Dabo A, Kouriba B, Traoré A, Diarra Y, Doumbo O
Département d'Epidémiologie des Affections Parasitaires, Faculté de Médecine, de Pharmacie et d'Odontostomatologie, Bamako, Mali.
Med Trop (Mars). 2010 Feb;70(1):49-52.
The purpose of this study was to document the epidemiology, symptoms and treatment of snake envenomation in Mali between 2005 and 2006. Data was collected using two methods, i.e., household surveys and retrospective surveys. Household surveys carried out in a village of 597 people showed that the annual average incidence was 164 snakebites per 100,000 inhabitants. Retrospective surveys were conducted in 35 healthcare facilities (5 regional hospitals and 30 district health centers) located in 5 parts of the country. Study periods ranged from 2 to 11 years depending on the location. The mean annual incidence of snakebite including dry-bites without envenomation was 27 per 100,000 inhabitants (range, 15-59). Hospital mortality was 4.7% (67/1433) (range, 2.2-6.7%). The population at risk consisted mainly of working men who accounted for 68.4% (980/1433). Patients between 15 and 30 years accounting for 41.2% (590/1433) of the sample were at highest risk for snakebite (chi2=9.96; p=6.10-3). The frequency of snakebite increased from 9.9% (142/1433) in Mopti in the North to 39.9% (572/1433) in Sikasso in the South (chi2=11.93; p=0,017). Snakebites most frequently occurred during the rainy season (56.6%) but only 0.68% of victims were referred to the health center. Hemorrhagic and inflammatory syndromes were the main complications of envenomation. Treatment was always symptomatic. Antivenom serum requirements ranged from 63 to 200 ampoules per year. Our results show that the frequency of snakebites remains grossly underestimated based on hospital data.
本研究的目的是记录2005年至2006年期间马里蛇咬伤的流行病学、症状及治疗情况。数据收集采用两种方法，即家庭调查和回顾性调查。在一个有597人的村庄进行的家庭调查显示，年平均发病率为每10万居民中有164例蛇咬伤。回顾性调查在该国5个地区的35家医疗机构（5家地区医院和30家区级卫生中心）开展。根据地点不同，研究时间段从2年到11年不等。包括未中毒的干咬在内，蛇咬伤的年平均发病率为每10万居民中有27例（范围为15 - 59例）。医院死亡率为4.7%（67/1433）（范围为2.2% - 6.7%）。高危人群主要是在职男性，占68.4%（980/1433）。15至30岁的患者占样本的41.2%（590/1433），蛇咬伤风险最高（卡方=9.96；p = 6.10 - 3）。蛇咬伤的发生率从北部莫普提的9.9%（142/1433）增加到南部锡卡索的39.9%（572/1433）（卡方=11.93；p = 0.017）。蛇咬伤最常发生在雨季（56.6%），但只有0.68%的受害者被送往卫生中心。出血和炎症综合征是中毒的主要并发症。治疗总是对症治疗。每年抗蛇毒血清需求量在63至200安瓿之间。我们的结果表明，基于医院数据，蛇咬伤的发生率仍被严重低估。
