Preamble
Globally, over 5.4 million persons are bitten with nearly 140,000 deaths per annum, mostly in Asia, Africa and Latin America. Nigeria contributes the highest burden of SBE in sub-Saharan Africa, estimated at 20,000 snakebite envenoming (SBE) with nearly 2000 deaths, approximately 15% of the continent’s burden.
About Snakebite
Snakebite envenoming (SBE) is a bonafide life-threatening medical emergency. The saw-scaled or carpet viper is a major cause of snakebites in Nigeria and along with the African spitting cobra, Egyptian cobra and forest cobra and puff-adder, covers more than 90% of serious snakebites in Nigeria. While carpet viper is an important cause of bleeding, the puff-adder is recognised for causing severe local swelling, necrosis and tissue damage; paralysis remains the hallmark of Egyptian or forest cobra and mamba bites. Antivenom is the mainstay of SBE therapy even though there are challenges with its supply and costs to bitten patients [average N 60,000 (N 30,000 – N 90,000 per vial] often constitute catastrophic health expenditure (CHE).
Addressing these challenges requires a multi-pronged approach, including making policies that ensure production/procurement of effective, available, affordable and accessible antivenoms, training of healthcare workers to ensure judicious use of the scarce antivenoms and ensuring an effective supply chain.
This advisory is aimed at providing guidance on first aid to the public, assessment and treatment for healthcare workers, and a call to policymakers on ensuring availability, accessibility and effective management of snakebite.
Prevention of snakebites
Preventing and responding to snakebite, like other tropical and or infectious diseases is a collective responsibility. It requires health education on risks and strategies to prevent snakebites. The following are noteworthy:
2. 1. Keep surroundings clean and clutter-free by cutting tall grasses and clearing bushes within and around home
2. Cover dustbins and properly dispose of refuse or waste to limit rodents as they are prey for snake
3. Seal cracks and holes in pipes, walls, floors, and doors etc.
- 4. Avoid sleeping on the floor; raise beds off the floor where possible.
- 5. Use of cover boots by farme
- 6. Have a light source when approaching dark or hidden corne
- 7. Do not keep poultry in the house; they attract snakes that prey on them.
- 8. Store food in rat-proof containers and eliminate all hiding places for snake
First aid
To the lay population, snakebites are frequently followed by panic, confusion and uncertainties regarding the possible outcomes which may range from sub-clinical to severe, disability and even death. The following is a simplified first aid to be provided to a snake bite victim:
- 1. Reassure the victim and allay fea
- 2. Make plans to immediately take the patient to a healthcare facility with a competent healthcare worker, antivenom, and intensive ca
- 3. Avoid delay in reaching appropriately equipped or resourced and or designated snakebite treatment health facil
- 4. If there is spitting of venom into the eyes, quickly wash with plenty of wate
- 5. Immobilise the bitten limb as much as possible (may use a splint) and avoid unnecessary movement by the victim as this may enhance the rapid spread of the venom.
- 6. Avoid traditional practices such as wound incisions, cauterisation, and application of herbs, blackstone, or animal excrement as they could be harmful or at least delay access to effective treatment.
- 7. Also, avoid using tourniquets to tie the bitten limb, washing the site with soap, sucking out venom from the bite site, and applying ice packs or electric sho
- 8. Remove all objects such as rings, bracelets, socks, etc that form any band around the bitten pa
Policy makers
The health authorities should:
1.1 Ensure effective surveillance and surveys to determine the incidence of snake bite as well as map hotspots and high burden areas to enable targeted and effective deployment of intervention for snakebite prevention and con
- 2. Establish supply chain for the procurement and distribution of antivenom in strategic locations as was done for other neglected tropical diseases like Lassa feve
- 3. Ensure training healthcare workers on basic management of snakebite and establish a hub-and-spoke model for detection, notification, and effective use of antivenom
- 4. Encourage public-private partnership for financing research and development of antivenoms in the coun
- 5. Identify and implement multicomponent strategies for intensified advocacy, community engagement, healthcare worker trainings, production, procurement and distribution and effective utilisation of antivenom.
- 6. Leverage the institutional and governance structure provided by African governments to address the challenges that militate against the availability and effective use of antivenom
- 7. Ensure policies for government procurements and free public provision of antivenom, insurance coverage for snakebite care, targeted subsidies, emergency care and pooled antivenom procurements through price negotiations (federal, state, local, parastatals) to reduce co
- 8. Strengthening regulatory capacity of NAFDAC to expeditiously assess, review, license, monitor utilization and periodically assess (or request from producers) evidence of efficacy and safety of antivenom
About the NIDS
The NIDS was established to advance the prevention and control of infectious diseases in Nigeria and our members actively support the NCDC and other relevant ministries, departments and agencies engaged in emergency preparedness and response to infectious diseases in the country.
Join the NIDS using: https://nids.org.ng/