertain efficacy of available antivenoms exacerbates the complexity of designing intervention measures to reduce the burden of snakebite in sub-Saharan Africa. The objective of this study was to preclinically determine the ability of antivenoms available in Kenya to neutralise the lethal effects of venoms from the most medically important snakes in East Africa. Methods: We collected venom samples from the most medically important snakes in East Africa and determined their toxicity in a mouse model. Using a ‘gold standard' comparison protocol, we preclinically tested the comparative venom-neutralising efficacy of four antivenoms available in Kenya with two antivenoms of clinically-proven efficacy. To explain the variant efficacies of these antivenoms we tested the IgG-venom binding characteristics of each antivenom using in vitro IgG titre, avidity and venom-protein specificity assays. We also measured the IgG concentration of each antivenom. Findings: None of the six antivenoms are preclinically effective, at the doses tested, against all of the most medically important snakes of the region. The very limited snake polyspecific efficacy of two locally available antivenoms is of concern. In vitro assays of the abilities of ‘test' antivenom IgGs to bind venom proteins were not substantially different from that of the ‘gold standard' antivenoms. The least effective antivenoms had the lowest IgG content/vial. Conclusions: Manufacture-stated preclinical efficacy statements guide decision making by physicians and antivenom purchasers in sub-Saharan Africa. This is because of the lack of both clinical data on the efficacy of most of the many antivenoms used to treat patients and independent preclinical assessment. Our preclinical efficacy assessment of antivenoms available in Kenya identifies important limitations for two of the most commonly-used antivenoms, and that no antivenom is preclinically effective against all the regionally important snakes. The potential implication to snakebite treatment is of serious concern in Kenya and elsewhere in sub-Saharan Africa, and underscores the dilemma physicians face, the need for clinical data on antivenom efficacy and the medical and societal value of establishing independent preclinical antivenom-efficacy testing facilities throughout the continent.},
author = {Harrison, Robert A. and Oluoch, George O. and Ainsworth, Stuart and Alsolaiss, Jaffer and Bolton, Fiona and Arias, Ana Silvia and Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a and Rowley, Paul and Kalya, Stephen and Ozwara, Hastings and Casewell, Nicholas R.},
doi = {10.1371/journal.pntd.0005969},
editor = {Chippaux, Jean-Philippe},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Harrison et al. - 2017 - Preclinical antivenom-efficacy testing reveals potentially disturbing deficiencies of snakebite treatment capab.pdf:pdf},
issn = {19352735},
journal = {PLoS Neglected Tropical Diseases},
month = {oct},
number = {10},
pages = {e0005969},
title = {{Preclinical antivenom-efficacy testing reveals potentially disturbing deficiencies of snakebite treatment capability in East Africa}},
url = {https://dx.plos.org/10.1371/journal.pntd.0005969},
volume = {11},
year = {2017}
}
@article{Habib2013,
abstract = {Snakebite envenoming is a major public health problem among rural communities of the Nigerian savanna. The saw-scaled or carpet viper (Echis ocellatus) and, to a lesser extent, the African cobras (Naja spp.) and puff adders (Bitis arietans) have proved to be the most important cause of mortality and morbidity. The main clinical features of E. ocellatus envenoming are systemic hemorrhage, incoagulable blood, shock, local swelling, bleeding and, occasionally, necrosis. Bites may be complicated by amputation, blindness, disability, disfigurement, mutilation, tissue destruction and psychological consequences. Antivenom remains the hallmark and mainstay of envenoming management while studies in Nigeria confirm its protection of over 80% against mortality from carpet-viper bites. However, the availability, distribution and utilization of antivenom remain challenging although two new antivenoms (monospecific EchiTab G and trispecific EchiTab ICP-Plus) derived from Nigerian snake venoms have proven very effective and safe in clinical trials. A hub-and-spoke strategy is suggested for broadening antivenom access to endemic rural areas together with instituting quality assurance, standardization and manpower training. With the advent of antivenomics, national health authorities must be aided in selecting and purchasing antivenoms appropriate to their national needs while manufacturers should be helped in practical ways to improve the safety, efficacy and potential coverage against snake venoms and pricing of their products.},
author = {Habib, Abdulrazaq G.},
doi = {10.1186/1678-9199-19-27},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib - 2013 - Public health aspects of snakebite care in West Africa perspectives from Nigeria(2).pdf:pdf},
issn = {1678-9199},
journal = {Journal of Venomous Animals and Toxins including Tropical Diseases},
keywords = {Antivenom,Carpet viper,Envenoming,Hub-and-spoke,Nigeria,Snakebite},
month = {oct},
number = {1},
pages = {27},
publisher = {BioMed Central Ltd.},
title = {{Public health aspects of snakebite care in West Africa: perspectives from Nigeria}},
url = {http://jvat.biomedcentral.com/articles/10.1186/1678-9199-19-27},
volume = {19},
year = {2013}
}
@article{Ralph2019,
abstract = {Regional collaboration is crucial to end preventable deaths and disability from snakebites in South Asia, say Ravikar Ralph and colleagues.},
author = {Ralph, Ravikar and Sharma, Sanjib Kumar and Faiz, Mohammad Abul and Ribeiro, Isabela and Rijal, Suman and Chappuis, Fran{\c{c}}ois and Kuch, Ulrich},
doi = {10.1136/bmj.k5317},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ralph et al. - 2019 - The timing is right to end snakebite deaths in South Asia.pdf:pdf},
issn = {0959-8138},
journal = {BMJ},
month = {jan},
pages = {k5317},
title = {{The timing is right to end snakebite deaths in South Asia}},
url = {http://www.bmj.com/lookup/doi/10.1136/bmj.k5317},
volume = {364},
year = {2019}
}
@article{Shashar2018,
abstract = {Background: Published annual estimates report a global burden of 2.5 million snakebite cases and >100,000 deaths. In Israel, envenomations are the third most frequent cause of poisonings that are of moderate to major clinical severity. Most studies focus on the clinical descriptions of snakebites in tropical climates, and we sought to investigate the association between snakebite frequency and meteorological parameters. Objective: We sought to investigate the seasonality of snakebites and evaluate the association between increasingly common heat waves and other meteorological parameters and snakebite frequency in a semiarid nontropical climate. Methods: We obtained data for all medical evacuations (2008–2015) because of snakebites in Israel. Climate data included daily 24-hour average temperature (°C) and relative humidity (%). We used a time-stratified case crossover method, in which a conditional logistic regression was applied to estimate the association, and we also stratified our analysis by season and by region. Results: We identified 1234 snakebite cases over 8 years, of which most (74.2%) occurred in hot seasons and between 6 PM and 9 PM. The risk of snakebite was positively associated with temperature >23°C (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.01–1.53) and inversely with humidity >40% (OR 0.74, 95% CI 0.57–0.97). We also found an association with heat waves both in cold (OR 1.62, 95% CI 1.01–2.60) and hot seasons (OR 1.50, 95% CI 1.18–1.92). Conclusions: In a semiarid nontropical climate, we observed an association between an increase in the number of snakebite cases and higher temperatures and lower humidity. Moreover, heat waves increased the frequency of snakebites in both cold and hot seasons.},
author = {Shashar, Sagi and Yitshak-Sade, Maayan and Sonkin, Roman and Novack, Victor and Jaffe, Eli},
doi = {10.1016/j.jemermed.2018.02.002},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Shashar et al. - 2018 - The Association Between Heat Waves and Other Meteorological Parameters and Snakebites Israel National Study.pdf:pdf},
issn = {07364679},
journal = {Journal of Emergency Medicine},
keywords = {Israel,heat waves,humidity,meteorological parameters,relative,season,snakebites,snakes,temperature},
month = {jun},
number = {6},
pages = {819--826},
title = {{The Association Between Heat Waves and Other Meteorological Parameters and Snakebites: Israel National Study}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0736467918301112},
volume = {54},
year = {2018}
}
@article{Gutierrez2007,
abstract = {The therapy of snakebite envenomation has been based on the parenteral administration of animal-derived antivenoms. Despite the success of this treatment at reducing the impact of snakebite mortality and morbidity, mostly due to their capacity to neutralize systemically-acting toxins, antivenoms are of relatively low efficacy in the prevention of venom-induced local tissue damage, which often leads to permanent disability. The issue of safety also remains a concern, particularly for some antivenoms which induce a relatively high incidence of adverse reactions. Consequently, there is a need to improve the therapy of snakebite envenomations on the following lines: (a) the technologies to produce antivenoms require improvements aimed at obtaining more refined preparations of higher efficacy and safety, while being affordable for the public health systems of developing countries. (b) The growing knowledge on the biochemistry and toxicology of snake venoms should pave the way for the identification of natural and synthetic inhibitors of venom toxins, particularly of those involved in local tissue pathology. Such inhibitors might become a highly effective therapeutic tool for the abrogation of venom-induced local tissue damage. (c) A better knowledge of the inflammatory events secondary to venom actions may open the possibility of modulating such response, in order to prevent further tissue damage and to promote successful tissue repair and regeneration. A global partnership, involving many participants and combining scientific, technological and public health actions, is required to achieve a leap forward in the treatment of snakebite envenomations world-wide.},
author = {Gutierrez, Jose and Lomonte, Bruno and Leon, Guillermo and Rucavado, Alexandra and Chaves, Fernando and Angulo, Yamileth},
doi = {10.2174/138161207782023784},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Gutierrez et al. - 2007 - Trends in Snakebite Envenomation Therapy Scientific, Technological and Public Health Considerations.pdf:pdf},
issn = {13816128},
journal = {Current Pharmaceutical Design},
month = {oct},
number = {28},
pages = {2935--2950},
title = {{Trends in Snakebite Envenomation Therapy: Scientific, Technological and Public Health Considerations}},
url = {http://www.eurekaselect.com/openurl/content.php?genre=article&issn=1381-6128&volume=13&issue=28&spage=2935},
volume = {13},
year = {2007}
}
@article{Perehudoff2019a,
abstract = {Universal health coverage (UHC) aims to ensure that all people have access to health services including essential medicines without risking financial hardship. Yet, in many low-and middle-income countries (LMICs) inadequate UHC fails to ensure universal access to medicines and protect the poor and vulnerable against catastrophic spending in the event of illness. A human rights approach to essential medicines in national UHC legislation could remedy these inequities. This study identifies and compares legal texts from national UHC legislation that promote universal access to medicines in the legislation of 16 mostly LMICs: Algeria, Chile, Colombia, Ghana, Indonesia, Jordan, Mexico, Morocco, Nigeria, Philippines, Rwanda, South Africa, Tanzania, Turkey, Tunisia and Uruguay. The assessment tool was developed based on WHO's policy guidelines for essential medicines and international human rights law; it consists of 12 principles in three domains: legal rights and obligations, good governance, and technical implementation. Relevant legislation was identified, mapped, collected and independently assessed by multi-disciplinary, multi-lingual teams. Legal rights and State obligations toward medicines are frequently codified in UHC law, while most good governance principles are less common. Some technical implementation principles are frequently embedded in national UHC law (i.e. pooled user contributions and financial coverage for the vulnerable), while others are infrequent (i.e. sufficient government financing) to almost absent (i.e. seeking international assistance and cooperation). Generally, upper-middle and high-income countries tended to embed explicit rights and obligations with clear boundaries, and universal mechanisms for accountability and redress in domestic law while less affluent countries took different approaches. This research presents national law makers with both a checklist and a wish list for legal reform for access to medicines, as well as examples of legal texts. It may support goal 7 of the WHO Medicines & Health Products Strategic Programme 2016-30 to develop model legislation for medicines reimbursement.},
author = {Perehudoff, S. Katrina and Alexandrov, Nikita V. and Hogerzeil, Hans V.},
doi = {10.1093/heapol/czy101},
issn = {14602237},
journal = {Health Policy and Planning},
keywords = {Access,accountability,equity,essential drugs,government,health financing,health insurance,human rights,legislation,user fees,vulnerable populations},
month = {dec},
number = {Supplement_3},
pages = {III48--III57},
pmid = {31816073},
title = {{Legislating for universal access to medicines: A rights-based cross-national comparison of UHC laws in 16 countries}},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910076/ https://academic.oup.com/heapol/article/34/Supplement_3/iii48/5670623 http://www.ncbi.nlm.nih.gov/pubmed/31816073 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC6910076},
volume = {34},
year = {2019}
}
@article{Chippaux2017b,
abstract = {Background: Better knowledge of the epidemiological characteristics of snakebites could help to take measures to improve their management. The incidence and mortality of snakebites in the Americas are most often estimated from medical and scientific literature, which generally lack precision and representativeness. Methodology/Principal findings: Authors used the notifications of snakebites treated in health centers collected by the Ministries of Health of the American countries to estimate their incidence and mortality. Data were obtained from official reports available on-line at government sites, including those of the Ministry of Health in each country and was sustained by recent literature obtained from PubMed. The average annual incidence is about 57,500 snake bites (6.2 per 100,000 population) and mortality is close to 370 deaths (0.04 per 100,000 population), that is, between one third and half of the previous estimates. The incidence of snakebites is influenced by the abundance of snakes, which is related to (i) climate and altitude, (ii) specific preferences of the snake for environments suitable for their development, and (iii) human population density. Recent literature allowed to notice that the severity of the bites depends mainly on (i) the snake responsible for the bite (species and size) and (ii) accessibility of health care, including availability of antivenoms. Conclusions/Significances: The main limitation of this study could be the reliability and accuracy of the notifications by national health services. However, the data seemed consistent considering the similarity of the incidences on each side of national boundaries while the sources are distinct. However, snakebite incidence could be underestimated due to the use of traditional medicine by the patients who escaped the reporting of cases. However, gathered data corresponded to the actual use of the health facilities, and therefore to the actual demand for antivenoms, which should make it possible to improve their management.},
author = {Chippaux, Jean Philippe},
doi = {10.1371/journal.pntd.0005662},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Chippaux - 2017 - Incidence and mortality due to snakebite in the Americas.pdf:pdf},
issn = {19352735},
journal = {PLoS Neglected Tropical Diseases},
month = {jun},
number = {6},
publisher = {Public Library of Science},
title = {{Incidence and mortality due to snakebite in the Americas}},
volume = {11},
year = {2017}
}
@article{Chippaux2011,
abstract = {Snakebites represent an important neglected public health problem in many developing countries. There is a lack of epidemiological data, which would be very useful for the organisation of snakebite management and provision of antivenom. An extensive literature search for the years 1970-2010 was performed. Data were analysed using meta-analysis to take into account the heterogeneity between the studies and their respective weight. Incidence, mortality and population at risk were estimated after stratification according to the environment (urban or rural) and survey methodologies (national, hospital or community studies). The incidence of snakebite was inversely correlated with population density. The number of envenomings was estimated at 314,078 [CI95% = 251,513-377,462], of which 95% occurred in rural areas. The remainder occurred in cities. The annual mortality was estimated at 7,331 [5,148-9,568], of which 97% occurred in a rural environment. The annual number of amputations ranged from 5,908 to 14,614. The population most at risk was young men engaged in agricultural or pastoral labours. Household surveys indicated that actual incidence and mortality were likely 3-5 times higher. The difference maybe explained by treatment seeking behaviour. However, incidences and mortalities reported here reflect the number of patients who attend modern health facilities, giving underestimated figures of the burden of snakebites in sub-Saharan Africa but realistic current requirements for antivenoms. {\textcopyright} 2011 Elsevier Ltd.},
author = {Chippaux, Jean-Philippe},
doi = {10.1016/j.toxicon.2010.12.022},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Chippaux - 2011 - Estimate of the burden of snakebites in sub-Saharan Africa A meta-analytic approach.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Envenoming,Epidemiology,Snakebite,Sub-Saharan Africa},
month = {mar},
number = {4},
pages = {586--599},
title = {{Estimate of the burden of snakebites in sub-Saharan Africa: A meta-analytic approach}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010111000055},
volume = {57},
year = {2011}
}
@article{Ghosh2018,
abstract = {Objective Snakebite is one of the neglected tropical diseases that World Health Organization (WHO) aimed to eradicate. The objective of the study is to investigate the mortality and morbidity due to snakebite at Midnapore Medical College & Hospital in Paschim Medinipur district, West Bengal, India. Methods & materials This is a record-based, retrospective, descriptive epidemiological study conducted from January 2012 to December 2016 at Midnapore Medical College and Hospital(MMCH), Paschim Medinipur district, West Bengal. The incidence and determinants of snakebite related mortality with reference to types of envenomation, age, sex, site of bite, clinical manifestations of snakebite, bite to hospital and bite to AVS treatment time, first aid and management of snakebite were investigated during the study. The data was analyzed by SPSS (Version 18) software.All results were expressed as percentage. Results Total number of snakebite deaths in Midnapore Medical College and Hospital(MMCH) was 222 from the period 2012–2016. Number of males was 134(60.36%) and female 88 (39.63%). Maximum snakebite deaths occurred in the age group of 31–40 years during agricultural and outdoor activities. Most of the snakebites occurred during June-September. Out of the 222 cases of snakebite, 182(82%) cases were due to viper envenomation. Maximum number of cases(n = 162) were detected in the interval between 4.00 PM to 8.00 PM. The bite to hospital time was found to be 180 ± 3.5 mins (n = 190 cases) and bite to AVS injection time was found to be 240 ± 3.5 mins (n = 190 cases). The mean bleeding time was 12.55 ± 3.2 min (n = 190 cases). The mean clotting time was found to be 20.1 ± 2.55 min (n = 190 cases). The symptoms of envenomation included local signs of inflammation(100% cases), blisters and necrosis (45% cases), renal failure (20% cases), coagulopathies(57% cases), ptosis(10% cases), dysphagia(2%) and respiratory distress(15% cases). The WHO protocol for snakebite management was followed for treatment of snakebite victims. Conclusion Snake bite is a neglected, life-threatening emergency in developing countries such as India and demands immediate anti-venom therapy. Hospital studies are a key source of information about snake bites. The ready availability and appropriate use of AVS, close monitoring of patients, the institution of ventilator support and if required, early referral to a larger hospital all help to reduce the mortality. Thus knowledge of the varied clinical manifestations of snake bite is important for effective management in hospitals by a complete health care team.},
author = {Ghosh, Rituparna and Mana, Koushik and Gantait, Kripasindhu and Sarkhel, Sumana},
doi = {10.1016/j.toxrep.2017.11.008},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ghosh et al. - 2018 - A retrospective study of clinico-epidemiological profile of snakebite related deaths at a Tertiary care hospital i.pdf:pdf},
issn = {22147500},
journal = {Toxicology Reports},
keywords = {Paschim medinipur district,Retrospective,Snakebite,Tertiary care hospital},
pages = {1--5},
title = {{A retrospective study of clinico-epidemiological profile of snakebite related deaths at a Tertiary care hospital in Midnapore, West Bengal, India}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S2214750017301038},
volume = {5},
year = {2018}
}
@article{Dalhat2012,
abstract = {Source: BIOSIS},
author = {Dalhat, Mahmood M. and Muhammad, Hamza and Abubakar, Saidu B. and Garba, Iliasu and Yola, Ibrahim M. and Habib, Abdulrazaq G.},
doi = {10.1016/j.toxicon.2012.04.237},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Dalhat et al. - 2012 - 236. Determinants of High Cost of Care Among Victims of Snake Bite in Kaltungo, Gombe State, Nigeria, 2009.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
month = {aug},
number = {2},
pages = {216--217},
title = {{236. Determinants of High Cost of Care Among Victims of Snake Bite in Kaltungo, Gombe State, Nigeria, 2009}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010112003339},
volume = {60},
year = {2012}
}
@article{Mensah2016,
abstract = {BACKGROUND: A snake bite is an injury caused by a bite from a snake, often resulting in puncture wounds, amputations and sometimes envenomation. Envenoming resulting from snake bite is a particularly important public health problem in rural areas of tropical and sub-tropical countries in Africa. This paper reports the incidence of snake bites and its associated mortality in the Western Region of Ghana. METHOD: The study was a descriptive cross-sectional review of 2006 - 2010 snake bite secondary data generated by the Western Regional Health Information Office in Ghana. Data was extracted from the District Health Information Management System (DHIMS) database. Data was managed and analyzed using SPSS Version 16.0. Univariate analyses were expressed as percentages and graphs. RESULTS: The year 2009 recorded the highest incidence of Snake bites in the Western Region with Juabeso district recording the highest incidence of snake bites over the study period. Over the period about 55% of the incidence was between 50 - 100 per 100,000 population. The total number of snake bites recorded in the region for the period was 7,275, of which 52% (3,776) were males. About 60% of the patients were of the age group 15-49 years. A total of 12 reported snake bite deaths were recorded, of which 67% were men. This study recommends to the Districts Health Directorates in the Western Region to regularly organize community education on snake bite and the use of protective clothing by the farmers. FUNDING: None declared.},
author = {Mensah, Ebenezer K and Karikari, Kwaku and Aikins, Moses and Vanotoo, Linda and Sackey, Samuel and Ohuabunwo, Chima and Wurapa, Fred and Sifah, Tweneboah K and Afari, Edwin},
doi = {10.4314/gmj.v50i2.8},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Mensah et al. - 2016 - Secondary analysis of snake bite data in the Western Region of Ghana 2006-2010.pdf:pdf},
issn = {00169560},
journal = {Ghana medical journal},
keywords = {District Health Information Management System,Envenomation,Ghana,Incidence,Snake bite,Western Region},
month = {jun},
number = {2},
pages = {103--106},
pmid = {27635098},
publisher = {Ghana Medical Association},
title = {{Secondary analysis of snake bite data in the Western Region of Ghana: 2006-2010}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27635098 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5012143},
volume = {50},
year = {2016}
}
@article{Wood2009,
