University of Washington, Department of Global Health, Seattle, Washington, United States of America.
Department of Global Health Delivery, University of Global Health Equity, Butaro, Rwanda.
PLoS Negl Trop Dis. 2024 Aug 21;18(8):e0012378. doi: 10.1371/journal.pntd.0012378. eCollection 2024 Aug.
Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020.
This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment.
The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post/center, or hospital), while 87% sought informal care (family/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom.
This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies.
蛇伤中毒（SBE）是一种潜在的危及生命的事件，可能导致严重的身体、心理和经济困难，特别是在撒哈拉以南非洲等资源匮乏的地区。在卢旺达，尚未对 SBE 进行流行病学评估，以指导卫生部努力减轻负担。本研究有两个主要目的：首先，估计各地区的蛇咬伤发生率；其次，描述 2020 年卢旺达东部省蛇咬伤受害者寻求正规和非正规医疗保健的行为。
这项横断面研究采用了整群抽样方法，涉及社区卫生工作者（CHWs），他们在七个地区记录蛇咬伤病例。描述性分析考虑了抽样权重，根据作为第一治疗点寻求的治疗类型评估了医疗保健寻求行为。
该研究调查了 763 个村庄的 390546 个人，估计全省年发病率为每 1000 人 4.3 例。发病率估计从 Nyagatare 每 1000 人 1.1 例到 Bugesera 和 Ngoma 区每 1000 人 9.1 例不等。在 CHWs 记录的 2545 例病例中，有 3 例导致死亡。关于医疗保健寻求行为，13%（143 例中有 13%）的蛇伤受害者最初咨询了正规医疗服务提供者（CHWs、卫生哨所/中心或医院），而 87%（1098 例中有 87%）寻求了非正规医疗（家庭/朋友、药剂师或传统治疗师）。大约一半的受害者（583 例，占 53.1%）报告有严重症状。不安全的做法包括皮肤切割/烧伤、止血带应用、使用黑石头和毒液提取；只有 24 例（2.2%）接受了抗蛇毒血清。
这项大规模的基于社区的评估突出了地区之间蛇咬伤发生率的差异，并证实了传统治疗师经常参与管理。改善抗蛇毒血清的可及性和提高社区对无效做法风险的认识，以及及时利用正规医疗保健，至关重要。医疗保健提供者、传统治疗师、社区领导人和决策者之间的合作对于实施有针对性的干预措施以加强蛇伤预防和管理策略至关重要。
