Gothenburg Global Biodiversity Centre, Göteborg, Sweden; Department of Biological and Environmental Sciences, University of Gothenburg, Göteborg, Sweden; Faculty of Natural Sciences, Lúrio University, Cabo Delgado, Mozambique.
Faculty of Natural Sciences, Lúrio University, Cabo Delgado, Mozambique.
Toxicon. 2022 Nov;219:106932. doi: 10.1016/j.toxicon.2022.106932. Epub 2022 Sep 28.
Snakebites in sub-Saharan Africa account for 20,000 to 32,000 annual deaths. But since most data is retrieved from hospital or incomplete central databases, and many victims do not seek hospital treatment or prefer traditional remedies, the current numbers are likely underestimated. In order to reduce snakebite incidence by 50% by 2030 as targeted by World Health Organization, it is crucial to accurately quantify and understand the current rates of snakebite incidence, which can only be reliably measured through household surveys. In this study, we interviewed 1037 households in nine communities in Cabo Delgado, northern Mozambique. Our aim was to quantify true snakebite incidence and under-reporting, by comparing the total number of snakebites reported to our team during household surveys with the subset of reports that reached health centers. We additionally quantified snakebite incidence in terms of species, location of the attack, type of treatment, season, and gender of the victims. These data allow us to propose conservative extrapolations of snakebite incidence and mortality for the province of Cabo Delgado and for Mozambique. Of all snakebites reported in the surveys (N = 296), most incidents were treated exclusively by traditional doctors (N = 174; 59%) and 25% were not seen by any doctor. Most bites occurred on farms and during the rainy season. Using a conservative estimation where we assume our results to be extrapolatable for the whole of rural Mozambique, but considering snakebites in urban areas to be inexistent, we propose that in Cabo Delgado, every year at least 6124 people are victims of snakebites, of which at least 791 result in deaths. In Mozambique, we extrapolated that every year at least 69,261 people are victims of snakebite, of which at least 8950 result in death (one in eight snakebites is fatal). Our estimates are the first for Mozambique based on data retrieved in the country, and despite being an underestimation they increase snakebite incidence levels ten-fold and the number of deaths by 30-fold. Urgent and widespread surveys are needed to further assess the full extent of snakebites in sub-Saharan Africa, explore regional patterns and develop mitigation plans.
在撒哈拉以南非洲，蛇伤每年导致 2 万至 3.2 万人死亡。但由于大多数数据是从医院或不完整的中央数据库中提取的，而且许多受害者没有寻求医院治疗或更喜欢传统疗法，因此目前的数字可能被低估了。为了实现世界卫生组织设定的到 2030 年将蛇伤发病率降低 50%的目标，准确量化和了解当前的蛇伤发病率至关重要，而这只能通过家庭调查来可靠地测量。在这项研究中，我们在莫桑比克北部德尔加多角省的 9 个社区采访了 1037 户家庭。我们的目的是通过将家庭调查中向我们团队报告的蛇伤总数与到达卫生中心的报告子集进行比较，来量化真实的蛇伤发生率和漏报率。我们还根据物种、攻击地点、治疗类型、季节和受害者性别来量化蛇伤发生率。这些数据使我们能够对德尔加多角省和莫桑比克的蛇伤发病率和死亡率进行保守的推断。在调查中报告的所有蛇伤中（N=296），大多数事件仅由传统医生治疗（N=174；59%），25%的事件没有接受任何医生的治疗。大多数咬伤发生在农场和雨季。采用保守估计，我们假设我们的结果可外推至整个莫桑比克农村地区，但认为城市地区没有蛇伤，我们提出在德尔加多角省，每年至少有 6124 人是蛇伤的受害者，其中至少有 791 人死亡。我们推断，在莫桑比克，每年至少有 69261 人是蛇伤的受害者，其中至少有 8950 人死亡（每 8 例蛇伤就有 1 例致命）。我们的估计是基于该国获取的数据得出的莫桑比克的首次估计，尽管这是一个低估，但它将蛇伤发病率提高了 10 倍，将死亡人数增加了 30 倍。需要进行紧急和广泛的调查，以进一步评估撒哈拉以南非洲蛇伤的全部范围，探索区域模式并制定缓解计划。