abstract = {OBJECTIVE We aimed to study the outcomes of severe snakebites in patients admitted to Ngwelezana Hospital in north-eastern KwaZulu-Natal, the seasonal variations, and the effectiveness and complications of antivenom. DESIGN A prospective observational outcomes study was conducted over one year (1 June 2007 to 31 May 2008). The study group was from the north-eastern KwaZulu-Natal region of South Africa, with a population of approximately 3 million people, and included all patients bitten by snakes and admitted to the Ngwelezana Hospital Emergency Medicine Unit (EMU). Departmental practice guidelines were documented and followed. OUTCOME MEASURES End-points for patient outcomes included transfer from the EMU to the ward, discharge home from the EMU, and follow-up of patients who required surgery or ICU care. RESULTS A total of 243 snakebite patients were recorded. The highest incidence was in the summer months; 46 (18.93%) patients experienced one or more severe complications; 29 (11.93%) patients received some form of definitive management in hospital; and 22 (9.05%) of the latter patients received antivenom. Antivenom was administered to more children than adults. Adverse reactions to antivenom were common: an allergic response occurred in 4 (15.4%) patients, and anaphylaxis in 6 (23.1%); the highest incidence occurred in the <10-year-old age group. No deaths were recorded. CONCLUSIONS Snakebites are common in the summer months in north eastern KwaZulu-Natal. Children are particularly vulnerable to snakebites and the effects of antivenom. Adverse reactions to antivenom are common. Severe snakebites that require antivenom should be managed in a hospital setting with advanced airway support. The syndromic approach to treatment is simple and effective.},
author = {Wood, Darryl and Webb, Caroline and DeMeyer, Jenine},
doi = {10.7196/SAMJ.3204},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Wood, Webb, DeMeyer - 2009 - Severe snakebites in northern KwaZulu-Natal treatment modalities and outcomes.pdf:pdf},
issn = {0256-9574},
journal = {South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde},
month = {nov},
number = {11},
pages = {814--8},
pmid = {20218483},
title = {{Severe snakebites in northern KwaZulu-Natal: treatment modalities and outcomes.}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20218483},
volume = {99},
year = {2009}
}
@article{Kumar2019,
abstract = {Background: Snake bite is considered as one of the most significant health related problems throughout the world. According to the WHO, a snake bite is an important medical problem. It has been a neglected extrinsic injury in tropical and sub-tropical developing countries including India. It has been estimated that every year there are almost 83,000 snake bites and 11,000 deaths due to snake bites in India. The Goal of this study is to access knowledge, attitude and practice (KAP) among interns so as to find out gaps in academics and bridge them. Findings of this study will benefit community at large.Methods: An institutional based cross sectional study was conducted for the entire batch of interns in a tertiary care center in Trivandrum, Kerala, South India during June–September 2018. A non-probability sampling was done. Data was collected by self-administered questionnaire.Results: Among 100 students 48% had a score equal to and above 8 which was taken as good level of knowledge and 52% had poor level of knowledge. Attitude towards management of snake bite was 100% among study subjects. Only 35% of students had median score above 4 as good level of practice and remaining 65% had poor level of practice.Conclusions: Respondents have adequate knowledge on snake bites. They discarded various prevailing myths in society. Although study showed adequate attitude towards management, that was not reflected in practice. This gap can be overcome by teaching in simulated environment, so as to make them competent enough for managing snake bites.},
author = {Kumar, Amritesh and Gopakumar, Soumya and Sathyan, Sruthy and Singh, S. Blessed and Bhasy, Beena Idicheriya},
doi = {10.18203/2394-6040.ijcmph20190637},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kumar et al. - 2019 - A KAP study on snakebite and its management among medical interns in a tertiary care medical college and hospital.pdf:pdf},
issn = {2394-6032},
journal = {International Journal Of Community Medicine And Public Health},
month = {feb},
number = {3},
pages = {1340},
publisher = {Medip Academy},
title = {{A KAP study on snakebite and its management among medical interns in a tertiary care medical college and hospital in Trivandrum district, Kerala}},
url = {https://www.ijcmph.com/index.php/ijcmph/article/view/4333},
volume = {6},
year = {2019}
}
@article{Michael2011,
abstract = {We studied pre-hospital practices of 72 consecutive snake bite victims at a hospital in north-central Nigeria. The primary outcome assessed was death or disability at hospital discharge. Victims were predominantly male farmers, and in 54 cases (75%) the snake was identified as a carpet viper (Echis ocellatus), with the remainder unidentified. Most subjects (58, 81%) attempted at least one first aid measure after the bite, including tourniquet application (53, 74%), application (15, 21%) or ingestion (10, 14%) of traditional concoctions, bite site incision (8, 11%), black stone application (4, 5.6%), and suction (3, 4.2%). The majority (44, 61%) presented late (after 4. hours). Most (53, 74%) had full recovery at hospital discharge. Three deaths (4.2%) and thirteen (18%) disabilities (mainly tissue necrosis) occurred. The use of any first aid was associated with a longer hospital stay than no use (4.6 ± 2.0 days versus 3.6 ± 2.7 days, respectively, P=0.02). The antivenom requirement was greater in subjects who had used a tourniquet (P=0.03) and in those who presented late (P=0.02). Topical application (Odds Ratio 15, 95% CI 1.4-708) or ingestion of traditional concoctions (OR 20, 95% CI 1.4-963) were associated with increased risk of death or disability. Ingestion and application of concoctions were associated with a longer time interval before presentation, a higher cost of hospitalization, and an increased risk of wound infection. {\textcopyright} 2010 Royal Society of Tropical Medicine and Hygiene.},
author = {Michael, Godpower C. and Thacher, Tom D. and Shehu, Mohammed I.L.},
doi = {10.1016/j.trstmh.2010.09.005},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Michael, Thacher, Shehu - 2011 - The effect of pre-hospital care for venomous snake bite on outcome in Nigeria.pdf:pdf},
issn = {00359203},
journal = {Transactions of the Royal Society of Tropical Medicine and Hygiene},
keywords = {Africa,Envenomation,Epidemiology,First aid,Rural health,Viper},
month = {feb},
number = {2},
pages = {95--101},
title = {{The effect of pre-hospital care for venomous snake bite on outcome in Nigeria}},
url = {https://academic.oup.com/trstmh/article-lookup/doi/10.1016/j.trstmh.2010.09.005},
volume = {105},
year = {2011}
}
@article{Laustsen2017,
abstract = {Snakebite envenoming is a major public health burden in tropical parts of the developing world. In sub-Saharan Africa, neglect has led to a scarcity of antivenoms threatening the lives and limbs of snakebite victims. Technological advances within antivenom are warranted, but should be evaluated not only on their possible therapeutic impact, but also on their cost-competitiveness. Recombinant antivenoms based on oligoclonal mixtures of human IgG antibodies produced by CHO cell cultivation may be the key to obtaining better snakebite envenoming therapies. Based on industry data, the cost of treatment for a snakebite envenoming with a recombinant antivenom is estimated to be in the range USD 60–250 for the Final Drug Product. One of the effective antivenoms (SAIMR Snake Polyvalent Antivenom from the South African Vaccine Producers) currently on the market has been reported to have a wholesale price of USD 640 per treatment for an average snakebite. Recombinant antivenoms may therefore in the future be a cost-competitive alternative to existing serum-based antivenoms.},
author = {Laustsen, Andreas H. and Johansen, Kristoffer H. and Engmark, Mikael and Andersen, Mikael R.},
doi = {10.1371/journal.pntd.0005361},
issn = {19352735},
journal = {PLoS Neglected Tropical Diseases},
number = {2},
title = {{Recombinant snakebite antivenoms: A cost-competitive solution to a neglected tropical disease?}},
volume = {11},
year = {2017}
}
@misc{Jamaiah2004,
abstract = {The records of 284 snake bite cases presenting to the Kangar District Hospital, Perlis, West Malaysia, from January 1999 till December 2000 were carefully reviewed. Data on prevalence and types of snake bites, were recorded. The majority of the cases were among Malays (60.2%), followed by Chinese (16.9%), Indians (13%), and others which include Thai nationals, army personnel from Sabah and Sarawak, and foreign tourists (9.8%). A higher incidence was found in males (60.2%) and most cases were seen in the age group of 10-19 years (33%). Snake bites were more common between 2 PM and 9 PM (47.6%) and from 7 AM to 2 PM (33.4%). The snakes were positively identified in 68 cases, of which 50 were common cobras (Naja naja) (73%), 16 were Malayan pit vipers (Agkistrodon rhodostoma) (24%) and two were sea-snakes (3%).},
author = {Jamaiah, I. and Rohela, M. and Roshalina, R. and Undan, R. C.},
booktitle = {Southeast Asian Journal of Tropical Medicine and Public Health},
issn = {01251562},
number = {4},
pages = {962--965},
pmid = {15916099},
title = {{Prevalence of snake bites in Kangar District Hospital, Perlis, West Malaysia: A retrospective study (January 1999-December 2000)}},
url = {https://pubmed.ncbi.nlm.nih.gov/15916099/},
volume = {35},
year = {2004}
}
@article{Parker-Cote2018,
abstract = {Background: Antivenom is the definitive treatment for venomous snakebites, but is expensive and not available in many rural and poorly developed regions. Timely transportation to facilities that stock and administer antivenom may not be available in rural areas with poorly developed emergency medical services. These factors have led to consideration of measures to delay onset of toxicity or alternatives to antivenom therapy. Methods: PubMed searches were conducted for articles on snakebite treatment, or that contained first aid, emergency medical services, tourniquets, pressure immobilization bandages, suction devices, and lymphatic flow inhibitors. Results: The reviewed articles describe how venoms spread after a venomous snakebite on an extremity, list the proposed first aid measures for delaying the spread of venoms, and evaluate the scientific studies that support or refute methods of snakebite first aid. The recommendations for field treatment of venomous snakebites will be discussed. Conclusions: The evidence suggests that pressure immobilization bandages and related strategies are the best interventions to delay onset of systemic toxicity from venomous snakebites but may increase local toxicity for venoms that destroy tissue at the site of the bite, so their use should be individualized to the circumstances and nature of the venom.},
author = {Parker-Cote, Jennifer and Meggs, William},
doi = {10.3390/tropicalmed3020045},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Parker-Cote, Meggs - 2018 - First Aid and Pre-Hospital Management of Venomous Snakebites.pdf:pdf},
issn = {2414-6366},
journal = {Tropical Medicine and Infectious Disease},
keywords = {Emergency medicine services,First aid,Pressure immobilization bandages,Snakebites},
month = {apr},
number = {2},
pages = {45},
title = {{First Aid and Pre-Hospital Management of Venomous Snakebites}},
url = {http://www.mdpi.com/2414-6366/3/2/45},
volume = {3},
year = {2018}
}
@misc{Mynewsgh.com2018,
abstract = {The Upper West Region is in a dire need of medical doctors as the doctor to patient ratio is begging at 1:14,310 making the people suffer the consequences by the virtue of their location},
author = {Mynewsgh.com},
pages = {1},
title = {{U/W: Doctor-Patient ratio affecting lives – Minister | Health News 2018-07-30}},
url = {https://www.ghanaweb.com/GhanaHomePage/NewsArchive/U-W-Doctor-Patient-ratio-affecting-lives-Minister-672924},
urldate = {2019-10-16},
year = {2018}
}
@article{Abubakar2010,
abstract = {BACKGROUND: In West Africa, envenoming by saw-scaled or carpet vipers (Echis ocellatus) causes great morbidity and mortality, but there is a crisis in supply of effective and affordable antivenom (ISRCTN01257358). METHODS: In a randomised, double-blind, controlled, non-inferiority trial, "EchiTAb Plus-ICP" (ET-Plus) equine antivenom made by Instituto Clodomiro Picado was compared to "EchiTAb G" (ET-G) ovine antivenom made by MicroPharm, which is the standard of care in Nigeria and was developed from the original EchiTAb-Fab introduced in 1998. Both are caprylic acid purified whole IgG antivenoms. ET-G is monospecific for Echis ocellatus antivenom (initial dose 1 vial) and ET-Plus is polyspecific for E. ocellatus, Naja nigricollis and Bitis arietans (initial dose 3 vials). Both had been screened by pre-clinical and preliminary clinical dose-finding and safety studies. Patients who presented with incoagulable blood, indicative of systemic envenoming by E. ocellatus, were recruited in Kaltungo, north-eastern Nigeria. Those eligible and consenting were randomly allocated with equal probability to receive ET-Plus or ET-G. The primary outcome was permanent restoration of blood coagulability 6 hours after the start of treatment, assessed by a simple whole blood clotting test repeated 6, 12, 18, 24 and 48 hr after treatment. Secondary (safety) outcomes were the incidences of anaphylactic, pyrogenic and late serum sickness-type antivenom reactions. FINDINGS: Initial doses permanently restored blood coagulability at 6 hours in 161/194 (83.0%) of ET-Plus and 156/206 (75.7%) of ET-G treated patients (Relative Risk [RR] 1.10 one-sided 95% CI lower limit 1.01; P = 0.05). ET-Plus caused early reactions on more occasions than did ET-G [50/194 (25.8%) and 39/206 (18.9%) respectively RR (1.36 one-sided 95% CI 1.86 upper limit; P = 0.06). These reactions were classified as severe in 21 (10.8%) and 11 (5.3%) of patients, respectively. CONCLUSION: At these doses, ET-Plus was slightly more effective but ET-G was slightly safer. Both are recommended for treating E. ocellatus envenoming in Nigeria. TRIAL REGISTRATION: Current Controlled Trials ISRCTN01257358.},
author = {Abubakar, Isa S. and Abubakar, Saidu B. and Habib, Abdulrazaq G. and Nasidi, Abdulsalam and Durfa, Nandul and Yusuf, Peter O. and Larnyang, Solomon and Garnvwa, John and Sokomba, Elijah and Salako, Lateef and Theakston, R. David G. and Juszczak, Ed and Alder, Nicola and Warrell, David A.},
doi = {10.1371/journal.pntd.0000767},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Abubakar et al. - 2010 - Randomised controlled double-blind non-inferiority trial of two antivenoms for Saw-scaled or carpet viper (Echi.pdf:pdf},
journal = {PLoS Neglected Tropical Diseases},
month = {jul},
number = {7},
title = {{Randomised controlled double-blind non-inferiority trial of two antivenoms for Saw-scaled or carpet viper (Echis ocellatus) envenoming in Nigeria}},
volume = {4},
year = {2010}
}
@article{Rahman2010,
abstract = {Background Snake bite is a neglected public health problem in the world and one of the major causes of mortality and morbidity in many areas, particularly in the rural tropics. It also poses substantial economic burdens on the snake bite victims due to treatment related expenditure and loss of productivity. An accurate estimate of the risk of snake bite is largely unknown for most countries in the developing world, especially South-East Asia.  Methodology/Principal Findings We undertook a national epidemiological survey to determine the annual incidence density of snake bite among the rural Bangladeshi population. Information on frequency of snake bite and individuals' length of stay in selected households over the preceding twelve months was rigorously collected from the respondents through an interviewer administered questionnaire. Point estimates and confidence intervals of the incidence density of snake bite, weighted and adjusted for the multi-stage cluster sampling design, were obtained. Out of 18,857 study participants, over one year a total of 98 snake bites, including one death were reported in rural Bangladesh. The estimated incidence density of snake bite is 623.4 / 100,000 person years (95% C I 513.4–789.2 /100,000 person years). Biting occurs mostly when individuals are at work. The majority of the victims (71%) receive snake bites to their lower extremities. Eighty-six percent of the victims received some form of management within two hours of snake bite, although only three percent of the victims went directly to either a medical doctor or a hospital.  Conclusions/Significance Incidence density of snake bite in rural Bangladesh is substantially higher than previously estimated. This is likely due to better ascertainment of the incidence through a population based survey. Poor access to health services increases snake bite related morbidity and mortality; therefore, effective public health actions are warranted.},
author = {Rahman, Ridwanur and Faiz, M. Abul and Selim, Shahjada and Rahman, Bayzidur and Basher, Ariful and Jones, Alison and D'Este, Catherine and Hossain, Moazzem and Islam, Ziaul and Ahmed, Habib and Milton, Abul Hasnat},
doi = {10.1371/journal.pntd.0000860},
editor = {Lalloo, David G.},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Rahman et al. - 2010 - Annual Incidence of Snake Bite in Rural Bangladesh.pdf:pdf},
issn = {1935-2735},
journal = {PLoS Neglected Tropical Diseases},
month = {oct},
number = {10},
pages = {e860},
pmid = {21049056},
publisher = {Public Library of Science},
title = {{Annual Incidence of Snake Bite in Rural Bangladesh}},
url = {https://dx.plos.org/10.1371/journal.pntd.0000860 http://www.ncbi.nlm.nih.gov/pubmed/21049056 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC2964284},
volume = {4},
year = {2010}
}
@article{Wagener2017,
abstract = {Background. Snakebites can produce severe local and systemic septic complications as well as being associated with significant overall morbidity and even mortality. Objective. A prospective audit was undertaken to determine the bacterial causation of wound infection secondary to snakebite, and attempt to quantify the burden of disease. Methods. The audit was undertaken at Ngwelezane Hospital, which provides both regional and tertiary services for north-eastern KwaZulu-Natal Province, South Africa, over a 4-month period. Records of patients who required surgical debridement for extensive skin and soft-tissue necrosis were analysed. At the time of debridement, tissue samples of necrotic or infected tissue were sent for bacteriological analysis as standard of care. Microbiology results were analysed. Results. A total of 164 patients were admitted to hospital for management of snakebite, of whom 57 required surgical debridement and 42 were included in the final microbiological analysis. Children were found to be the most frequent victims of snakebite; 57.8% of patients in this study were aged ≤10 years and 73.7% ≤15 years. Culture showed a single organism in 32/42 cases, two organisms in 8 and no growth in 2. Eight different types of organisms were cultured, five of them more than once. Thirty-five specimens (83.3%) grew Gram-negative Enterobacteriaceae, the most frequent being Morganella morganii and Proteus species. Thirteen specimens (31.0%) grew Enterococcus faecalis. Gram-negative Enterobacteriaceae showed 31.4% sensitivity to ampicillin, 40.0% sensitivity to amoxicillin plus clavulanic acid, 34.3% sensitivity to cefuroxime, 97.1% sensitivity to ceftriaxone, and 100% sensitivity to ciprofloxacin, gentamicin and amikacin. E. faecalis was 92.3% sensitive to amoxicillin, 92.3% sensitive to amoxicillin plus clavulanic acid, 100% sensitive to ciprofloxacin, 92.3% resistant to erythromycin and 100% resistant to ceftriaxone. Conclusion. Children are particularly vulnerable to snakebite, and the consequences can be devastating. While the majority of patients in this study were shown to have secondary bacterial infection, debridement and subsequent wound management is considered the mainstay of treatment. Common organisms are Enterobacteriaceae and enterococci. There appears to be a role for antibiotics in the management of these patients. A good antibiotic policy is strongly advocated.},
author = {Wagener, M. and Naidoo, M. and Aldous, C.},
doi = {10.7196/SAMJ.2017.v107i4.12084},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Wagener, Naidoo, Aldous - 2017 - Wound infection secondary to snakebite.pdf:pdf},
issn = {2078-5135},
journal = {South African Medical Journal},
month = {mar},
number = {4},
pages = {315},
pmid = {28395682},
publisher = {South African Medical Association},
title = {{Wound infection secondary to snakebite}},
url = {http://www.samj.org.za/index.php/samj/article/view/11855},
volume = {107},
year = {2017}
}
@article{Warrell2010,
abstract = {Snake bite is a common and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. Its public health importance has been largely ignored by medical science. Snake venoms are rich in protein and peptide toxins that have specificity for a wide range of tissue receptors, making them clinically challenging and scientifically fascinating, especially for drug design. Although the full burden of human suffering attributable to snake bite remains obscure, hundreds of thousands of people are known to be envenomed and tens of thousands are killed or maimed by snakes every year. Preventive efforts should be aimed towards education of affected communities to use proper footwear and to reduce the risk of contact with snakes to a minimum through understanding of snakes' behaviour. To treat envenoming, the production and clinical use of antivenom must be improved. Increased collaboration between clinicians, epidemiologists, and laboratory toxinologists should enhance the understanding and treatment of envenoming. {\textcopyright} 2010 Elsevier Ltd. All rights reserved.},
author = {Warrell, David A.},
doi = {10.1016/S0140-6736(09)61754-2},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Warrell - 2010 - Snake bite.pdf:pdf},
issn = {01406736},
journal = {The Lancet},
month = {jan},
number = {9708},
pages = {77--88},
pmid = {20109866},
publisher = {Lancet Publishing Group},
title = {{Snake bite}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0140673609617542 http://www.ncbi.nlm.nih.gov/pubmed/20109866},
volume = {375},
year = {2010}
}
@article{Habib2018,
abstract = {The scourge of snakebite has been well documented but largely ignored by the global health community for several decades, especially the role that economics has played in causing and exacerbating this crisis. Every year millions of people in low and middle-income countries face death, disability and disadvantage from snakebite envenoming (SBE) without access to appropriate treatment. Health-economic factors pervade every aspect of this neglected problem. A multitude of financial and commercial factors helped to cause, and now perpetuate, shortages of high quality, affordable and region-appropriate antivenom in areas where they are most needed. Alongside the death, physical disability and psychological anguish from SBE is a debilitating financial toll, which includes both direct costs of treatment and indirect costs from lost income. SBE is a problem that disproportionately affects poor, rural and agrarian communities, with most victims being young and industrious subsistence workers. The burden of envenoming is often felt by families and communities that can least afford it, and negatively impacts local and national productivity. The lack of long-term investment in health systems to properly manage SBE has led to insufficient funding for antivenom development, procurement, quality control and distribution, despite highly favourable cost effectiveness of some antivenoms. This has contributed to market failures that have seen antivenom output fall and become inaccessible to most victims. Solutions to these problems exist and are achievable, however the challenge for advocates is to appreciate the importance of health-economics and ensure that strategies to redress the economic causes and consequences of SBE are themselves cost-effective and financially sustainable.},
author = {Habib, Abdulrazaq G. and Brown, Nicholas I.},
doi = {10.1016/j.toxicon.2018.05.009},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib, Brown - 2018 - The snakebite problem and antivenom crisis from a health-economic perspective(2).pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Antivenom,Cost-effectiveness,DALY,Economic,Healthcare,Neglected tropical disease,Snakebite,Socioeconomic},
month = {aug},
pages = {115--123},
publisher = {Elsevier Ltd},
title = {{The snakebite problem and antivenom crisis from a health-economic perspective}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S004101011830196X https://www.sciencedirect.com/science/article/abs/pii/S004101011830196X},
volume = {150},
year = {2018}
}
@article{Gutierrez2018,
abstract = {Snakebite envenoming is a serious global public health problem, and international initiatives, under the coordination of the World Health Organization and its regional offices, are being developed to reduce the impact of this neglected tropical disease. The global availability of safe and effective antivenoms is one of the key aspects in this global strategy. This review discusses the role of public antivenom manufacturing laboratories for ensuring the supply of antivenoms. The difficulties faced by public laboratories are discussed, together with some tasks that need to be implemented for strengthening them. In addition, the concept of ‘redundancy' in the supply of antivenoms is emphasized, as a way to cope with the risks associated with the provision of antivenoms by few manufacturers. In general, the public sector should play a leading role, in antivenom availability and other aspects as well, within the global struggle to reduce the mortality and morbidity caused by snakebite envenoming.},
