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The State of Snake Envenomation in Rwanda: Case identification and physician compliance
Date Issued
2019-07
Author(s)
Richard Nduwayezu
University of Global Health Equity
Abstract
Background:
Snakebite envenomation (SNE) continues to claim the lives of humans and livestock mostly in underprivileged communities where access to effective anti venom is poor. Snakebite kills 125 000 people per year and permanently maims 400 000, making it a serious and underreported issue for rural and impoverished families in South America, South Asia, and Africa. Currently, there is no published data on snakebites in Rwanda, and therefore there are no credible estimates on the magnitude of SNE and hospital capacity to treat victims.
Objectives:
The study aimed to measure the magnitude of SNE cases and the compliance of the SNE treatment guideline in district hospital (DHs) and provincial hospitals (PHs) in Rwanda by July 2019. Finally, to propose evidence-based interventions to minimize SNE among vulnerable groups, enhance prevention and improve treatment outcomes in Rwanda.
Methods:
This research is a quantitative descriptive cross-sectional study conducted in 36 DHs and 4 PHs in Rwanda where animal bite cases were recorded in the integrated Health Management Information System. We reviewed hospital records to estimate the number of snakebite victims accessing hospital care. Patient file from those seeking care for snakebites were audited to assess the compliance of the SNE treatment guidelines from the Ministry of Health. Hospital pharmacies were checked for the availability of antivenom in the past two years.
Results:
In 2017 and 2018, DHs and PHs in Rwanda recorded 363 snakebite cases out of 2600 animal bite cases. Of all type of animal bites, snakebites were the second leading cause of emergency consultation and hospitalization. Among the snakebites cases 61.4% were women,38.6% were males with a mean age of 27.7 years, and the majority of cases were found in the Eastern province. There were no recorded cases of death caused by SNE in all hospitals. Among 196 audited cases, the average national compliance was 62.5%.Compliance to specific criteria such as prescription of anti-venom (31%), vitamin K (4%), and anti-tetanus (4%) were lowest. Over the past two years only 3 hospitals had antivenom available in their pharmacy. This highlight weak supply chain of antivenom in health facilities in Rwanda.
Conclusion:
This study provides baseline data on SNE reported in DHs and PHs in Rwanda and provides information on hospital capacity to treat victims. Further studies to explore the patient experience post snakebite and surveillance mechanisms both at the health facility and at the community level should be prioritized. Furthermore, there is a great need to put in place interventions to improve the supply chain of antivenom in all health facilities in order to provide prompt and effective treatment to snakebites victims.
Snakebite envenomation (SNE) continues to claim the lives of humans and livestock mostly in underprivileged communities where access to effective anti venom is poor. Snakebite kills 125 000 people per year and permanently maims 400 000, making it a serious and underreported issue for rural and impoverished families in South America, South Asia, and Africa. Currently, there is no published data on snakebites in Rwanda, and therefore there are no credible estimates on the magnitude of SNE and hospital capacity to treat victims.
Objectives:
The study aimed to measure the magnitude of SNE cases and the compliance of the SNE treatment guideline in district hospital (DHs) and provincial hospitals (PHs) in Rwanda by July 2019. Finally, to propose evidence-based interventions to minimize SNE among vulnerable groups, enhance prevention and improve treatment outcomes in Rwanda.
Methods:
This research is a quantitative descriptive cross-sectional study conducted in 36 DHs and 4 PHs in Rwanda where animal bite cases were recorded in the integrated Health Management Information System. We reviewed hospital records to estimate the number of snakebite victims accessing hospital care. Patient file from those seeking care for snakebites were audited to assess the compliance of the SNE treatment guidelines from the Ministry of Health. Hospital pharmacies were checked for the availability of antivenom in the past two years.
Results:
In 2017 and 2018, DHs and PHs in Rwanda recorded 363 snakebite cases out of 2600 animal bite cases. Of all type of animal bites, snakebites were the second leading cause of emergency consultation and hospitalization. Among the snakebites cases 61.4% were women,38.6% were males with a mean age of 27.7 years, and the majority of cases were found in the Eastern province. There were no recorded cases of death caused by SNE in all hospitals. Among 196 audited cases, the average national compliance was 62.5%.Compliance to specific criteria such as prescription of anti-venom (31%), vitamin K (4%), and anti-tetanus (4%) were lowest. Over the past two years only 3 hospitals had antivenom available in their pharmacy. This highlight weak supply chain of antivenom in health facilities in Rwanda.
Conclusion:
This study provides baseline data on SNE reported in DHs and PHs in Rwanda and provides information on hospital capacity to treat victims. Further studies to explore the patient experience post snakebite and surveillance mechanisms both at the health facility and at the community level should be prioritized. Furthermore, there is a great need to put in place interventions to improve the supply chain of antivenom in all health facilities in order to provide prompt and effective treatment to snakebites victims.
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2019_MGHD4 Capstone Snakebite in Rwanda.pdf
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