author = {Guti{\'{e}}rrez, Jos{\'{e}}},
doi = {10.3390/toxins11010005},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Guti{\'{e}}rrez - 2018 - Global Availability of Antivenoms The Relevance of Public Manufacturing Laboratories.pdf:pdf},
issn = {2072-6651},
journal = {Toxins},
keywords = {Antivenoms,Availability,Preclinical efficacy,Public laboratories,Snakebite envenoming},
month = {dec},
number = {1},
pages = {5},
title = {{Global Availability of Antivenoms: The Relevance of Public Manufacturing Laboratories}},
url = {http://www.mdpi.com/2072-6651/11/1/5},
volume = {11},
year = {2018}
}
@article{Anderson2018,
abstract = {Snake envenoming is a serious and neglected public health crisis that is responsible for as many as 125,000 deaths per year, which is one of the reasons the World Health Organization has recently reinstated snakebite envenoming to its list of category A neglected tropical diseases. Here, we investigated the ability of human mast cell proteases to detoxify six venoms from a spectrum of phylogenetically distinct snakes. To this end, we developed a zebrafish model to assess effects on the toxicity of the venoms and characterized the degradation of venom proteins by mass spectrometry. All snake venoms tested were detoxified by degradation of various venom proteins by the mast cell protease tryptase $\beta$, and not by other proteases. Our data show that recombinant human tryptase $\beta$ degrades and detoxifies a phylogenetically wide range of venoms, indicating that recombinant human tryptase could possibly be developed as a universal antidote to venomous snakebites.},
author = {Anderson, Elizabeth and Stavenhagen, Kathrin and Kolarich, Daniel and Sommerhoff, Christian P. and Maurer, Marcus and Metz, Martin},
doi = {10.3389/fimmu.2018.01532},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Anderson et al. - 2018 - Human Mast Cell Tryptase Is a Potential Treatment for Snakebite Envenoming Across Multiple Snake Species(2).pdf:pdf},
issn = {1664-3224},
journal = {Frontiers in Immunology},
keywords = {Antivenom,Mast cell,Proteases,Snakes,Venom},
month = {jul},
number = {JUL},
title = {{Human Mast Cell Tryptase Is a Potential Treatment for Snakebite Envenoming Across Multiple Snake Species}},
url = {https://www.frontiersin.org/article/10.3389/fimmu.2018.01532/full},
volume = {9},
year = {2018}
}
@article{Welton2017,
abstract = {Introduction It has been over 20 years since a national review of recorded deaths from snake envenoming. The present study aimed to provide an updated review of the epidemiology of deaths from snake bites in Australia. Methods Deaths were identified from January 2000 to December 2016 from the National Coronial Information System. Cases identified due to snakes were extracted with data on coronial findings, autopsy and police records. Results Thirty five deaths (2.2 per year) were ascribed or antecedent to a snake bite. Sixteen cases were attributed to snake bite/envenoming as leading directly to death, with other direct causes of death being multiple organ failure (n = 3), intracerebral haemorrhage (n = 2), cerebral hypoxia or anoxia (n = 3), cardiac arrest (n = 1), complications of snake bite (n = 3) or brain stem death (n = 1). Four cases did not have a snake bite indicated in the case history, with an initial diagnosis of either hyperthermia, stroke, gastroenteritis and a horse accident. The median age was 46.5 years (range 1.5–70 years), and 74% were males (n = 25). The time from bite to death varied from 1 h to 19 days. Fifty four percent of bites occurred at the person's residence (n = 1), with 17 being in an urban environment. Conclusions Death from snake bite remains rare in Australia, and has maintained a steady rate for over 20 years. Usually considered a ‘rural issue', and with varying recorded causes of death, a nationally co-ordinated effort to further review the national picture of envenoming in Australia can inform education and resource needs within state and local contexts.},
author = {Welton, Ronelle E. and Liew, Danny and Braitberg, George},
doi = {10.1016/j.toxicon.2017.03.008},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Welton, Liew, Braitberg - 2017 - Incidence of fatal snake bite in Australia A coronial based retrospective study (2000–2016).pdf:pdf},
issn = {18793150},
journal = {Toxicon},
keywords = {Australia,Envenoming,Mortality,Snake},
month = {jun},
pages = {11--15},
title = {{Incidence of fatal snake bite in Australia: A coronial based retrospective study (2000–2016)}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010117300958},
volume = {131},
year = {2017}
}
@article{Mahmood2019,
abstract = {Introduction Every year millions of people in developing countries suffer from snakebite, causing a large number of deaths and long term complications. Prevention and appropriate first aid could reduce the incidence and improve the health outcomes for those who suffer bites. However, many communities where snakebite is a major issue suffer from a lack of information about prevention and first aid measures that a family or community member could take to prevent severe envenoming, complications and poor outcomes. Myanmar suffers from a high burden of snakebites with a large number of deaths. As part of a health services and community development program, a community survey was conducted to identify communities' knowledge about snakebite and their sequelae, and knowledge and practice about first aid and health services use. Method 4,276 rural residents of Kyaukse and Madaya townships in the Mandalay region were recruited by cluster sampling, involving random selection of 144 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire. Results The incidence of snakebite was 116/100,000 people. Respondents reported 15 different types of snakes in the area, with Russell's Viper, Cobra and Green snakes as the most common. 88% of the people informed that working in the fields and forests was when most of the bites occur. A majority knew about snakebite prevention methods such as wearing long boots. However, only a few people knew about the specific symptoms caused by snakebites. Only 39% knew about the correct methods of first aid. More than 60% mentioned tourniquet as a first aid method, though this may cause significant complications such as ischaemia of the limb. 88% said that they would take a snakebite victim to a government hospital, and 58% mentioned availability of antivenom as the reason for doing this. At the same time, the majority mentioned that traditional methods existed for first aid and treatment and 25% mentioned at least one harmful traditional method as an effective measure that they might use. Conclusion The community is aware of snakebites as a major public health issue and know how to prevent them. However, the high incidence of snakebites point to lack of application of preventive methods. The community recognise the need for treatment with antivenom. However, inadequate knowledge about appropriate first aid methods, and a reliance on using tourniquets require a targeted education program. Existing knowledge in communities, albeit insufficient, provides a good starting point for mass media educational campaigns.},
author = {Mahmood, Mohammad Afzal and Halliday, Dale and Cumming, Robert and Thwin, Khin Thida and Myitzu, Mya and White, Julian and Alfred, Sam and Warrell, David A. and Bacon, David and Naing, Win and Aung, Htay and Thein, Myat Myat and Chit, Nyein Nyein and Serhal, Sara and Nwe, Myat Thet and Aung, Pyae Phyo and Peh, Chen Au},
doi = {10.1371/journal.pntd.0007171},
editor = {de Silva, Janaka},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Mahmood et al. - 2019 - Inadequate knowledge about snakebite envenoming symptoms and application of harmful first aid methods in the com.pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {feb},
number = {2},
pages = {e0007171},
title = {{Inadequate knowledge about snakebite envenoming symptoms and application of harmful first aid methods in the community in high snakebite incidence areas of Myanmar}},
url = {http://dx.plos.org/10.1371/journal.pntd.0007171},
volume = {13},
year = {2019}
}
@article{Williams2015,
abstract = {Vulnerable populations need urgent access to effective and affordable treatments},
author = {Williams, David J.},
doi = {10.1136/bmj.h5378},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Williams - 2015 - Snake bite A global failure to act costs thousands of lives each year Vulnerable populations need urgent access to eff.pdf:pdf},
issn = {17561833},
journal = {BMJ (Online)},
month = {oct},
pages = {h5378},
title = {{Snake bite: A global failure to act costs thousands of lives each year: Vulnerable populations need urgent access to effective and affordable treatments}},
url = {http://www.bmj.com/lookup/doi/10.1136/bmj.h5378},
volume = {351},
year = {2015}
}
@article{Larson2013,
abstract = {Disability-adjusted-life-years lost (DALYs) is a common outcome metric for cost-effectiveness analyses, and the equations used for such calculations have been presented previously by Fox-Rushby and Hanson (see, e.g., " Health Policy and Planning 16:326-331, 2001" ). While the equations are clear, the logic behind them is opaque at best for a large share of public health practitioners and students. The objective of this paper is to show how to calculate DALYs using a discrete time formulation that is easy to teach to students and public health practitioners, is easy to apply for those with basic discounting skills, and is consistent with the discounting methods typically included on the costing side of cost-effectiveness analysis. A continuous-time adjustment factor is derived that can be used to ensure exact consistency between the continuous and discrete time approaches, but this level of precision is typically unnecessary for cost-effectiveness analyses. To illustrate the approach, both a new, simple example and the same example presented in Fox-Rushby and Hanson are used throughout the paper. {\textcopyright} 2013 Larson; licensee BioMed Central Ltd.; licensee BioMed Central Ltd.},
author = {Larson, Bruce A},
doi = {10.1186/1478-7547-11-18},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Larson - 2013 - Calculating disability-adjusted-life-years lost (DALYs) in discrete-time.pdf:pdf},
issn = {14787547},
journal = {Cost Effectiveness and Resource Allocation},
keywords = {Cost-effectiveness,Disability adjusted life years lost,Discrete time},
month = {aug},
number = {1},
pages = {1--6},
pmid = {23927817},
title = {{Calculating disability-adjusted-life-years lost (DALYs) in discrete-time}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23927817 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3776440},
volume = {11},
year = {2013}
}
@article{Muhammed2017,
abstract = {Background: Snakebite though neglected, affects 5 million people yearly. More neglected is the psychological effect of envenomation. We determined prevalence and pattern of depression among patients admitted into snakebite wards of Kaltungo General Hospital Nigeria, and percentage recognized by clinicians. We also assessed for factors associated with depression. Methods: In a descriptive hospital based study, we used Patient Health questionnaire (PHQ-9) to make diagnosis of depression among the patients. We reviewed patients' clinical records to determine clinicians' recognition of depression. Results: Of 187 interviews analyzed, 47 (25%) had depression with none recognized by attending clinicians. Patients with snakebite complications (odd ratio [OR] 3.1, 95% CI 1.1-8.5), and previous history of snakebites (OR 2.7, 95% CI 1.1-6.1) were associated with mild depression. Worrying about family welfare (OR 31.5, 95% CI 6.5-152.9), financial loss (OR 14.6, 95% CI 1.8-121.5) and time loss (OR 14.6, 95% CI 1.8-121.5), past history of snakebites (OR 8.3, 95% CI 1.9-36.5) and lower income (Mean difference -25,069 [84 USD], 95% CI 35,509 [118 USD]-14,630 [49 USD]) were associated with severe depression. Conclusion: A quarter of in-patients of snakebite wards of the general hospital had comorbid depression that went unrecognized. Independent predictors of depression such as past history of snakebite, worrying about relations and having snakebite complications could help clinicians anticipate depression among patients. We recommend training of clinicians in the hospital on recognition of common psychological disorders like depression.},
author = {Muhammed, Abdulaziz and Dalhat, Mahmood M. and Joseph, Babalola O. and Ahmed, Abubakar and Nguku, Patrick and Poggensee, Gabriele and Adeiza, Mukthar and Yahya, Garba I. and Hamza, Muhammad and Habib, Zaiyad G. and Oladimeji, Abisola M. and Nasidi, Abdulsalam and Balla, Abubakar and Nashabaru, Ibrahim and Sani-Gwarzo, Nasir and Yakasai, Ahmad M. and Difa, Joshua A. and Sheikh, Taiwo Lateef and Habib, Abdulrazaq G.},
doi = {10.1186/s13033-017-0132-8},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Muhammed et al. - 2017 - Predictors of depression among patients receiving treatment for snakebite in General Hospital, Kaltungo, Gombe.pdf:pdf},
issn = {1752-4458},
journal = {International Journal of Mental Health Systems},
keywords = {Depression,Envenomation,General hospital,Snakebites},
month = {dec},
number = {1},
pages = {26},
title = {{Predictors of depression among patients receiving treatment for snakebite in General Hospital, Kaltungo, Gombe State, Nigeria: August 2015}},
url = {http://ijmhs.biomedcentral.com/articles/10.1186/s13033-017-0132-8},
volume = {11},
year = {2017}
}
@article{Feitosa2015,
abstract = {The Amazon region reports the highest incidence of snakebite envenomings in Brazil. We aimed to describe the epidemiology of snakebites in the state of Amazonas and to investigate factors associated with disease severity and lethality. We used a nested case-control study, in order to identify factors associated with snakebite severity and mortality using official Brazilian reporting systems, from 2007 to 2012. Patients evolving to severity or death were considered cases and those with non-severe bites were included in the control group. During the study period, 9,191 snakebites were recorded, resulting in an incidence rate of 52.8 cases per 100,000 person/years. Snakebites mostly occurred in males (79.0%) and in rural areas (70.2%). The most affected age group was between 16 and 45 years old (54.6%). Fifty five percent of the snakebites were related to work activities. Age ≤15 years [OR=1.26 (95% CI=1.03-1.52); (p=0.018)], age ≥65 years [OR=1.53 (95% CI=1.09-2.13); (p=0.012)], work related bites [OR=1.39 (95% CI=1.17-1.63); (p<0.001)]and time to medical assistance >6 hours [OR=1.73 (95% CI=1.45-2.07); (p<0.001)] were independently associated with the risk of severity. Age ≥65 years [OR=3.19 (95% CI=1.40-7.25); (p=0.006)] and time to medical assistance >6 hours [OR=2.01 (95% CI=1.15-3.50); (p=0.013)] were independently associated with the risk of death. Snakebites represent an occupational health problem for rural populations in the Brazilian Amazon with a wide distribution. These results highlight the need for public health strategies aiming to reduce occupational injuries. Most cases of severe disease occurred in the extremes of age, in those with delays in medical attention and those caused by Micrurus bites. These features of victims of snakebite demand adequate management according to well-defined protocols, ncluding prompt referral to tertiary centres when necessary, as well as an effective response from surveillance systems and policy makers for these vulnerable groups.},
author = {Feitosa, Esa{\'{u}} L. and Sampaio, Vanderson S. and Salinas, Jorge L. and Queiroz, Amanda M. and da Silva, Iran Mendon{\c{c}}a and Gomes, Andr{\'{e}} A. and Sachett, Jacqueline and Siqueira, Andr{\'{e}} M. and Ferreira, Luiz Carlos L. and dos Santos, Maria Cristina and Lacerda, Marcus and Monteiro, Wuelton},
doi = {10.1371/journal.pone.0132237},
editor = {Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Feitosa et al. - 2015 - Older Age and Time to Medical Assistance Are Associated with Severity and Mortality of Snakebites in the Brazili.pdf:pdf},
issn = {1932-6203},
journal = {PLOS ONE},
month = {jul},
number = {7},
pages = {e0132237},
title = {{Older Age and Time to Medical Assistance Are Associated with Severity and Mortality of Snakebites in the Brazilian Amazon: A Case-Control Study}},
url = {https://dx.plos.org/10.1371/journal.pone.0132237},
volume = {10},
year = {2015}
}
@misc{Chippaux2012,
abstract = {Noabstract: letter Extract: In Africa, snakebites and scorpion stings have long been oppressive for indigenous peoples, frightening for foreign travelers and confusing for medical personnel... In many tropical countries, studies were performed to assess the importance and management of envenomations. Since the 18th century, many works have addressed Indian venomous snakes and treatment of their bites (1, 2). In Brazil, studies began in the late 19th century (3). In Africa, apart from some systematic zoological studies in the early or mid 20th century, sustained research commenced mainly after the end of the colonial era (4-8). However to date, the incidence and mortality in Africa remain poorly known, limiting the organization of management and prediction of therapeutic needs (9).},
author = {Chippaux, Jean Philippe},
booktitle = {Journal of Venomous Animals and Toxins Including Tropical Diseases},
doi = {10.1590/S1678-91992012000400002},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Chippaux - 2012 - African Society of Toxinology A new opportunity for integrating the control of envenomations in Africa.pdf:pdf},
issn = {16789199},
number = {4},
pages = {357--360},
publisher = {BioMed Central Ltd.},
title = {{African Society of Toxinology: A new opportunity for integrating the control of envenomations in Africa}},
volume = {18},
year = {2012}
}
@article{Halilu2019,
abstract = {There is no reliable estimate of burden of snakebite-envenoming (SBE) in Sub-Saharan Africa (SSA). We derived from a meta-analysis the burden of SBE related deaths, amputations and Post-Traumatic Stress Disorder (PTSD) in 41 countries in SSA. The annual burden was estimated at 1.03 million DALYs (95% Confidence Interval: 0.80–1.28 million DALYs). This is similar to or higher than the burden of many Neglected Tropical Diseases (NTDs) and the finding advocates for a commensurate resources allocation towards control of SBE.},
author = {Halilu, Sadiq and Iliyasu, Garba and Hamza, Muhammad and Chippaux, Jean Philippe and Kuznik, Andreas and Habib, Abdulrazaq G.},
doi = {10.1016/j.toxicon.2018.12.002},
issn = {18793150},
journal = {Toxicon},
keywords = {Burden,Disability adjusted life years,Snakebite,Sub-Saharan Africa},
month = {mar},
pages = {1--4},
title = {{Snakebite burden in Sub-Saharan Africa: estimates from 41 countries}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010118311802},
volume = {159},
year = {2019}
}
@techreport{WorldHealthOrganisationWHO1996,
abstract = {The people most affected by rabid dog bites, snake bites and scorpion stings usually live in poor rural communities where medical resources are often sparse. Because they lack a strong political voice, their problems tend to be overlooked by politicians and health authori-ties who are based in capital cities and are poorly informed about major public health issues affecting rural areas. Consequently, the impact of these health issues, although dramatic and economically signifi cant, does not appear as a priority in the design of national public health programmes. These are therefore the most neglected among today's neglected global health problems. The gravity of this situation should be discussed explicitly in national, regional and global health fora, in order to give these neglected diseases and their abandoned victims the atten-tion they deserve. The situation is particularly poignant because, in contrast to some other diseases, a highly effective treatment already exists: the timely administration of specifi c antiserum. Rabies, for instance, is entirely preventable even after severe exposure, provided post-exposure prophylaxis, completed with rabies immunoglobulin, can be given. Similarly, the mortality and morbidity of snake bites and scorpion stings can be reduced to very low levels by timely administration of appropriate antivenoms. The state of antisera production worldwide varies greatly. Public access to production technology following GMP standards, together with a concerted exchange process through workshops, direct technical assistance and innovation in specifi c aspects of manufacture and training, should allow the less developed manufacturing laboratories to strengthen their technical and production capacities. The possibility of partnerships should be promoted, including, in the case of antivenoms, the creation of groups developing the skills needed for the preparation of high quality venom pools and the subsequent preparation of antivenoms.In summary, the current situation of the management of potentially rabid mammal bites and envenomings by snake bites or scorpion stings worldwide is a global public health emergency. There is a lack of awareness of the magnitude of the problem by health authorities and politi-cians alike, due to both the scarcit y of adequate statistics on the real impact of these diseases, and the lack of advocacy by and on behalf of the affected groups, mostly children and rural agricultural workers. Worldwide production of these antisera has declined, due to economic constraints that have forced the withdrawal of some private producers, and to the weakening of public-sector manufacturers in the public sector in many countries. Moreover, the poor quality of some antisera and the resulting defi ciency in their effi cacy and safety, together with defi cient distribution policies and inadequate training of medical and nursing staff requires an urgent international action. The gravity of this problem, and the complexity of its causes, demands from the public health community, and especially from the WHO and humanitarian international agencies, a concerted, rapid and effective global response to reduce the burden of human suffering incurred by rabies, and snake and scorpion envenomings.},
archivePrefix = {arXiv},
arxivId = {cs/9605103},
author = {{World Health Organisation (WHO)}},
booktitle = {Journal of Artificial Intelligence Research},
doi = {10.1613/jair.301},
eprint = {9605103},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/World Health Organisation (WHO) - 1996 - Rabies and envenomings a neglected public health issue report of a Consultative Meeting, WHO,.pdf:pdf},
isbn = {9789241563482},
issn = {9789241563482},
number = {January},
pages = {237--285},
pmid = {20083102538},
primaryClass = {cs},
title = {{Rabies and envenomings : a neglected public health issue : report of a Consultative Meeting, WHO, Geneva, 10 January 2007.}},
url = {http://www.who.int/bloodproducts/animal_sera/Rabies.pdf},
volume = {4},
year = {1996}
}
@article{Schulte2016,
abstract = {BACKGROUND: Snakebites are not a reportable condition (to state health departments), and 1 abs major assessment of US children with snakebites was published 50 years ago. Increasing urbanization, population shifts south and west, newer antivenom therapy, and the importation of exotic snakes may have changed snakebites. Poison control centers are often consulted on treatment and collect surveillance data. METHODS: Generic codes for venomous, nonvenomous, and unknown snakebites were used to characterize victims aged ≤18 years reported to US poison control centers between 2000 and 2013. Data included demographic characteristics, snake types, and outcomes. RESULTS: Callers reported 18 721 pediatric snakebites (annual mean, 1337). Two-thirds were male (n = 12 688 [68%]), with a mean age of 10.7 years. One-half of the snakebites were venomous (n = 9183 [49%]), with copperheads (n = 3602 [39%]) and rattlesnakes (n = 2859 [31%]) the most frequently identified. Reported copperhead bites increased 137% and unknown crotalids (venomous) increased 107%. Exotic (nonnative) exposures were reported in 2% of cases. All 50 states reported snakebites, but one-quarter occurred in Texas and Florida. Rates for total snakebites and venomous snakebites were highest in West Virginia, Oklahoma, and Louisiana. One-fifth required ICU admission. Limited data for 28% of bites for antivenom treatment suggests increasing use. Four victims died. CONCLUSIONS: The epidemiology of pediatric snakebites is changing. One-half of the reported exposures were venomous, and copperhead bites and exotic species are being reported more frequently. Although snakebite-related deaths are rare, ICU admission is common. Antivenom treatment is incompletely reported, but its use is increasing.},
author = {Schulte, Joann and Domanski, Kristina and Smith, Eric Anthony and Menendez, Annelle and Kleinschmidt, Kurt C. and Roth, Brett A.},
doi = {10.1542/peds.2016-0491},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Schulte et al. - 2016 - Childhood victims of snakebites 2000-2013.pdf:pdf},
issn = {10984275},
journal = {Pediatrics},
month = {nov},
number = {5},
pages = {e20160491},
title = {{Childhood victims of snakebites: 2000-2013}},
url = {http://pediatrics.aappublications.org/lookup/doi/10.1542/peds.2016-0491},
volume = {138},
year = {2016}
}
@article{Kumar2015,
abstract = {Introduction: Snake bite is a very common problem in rural India which even today leads to a large number of deaths. This is because the uninformed community memb traditional healing measures which cause loss of vital time which is very important for the survival of the patient. Objectives: To assess the knowledge of the study population on snake bite and to elicit any association of this knowledge with their demographic and socioeconomic characteristics. Material and methods: An observational, cross Block of Hooghly district of West Bengal. The head of the family or in his absence the members was interviewed with a pre Results: Farming was the occupation of the majority (17.7%). 45% belonged to the social class I and social class IV and V. Only 58.85% of the study population were aware that the incidence of snake bite can be reduced. 68% were aware of immobilisation of the affected part was the initial first aid measure and only 4% had the harmful.. Correct knowledge on the availability of specific treatment was present among 85.1% and 77.1% knew where specific treatment is available. Education OR 2.51 4.44 (2.35-8.40), PCI OR 2.05 Conclusion: There is a paucity of knowledge on different domains of snakebite. Hence dissemination of correct knowledge is necessary to remove their misconc},
author = {Kumar, A and Dasgupta, A and Biswas, D and Sahoo, S and Das, S and Preeti, P},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kumar et al. - 2015 - Knowledge regarding snake bite in rural Bengal – Are they still lingering on myths and misconceptions.pdf:pdf},
issn = {2394-0026},
journal = {http://iaimjournal.com/wp-content/uploads/2015/07/iaim_2015_0207_07.pdf},
keywords = {Article,Collar,First aid,Immobilisation,Knowledge,Snake bite},
number = {7},
pages = {36--41},
title = {{Knowledge regarding snake bite in rural Bengal – Are they still lingering on myths and misconceptions.}},
url = {https://imsear.searo.who.int/handle/123456789/164789},
volume = {2},
year = {2015}
}
@article{Vongphoumy2016,
abstract = {Snakebites are a seriously neglected public health problem in Lao PDR. Community-based cross-sectional surveys in two districts of Savannakhet province in Southern Laos revealed an incidence of up to 1105 snakebites per 100,000 persons per year. In contrast the number of snakebite patients treated in district and provincial hospitals are low. In order to improve health care for snakebite victims, antivenom was introduced to Savannakhet provincial hospital in July 2013 and medical staff has been trained in management of venomous snakebites at the same time. After the intervention the number of snakebite patients treated at the provincial hospital increased significantly from 4 patients in 2012 to 158 snakebite patients between July 2013 and November 2015. They were included into a prospective, consecutive case series. Median age was 32 years (range 1.5-70 years) and male-to-female ratio 2.2:1. Forty patients were bitten by Malayan pit vipers, 26 by green pit vipers, 24 by cobras, including 3 cases of venom ophthalmia, 5 by kraits, 8 by non-venomous species and in 55 cases the snake could not be identified. Forty-three out of 158 patients received horse derived F(ab')2 antivenom from Queen Saovabha Memorial Institute (QSMI) in Bangkok. Twenty-three patients (53%) developed early adverse reactions (EARs) within one hour after antivenom administration, including 13 patients (30%) with severe anaphylaxis. This extremely high rate of severe EARs turns the use of antivenom into a risky intervention. In contrast a retrospective chart review from Chulalongkorn University in Bangkok found only 3.5% early reactions including 1.2% severe anaphylactic reactions using the same antivenom from QSMI between 1997 and 2006. The reason for this enormous difference remains unclear. A better understanding of the aetiology and pathophysiology behind antivenom induced anaphylaxis is crucial in order to identify patients at risk and to improve safety of antivenom administration.},
author = {Vongphoumy, Inthanomchanh and Chanthilat, Phankham and Vilayvong, Phongmany and Blessmann, Joerg},
doi = {10.1016/j.toxicon.2016.03.011},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Vongphoumy et al. - 2016 - Prospective, consecutive case series of 158 snakebite patients treated at Savannakhet provincial hospital, La.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Anaphylaxis,F(ab')2 snake antivenom,Lao PDR,Venomous snakebites},
month = {jul},
pages = {13--21},
pmid = {26995210},
publisher = {Elsevier Ltd},
title = {{Prospective, consecutive case series of 158 snakebite patients treated at Savannakhet provincial hospital, Lao People's Democratic Republic with high incidence of anaphylactic shock to horse derived F(ab')2 antivenom}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010116300514},
volume = {117},
year = {2016}
}
@misc{WorldHealthOrganizationWHO2019,
abstract = {Though the exact number of snake bites is unknown, an estimated 5.4 million people are bitten each year with up to 2.7 million envenomings. Around 81 000 to 138 000 people die each year because of snake bites, and around three times as many amputations and other permanent disabilities are caused by snakebites annually. Bites by venomous snakes can cause paralysis that may prevent breathing, bleeding disorders that can lead to a fatal haemorrhage, irreversible kidney failure and tissue damage that can cause permanent disability and limb amputation. Agricultural workers and children are the most affected. Children often suffer more severe effects than adults, due to their smaller body mass.},
author = {{World Health Organization (WHO)}},
title = {{Snakebite envenoming}},
url = {https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming},
urldate = {2020-07-31},
year = {2019}
}
@article{Longbottom2018,
abstract = {Background: Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed. Methods: We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality. Findings: We provide a map showing the ranges of 278 snake species globally. Although about 6{\textperiodcentered}85 billion people worldwide live within range of areas inhabited by snakes, about 146{\textperiodcentered}70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272{\textperiodcentered}91 million individuals (65{\textperiodcentered}25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519{\textperiodcentered}46 million individuals (27{\textperiodcentered}79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750{\textperiodcentered}19 million (10{\textperiodcentered}95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92{\textperiodcentered}66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia. Interpretation: Identifying 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. Funding: Bill & Melinda Gates Foundation.},
author = {Longbottom, Joshua and Shearer, Freya M. and Devine, Maria and Alcoba, Gabriel and Chappuis, Francois and Weiss, Daniel J. and Ray, Sarah E and Ray, Nicolas and Warrell, David A. and {Ruiz de Casta{\~{n}}eda}, Rafael and Williams, David J. and Hay, Simon I. and Pigott, David M.},
doi = {10.1016/S0140-6736(18)31224-8},
issn = {01406736},
journal = {The Lancet},
month = {aug},
number = {10148},
pages = {673--684},
pmid = {30017551},
title = {{Vulnerability to snakebite envenoming: a global mapping of hotspots}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0140673618312248},
volume = {392},
year = {2018}
}
@article{Hernandez2019,
abstract = {Background: Snake envenomation is associated with major morbidity especially in low- and middle-income countries and may require fasciotomy. We determined patient factors associated with the need for fasciotomy after venomous snake bites in children located in KwaZulu-Natal, South Africa. Methods: Single institutional review of historical data (2012–2017) for children (<18 years) sustaining snake envenomation was performed. Clinical data, management, and outcomes were abstracted. Syndromes after snake bite were classified according to Blaylock nomenclature: progressive painful swelling (PPS), progressive weakness (PW), or bleeding (B), as it is difficult to reliably identify the species of snake after a bite. Comparative and multivariable analyses to determine factors associated with fasciotomy were performed. Results: There were 72 children; mean age was 7 (±3) years, 59% male. Feet were most commonly affected (n = 27, 38%) followed by legs (n = 18, 25%). Syndromes (according to Blaylock) included PPS (n = 63, 88%), PW (n = 5, 7%), and B (n = 4, 5%). Eighteen patients underwent fasciotomy, and one required above knee amputation. Nine patients received anti-venom. Few patients (15%) received prophylactic beta-lactam antibiotics. Hemoglobin < 11 mg/dL, leukocytosis, INR >1.2, and age-adjusted shock index were associated with fasciotomy. On regression, age-adjusted shock index and hemoglobin concentration < 11 mg/dL, presentation >24 h after snake bite, and INR >1.2 were independently associated with fasciotomy. Model sensitivity was 0.89 and demonstrated good fit. Conclusions: Patient factors were associated with the fasciotomy. These factors, coupled with clinical examination, may identify those who need early operative intervention. Improving time to treatment and the appropriate administration of anti-venom will minimize the need for surgery. Level of evidence: III.},
author = {Hernandez, Matthew C. and Traynor, Michael and Bruce, John L. and Bekker, Wanda and Laing, Grant L. and Aho, Johnathon M. and Kong, Victor Y. and Klinkner, Denise B. and Zielinski, Martin D. and Clarke, Damian L.},
doi = {10.1007/s00268-019-04953-9},
issn = {14322323},
journal = {World Journal of Surgery},
month = {jul},
number = {7},
pages = {1636--1643},
pmid = {30783764},
publisher = {Springer New York LLC},
title = {{Surgical Considerations for Pediatric Snake Bites in Low- and Middle-Income Countries}},
url = {http://link.springer.com/10.1007/s00268-019-04953-9},
volume = {43},
year = {2019}
}
@article{Gutierrez2020,
abstract = {Snakebite envenomings occur in complex ecological, social, economic, cultural, and political contexts. Hence, the understanding of this public health issue demands systemic and holistic approaches. Ecohealth constitutes a valuable paradigm to study snakebites, as it emphasizes on the close linkages between ecosystems, society, and health. This essay highlights some of the areas in the field of snakebite envenoming that could greatly benefit from an Ecohealth approach based on trans-disciplinary research, systems thinking, and the involvement of stakeholders at many levels. Ecohealth focuses not only on the generation of knowledge through research, but also in the translation of knowledge into actions.},
author = {Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a},
doi = {10.1016/j.toxcx.2020.100043},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Guti{\'{e}}rrez - 2020 - Snakebite envenoming from an Ecohealth perspective.pdf:pdf},
issn = {25901710},
journal = {Toxicon: X},
keywords = {Ecohealth,One health,Snakebite envenoming,Trans-disciplinary research},
month = {sep},
pages = {100043},
publisher = {Elsevier Ltd},
title = {{Snakebite envenoming from an Ecohealth perspective}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S2590171020300217},
volume = {7},
year = {2020}
}
@article{Johnston2017,
abstract = {Objective: To describe the epidemiology, treatment and adverse events after snakebite in Australia. Design: Prospective, multicentre study of data on patients with snakebites recruited to the Australian Snakebite Project (2005–2015) and data from the National Coronial Information System. Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed snakebites from July 2005 to June 2015 and consenting to participation. Main outcome measures: Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths. Results: 1548 patients with suspected snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7–6.3 hours). Conclusions: Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. Themedian antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.},
author = {Johnston, Christopher I. and Ryan, Nicole M. and Page, Colin B. and Buckley, Nicholas A. and Brown, Simon G.A. and O'Leary, Margaret A and Isbister, Geoffrey K.},
doi = {10.5694/mja17.00094},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Johnston et al. - 2017 - The Australian Snakebite Project, 2005–2015 (ASP‐20).pdf:pdf},
issn = {0025-729X},
journal = {Medical Journal of Australia},
month = {aug},
number = {3},
pages = {119--125},
title = {{The Australian Snakebite Project, 2005–2015 (ASP‐20)}},
url = {https://onlinelibrary.wiley.com/doi/abs/10.5694/mja17.00094},
volume = {207},
year = {2017}
}
@phdthesis{ADOBASOM-ANANE2018,
abstract = {Snakebite poisoning is a public health concern to persons in agrarian environments and the northern region of Ghana is no exception. Youthful male agricultural and field workers have been reported to be at higher risk of snakebite, hence necessitating a study to determine the full extent of the snakebite problem in the Tamale Teaching Hospital.The objective of this study wasto determine the epidemiological characteristics of the snakebite cases that were reported at the Tamale Teaching Hospital.A retrospective review of snakebite cases reported to the Tamale Teaching Hospital between January, 2013 and June, 2014 was carried out. A total of 150 cases were reviewed and the data analysed using SPSS version 20with all chart drawn using MicrosoftExcel 2013. The results of the study were, theprevalence of snakebite cases reported at the hospital was89/100,000 population. Majority of the victims were between 15-59 years (65%). Males (64.7%) were the majority with farmers(46%) being the most affected. The majorityof cases occurred in February, March and September mostly from the rural areas with the East Gonja district having the highest. The lower limbs were the commonly bittensite with most occurring during the daytime (68.67%) and outdoors (75.33%). Pain, swelling and bleeding were the commonest clinical presentations of thevictims whiles 68.67% of them used first aid. The carpet viper was the only positively identified snake. Of the 78.67% of the victims who received ASV, 6.78% adversely reacted. The outcome of the cases were 84% cured, 12% discharged against medical advice and 4% dead.In conclusion, snakebite prevalence is high atthe TTH, affecting mainly young agricultural male workers in the rural partsof the region. The carpet viperis responsible for most bites and ASV administration was the mainstay of snakebite management},
author = {Adobasom-anane, Austin Gideon},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Adobasom-anane - 2018 - Restrospective Study of Snakebite Cases at Tamale Teaching Hospital(2).pdf:pdf},
pages = {1--158},
title = {{Restrospective Study of Snakebite Cases at Tamale Teaching Hospital}},
url = {moz-extension://71759379-7305-4d9f-ac75-b7ed5b16515b/enhanced-reader.html?openApp&pdf=http%3A%2F%2Fudsspace.uds.edu.gh%2Fbitstream%2F123456789%2F1751%2F1%2FRETROSPECTIVE%2520STUDY%2520OF%2520SNAKEBITE%2520CASES%2520AT%2520THE%2520TAMALE%2520TEACHING%2520H},
year = {2018}
}
@article{Gaus2013,
abstract = {Objectives In low-income countries, snakebites are frequently managed in rural areas in health centers with severely constrained resources. Many healthcare providers in these settings have limited access to the numerous and relatively expensive laboratory studies used to diagnose envenomation. The relatively simple and inexpensive 20-minute whole blood clotting test (WBCT) has been recommended by several international organizations for the diagnosis of certain venomous snakebites. This study proposes to confirm the utility of the WBCT as the sole laboratory diagnostic tool to determine systemic envenomation in hematotoxic snakebite management in severely resource-constrained areas of the world. Methods The authors reviewed all 110 cases of snakebite during a 6-year period in a small hospital in rural Ecuador using the WBCT. Results All cases presented within 24 hours of snakebite. Twenty cases revealed normal coagulation with no clinical evidence of systemic envenomation. Ninety cases had no evidence of clot formation (positive WBCT) at 20 minutes, suggesting systemic envenomation. Of these 90 cases, according to a classification scale, 54 were mild, 26 were moderate, and 10 were severe envenomations requiring transfer to tertiary care. All mild and moderate systemic envenomations were successfully treated at the rural hospital. All severe envenomations were treated initially with antivenom before transfer to tertiary care. One patient with severe envenomation died in tertiary care. Conclusions The WBCT was predictive of the presence or absence of systemic envenomation from snakebite in our region. The WBCT guided the successful management of mild and moderate systemic envenomation, and spared patients with no evidence of systemic envenomation from potential side effects of antivenom.},
author = {Gaus, David P. and Herrera, Diego F. and Troya, Carlos J. and Guevara, Alicia H.},
doi = {10.1016/j.wem.2013.08.001},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Gaus et al. - 2013 - Management of snakebite and systemic envenomation in rural ecuador using the 20-minute whole blood clotting test.pdf:pdf},
issn = {10806032},
journal = {Wilderness and Environmental Medicine},
keywords = {international health,snakebite,whole blood clotting test},
month = {dec},
number = {4},
pages = {345--350},
pmid = {24119570},
title = {{Management of snakebite and systemic envenomation in rural ecuador using the 20-minute whole blood clotting test}},
volume = {24},
year = {2013}
}
@article{Aktar2016,
abstract = {Background: Snakebites are an emergency medical condition and require rapid treatment procedures in children. Objectives: This study aimed to present an overview of the demographic characteristics, clinical presentations, laboratory findings, severity, and complications that developed in pediatric patients due to snakebites. Patients and Methods: A total of 151 children with snakebite were enrolled in the study. All patients had a history of snakebite obtained between June 2006 and August 2015 retrospectively. Results: Duration of hospitalization (P < 0.001), rural occurrence (P < 0.001), white blood cell (WBC) count (P = 0.002), aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio (P = 0.010), hypoproteinemia (P = 0.001), hypoalbuminemia (P < 0.001), and hypocalcemia (P = 0.005) were significantly high in the severe snakebite group. WBC (P = 0.006) and AST/ALT ratio (P = 0.018) were significantly higher on the first day of the snakebite than on subsequent days. Conclusions: Children admitted to the hospital due to snakebite should be monitored for at least 24-48 hours even if no signs of clinical envenomation could be observed. According to the severity of the disease, antivenom should be administered to the patients. Duration of hospitalization, rural occurrence, WBC count, AST/ALT ratio, CK, hypoproteinemia, hypoalbuminemia, and hypocalcemia can be associated with the severity of snakebite. WBC AST/ALT ratio can be used as follow-up criteria in children with snakebite.},
author = {Aktar, Fesih and Aktar, Safak and Yolbas, Ilyas and Tekin, Recep},
doi = {10.5812/ijp.5212},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Aktar et al. - 2016 - Evaluation of Risk Factors and Follow-Up Criteria for Severity of Snakebite in Children.pdf:pdf},
issn = {2008-2142},
journal = {Iranian Journal of Pediatrics},
keywords = {Antivenom,Child,Envenomation,Snakebite},
month = {jul},
number = {4},
title = {{Evaluation of Risk Factors and Follow-Up Criteria for Severity of Snakebite in Children}},
url = {https://sites.kowsarpub.com/ijp/articles/5212.html},
volume = {26},
year = {2016}
}
@misc{GHSUWR2015,
author = {{GHS UWR}},
booktitle = {ghs},
title = {{About Us | Upper East Regional Health Directorate | Ghana Health Service}},
url = {http://www.ghanahealthservice.org/rhdcategory.php?ghsrid=3&cid=39},
urldate = {2019-10-17},
year = {2015}
}
@article{Waiddyanatha2019,
abstract = {Long-term effects of envenoming compromise the quality of life of the survivors of snakebite. We searched MEDLINE (from 1946) and EMBASE (from 1947) until October 2018 for clinical literature on the long-term effects of snake envenoming using different combinations of search terms. We classified conditions that last or appear more than six weeks following envenoming as long term or delayed effects of envenoming. Of 257 records identified, 51 articles describe the long-term effects of snake envenoming and were reviewed. Disability due to amputations, deformities, contracture formation, and chronic ulceration, rarely with malignant change, have resulted from local necrosis due to bites mainly from African and Asian cobras, and Central and South American Pit-vipers. Progression of acute kidney injury into chronic renal failure in Russell's viper bites has been reported in several studies from India and Sri Lanka. Neuromuscular toxicity does not appear to result in long-term effects. Endocrine anomalies such as delayed manifestation of hypopituitarism following Russell's viper bites have been reported. Delayed psychological effects such as depressive symptoms, post-traumatic stress disorder and somatisation have been reported. Blindness due to primary and secondary effects of venom is a serious, debilitating effect. In general, the available studies have linked a clinical effect to a snakebite in retrospect, hence lacked accurate snake authentication, details of acute management and baseline data and are unable to provide a detailed picture of clinical epidemiology of the long-term effects of envenoming. In the future, it will be important to follow cohorts of snakebite patients for a longer period of time to understand the true prevalence, severity, clinical progression and risk factors of long-term effects of snake envenoming.},
author = {Waiddyanatha, Subodha and Silva, Anjana and Siribaddana, Sisira and Isbister, Geoffrey},
doi = {10.3390/toxins11040193},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Waiddyanatha et al. - 2019 - Long-term Effects of Snake Envenoming.pdf:pdf},
issn = {2072-6651},
journal = {Toxins},
month = {mar},
number = {4},
pages = {193},
title = {{Long-term Effects of Snake Envenoming}},
url = {https://www.mdpi.com/2072-6651/11/4/193},
volume = {11},
year = {2019}
}
@article{Schiermeier2015,
abstract = {Background: Snakebite has only recently been recognized as a neglected tropical disease by the WHO. Knowledge regarding snakebites and its care is poor both at the population level, and at the health care staff level. The goal of this study was to describe the level of knowledge and clinical practice regarding snakebite among health care staff from Cameroon. Methods: A two-day training dedicated to snakebite and its care was organized in 2015 in Yaound{\'{e}}, capital city of Cameroon. A total of 98 health care staff from all over Cameroon attended the training. Prior to and after the training, an evaluation quantified the attendees' level of knowledge. Pre- and post-training evaluations were compared to assess knowledge improvement. Results: Overall, prior to the training knowledge regarding snakebite and care was poor, and wrong beliefs that “pierre noire” or tourniquet were useful in case of snakebite were common. Knowledge was statistically improved after the training. Conclusion: Trainings dedicated to all type of health care staff towards snakebite to improve care are needed, this training must take into consideration the context and the targeted population.},
author = {Schiermeier, Quirin},
doi = {10.1038/525299a},
editor = {Habib, Abdulrazaq G.},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Schiermeier - 2015 - Africa braced for snakebite crisis.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Schiermeier - 2015 - Africa braced for snakebite crisis(2).pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Schiermeier - 2015 - Africa braced for snakebite crisis(3).pdf:pdf},
issn = {14764687},
journal = {Nature},
keywords = {Allied health care professionals,Cameroon,Disease surveillance,Global health,Nurses,Physicians,Professions,Snakebite},
month = {sep},
number = {7569},
pages = {299},
pmid = {26381961},
publisher = {Nature Publishing Group},
title = {{Africa braced for snakebite crisis}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26381961 http://www.nature.com/articles/525299a https://dx.plos.org/10.1371/journal.pntd.0006716},
volume = {525},
year = {2015}
}
@article{Mise2016,
abstract = {This study investigated the correlation between the incidence of snakebite and indicators of agricultural development in municipal districts of the State of Bahia, Brazil. An ecological study was conducted with the 27,347 cases of snakebite poisoning reported to the Reportable Diseases National Information System in municipalities from the State of Bahia, Brazil, 2000–2009. The unit of analysis was each one of the 417 State municipalities, and the outcome variable was the average annual incidence of snakebite. Data were analyzed by multiple linear regression technique. The average annual incidence of snakebite ranged from zero to 221.96 per 100,000 inhabitants, according to the municipalities. The incidence of snakebite was positively and strongly associated with municipality characteristics: planted areas of cocoa and coffee, and the size of domestic bred chicken and bovine livestocks. It was concluded that several characteristics related to municipal agricultural profile were strongly associated with the incidence of snakebite.},
author = {Mise, Yukari Figueroa and Lira-da-Silva, Rej{\^{a}}ne Maria and Carvalho, Fernando Martins},
doi = {10.5604/12321966.1219179},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Mise, Lira-da-Silva, Carvalho - 2016 - Agriculture and snakebite in Bahia, Brazil – An ecological study.pdf:pdf},
issn = {18982263},
journal = {Annals of Agricultural and Environmental Medicine},
keywords = {Agriculture,Incidence,Snake bites},
month = {jul},
number = {3},
pages = {416--419},
title = {{Agriculture and snakebite in Bahia, Brazil – An ecological study}},
url = {http://www.journalssystem.com/aaem/Agriculture-and-snakebite-in-Bahia-Brazil-An-ecological-study,72441,0,2.html},
volume = {23},
year = {2016}
}
@article{Tchaou2016,
abstract = {{\textcopyright} 2016 Tchaou et al. Background: In Africa, snakebite envenomations are frequently complicated by life-threatening hemorrhagic syndromes. The authors of the present study conducted a prospective analysis at the University Hospital of Parakou (north of Benin) for seven months (January 1 to July 31, 2014) to assess the contribution of ultrasonography to the diagnosis of internal bleedings and management of envenomation. Methods: An ultrasound examination was performed in all patients with clinical envenomation regardless of its severity. The study involved 32 patients admitted to the ICU of the University Hospital of Parakou. Results: The average age was 27 ± 13.9 years. The main signs of severity were: prolongation of clotting time (88 %), severe anemia (41 %), clinical hemorrhage (47 %), and shock (19 %). The ultrasound imaging showed internal hemorrhage in 18 patients (56 %). There were hematomas (22 %), hemoperitoneum (13 %) or a combination of both (22 %). The occurrence of internal bleeding and hemoperitoneum were mainly related to the delay of hospital presentation (p = 0.007) and the existence of external bleeding (p = 0.04). Thirty patients (94 %) received antivenom. Case fatality rate was 3.1 %. Conclusion: Ultrasonography may help in diagnosing internal bleeding, even in patients that did not show external hemorrhages, and evaluating its importance. As a consequence, the management of snakebite victims may be significantly improved.},
author = {Tchaou, Blaise Adelin and de Tov{\'{e}}, Kofi Mensa Savi and de Tov{\'{e}}, Yolande Sissinto Savi and Djomga, Aur{\'{e}}lien Tch{\'{e}}maha C. and Aguemon, Abdou Rahman and Massougbodji, Achille and Chippaux, Jean Philippe},
doi = {10.1186/s40409-016-0063-x},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Tchaou et al. - 2016 - Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation.pdf:pdf},
issn = {16789199},
journal = {Journal of Venomous Animals and Toxins Including Tropical Diseases},
keywords = {Envenomation,Hematoma,Hemoperitoneum,Internal bleeding,Ultrasound},
number = {1},
publisher = {BioMed Central Ltd.},
title = {{Contribution of ultrasonography to the diagnosis of internal bleeding in snakebite envenomation}},
volume = {22},
year = {2016}
}
@article{Gutierrez2010,
abstract = {Snakebite envenoming is a neglected public health challenge of compelling importance in many regions of the world, particularly sub-Saharan Africa, Asia, Latin America and Papua-New Guinea. Addressing the problem of snakebite effectively demands an integrated multifocal approach, targeting complex problems and involving many participants. It must comprise:. (a) Acquisition of reliable information on the incidence and mortality attributable to snakebite envenoming, and the number of people left with permanent sequelae. (b) Improvements in production of effective and safe antivenoms, through strategies aimed at strengthening the technological capacity of antivenom manufacturing laboratories. (c) Increasing the capacity of low-income countries to produce specific immunogens (snake venoms) locally, and to perform their own quality control of antivenoms. (d) Commitments from regional producers to manufacture antivenoms for countries where antivenom production is not currently feasible. (e) Implementation of financial initiatives guaranteeing the acquisition of adequate volumes of antivenom at affordable prices in low-income countries. (f) Performance of collaborative studies on the safety and effectiveness of antivenoms assessed preclinically and by properly designed clinical trials. (g) Development of antivenom distribution programmes tailored to the real needs and epidemiological situations of rural areas in each country. (h) Permanent training programmes for health staff, particularly in rural areas where snakebites are frequent. (i) Implementation of programmes to support those people whose snakebites resulted in chronic disabilities. (j) Preventive and educational programmes at the community level, with the active involvement of local organizations and employing modern methods of health promotion.Such an integrated approach, currently being fostered by the Global Snake Bite Initiative of the International Society on Toxinology and by the World Health Organization, will help to alleviate the enormous burden of human suffering inflicted by snakebite envenoming. {\textcopyright} 2009 Elsevier Ltd.},
author = {Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a and Williams, David and Fan, Hui Wen and Warrell, David A.},
doi = {10.1016/j.toxicon.2009.11.020},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Guti{\'{e}}rrez et al. - 2010 - Snakebite envenoming from a global perspective Towards an integrated approach.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Antivenom,Clinical trials,Community education,Disability,Envenoming,Neglected disease,Prevention,Quality control,Snakebite,Training health personnel,Transfer of technology},
month = {dec},
number = {7},
pages = {1223--1235},
title = {{Snakebite envenoming from a global perspective: Towards an integrated approach}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010109005510},
volume = {56},
year = {2010}
}
@article{Pattinson2017,
abstract = {Background. This audit of snakebites was undertaken to document our experience with snakebite in the western part of KwaZulu-Natal (KZN) Province, South Africa (SA). Objective. To document our experience with snakebite in the western part of KZN, and to interrogate the data on patients who required some form of surgical intervention. Methods. A retrospective study was undertaken at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, SA. The Hybrid Electronic Medical Registry was reviewed for the 5-year period January 2012 - December 2016. All patients admitted to the service for management of snakebite were included. Results. The offending snake is rarely identified, and the syndromic approach is now the mainstay of management. Most envenomations seen during the study period were cytotoxic, presenting with painful progressive swelling (PPS). We did not see any purely neurotoxic or haemotoxic envenomations. Antivenom is required for a subset of patients. The indications are essentially PPS that increases by >15 cm over an hour, PPS up to the elbow or knee after 4 hours, PPS of the whole limb after 8 hours, threatened airway, shortness of breath, associated clotting abnormalities and compartment syndrome. If no symptoms have manifested within 1 hour of a snakebite, clinically significant envenomation is unlikely to have occurred. Antivenom is associated with a high rate of anaphylaxis and should only be administered when absolutely indicated, preferably in a high-care setting under continuous monitoring. The need for surgery is less well defined. Urgent surgery is indicated for compartment syndrome of the limb, which is a potentially life- and limb-threatening condition. Its diagnosis is usually made clinically, but this is difficult in snakebites. Morbidity and cost increase dramatically once fasciotomy is required, as evidenced by much longer hospital stay. There is frequently a degree of cross-over between cytotoxicity and haemotoxicity in envenomations that require fasciotomy, which means that fasciotomy may result in catastrophic bleeding and should be preceded by the administration of antivenom, especially in patients with a low platelet count or a high international normalised ratio. Physiological and biochemical markers are unhelpful in assessing the need for fasciotomy. Objective methods include measurement of compartment pressures and ultrasound. Conclusion. The syndromic management of snakebite is effective and safe. There is a high incidence of anaphylactic reactions to antivenom, and its administration must be closely supervised. In our area we overwhelmingly see cytotoxic snakebites with PPS. Surgery is often needed, and we need to refine our algorithms in terms of deciding on surgery.},
author = {Pattinson, J. P. and Kong, V. Y. and Bruce, J. L. and Oosthuizen, G. V. and Bekker, W. and Laing, G. L. and Wood, D. and Brysiewicz, P. and Clarke, D. L.},
doi = {10.7196/SAMJ.2017.v107i12.12628},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Pattinson et al. - 2017 - Defining the need for surgical intervention following a snakebite still relies heavily on clinical assessment.pdf:pdf},
issn = {2078-5135},
journal = {South African Medical Journal},
keywords = {Age,Gender,KwaZulu-Natal,Outcomes,Snakebite,South Africa,Surgical intervention,Syndromic approach},
month = {nov},
number = {12},
pages = {1082},
pmid = {29262961},
publisher = {South African Medical Association},
title = {{Defining the need for surgical intervention following a snakebite still relies heavily on clinical assessment: The experience in Pietermaritzburg, South Africa}},
url = {http://www.samj.org.za/index.php/samj/article/view/12145},
volume = {107},
year = {2017}
}
@article{Habib2015,
abstract = {Background: Snakebite envenoming (SBE) is a major problem in rural areas of West Africa (WA). Compared to other Neglected Tropical Diseases (NTD), the public health burden of SBE has not been well characterized. We estimated the impact of snakebite mortality and morbidity using the Disability Adjusted Life Years (DALYs) metrics for 16 countries in WA. Methods: We used the reported annual number of SB deaths and mean age at time of SB and converted these into years of life lost (YLL). Similarly, the years of life lived with disability (YLD) were estimated by multiplying the number of amputations by the respective disability weight of 0.13. Results: In WA, the annual cases of SB mortality and amputations ranged from 24 (95% Confidence Interval: 19–29) and 28 (17–48) respectively in Guinea-Bissau with the highest estimates of 1927 (1529–2333) and 2368 (1506–4043) respectively in Nigeria. We calculated that the annual DALYs associated with a SB death ranged from 1550 DALYs (95%CI: 1227–1873 DALYs) in Guinea Bissau to 124,484 DALYs (95%CI: 98,773–150,712 DALYs) in Nigeria. The annual DALYs associated with amputation for the two countries were 149 DALYs (95%CI: 91–256 DALYs) and 12,621 DALYs (95%CI: 8027–21,549 DALYs) respectively. The total burden of SBE was estimated at 319,874 DALYs (95% CI: 248,357–402,654 DALYs) in the 16 countries in WA. These estimates are similar, and in some instances even higher, than for other NTDs encountered in WA (e.g., Buruli ulcer, Echinococcosis, Intestinal Nematode Infections, Leishmaniasis, Onchocerchiasis, Trachoma and Trypanosomiasis) as reported in the Global Burden of Diseases 2010 (GBD). Conclusions: The public health burden of SBE in WA is very substantial and similar to other more widely recognized NTDs. Efforts and funding commensurate with its burden should be made available for the control of snakebite in the sub-region.},
author = {Habib, Abdulrazaq G. and Kuznik, Andreas and Hamza, Muhammad and Abdullahi, Maryam I. and Chedi, Basheer A. and Chippaux, Jean-Philippe and Warrell, David A.},
doi = {10.1371/journal.pntd.0004088},
editor = {de Silva, H Janaka},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib et al. - 2015 - Snakebite is Under Appreciated Appraisal of Burden from West Africa.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib et al. - 2015 - Snakebite is Under Appreciated Appraisal of Burden from West Africa(2).pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {sep},
number = {9},
pages = {e0004088},
pmid = {26398046},
publisher = {Public Library of Science},
title = {{Snakebite is Under Appreciated: Appraisal of Burden from West Africa}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26398046 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4580425 https://dx.plos.org/10.1371/journal.pntd.0004088},
volume = {9},
year = {2015}
}
@article{Habib2012,
abstract = {Background: In West Africa antivenoms have been useful in clinical management of snakebite envenoming. Response is often dramatic especially following carpet viper envenoming where restoration of blood coagulability and resolution of spontaneous haemorrhage is rapidly achieved. In bites from certain snakes manifesting with similar coagulopathies elsewhere, antivenom effectiveness may be less dramatic and its use has been questioned. We therefore critically evaluated clinical studies on envenoming and antivenom therapy conducted in the region to determine their effects and explored the appropriate strategies for delivery of care. Efficacy of antivenoms developed from the region was explored from preclinical studies. Methods: All observational, interventional and preclinical studies conducted in the region (or on antivenoms derived from the region) were systematically evaluated to determine the effect of antivenoms used in the studies. Effectiveness of antivenoms in resolving features of envenoming or curtailing mortality was determined where feasible. Different strategies for optimally delivering antivenom therapy in rural savanna populations was explored and compared. Published data was re‐analyzed. Results: There were 23 studies reported with evaluable information on aspects of antivenom therapy from the region. There were 12 observational studies (8 noncomparative and 4 comparative clinical studies), 4 comparative clinical trials and 7 preclinical studies. 13 of the 16 clinical studies determined and strongly suggested effectiveness of antivenom therapy. From 3 of the comparative studies: regionally appropriate antivenom therapy conferred protection against deaths by 87% (95%CI: 52‐97%) when compared to inappropriate therapy, by 83% (95%CI: 4‐97%) when compared to no therapy, and by 90% (95% CI: 55‐98%) when combined with staff education and standardization of clinical management. In preclinical studies most antivenoms used in practice have activity against venoms of local snakes and effect may be broader extending to more species in larger areas of Sub‐Saharan Africa. Modality of antivenom delivery usually follows a 'centralized' district‐peri‐urban approach while 'decentralized' hub‐and‐spoke rural model which reduces delay (found to predispose to mortality) found to access has not been used commonly. Conclusion: Antivenom therapy is effective in management of snakebite especially carpet viper envenoming in West Africa. While a placebo controlled trial will be unethical, antivenoms confer protection of over 80% against death in observational studies. Strategies for improving care should include utilizing regionally appropriate antivenoms, educating staff and standardizing clinical care. Centralized versus de‐centralized modes of antivenom delivery should be explored further to determine respective benefits, risks, costs and feasibility of the approaches.},
author = {Habib, Abdulrazaq G.},
doi = {10.1016/j.toxicon.2012.04.236},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib - 2012 - 235. Antivenom Therapy Following Snakebite Effectiveness and Strategies for Delivery in West Africa.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
month = {aug},
number = {2},
pages = {216},
title = {{235. Antivenom Therapy Following Snakebite: Effectiveness and Strategies for Delivery in West Africa}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010112003327},
volume = {60},
year = {2012}
}
@article{Perehudoff2019,
abstract = {BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to pound28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.},
author = {Perehudoff, S Katrina and Alexandrov, Nikita V and Hogerzeil, Hans V},
doi = {10.1093/HEAPOL},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Perehudoff, Alexandrov, Hogerzeil - 2019 - Imported from httpsacademic.oup.comheapolissue33suppl_1.pdf:pdf},
journal = {Health Policy and Planning},
number = {Suppl 3},
pages = {iii48},
publisher = {Oxford University Press},
title = {{Imported from https://academic.oup.com/heapol/issue/33/suppl_1}},
url = {/pmc/articles/PMC6910076/?report=abstract https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910076/},
volume = {34},
year = {2019}
}
@article{Elhattimy2018,
abstract = {OBJECTIVES: Envenomation from snake bites is a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the epidemiological features of snake bites in Morocco and to evaluate time-space trends in snake bite incidence, the mortality rate, and the case-fatality rate. METHODS: This is a retrospective study of snake bite cases reported to the Moroccan Poison Control Center between 1999 and 2013. RESULTS: During the study period, 2,053 people were bitten by snakes in Morocco. Most victims were adults (55.4%). The average age of the patients was 26.48±17.25 years. More than half of the cases (58.1%) were males. Approximately 75% of snake bites happened in rural areas, and 85 deaths were recorded during this period. The incidence of snake bites remained generally steady over the 15-year period of this study, with a marked increase noted since 2012. The mortality rate has increased slightly, from 0.02 deaths per 100,000 inhabitants in 1999 to 0.05 in 2013. The geographical distribution of snake bite cases in the regions of Morocco showed that Tanger-T{\'{e}}touan had the highest annual incidence of snake bites (1.41 bites per 100,000 inhabitants). However, the highest annual mortality rates were recorded in the Guelmim-Es Semara and Souss-Massa-Dr{\^{a}}a regions (0.09 deaths per 100,000 inhabitants for both regions). CONCLUSIONS: The geographical distribution of the incidence, mortality, and case-fatality rates of snake bites in Morocco showed large disparities across regions during the three 5-year periods included in this study, meaning that certain areas can be considered high-risk for snake bites.},
author = {{El Hattimy}, Fai{\c{c}}al and Chafiq, Fouad and Hami, Hinde and Mokhtari, Abdelghani and Soulaymani, Abdelmajid and Rachida, Soulaymani Bencheikh},
doi = {10.4178/epih.e2018024},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ng et al. - 2014 - Cost-of-illness studies of diabetes mellitus A systematic review.pdf:pdf},
issn = {2092-7193},
journal = {Epidemiology and Health},
keywords = {Epidemiology,Morbidity,Morocco,Mortality,Snake bites,Time-space trends},
month = {jun},
pages = {e2018024},
title = {{Geographical distribution of health indicators related to snake bites and envenomation in Morocco between 1999 and 2013}},
url = {http://e-epih.org/journal/view.php?doi=10.4178/epih.e2018024},
volume = {40},
year = {2018}
}
@article{Bhargava2018,
abstract = {Varieties of venomous snakes inhabit in the world which accidentally take thousands of human lives every year. This severe medical emergency constantly persuades national and international health agencies to look at efficient epidemiological profiling of snake-bite cases for the proper management of this sympathetic problem. Establishing the accurate database of snake-bite in humans from different localities of India may perhaps lack certainty due to few inevitable reasons such as consideration of this problem as less emergent problem in disparity to pesticide poisoning, difficulty in the accessibility to rural and tribal areas where chances of snake-bite remain ceiling, lack of inspiring models of snake-bite management training, reduced reporting system, and pitiable maintenance of hospital data in India. Therefore, the present modest study was carried out to explore valuable information regarding snake-bite problem in Haryana. Factual data on snake-bite incidences happened from 2011 to 2015 were collected from government hospitals and medical institutes of Haryana. This retrospective study disclosed a few characteristic points related to the frequency of snake-bite cases, gender involved, anti-snake venom (ASV) treatment, and numbers of deaths with snake-bite. Records revealed a total of 6555 cases of snake-bite including 130 deaths reported in Haryana during the study period. A significant variation in the occurrence of snake-bite cases was also recorded in different areas of Haryana. There was a huge database of recorded snake-bite cases from government medical institute but district wise survey disclosed the maximum number of snake-bite incidences, especially amongst males from Panchkula. The present study has provided a more updated and comprehensive record of snake-bite from Haryana during 2011–2015. A huge burden of snake-bite amongst human was found in Haryana; hence, the findings of this study purposely enlighten people about the size of this problem in the selected region. However, this study also remained limited due to lack of information on a few important parameters and availability of homogeneous data.},
author = {Bhargava, Saurabh and Kaur, Ramanjeet and Singh, Rajvinder},
doi = {10.1016/j.jflm.2017.12.004},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Bhargava, Kaur, Singh - 2018 - Epidemiological profile of snake-bite cases from Haryana A five year (2011–2015) retrospective study.pdf:pdf},
issn = {1752928X},
journal = {Journal of Forensic and Legal Medicine},
month = {feb},
pages = {9--13},
title = {{Epidemiological profile of snake-bite cases from Haryana: A five year (2011–2015) retrospective study}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S1752928X17301890},
volume = {54},
year = {2018}
}
@article{Habib2015a,
abstract = {Economic analysis was conducted from a public healthcare system perspective. Estimates of model inputs were obtained from the literature. Incremental Cost Effectiveness Ratios (ICERs) were quantified as deaths and Disability-Adjusted-Life-Years (DALY) averted from antivenom therapy. A decision analytic model was developed and analyzed with the following model base-case parameter estimates: type of snakes causing bites, antivenom effectiveness to prevent death, untreated mortality, risk of Early Adverse Reactions (EAR), mortality risk from EAR, mean age at bite and remaining life expectancy, and disability risk (amputation). End-user costs applied included: costs of diagnosing and monitoring envenoming, antivenom drug cost, supportive care, shipping/freezing antivenom, transportation to-and-from hospital and feeding costs while on admission, management of antivenom EAR and free alternative snakebite care for ineffective antivenom. We calculated a cost/death averted of ($2330.16) and cost/DALY averted of $99.61 discounted and $56.88 undiscounted. Varying antivenom effectiveness through the 95% confidence interval from 55% to 86% yield a cost/DALY averted of $137.02 to $86.61 respectively. Similarly, varying the prevalence of envenoming caused by carpet viper from 0% to 96% yield a cost/DALY averted of $254.18 to $78.25 respectively. More effective antivenoms and carpet viper envenoming rather than non-carpet viper envenoming were associated with lower cost/DALY averted. Treatment of snakebite envenoming in Nigeria is cost-effective with a cost/death averted of $2330.16 and cost/DALY averted of $99.61 discounted, lower than the country's gross domestic product per capita of $1555 (2013). Expanding access to effective antivenoms to larger segments of the Nigerian population should be a considered a priority. Snakebite envenoming is a major public health problem throughout the rural tropics. Antivenom is effective in reducing mortality and remains the mainstay of therapy. This study aimed to determine the cost-effectiveness of using effective antivenoms for Snakebite envenoming in Nigeria.},
author = {Habib, Abdulrazaq G. and Lamorde, Mohammed and Dalhat, Mahmood M. and Habib, Zaiyad G. and Kuznik, Andreas},
doi = {10.1371/journal.pntd.0003381},
editor = {Lalloo, David G.},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib et al. - 2015 - Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria(2).pdf:pdf},
issn = {19352735},
journal = {PLoS Neglected Tropical Diseases},
month = {jan},
number = {1},
pages = {e3381},
title = {{Cost-effectiveness of Antivenoms for Snakebite Envenoming in Nigeria}},
url = {https://dx.plos.org/10.1371/journal.pntd.0003381},
volume = {9},
year = {2015}
}
@article{Sawalha2010,
abstract = {The objectives were to (i) analyse the pattern of poisoning and (ii) study gender distribution and management protocol of poisoning in patients diagnosed with acute poisoning. A retrospective analysis of cases diagnosed with acute poisoning and admitted to the emergency department of Al-Wattani governmental hospital during the year of 2008 was carried out. Data from patients' medical files were collected and then analysed using Statistical Package for Social Sciences (spss; SPSS Inc., Chicago, IL, USA), version 16. There were 674 cases diagnosed with acute poisoning in 2008 which accounted for 1.5% of the total admission to the hospital. The mean age of the cases was 21.8 ± 18.1 years. Approximately, 58% of poisoning cases occurred at home. Male to female ratio was 1.5:1. The maximum number of poisoning occurred during summer season. Poisoning cases were maximum in the age category >18 years. More than half (92%) of the cases were of unintentional type of poisoning. Unintentional poisoning was significantly more common among males (61.3%; p < 0.01), while intentional was more common among females (64.8%; p < 0.001). The causative agents encountered were mainly biological agents (77.4%), pharmaceuticals (11.6%), and other chemicals (10.9%). The most common route of poisoning was through stings (72.3%), followed by oral ingestion (23.5%) and inhalation (3.4%). The majority (91.1%) of cases did not undergo any decontamination methods. Of those who had decontamination procedure, gastric lavage was the most commonly used. This is the first study in Palestine that presents data on the pattern of acute poisoning. Awareness campaigns should be held about potentially toxic materials in the region, and methods of poison prevention should be spread among the public. {\textcopyright} 2010 The Authors. Basic & Clinical Pharmacology & Toxicology {\textcopyright} 2010 Nordic Pharmacological Society.},
author = {Sawalha, Ansam F. and Sweileh, Waleed M. and Tufaha, Maysoon T. and Al-Jabi, Dua' Y.},
doi = {10.1111/j.1742-7843.2010.00601.x},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Sawalha et al. - 2010 - Analysis of the pattern of acute poisoning in patients admitted to a governmental hospital in palestine.pdf:pdf},
issn = {17427835},
journal = {Basic and Clinical Pharmacology and Toxicology},
month = {jun},
number = {5},
pages = {914--918},
title = {{Analysis of the pattern of acute poisoning in patients admitted to a governmental hospital in palestine}},
url = {http://doi.wiley.com/10.1111/j.1742-7843.2010.00601.x},
volume = {107},
year = {2010}
}
@article{Potet2019,
abstract = {Background Snakebite envenoming kills more than more than 20,000 people in Sub-Saharan Africa every year. Poorly regulated markets have been inundated with low-price, low-quality antivenoms. This review aimed to systematically collect and analyse the clinical data on all antivenom products now available in markets of sub-Saharan Africa. Methodology/Principal findings Our market analysis identified 12 polyspecific and 4 monospecific antivenom products in African markets. Our search strategy was first based on a systematic search of publication databases, followed by manual searches and discussions with experts. All types of data, including programmatic data, were eligible. All types of publications were eligible, including grey literature. Cohorts of less than 10 patients were excluded. 26 publications met the inclusion criteria. Many publications had to be excluded because clinical outcomes were not clearly linked to a specific product. Our narrative summaries present product-specific clinical data in terms of safety and effectiveness against the different species and envenoming syndromes. Three products (EchiTabPlus, EchiTabG, SAIMR-Echis-monovalent) were found to have been tested in robust clinical studies and found effective against envenoming caused by the West African carpet viper (Echis ocellatus). Four products (Inoserp-Panafricain, Fav-Afrique, SAIMR-Polyvalent, Antivipmyn-Africa) were found to have been evaluated only in observational single-arm studies, with varying results. For nine other products, there are either no data in the public domain, or only negative data suggesting a lack of effectiveness. Conclusions/Significance Clinical data vary among the different antivenom products currently in African markets. Some products are available commercially although they have been found to lack effectiveness. The World Health Organization should strengthen its capacity to assess antivenom products, support antivenom manufacturers, and assist African countries and international aid organizations in selecting appropriate quality antivenoms.},
author = {Potet, Julien and Smith, James and McIver, Lachlan},
doi = {10.1371/journal.pntd.0007551},
editor = {Chippaux, Jean-Philippe},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Potet, Smith, McIver - 2019 - Reviewing evidence of the clinical effectiveness of commercially available antivenoms in sub-Saharan Af(2).pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {jun},
number = {6},
pages = {e0007551},
title = {{Reviewing evidence of the clinical effectiveness of commercially available antivenoms in sub-Saharan Africa identifies the need for a multi-centre, multi-antivenom clinical trial}},
url = {http://dx.plos.org/10.1371/journal.pntd.0007551},
volume = {13},
year = {2019}
}
@article{Nhachi1994,
abstract = {Over a period of 2 years (January 1991 to December 1992) 274 cases of snake bite were admitted to hospital in the eight provinces of Zimbabwe. Of these patients, 54% were males and 88% belonged to the 6–40‐year age group. Five deaths (1.8% of the total cases) were reported. The majority of snake bites (63%) occurred at night (between 6.30 p.m. and midnight) and over 74% took place during the hot rainy season, i.e. between November and April. In over 58% of the cases the victim accidentally stepped on the snake, the snake being cobra in 37%, puff adder in 20% and the black and green mamba in 18% of the cases. Most of the bites occurred on the leg, below the knee. Treatment of snake envenomation consisted mainly of the administration of antibiotics (151 cases), analgesics (144 cases), antivenom tropical snake polyvalent (ATT) (89 cases), antitoxoid tetanus (TT) (61 cases), antihistamines (47 cases) and traditional medicines (43 cases). This study indicates that snake envenomation in rural Zimbabwe is common but fatalities are relatively rare. Copyright {\textcopyright} 1994 John Wiley & Sons, Ltd.},
author = {Nhachi, Charles F.B. and Kasilo, Ossy M.J.},
doi = {10.1002/jat.2550140308},
issn = {10991263},
journal = {Journal of Applied Toxicology},
keywords = {adder,antivenom,cobra,mamba,poisoning,polyvalent,snake venom,treatment},
month = {may},
number = {3},
pages = {191--193},
pmid = {8083480},
publisher = {John Wiley & Sons, Ltd},
title = {{Snake poisoning in rural Zimbabwe—A prospective study}},
url = {http://doi.wiley.com/10.1002/jat.2550140308},
volume = {14},
year = {1994}
}
@article{Williams2019,
abstract = {In one of his final essays, statesman and former United Nations secretary general Kofi Annan said, ‘Snakebite is the most important tropical disease you've never heard of' [1]. Mr. Annan firmly believed that victims of snakebite envenoming should be recognised and afforded greater efforts at improved prevention, treatment, and rehabilitation. During the last years of his life, he advocated strongly for the World Health Organisation (WHO) and the global community to give greater priority to this disease of poverty and its victims. Snakebite envenoming (SBE) affects as many as 2.7 million people every year, most of whom live in some of the world's most remote, poorly developed, and politically marginalised tropical communities [2]. With annual mortality of 81,000 to 138,000 and 400,000 surviving victims suffering permanent physical and psychological disabilities, SBE is a disease in urgent need of attention [2–4]. Like many diseases of poverty, SBE has failed to attract requisite public health policy inclusion and investment for driving sustainable efforts to reduce the medical and societal burden. This is largely due to the demographics of the affected populations and their lack of political voice [5].},
author = {Williams, David J. and Faiz, Mohd Abul and Abela-Ridder, Bernadette and Ainsworth, Stuart and Bulfone, Tommaso C. and Nickerson, Andrea D. and Habib, Abdulrazaq G. and Junghanss, Thomas and Fan, Hui Wen and Turner, Michael and Harrison, Robert A. and Warrell, David A.},
doi = {10.1371/journal.pntd.0007059},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Williams et al. - 2019 - Strategy for a globally coordinated response to a priority neglected tropical disease Snakebite envenoming.pdf:pdf},
issn = {19352735},
journal = {PLoS Neglected Tropical Diseases},
month = {feb},
number = {2},
publisher = {Public Library of Science},
title = {{Strategy for a globally coordinated response to a priority neglected tropical disease: Snakebite envenoming}},
volume = {13},
year = {2019}
}
@article{Ahsan2018,
abstract = {Background: Snake bile is a very common incidence among the rural people.Objective: This study was aimed to assess the pattern of snakebite in rural community through community engagement.Methodology: It uses the methodological triangulation qualitative and quantitative approach as well as a case study design in analyzing data, whereby the exploratory-descriptive design is followed. The findings from survey study on snake bite have been elicited from face to face interview with 243 number of medical professionals/health service providers consisting of 113 number of MBBS doctors, 86 number of nurses and 46 number of other health practitioners. The study area consisted of 5 zilla sadar hospitals and 15 upazilla health complexes. We purposively select the 243 sample(Doctors, Nurses, Paramedics ,Others) from the selected districts and its consisting random upazillas from the govt. sector hospitals keeping in mind gender balance (Male -Female) as a primary total target population. So in total, 5division and itsconsisting random upazilas hospital including union health complex hospital personnel will be interviewed throughout mention areas of Bangladesh. Result: Most of the health professionals (93.8%) stated that the existence of facilities in their respective hospitals is not adequate to manage the treatment of snake bite victims. Of the total number of medical personnel - around 30.0% of the health professionals had the opportunity to manage snake bite in their respective span of service (50.4% of MBBS docs + 11.6% of nurses + 11.4% of other practitioners).The findings show that majority of 87.6% of doctors, 85.0% of nurses and 95.5% of other practitioners mentioned rainy season as the most prevalent time for occurrence of snake bite in rural areas of Bangladesh. As for whether all snake bites are poisonous- around 17.0% of doctors followed by 18.6% of nurses and 16.0% of other practitioners are found to have wrong notion about mentioning that all snake bites are poisonous but in reality this is not true.Conclusion: There is insufficient knowledge, skill and experience of how to treat snake bite victims. Journal of Current and Advance Medical Research 2017;4(1):17-22},
author = {Ahsan, HM Nazmul and Rahman, Md Ridwanur and Amin, Robed and Chowdhury, Enamul Hoque},
doi = {10.3329/jcamr.v4i1.36170},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Ahsan et al. - 2018 - Knowledge of Snake Bite Management among Health Service Providers at a Rural Community of Bangladesh.pdf:pdf},
issn = {2313-447X},
journal = {Journal of Current and Advance Medical Research},
month = {apr},
number = {1},
pages = {17--22},
publisher = {Bangladesh Journals Online (JOL)},
title = {{Knowledge of Snake Bite Management among Health Service Providers at a Rural Community of Bangladesh}},
volume = {4},
year = {2018}
}
@article{Wijesinghe2015,
abstract = {Background: Snakebite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims. Aim: To assess the effectiveness of a brief intervention which can be provided by non-specialist doctors aimed at reducing psychological morbidity following snakebite envenoming. Method: In a single blind, randomized controlled trial, snakebite victims with systemic envenoming [n = 225, 168 males, mean age 42.1 (SD 12.4) years] were randomized into three arms. One arm received no intervention (n = 68, Group A), the second received psychological first aid and psychoeducation (dispelling prevalent cultural beliefs related to snakebite which promote development of a sick role) at discharge from hospital (n = 65, Group B), while the third received psychological first aid and psychoeducation at discharge and a second intervention one month later based on cognitive behavioural principles (n = 69, Group C). All patients were assessed six months after hospital discharge for the presence of psychological symptoms and level of functioning using standardized tools. Results: At six months, there was a decreasing trend in the proportion of patients who were positive for psychiatric symptoms of depression and anxiety from Group A through Group B to Group C (Chi square test for trend = 7.901, p = 0.005). This was mainly due to a decreasing trend for symptoms of anxiety (chi-square for trend = 11.256, p = 0.001). There was also decreasing trend in the overall prevalence of disability from Group A through Group B to Group C (chi square for trend = 7.551, p = 0.006), predominantly in relation to disability in family life (p = 0.006) and social life (p = 0.005). However, there was no difference in the proportion of patients diagnosed with depression between the three groups (chi square for trend = 0.391, p = 0.532), and the intervention also had no effect on post-traumatic stress disorder. Conclusions: A brief psychological intervention, which included psychological first aid and psychoeducation plus cognitive behavioural therapy that can be provided by non-specialist doctors appeared to reduce psychiatric symptoms and disability after snakebite envenoming, but not depression or post-traumatic stress disorder. Trial Registration: Sri Lanka Clinical Trials Registry: SLCTR/2011/003.},
author = {Wijesinghe, Chamara A. and Williams, Shehan S. and Kasturiratne, Anuradhani and Dolawaththa, Nishantha and Wimalaratne, Piyal and Wijewickrema, Buddhika and Jayamanne, Shaluka F. and Isbister, Geoffrey K. and Dawson, Andrew H. and Lalloo, David G. and de Silva, H. Janaka},
doi = {10.1371/journal.pntd.0003989},
editor = {Franco-Paredes, Carlos},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Wijesinghe et al. - 2015 - A Randomized Controlled Trial of a Brief Intervention for Delayed Psychological Effects in Snakebite Victims.pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {aug},
number = {8},
pages = {e0003989},
title = {{A Randomized Controlled Trial of a Brief Intervention for Delayed Psychological Effects in Snakebite Victims}},
url = {https://dx.plos.org/10.1371/journal.pntd.0003989},
volume = {9},
year = {2015}
}
@article{Williams2011,
abstract = {The development of snake antivenoms more than a century ago should have heralded effective treatment of the scourge of snakebite envenoming in impoverished, mostly rural populations around the world. That snakebite still exists today, as a widely untreated illness that maims, kills and terrifies men, women and children in vulnerable communities, is a cruel anachronism. Antivenom can be an effective, safe and affordable treatment for snakebites, but apathy, inaction and the politicisation of public health have marginalised both the problem (making snakebite arguably the most neglected of all neglected tropical diseases) and its solution. For lack of any coordinated approach, provision of antivenoms has been pushed off the public health agenda, leading to an incongruous decline in demand for these crucial antidotes, excused and fed by new priorities, an absence of epidemiological data, and a poor regulatory framework. These factors facilitated the infiltration of poor quality products that degrade user confidence and undermine legitimate producers. The result is that tens of thousands are denied an essential life-saving medicine, allowing a toll of human suffering that is a summation of many individual catastrophes. No strategy has been developed to address this problem and to overcome the intransigence and inaction responsible for the global tragedy of snakebite. Attempts to engage with the broader public health community through the World Health Organisation (WHO), GAVI, and other agencies have failed. Consequently, the toxinology community has taken on a leadership role in a new approach, the Global Snakebite Initiative, which seeks to mobilise the resources, skills and experience of scientists and clinicians for whom venoms, toxins, antivenoms, snakes and snakebites are already fields of interest. Proteomics is one such discipline, which has embraced the potential of using venoms in bio-discovery and systems biology. The fields of venomics and antivenomics have recently evolved from this discipline, offering fresh hope for the victims of snakebites by providing an exciting insight into the complexities, nature, fundamental properties and significance of venom constituents. Such a rational approach brings with it the potential to design new immunising mixtures from which to raise potent antivenoms with wider therapeutic ranges. This addresses a major practical limitation in antivenom use recognised since the beginning of the 20th century: the restriction of therapeutic effectiveness to the specific venom immunogen used in production. Antivenomic techniques enable the interactions between venoms and antivenoms to be examined in detail, and if combined with functional assays of specific activity and followed up by clinical trials of effectiveness and safety, can be powerful tools with which to evaluate the suitability of current and new antivenoms for meeting urgent regional needs. We propose two mechanisms through which the Global Snakebite Initiative might seek to end the antivenom drought in Africa and Asia: first by establishing a multidisciplinary, multicentre, international collaboration to evaluate currently available antivenoms against the venoms of medically important snakes from specific nations in Africa and Asia using a combination of proteomic, antivenomic and WHO-endorsed preclinical assessment protocols, to provide a validated evidence base for either recommending or rejecting individual products; and secondly by bringing the power of proteomics to bear on the design of new immunising mixtures to raise Pan-African and Pan-Asian polyvalent antivenoms of improved potency and quality. These products will be subject to rigorous clinical assessment. We propose radically to change the basis upon which antivenoms are produced and supplied for the developing world. Donor funding and strategic public health alliances will be sought to make it possible not only to sustain the financial viability of antivenom production partnerships, but also to ensure that patients are relieved of the costs of antivenom so that poverty is no longer a barrier to the treatment of this important, but grossly neglected public health emergency. {\textcopyright} 2011 Elsevier B.V.},
author = {Williams, David J. and Guti{\'{e}}rrez, Jos{\'{e}}-Mar{\'{i}}a and Calvete, Juan J. and W{\"{u}}ster, Wolfgang and Ratanabanangkoon, Kavi and Paiva, Owen and Brown, Nicholas I. and Casewell, Nicholas R. and Harrison, Robert A. and Rowley, Paul D. and O'Shea, Mark and Jensen, Simon D. and Winkel, Kenneth D. and Warrell, David A.},
doi = {10.1016/j.jprot.2011.05.027},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Williams et al. - 2011 - Ending the drought New strategies for improving the flow of affordable, effective antivenoms in Asia and Africa.pdf:pdf},
issn = {18743919},
journal = {Journal of Proteomics},
keywords = {Antivenoms,Global Snakebite Initiative,Neglected tropical diseases,Proteomics,Snakebite,Venomics and antivenomics},
month = {aug},
number = {9},
pages = {1735--1767},
title = {{Ending the drought: New strategies for improving the flow of affordable, effective antivenoms in Asia and Africa}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S1874391911002181},
volume = {74},
year = {2011}
}
@article{Habib2013a,
abstract = {In West Africa, response to specific, geographically appropriate, antivenom is often dramatic following carpet viper (Echis ocellatus) envenoming with rapid restoration of blood coagulability and resolution of spontaneous haemorrhage. Envenoming from Australasian snakes causing similar coagulopathies may respond less dramatically and the effectiveness of antivenom is being questioned. Here we have reviewed and re-analysed all published preclinical and clinical studies on envenoming and antivenom therapy conducted in West Africa to determine the effectiveness of antivenom. 22 studies provided relevant information: 12 observational studies, 4 RCTs and 6 preclinical studies. Four comparative studies confirmed statistically significant protection against mortality ranging from 57 to 87% using specific antivenoms compared to non-specific or no antivenoms. Meta-analysis estimated combined Odds Ratio (95% CI) of 0.25 (0.14-0.45) of dying among those treated with specific antivenom or 75% (95% CI: 55-86%) protection against death. Mortality more than doubled during times when stocks of reliable antivenoms ran out, with Relative Risk (95% CI)] of 2.33 (1.26-4.06). Serum kinetics of venom antigen/antivenom levels also confirmed that decline of venom antigen levels coincided with resolution of coagulopathy while decline of antivenom levels was associated with venom antigen reappearance and recurrence of coagulopathy. Preclinical and antivenomics analysis confirmed efficacy of regionally appropriate antivenoms against E. ocellatus and related species' venoms in Sub-Saharan Africa but not against Asian Echis carinatus venom. Antivenoms raised against E. carinatus were ineffective in human studies. In West Africa, specific antivenom is effective in managing carpet viper envenoming. A centralized hub-and-spoke strategy is suggested for broadening antivenom access to endemic rural areas together with instituting quality assurance, standardization and manpower training. Benefits, risks, cost-effectiveness and feasibility of the approach should be formally assessed. {\textcopyright} 2013 Elsevier Ltd.},
author = {Habib, Abdulrazaq G. and Warrell, David A.},
doi = {10.1016/j.toxicon.2013.01.002},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib, Warrell - 2013 - Antivenom therapy of carpet viper (Echis ocellatus) envenoming Effectiveness and strategies for delivery in West.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Antivenom,Carpet viper,Echis ocellatus,Effectiveness,Mortality,West Africa},
month = {jul},
pages = {82--89},
title = {{Antivenom therapy of carpet viper (Echis ocellatus) envenoming: Effectiveness and strategies for delivery in West Africa}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010113000147},
volume = {69},
year = {2013}
}
@misc{Hifumi2015,
abstract = {Snake bites are life-threatening injuries that can require intensive care. The diagnosis and treatment of venomous snake bites is sometimes difficult for clinicians because sufficient information has not been provided in clinical practice. Here we review the literature to present the proper management of bites by mamushi, habu, and yamakagashi snakes, which widely inhabit Japan and other Asian countries. No definite diagnostic markers or kits are available for clinical practice; therefore, definitive diagnosis of snake-venom poisoning requires positive identification of the snake and observation of the clinical manifestations of envenomation. Mamushi (Gloydius blomhoffii) bites cause swelling and pain that spreads gradually from the bite site. The platelet count gradually decreases due to the platelet aggregation activity of the venom and can decrease to <100,000/mm3. If the venom gets directly injected into the blood vessel, the platelet count rapidly decreases to <10,000/mm3 within 1 h after the bite. Habu (Protobothrops flavoviridis) bites result in swelling within 30 min. Severe cases manifest not only local signs but also general symptoms such as vomiting, cyanosis, loss of consciousness, and hypotension. Yamakagashi (Rhabdophis tigrinus) bites induce life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype, resulting in hypofibrinogenemia and increased levels of fibrinogen degradation products. Previously recommended first-aid measures such as tourniquets, incision, and suction are strongly discouraged. Once airway, breathing, and circulation have been established, a rapid, detailed history should be obtained. If a snake bite is suspected, hospital admission should be considered for further follow-up. All venomous snake bites can be effectively treated with antivenom. Side effects of antivenom should be prevented by sufficient preparation. Approved antivenoms for mamushi and habu are available. Yamakagashi antivenom is used as an off-label drug in Japan, requiring clinicians to join a clinical research group for its use in clinical practice.},
author = {Hifumi, Toru and Sakai, Atsushi and Kondo, Yutaka and Yamamoto, Akihiko and Morine, Nobuya and Ato, Manabu and Shibayama, Keigo and Umezawa, Kazuo and Kiriu, Nobuaki and Kato, Hiroshi and Koido, Yuichi and Inoue, Junichi and Kawakita, Kenya and Kuroda, Yasuhiro},
booktitle = {Journal of Intensive Care},
doi = {10.1186/s40560-015-0081-8},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Hifumi et al. - 2015 - Venomous snake bites Clinical diagnosis and treatment.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Hifumi et al. - 2015 - Venomous snake bites Clinical diagnosis and treatment(2).pdf:pdf},
issn = {20520492},
keywords = {Antivenom,Habu,Mamushi,Yamakagashi},
month = {dec},
number = {1},
pages = {16},
publisher = {BioMed Central Ltd.},
title = {{Venomous snake bites: Clinical diagnosis and treatment}},
url = {https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-015-0081-8},
volume = {3},
year = {2015}
}
@article{Inthanomchanh2017,
abstract = {Snakebite is a neglected condition and a common public health problem in Lao People's Democratic Republic (Lao PDR), with a high incidence of up to 1,105 cases per 100,000 persons per year. Snakebite patients with systemic envenoming do not receive effective treatment at local health facilities. Healthcare providers have only limited knowledge in assessing and providing the correct treatment for venomous snakebites. A cross-sectional study was conducted among 119 healthcare providers in Savannakhet Province, Lao PDR, with respect to their socio-demographic characteristics, knowledge of snake identification, and management of snakebite. Data was analyzed using SPSS. Logistic regression was performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) of adequate knowledge for treating snakebites among the healthcare providers. Among 119 participants, 27.7% and 45.4% had an adequate knowledge of snake identification and management of snakebites, respectively. Approximately 59% could correctly identify symptoms of envenomation, and 19.3% expressed confidence in treating snakebites. Study participants who had received training achieved significantly better snake identification results compared to those without training, with an OR of 2.54 (95% CI: 1.02-6.28). In particular, physicians achieved significantly better results compared to nurses in knowing how to manage snakebites, with an OR of 2.31 (95% CI: 1.04-5.12). Given the level of inadequate knowledge of snakebite management among healthcare providers in the province, more training in snakebite management is needed. University and Health Science Colleges should include snakebite management into the curriculum, to ensure that medical graduates have the appropriate knowledge and skills to treat snakebites.},
author = {Inthanomchanh, Vongphoumy and Reyer, Joshua A. and Blessmen, Joerg and Phrasisombath, Ketkesone and Yamamoto, Eiko and Hamajima, Nobuyuki},
doi = {10.18999/nagjms.79.3.299},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Inthanomchanh et al. - 2017 - Assessment of knowledge about snakebite management amongst healthcare providers in the provincial and two.pdf:pdf},
issn = {21863326},
journal = {Nagoya Journal of Medical Science},
keywords = {Assessment,Knowledge,Lao PDR,Savannakhet,Venomous snakebite},
number = {3},
pages = {299--311},
pmid = {28878435},
title = {{Assessment of knowledge about snakebite management amongst healthcare providers in the provincial and two district hospitals in Savannakhet Province, Lao PDR}},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577016/pdf/2186-3326-79-0299.pdf http://www.ncbi.nlm.nih.gov/pubmed/28878435 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5577016},
volume = {79},
year = {2017}
}
@article{Shahmy2017,
abstract = {Introduction: Sri Lanka records substantial numbers of snakebite annually. Primary rural hospitals are important contributors to health care. Health care planning requires a more detailed understanding of snakebite within this part of the health system. This study reports the management and epidemiology of all hospitalised snakebite in the Kurunegala district in Sri Lanka. Methodology: The district has 44 peripheral/primary hospitals and a tertiary care hospital-Teaching Hospital, Kurunegala (THK). This prospective study was conducted over one year. All hospitals received copies of the current national guidelines on snakebite management. Clinical and demographic details of all snakebite admissions to primary hospitals were recorded by field researchers and validated by comparing with scanned copies of the medical record. Management including hospital transfers was independently assessed against the national guidelines recommendation. Population rates were calculated and compared with estimates derived from recent community based surveys. Results: There were 2186 admissions of snakebites and no deaths in primary hospitals. An additional 401 patients from the district were admitted directly to the teaching hospital, 2 deaths were recorded in this group. The population incidence of hospitalized snakebite was 158/100,000 which was significantly lower than community survey estimates of 499/100,000. However there was no significant difference between the incidence of envenomation of 126/100,000 in hospitalised patients and 184/100,000 in the community survey. The utilisation of antivenom was appropriate and consistent with guidelines. Seventy patients received antivenom. Anaphylactic reactions to antivenom occurred in 22 patients, treatment reactions was considered to be outside the guidelines in 5 patients. Transfers from the primary hospital occurred in 399(18%) patients but the majority (341) did not meet the guideline criteria. A snake was identified in 978 cases; venomous snakebites included 823 hump-nosed viper (Hypnalespp), 61 Russell's viper, 14 cobra, 13 common krait, 03 saw scaled viper. Conclusions: Primary hospitals received a significant number of snakebites that would be missed in surveys conducted in tertiary hospitals. Adherence to guidelines was good for the use of antivenom but not for hospital transfer or treatment of anaphylaxis. The large difference in snakebite incidence between community and hospital studies could possibly be due to non-envenomed patients not presenting. As the majority of snakebite management occurs in primary hospitals education and clinical support should be focused on that part of the health system.},
author = {Shahmy, Seyed and Kularatne, Senanayake A. M. and Rathnayake, Shantha S. and Dawson, Andrew H.},
doi = {10.1371/journal.pntd.0005847},
editor = {Gotuzzo, Eduardo},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Shahmy et al. - 2017 - A prospective cohort study of the effectiveness of the primary hospital management of all snakebites in Kurunegal.pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {aug},
number = {8},
pages = {e0005847},
pmid = {28827807},
publisher = {Public Library of Science},
title = {{A prospective cohort study of the effectiveness of the primary hospital management of all snakebites in Kurunegala district of Sri Lanka}},
url = {https://dx.plos.org/10.1371/journal.pntd.0005847},
volume = {11},
year = {2017}
}
@article{Wood2016,
abstract = {Objective. To develop and validate a scoring system for managing snakebites in South Africa (SA). Methods. We studied all snakebite admissions to a regional hospital in KwaZulu-Natal, SA. The primary outcome was an active treatment intervention (ATI) defined as antivenom treatment or any surgical procedure. The development cohort consisted of 879 patients with snakebite who presented to the Ngwelezane Hospital Emergency Department from December 2008 to December 2013. Factors predictive of ATI and the optimal cut-off score for predicting an ATI were identified. These factors were then used to develop a standard scoring system. The score was then tested prospectively for accuracy in a new validation cohort consisting of 100 patients admitted for snakebite to our unit from 1 December 2014 to 31 March 2015. Accuracy of the score was determined. Results. Of 879 snakebite admissions, 146 in the development cohort and 40 of 100 in the development validation cohort reached the primary endpoint of an ATI. Six risk predictors for ATI were identified from the development cohort: age <14 years (odds ratio (OR) 2.13), delay to admission >7 hours (OR 4.63), white cell count >10 � 109/L (OR 3.15), platelets <92 � 109/L (OR 2.35), haemoglobin <7.1 g/dL (OR 5.68), international normalised ratio >1.2 (OR 2.25). Each risk predictor was assigned a score of 1; receiver operating characteristic curve analysis returned a value of >4 out of 6 as the optimal cut-off for prediction of an ATI (area under the curve 0.804; 95% confidence interval 0.758-0.84). Testing of the score on the validation cohort produced a specificity of 96.6% and a sensitivity of 22.5%. The positive predictive value and negative predictive value were 81.8% and 65.2%, respectively. Conclusion. Our results show that the identified score is a useful adjunct to clinical assessment in managing snakebite. Its value is greatest when used in those patients who fall in the mild to moderate clinical category. Until our severity score has been validated (or modified) for use across SA, we propose to name it the Zululand Severity Score; a true SA Severity Score may follow.},
author = {Wood, Darryl and Sartorius, B. and Hift, R.},
doi = {10.7196/SAMJ.2017.v107i1.11361},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Wood, Sartorius, Hift - 2016 - Classifying snakebite in South Africa Validating a scoring system.pdf:pdf},
issn = {2078-5135},
journal = {South African Medical Journal},
keywords = {Antivenom,Cytotoxic,Envenomation,Haemotoxic,Neurotoxic,Score,Snakebite},
month = {dec},
number = {1},
pages = {46},
title = {{Classifying snakebite in South Africa: Validating a scoring system}},
url = {http://www.samj.org.za/index.php/samj/article/view/11763},
volume = {107},
year = {2016}
}
@article{WHO2007,
abstract = {ISBN 978 92 4 156348 2 The aim of this Consultative Meeting was to discuss strategies for improving the quality and quantity of therapeutic antisera, essential drugs for the effective treatment of suspected rabid dog bites and envenoming by snake bites and scorpion stings. Inadequacies in the effi cacy, safety and production of these antisera have created a major global public health crisis, especially in Africa and Asia. Each year, millions of people are bitten by dogs or snakes or stung by scorpions and the failure to provide antisera costs at least 200,000 lives and at least as many cases of permanent physical handicap. The solution to this crisis demands an international effort to promote transfer of technology to affected countries, to improve standards through the WHO's prequalifi cation scheme and to facilitate distribution of antisera and training of medical personnel in their optimal use.},
author = {WHO},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/WHO - 2007 - A NEGLECTED Report of a Consultative Meeting.pdf:pdf},
isbn = {9789241563482},
number = {January},
title = {{A NEGLECTED Report of a Consultative Meeting}},
url = {http://www.who.int/medicines},
year = {2007}
}
@article{Tagwireyi2001,
abstract = {BACKGROUND Routine antibiotic prophylaxis following snakebite is not recommended but evidence suggests that it may be common practice in Zimbabwe. This study set out to determine and describe the extent of this practice at Parirenyatwa Hospital, a large teaching hospital in Zimbabwe METHODS A retrospective case review (1996 to 1999 inclusive) of all cases of snakebite was undertaken at Parirenyatwa Hospital. Cases with a diagnosis of snakebite, presenting within 24 hours of the bite and with no complications or concurrent illness were defined as "routine prophylactic antibiotic use". RESULTS From 78 cases which satisfied the inclusion criteria, 69 (88.5%) received antibiotics. Ten different antibiotics from 6 different classes were used with penicillins the most commonly prescribed (benzylpenicillin in 29% of cases, alone or in combination). Over 40% of antibiotics were given parenterally although all patients were conscious on admission. The total cost of antibiotics used was estimated at US$522.98. CONCLUSION Routine prophylactic use of antibiotics in snakebite at Parirenyatwa Hospital is common practice. This may highlight the lack of a clearly defined policy leading to wasteful inappropriate antibiotic use which is costly and may promote bacterial antibiotic resistance. Further work is required to investigate the reasons for this practice and to design appropriate interventions to counter it.},
author = {Tagwireyi, Dexter D. and Ball, Douglas E. and Nhachi, Charles F.B.},
doi = {10.1186/1472-6904-1-4},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Tagwireyi, Ball, Nhachi - 2001 - Routine prophylactic antibiotic use in the management of snakebite.pdf:pdf},
issn = {14726904},
journal = {BMC Clinical Pharmacology},
month = {nov},
title = {{Routine prophylactic antibiotic use in the management of snakebite}},
volume = {1},
year = {2001}
}
@article{Blessmann2018,
abstract = {Background: The annual incidence of snakebites in Vietnam is not known and only few publications about snakebite envenoming and medically relevant snakes can be found in English language literature. The present community-based surveys provide data on incidence of snakebites in three different geographic regions of Thua Thien Hue (TT Hue) province, central Vietnam and snake species responsible for bites in this region. Methodology/results: The cross-sectional community based surveys were conducted from March to July 2017. Multistage cluster sampling was applied and snakebite incidence was calculated at 58 snakebites per 100,000 person-years for the entire province, and 172, 69 and 10 snakebites per 100,000 person-years in the mountainous, coastal and urban region of TT Hue province, respectively. Thirty-one snakebite victims interviewed during the surveys reported 18 (58%) green pit viper bites (Trimeresurus species), 5 (16%) cobra bites (Naja kaouthia, Naja siamensis), 2 (7%) krait bites (Bungarus candidus, Bungarus fasciatus), 2 (7%) red-necked keelback bites (Rhabdophis subminiatus) and 4 bites from unidentified snakes (13%). The outcome was favourable for 28 snakebite victims (90%), two (6%) had minor sequelae and one (3%) victim died after a Malayan krait bite. Two hundred and twenty-one snakebite patients were treated in 9 district hospitals and one central hospital in TT Hue between 2014 and 2016. Eighty green pit vipers (84%), 12 cobras (13%) and 3 kraits (3%) were responsible for bites in 95 patients where snake identification was documented. Conclusions: Incidence of snakebites is surprisingly low in TT Hue province in central Vietnam in comparison to other regions in Asia, particularly to neighbouring Lao PDR. However, snakebites are still a significant health problem in the mountainous region and green pit vipers and cobras cause the vast majority of bites.},
author = {Blessmann, Joerg and Nguyen, Thanh Phuc Nhan and Bui, Thi Phuong Anh and Krumkamp, Ralf and Vo, Van Thang and Nguyen, Hoang Lan},
doi = {10.1016/j.toxicon.2018.11.009},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Blessmann et al. - 2018 - Incidence of snakebites in 3 different geographic regions in Thua Thien Hue province, central Vietnam Green pi.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Cobra,Green pit viper,Incidence,Snakebite,Vietnam},
month = {dec},
pages = {61--65},
title = {{Incidence of snakebites in 3 different geographic regions in Thua Thien Hue province, central Vietnam: Green pit vipers and cobras cause the majority of bites}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S004101011830730X},
volume = {156},
year = {2018}
}
@article{Habib2011,
abstract = {Snakebite is an important cause of mortality among rural dwellers in the savannah region of West Africa. We conducted a retrospective review of snakebite patients managed by experienced medical staff at Kaltungo in north-eastern Nigeria to determine the cause of death. During a 36 month period there were 94 deaths among 6687 victims (1.41%). Relative risk (RR) of mortality increased to 2.29 (95% CI 1.35-3.89) during a period when source of antivenom became unreliable. The increase was not due to seasonal variation. In a logistic regression model predictors of mortality were new central nervous system (CNS) features (Odds ratio (OR) = 24.61; 95% CI 6.93-87.41) and delay from bite to hospitalization (OR for every 1 h delay = 1.01; 95% CI 1.00-1.02). Treatment with antivenom was protective (OR = 0.17; 95% CI 0.03-0.96). Relationship of anaemia and shock to mortality were not maintained following adjustment. Effort should be made to provide regionally appropriate, affordable and effective antivenoms in addition to enforcement of continuous regulatory control measures. Antivenoms should be distributed to affected areas and treatment access points of care expanded to communities to diminish travel time. The populations at risk should be educated on avoiding unnecessary delays and on prevention of bites. {\textcopyright} 2010 Royal Society of Tropical Medicine and Hygiene.},
author = {Habib, A.G. and Abubakar, S.B.},
doi = {10.1016/j.inhe.2010.08.001},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Habib, Abubakar - 2011 - Factors affecting snakebite mortality in north-eastern Nigeria.pdf:pdf},
issn = {18763413},
journal = {International Health},
keywords = {Antivenom,Envenoming,Mortality,Savannah,Snakebite},
month = {mar},
number = {1},
pages = {50--55},
title = {{Factors affecting snakebite mortality in north-eastern Nigeria}},
url = {https://academic.oup.com/inthealth/article-lookup/doi/10.1016/j.inhe.2010.08.001},
volume = {3},
year = {2011}
}
@article{Avau2016,
abstract = {Background: The worldwide burden of snakebite is high, especially in remote regions with lesser accessibility to professional healthcare. Therefore, adequate first aid for snakebite is of the utmost importance. A wide range of different first aid techniques have been described in literature, and are being used in practice. This systematic review aimed to summarize the best available evidence concerning effective and feasible first aid techniques for snakebite. Methods: A systematic literature screening, performed independently by two authors in the Cochrane Library, MEDLINE and Embase resulted in 14 studies, fulfilling our predefined selection criteria, concerning first aid techniques for snakebite management. Data was extracted and the body of evidence was appraised according to the GRADE approach. Principal findings: The pressure immobilization technique was identified as the only evidence-based first aid technique with effectiveness on venom spread. However, additional studies suggest that proper application of this technique is not feasible for laypeople. Evidence concerning other first aid measures, such as the application of a tourniquet, suggests avoiding the use of these techniques. Conclusions: The practical recommendation for the treatment of snakebite in a first aid setting is to immobilize the victim, while awaiting the emergency services. However, given the low to very low quality of the data collected, high quality randomized controlled trials concerning the efficacy and feasibility of different variations of the pressure immobilization technique are warranted.},
author = {Avau, Bert and Borra, Vere and Vandekerckhove, Philippe and {De Buck}, Emmy},
doi = {10.1371/journal.pntd.0005079},
editor = {Chippaux, Jean-Philippe},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Avau et al. - 2016 - The Treatment of Snake Bites in a First Aid Setting A Systematic Review.pdf:pdf},
issn = {1935-2735},
journal = {PLOS Neglected Tropical Diseases},
month = {oct},
number = {10},
pages = {e0005079},
title = {{The Treatment of Snake Bites in a First Aid Setting: A Systematic Review}},
url = {https://dx.plos.org/10.1371/journal.pntd.0005079},
volume = {10},
year = {2016}
}
@article{Sulaiman2020,
abstract = {Background: Snakebites are emergent and life-threatening injuries that may require intensive care. Physicians face difficulties in dealing with snakebite injuries due to the knowledge gaps in the diagnosis and management of snakebites. The study aimed to assess medical students' knowledge about the diagnosis and management of snakebite injuries, as well as their proficiency in first aid methods in case of snakebite and perception regarding snakes and snakebite injuries. Methods: A cross-sectional study conducted among 200 medical students in their clinical years at An-Najah National University. A questionnaire was developed and distributed among those students. The questionnaire assessed the students' knowledge regarding the diagnosis and management of snakebites and their attitude regarding snakes and snakebites. The total scores of knowledge were obtained and tested based on the participants' demographic characteristics using the Kruskal-Wallis test and the Mann-Whitney U test. P-values of < 0.05 were considered to be statistically significant. Results: The mean age of participating medical students was 22.2 ± 2.4 (year). Half of these medical students were in there final year of study (sixth year). After the analysis was done, we found a knowledge deficit in snakebite diagnosis and management among medical students. The mean knowledge scores regarding Vipera palaestinae, signs and symptoms, laboratory investigations, anti-venom, and first aid were 3.8/13, 8.2/16, 6.1/10, 3.6/11 and 8.3/15 respectively for medical students. It was found that medical students in higher years of study had a higher knowledge of laboratory investigation, and males were more knowledgeable in the correct way for first aid methods than females (p < 0.036). Conclusions: The level of knowledge regarding the diagnosis and management of snakebites was not good enough among most of the students. In order to improve their knowledge, snakebite diagnosis and management should be introduced and focused on in medical curriculum. Also, formal first aid training classes for medical students should be introduced in order to teach them the correct and updated methods of first aid as they will be the future health care providers and proper first aid will effectively decrease morbidity and mortality of snakebites.},
author = {Sulaiman, Suha S. and Kharusha, Isra K. and Samara, Ahmad M. and Al-Jabi, Samah W. and Zyoud, Sa'Ed H.},
doi = {10.1186/s12995-020-00254-3},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Sulaiman et al. - 2020 - An assessment of medical students' proficiency in the diagnosis and management of snakebites A cross-sectional.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Unknown - Unknown - An assessment of medical students' proficiency in the diagnosis and management of snakebites a cross-sectional study.pdf:pdf},
issn = {1745-6673},
journal = {Journal of Occupational Medicine and Toxicology},
keywords = {Attitude,Diagnosis,First aid,Knowledge,Management,Medical students,Snakebite},
month = {feb},
number = {1},
pages = {3},
publisher = {BioMed Central Ltd.},
title = {{An assessment of medical students' proficiency in the diagnosis and management of snakebites: a cross-sectional study from Palestine}},
url = {https://link.springer.com/articles/10.1186/s12995-020-00254-3 https://link.springer.com/article/10.1186/s12995-020-00254-3 https://occup-med.biomedcentral.com/articles/10.1186/s12995-020-00254-3},
volume = {15},
year = {2020}
}
@article{Visser2004,
abstract = {A study was conducted in Mathias Hospital, Yeji, an area of Ghana, where snake bite cases are an important cause of morbidity and mortality, with a case fatality rate of 11% (8/72). Case management difficulties included uncertainty about the assessment of the severity of envenoming, the dosage of antivenom, and the response to treatment. An intervention with several components was introduced: development of a treatment protocol, staff training, monitoring of compliance and patient education. During a 33-month post-intervention period there was excellent protocol compliance, fewer snake bite complications, and a fall in mortality rate to 1.3% (3/238) compared with a 15-month baseline review. There was a 50% increase in snake bite admissions and fewer delays. To improve snake bite outcomes in comparable settings, particularly if inexperienced staff are involved in care, we recommend a similar quality assurance project, involving case review and use of a treatment protocol with monitoring of compliance to sustain an improved approach. {\textcopyright} 2004 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.},
author = {Visser, L. E. and Kyei-Faried, S. and Belcher, D.W},
doi = {10.1016/S0035-9203(03)00065-8},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Visser, Kyei-Faried, Belcher - 2004 - Protocol and monitoring to improve snake bite outcomes in rural Ghana.pdf:pdf},
issn = {00359203},
journal = {Transactions of the Royal Society of Tropical Medicine and Hygiene},
keywords = {Antivenom,Carpet viper,Envenoming,Ghana,Snake bite,Treatment protocol},
month = {may},
number = {5},
pages = {278--283},
title = {{Protocol and monitoring to improve snake bite outcomes in rural Ghana}},
url = {https://academic.oup.com/trstmh/article-lookup/doi/10.1016/S0035-9203(03)00065-8},
volume = {98},
year = {2004}
}
@article{Armstrong2019,
abstract = {In Bihar, an estimated 4500 snakebite deaths occur per year, but community data are scarce. Using a multi-stage cluster design, 4159 households were interviewed across six Community Development (CD) blocks in North Bihar, identifying 206 snakebites and 254 deaths between the Chhaat festivals of 2014 and 2015. Concurrently, 357 snakebite victims presented to Duncan Hospital from this area. None of the 254 verbal autopsies were attributed to snakebite envenoming. The annual community snakebite incidence was 643/100,000 person-years (95% confidence interval [CI] = 556–730) with peak incidence in women aged 30–39 years at 1323/100,000 person-years (95% CI = 837–1809). Two-thirds of snakebite victims attended traditional healers first for help (95% CI = 59.9–73.2). The community envenomation rate was 24.9/100,000 person-years (95% CI = 7.6–42.2). The hospital envenomation rate was 4.6% (95% CI = 3.5–5.7). Of the hospital snakebite deaths, 91% (10/11) were aged <16 years. Only 4.6% (95% CI = 4.1–5.1) of snakebite victims from this area presented at the local hospital.},
author = {Armstrong, Lois J. and Cynthia, Sharon and George, Miriam and Zachariah, Anand},
doi = {10.1177/0049475519865036},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Armstrong et al. - 2019 - Comparing community and hospital data of snakebite in North Bihar a community incidence survey and a parallel.pdf:pdf},
issn = {0049-4755},
journal = {Tropical Doctor},
keywords = {Snakebite,community,hospital,snakebite incidence},
month = {oct},
number = {4},
pages = {285--292},
title = {{Comparing community and hospital data of snakebite in North Bihar: a community incidence survey and a parallel hospital-based clinical study}},
url = {http://journals.sagepub.com/doi/10.1177/0049475519865036},
volume = {49},
year = {2019}
}
@article{Mohapatra2011,
abstract = {Background: India has long been thought to have more snakebites than any other country. However, inadequate hospital-based reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey. Methods and Findings: We conducted a nationally representative study of 123,000 deaths from 6,671 randomly selected areas in 2001-03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication. A total of 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15-29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6-4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8-6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500). Conclusions: Snakebite remains an underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India. {\textcopyright} 2011 Mohapatra et al.},
author = {Mohapatra, Bijayeeni and Warrell, David A. and Suraweera, Wilson and Bhatia, Prakash and Dhingra, Neeraj and Jotkar, Raju M. and Rodriguez, Peter S. and Mishra, Kaushik and Whitaker, Romulus and Jha, Prabhat},
doi = {10.1371/journal.pntd.0001018},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Mohapatra et al. - 2011 - Snakebite mortality in India A nationally representative mortality survey.pdf:pdf},
issn = {19352727},
journal = {PLoS Neglected Tropical Diseases},
month = {apr},
number = {4},
title = {{Snakebite mortality in India: A nationally representative mortality survey}},
volume = {5},
year = {2011}
}
@article{Longkumer2016,
abstract = {Background: The state of Bihar has the third largest number of snakebite deaths in India. The purpose of this study is to explore the factors related to human-snake conflicts in northwest Bihar and southern Nepal. Using these findings, various strategies were proposed to reduce the incidence of snakebites. Method: Data were collected from 609 patients at Duncan Hospital in Raxaul, Bihar, India between 1 July 2012 and 30 June 2013. Patients were included if they had a history of snakebite or unknown bites. Patients with symptoms of enven- omation but no known bites were also included, as were patients who were dead on arrival due to a snakebite. Results: The 10-19 year old age group is the peak age group (28.4%) for snakebite. There is a slight preponderance of males (52.7%). 51.4% of bites occurred on the foot/ankle. The envenomation rate was 12.6%. The mortality rate of those envenomed that arrived at the hospital alive was 6.3%. Fourteen people were dead on arrival at the hospital. 75% of people were unable to identify what, or what type of snake, bit them. Common Wolf Snakes (Lycodon aulicus) were the most common snakes brought to the hospital, followed by Spectacled Cobra (Naja naja). Patients who brought snakes to the hospital and attempted identification were all successful at identifying cobras, but all those who brought in Common Wolf Snakes incorrectly identified them as Kraits. The highest monthly frequency of snakebites occurred between June and September; while on a daily basis, the highest frequency occurred between 1700hrs-2200hrs, the time in which 39.1% of all bites occurred. 59.2% of the bites occurred in and around the house. Farming, housework, sleeping, playing, and toileting in fields were the activities most commonly occurring when bitten. Sleeping on the floor increased the risk of envenomation [OR= 5.8, 95%CI 1.8-18.6], while sleeping under a mosquito net decreased the risk of envenomation [OR= 0.17, 95%CI 0.04-0.6]. Conclusion: Snakebite is a rural hazard in Northern Bihar, not just an occupational hazard. Use of toilets and sleeping on beds with well tucked in mosquito nets may help prevent snakebites. Education to reduce the risk of snakebites should begin in childhood and be regularly reinforced prior to the rainy season. Prevention measures should include environmental management such as keeping eating areas clean and keeping food storage and sleeping areas a distance apart.},
author = {Longkumer, Takanungsang and Armstrong, Lois Joy and Santra, Vishal and Finny, Philip},
doi = {10.15566/cjgh.v3i1.77},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Longkumer et al. - 2016 - Human, snake, and environmental factors in human - snake conflict in North Bihar - A one-year descriptive s(3).pdf:pdf},
issn = {2167-2415},
journal = {Christian Journal for Global Health},
number = {1},
pages = {36},
title = {{Human, snake, and environmental factors in human - snake conflict in North Bihar - A one-year descriptive study}},
url = {https://journal.cjgh.org/index.php/cjgh/article/view/77},
volume = {3},
year = {2016}
}
@article{Gutierrez2016,
abstract = {During 45 years, the Instituto Clodomiro Picado (ICP, University of Costa Rica) has developed an ambitious scientific, technological, productive, and social program aimed at providing a better understanding of snakes and their venoms, contributing to the development, production and distribution of antivenoms, improving the prevention and management of snakebite envenomings, and strengthening human resources in science and technology. Among other topics, its research agenda has focused on the local tissue alterations induced by viperid snake venoms, i.e. myonecrosis, hemorrhage, dermonecrosis, extracellular matrix degradation, lymphatic vessel damage, and inflammation. In addition, the preclinical efficacy of antivenoms has been thoroughly investigated, together with the technological development of novel antivenoms. ICP's project has been based on a philosophical frame characterized by: (a) An integrated approach for confronting the problem of snakebites, involving research, production, extension activities, and teaching; (b) a cooperative and team work perspective in the pursuit of scientific, technological, productive, and social goals; (c) a search for excellence and continuous improvement in the quality of its activities; and (d) a vision of solidarity and compassion, based on the realization that snakebite envenomings mostly affect impoverished vulnerable populations in the rural settings of developing countries. A key aspect in this program has been the consolidation of international partnerships with groups of all continents, within a frame of academic and social cooperation, some of which are described in this review.},
author = {Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a},
doi = {10.1016/j.toxicon.2015.11.013},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Guti{\'{e}}rrez - 2016 - Understanding and confronting snakebite envenoming The harvest of cooperation.pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Antivenoms,Bothrops asper,Costa Rica,Hemorrhage,Myonecrosis,Neutralization,Snake venoms,Toxinology},
month = {jan},
pages = {51--62},
title = {{Understanding and confronting snakebite envenoming: The harvest of cooperation}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010115301392},
volume = {109},
year = {2016}
}
@article{Vaiyapuri2013,
abstract = {Background: Snakebite represents a significant health issue worldwide, affecting several million people each year with as many as 95,000 deaths. India is considered to be the country most affected, but much remains unknown about snakebite incidence in this country, its socio-economic impact and how snakebite management could be improved. Methods/Principal Findings: We conducted a study within rural villages in Tamil Nadu, India, which combines a household survey (28,494 people) of snakebite incidence with a more detailed survey of victims in order to understand the health and socio-economic effects of the bite, the treatments obtained and their views about future improvements. Our survey suggests that snakebite incidence is higher than previously reported. 3.9% of those surveyed had suffered from snakebite and the number of deaths corresponds to 0.45% of the population. The socio-economic impact of this is very considerable in terms of the treatment costs and the long-term effects on the health and ability of survivors to work. To reduce this, the victims recommended improvements to the accessibility and affordability of antivenom treatment. Conclusions: Snakebite has a considerable and disproportionate impact on rural populations, particularly in South Asia. This study provides an incentive for researchers and the public to work together to reduce the incidence and improve the outcomes for snake bite victims and their families. {\textcopyright} 2013 Vaiyapuri et al.},
author = {Vaiyapuri, Sakthivel and Vaiyapuri, Rajendran and Ashokan, Rajesh and Ramasamy, Karthikeyan and Nattamaisundar, Kameshwaran and Jeyaraj, Anburaj and Chandran, Viswanathan and Gajjeraman, Prabu and Baksh, M. Fazil and Gibbins, Jonathan M. and Hutchinson, E. Gail},
doi = {10.1371/journal.pone.0080090},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Vaiyapuri et al. - 2013 - Snakebite and its socio-economic impact on the rural population of Tamil Nadu, India.pdf:pdf},
issn = {19326203},
journal = {PLoS ONE},
month = {nov},
number = {11},
pmid = {24278244},
title = {{Snakebite and its socio-economic impact on the rural population of Tamil Nadu, India}},
volume = {8},
year = {2013}
}
@article{Okumu2019,
abstract = {Background: Data on the cost of snakebite injuries may inform key pillars of universal health coverage including proper planning, allocation, and utility of resources. This study evaluated the injuries, management, and costs resulting from snakebites at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kenya. Methods: In total, medical records of 127 snakebite victims attending JOOTRH between January 2011 and December 2016 were purposely selected and data on the age, gender, type of residence (urban or rural), part of the body bitten, time of bite, injuries, pre-hospital first aid, time to hospital, length of stay, treatment, and costs were collected. Regression analysis was used to predict the total indirect cost of snakebite injuries and p≤ 0.05 was considered significant. Mortality and loss of income of hospitalized victims were considered as direct costs. Results: It was found that 43 victims were 13-24 years of age, 64 were female, 94 were from rural areas, 92 were bitten on the lower limbs, 49 were bitten between 6.00 pm and midnight, 43 attempted pre-hospital first aid, and the median time to hospital was 4.5 hours. Antivenom, supportive therapy, antibiotics, antihistamines, corticosteroids, analgesics, and non-steroidal anti-inflammatory drugs were used. Cellulitis, compartment syndrome, gangrenous foot, psychiatric disorder, and death were the main complications. Most victims spent 1-5 days in hospital and the median cost of treating a snakebite was 2652 KES ($\sim$$26). Drugs, ward charges, and nursing procedures were the highest contributors to the total indirect cost. Victims hospitalized for 6-10 days and >10 days incurred 32% and 62% more costs, respectively, compared to those hospitalized for 1-5 days. Conclusions: The longer snakebite victims are hospitalized, the higher the cost incurred. Continuous medical education on the correct management of snakebites should be encouraged to minimize complications that may increase hospital stays and costs incurred.},
author = {Okumu, Mitchel Otieno and Patel, Minal Naran and Bhogayata, Foram Rajnkant and Ochola, Francis Okumu and Olweny, Irene Awuor and Onono, Joshua Orungo and Gikunju, Joseph Kangangi},
doi = {10.12688/f1000research.20268.1},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Okumu et al. - 2019 - Management and cost of snakebite injuries at a teaching and referral hospital in Western Kenya.pdf:pdf},
issn = {2046-1402},
journal = {F1000Research},
keywords = {costs of snakebite,management of snakebite,neglected tropical disease,snakebite,snakebite burden,snakebite envenoming,sub-Saharan Africa,universal health coverage},
language = {eng},
month = {sep},
pages = {1588},
pmid = {31824667},
title = {{Management and cost of snakebite injuries at a teaching and referral hospital in Western Kenya.}},
url = {https://f1000research.com/articles/8-1588/v1 http://www.ncbi.nlm.nih.gov/pubmed/31824667 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC6892383},
volume = {8},
year = {2019}
}
@article{TheLancet2017,
abstract = {The Nuffield Council on Bioethics has called for stricter controls over the provision of non-reconstructive cosmetic procedures, citing ethical concerns about their promotion and regulation in the UK and suggesting that they be made available only to people aged 18 years or older. Social media, advertising, and apps are being used to convey the message that these procedures are not only accessible but desirable, meaning that people could feel pressured to conform to a society's ideal of beauty at susceptible points in their development. The desire to change one's appearance is not new, but factors such as celebrity culture, use of unrealistic images in advertising, and the stratospheric rise of social media have helped cultivate an environment that can be toxic to self-esteem and body image. Although social media can have a positive influence on wellbeing, they have also been associated with increased anxiety and feelings of inadequacy in some young people. Social media policies on health-related advertising range from fairly stringent to non-existent, and cosmetic surgery apps are easily accessible and marketed as games for children as young as 9 years old. The very media that contribute to body dissatisfaction are not only stimulating demand but promoting so-called solutions. Demand for cosmetic procedures has increased the value of the UK cosmetic sector from {\pounds}720 million in 2005 to an estimated {\pounds}3{\textperiodcentered}6 billion in 2015. Despite this growth, and in spite of previous safety recommendations from reviews of the industry, the UK Government has failed to introduce consistent regulation of cosmetic products and non-surgical procedures. Because of this vacuum, few data are available on how many young people have cosmetic procedures, but in theory, a 16-year-old could have certain procedures involving use of an unregulated product, done by an unskilled and unregulated practitioner, without the involvement of a parent or medical professional. Campaigns such as Be Real, which is aimed at changing attitudes to body image in young people, are a step in the right direction, and educating children about body image is crucial. Nevertheless, more must be done to moderate the exposure of young people to the irresponsible marketing of potentially life-changing procedures. n The Lancet},
author = {{The Lancet}},
doi = {10.1016/S0140-6736(17)31751-8},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/The Lancet - 2017 - Snake-bite envenoming a priority neglected tropical disease.pdf:pdf},
issn = {1474547X},
journal = {The Lancet},
month = {jul},
number = {10089},
pages = {2},
pmid = {28677550},
publisher = {Elsevier},
title = {{Snake-bite envenoming: a priority neglected tropical disease}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28677550 https://linkinghub.elsevier.com/retrieve/pii/S0140673617317518},
volume = {390},
year = {2017}
}
@article{Harrison2016,
abstract = {The deliberations and conclusions of a Hinxton Retreat convened in September 2015, entitled “Mechanisms to reverse the public health neglect of snakebite victims” are reported. The participants recommended that the following priority actions be included in strategies to reduce the global impact of snake envenoming: (a) collection of accurate global snakebite incidence, mortality and morbidity data to underpin advocacy efforts and help design public health campaigns; (b) promotion of (i) public education prevention campaigns; (ii) transport systems to improve access to hospitals and (iii) establishment of regional antivenom-efficacy testing facilities to ensure antivenoms' effectiveness and safety; (c) exploration of funding models for investment in the production of antivenoms to address deficiencies in some regions; (d) establishment of (i) programs for training in effective first aid, hospital management and post-treatment care of victims; (ii) a clinical network to generate treatment guidelines and (iii) a clinical trials system to improve the clinical management of snakebite; (e) development of (i) novel treatments of the systemic and local tissue-destructive effects of envenoming and (ii) affordable, simple, point-of-care snakebite diagnostic kits to improve the accuracy and rapidity of treatment; (f) devising and implementation of interventions to help the people and communities affected by physical and psychological sequelae of snakebite.},
author = {Harrison, Robert A. and Guti{\'{e}}rrez, Jos{\'{e}} Mar{\'{i}}a},
doi = {10.3390/toxins8120351},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Harrison, Guti{\'{e}}rrez - 2016 - Priority actions and progress to substantially and sustainably reduce the mortality, morbidity and socioeco.pdf:pdf},
issn = {20726651},
journal = {Toxins},
keywords = {Antivenoms,Envenoming,Global snakebite initiative,Neglected tropical disease,Prevention,Snakebite},
month = {nov},
number = {12},
pages = {351},
title = {{Priority actions and progress to substantially and sustainably reduce the mortality, morbidity and socioeconomic burden of tropical snakebite}},
url = {http://www.mdpi.com/2072-6651/8/12/351},
volume = {8},
year = {2016}
}
@misc{Kasturiratne2008,
abstract = {Background: Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burden due to snakebites. Methods and Findings: The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant countryspecific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the Global Burden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deaths were estimated on the basis of observed mortality rates and the at-risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact that envenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually. Conclusions: Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa. Copyright: {\textcopyright} 2008 Kasturiratne et al.},
author = {Kasturiratne, Anuradhani and Wickremasinghe, A. Rajitha and {De Silva}, Nilanthi and Gunawardena, N. Kithsiri and Pathmeswaran, Arunasalam and Premaratna, Ranjan and Savioli, Lorenzo and Lalloo, David G. and {De Silva}, H. Janaka},
booktitle = {PLoS Medicine},
doi = {10.1371/journal.pmed.0050218},
editor = {Winkel, Ken},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kasturiratne et al. - 2008 - The global burden of snakebite A literature analysis and modelling based on regional estimates of envenomin.pdf:pdf;:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Kasturiratne et al. - 2008 - The global burden of snakebite A literature analysis and modelling based on regional estimates of enveno(3).pdf:pdf},
issn = {15491277},
month = {nov},
number = {11},
pages = {1591--1604},
pmid = {18986210},
title = {{The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths}},
url = {https://dx.plos.org/10.1371/journal.pmed.0050218},
volume = {5},
year = {2008}
}
@article{Williams2018,
abstract = {In the 1890s, hyperimmune sera proved effective in animals against challenge by the snake venom against which they had been raised. They were first used, apparently successfully, in a human patient in about 1895. Since then, antivenoms have become accepted as the only reliable specific treatment for snake-bite envenoming. Despite decades of accumulated clinical experience and a number of published randomized comparative and observational studies, the clinical effectiveness and safety of some antivenoms remain open to question, due to a lack of robust randomized controlled trial data. Antivenoms in some poorly regulated markets may have high rates of potentially fatal adverse effects and their use must be balanced by demonstrable effectiveness. Even those manufactured to strict regulatory requirements may pose a rare risk of severe adverse reactions. Most antivenoms currently marketed around the world were registered without first being studied clinically. There is increasing pressure to subject antivenoms, even those that are long-established, to the same protocols of rigorous pre-clinical and clinical assessment that are standard regulatory requirements for other drugs. Conventional clinical testing progresses through Phases I, II, III to IV. Most authorities consider antivenoms too dangerous to be used in Phase I studies in healthy volunteers. An alternative method for preliminary estimation of safety, dose-finding and effectiveness, is proposed - the “3 + 3” dose escalation or de-escalation design, in volunteer patients, as used in oncology to test cytotoxic drugs. Antivenoms are so widely used and well trusted, that there are few ethical justifications for placebo controls. However, placebo might be ethically justified if there were no proven effective treatment and or if withholding or delaying treatment posed acceptably negligible risks to the participants. Antivenom trials are most urgently needed in low-to middle-income countries where there are many practical, logistical and funding challenges. Basic requirements for clinical trials include identification of the biting species of snake in every case; the use of objective, clinically-relevant endpoints, such as restoration of blood coagulability; definition of inclusion, exclusion and withdrawal criteria; assurance of antivenom safety; ethical considerations; inclusion of one or more control (comparator) groups; and analysis based on intention to treat. The highest quality evidence comes from Phase II and larger Phase III studies that have been designed as statistically powerful, randomized, controlled trials (RCTs), ideally with blinding of patients and investigators to avoid bias. Because of the challenges to carrying out clinical trials of antivenoms, Phase IV trials (post-marketing surveillance) are potentially more important and useful than for most other drugs.},
author = {Williams, David J. and Habib, Abdulrazaq G. and Warrell, David A.},
doi = {10.1016/j.toxicon.2018.05.001},
file = {:C\:/Users/Kwaku Duah/AppData/Local/Mendeley Ltd./Mendeley Desktop/Downloaded/Johnston et al. - 2017 - The Australian Snakebite Project, 2005–2015 (ASP‐20).pdf:pdf},
issn = {00410101},
journal = {Toxicon},
keywords = {Adverse reactions,Antivenom,Blinding,Clinical trials,Ethical considerations,Placebo control,Post-marketing surveillance,Pre-clinical testing,Randomized controlled trials},
month = {aug},
pages = {1--10},
title = {{Clinical studies of the effectiveness and safety of antivenoms}},
url = {https://linkinghub.elsevier.com/retrieve/pii/S0041010118301764},
volume = {150},
year = {2018}
}

@article{Spyres2016,
	title = {Occupational Snake Bites: a Prospective Case Series of Patients Reported to the ToxIC North American Snakebite Registry},
	author = {{Spyres}, {Meghan B.} and {Ruha}, {Anne-Michelle} and {Seifert}, {Steven} and {Onisko}, {Nancy} and {Padilla-Jones}, {Angela} and {Smith}, {Eric Anthony}},
	year = {2016},
	month = {05},
	date = {2016-05-27},
	journal = {Journal of Medical Toxicology},
	pages = {365--369},
	volume = {12},
	number = {4},
	doi = {10.1007/s13181-016-0555-7},
	url = {http://dx.doi.org/10.1007/s13181-016-0555-7},
	langid = {en}
}

@misc{www.focus-economics.com,
author = {www.focus-economics.com},
title = {{Ghanaian Cedi Exchange Rate (USD to GHS) - News Forecasts}},
url = {https://www.focus-economics.com/country-indicator/ghana/exchange-rate},
urldate = {2021-11-29}
}

@Article{gtsummary,
    author = {Daniel D. Sjoberg and Karissa Whiting and Michael Curry and Jessica A. Lavery and Joseph Larmarange},
    title = {Reproducible Summary Tables with the gtsummary Package},
    journal = {{The R Journal}},
    year = {2021},
    url = {https://doi.org/10.32614/RJ-2021-053},
    doi = {10.32614/RJ-2021-053},
    volume = {13},
    issue = {1},
    pages = {570-580},
  }
  
   @Article{tidyverse,
    title = {Welcome to the {tidyverse}},
    author = {Hadley Wickham and Mara Averick and Jennifer Bryan and Winston Chang and Lucy D'Agostino McGowan and Romain Françoi and  Garrett Grolemun and  Alex Haye and  Lionel Henr and  Jim Heste and  Max Kuh and  Thomas Lin Pederse and  Evan Mille and  Stephan Milton Bach and  Kirill Müll and , Jeroen Oo and , David Robins and , Dana Paige Seid and , Vitalie Spi and , Kohske Takahas and , Davis Vaugh and , Claus Wil and , Kara W and , Hiroaki Yutani},
    year = {2019},
    journal = {Journal of Open Source Software},
    volume = {4},
    number = {43},
    pages = {1686},
    doi = {10.21105/joss.01686},
  }

@Manual{r42,
    title = {R: A Language and Environment for Statistical Computing},
    author = {{R Core Team}},
    organization = {R Foundation for Statistical Computing},
    address = {Vienna, Austria},
    year = {2022},
    url = {https://www.R-project.org/},
  }
  
  @Manual{officer,
    title = {officer: Manipulation of Microsoft Word and PowerPoint Documents},
    author = {David Gohel},
    year = {2022},
    note = {R package version 0.4.2},
    url = {https://CRAN.R-project.org/package=officer},
  }
  
  @Manual{flextable,
    title = {flextable: Functions for Tabular Reporting},
    author = {David Gohel},
    year = {2022},
    note = {R package version 0.7.1},
    url = {https://CRAN.R-project.org/package=flextable},
  }
  
  @Manual{ggpubr,
    title = {ggpubr: 'ggplot2' Based Publication Ready Plots},
    author = {Alboukadel Kassambara},
    year = {2020},
    note = {R package version 0.4.0},
    url = {https://CRAN.R-project.org/package=ggpubr},
  }