Background In 2017, the World Health Organization declared the snakebite envenomation as a neglected tropical disease. Annually, snakebite envenomation causes approximately 400,000 permanent disabilities and 95,000 deaths worldwide. People with the greatest risk of envenomation lack access to adequate health care, including treatment with antivenom. We developed na analysis of accessibility to antivenom in Brazil in order to verify the impacts on mortality. Methods and Findings Information about number of accidents, deaths, antivenom, medical assistance, and species, were retrieved from the Brazilian Health Informatics Department (DATASUS) from 2010 to 2015 and analyzed using geostatistics to evaluate the association between snakebite acidentes and mortality. An Spatial analysis using Global Morans I was performed in order to verify the presence of spatiality as an independent variable to the distribution of the accidents. In addition, we also tested three different analysis of regression using Ordinary Least Square (OLS), Spatial Error, and Geographically Weighed Regression (GWR), together with the information obtained from the DATASUS and sociodemographic indicators, to verify the spatial-temporal distribution of envenomation cases and time to reach the healthcare centers. The regression presenting the lowest Akaike Criterion Information (AIC), highest adjusted R2, and variables with p < 0.05 was selected to represent our model. Lastly, the accessibility index was performed using 2-step floating catchment area based on the amount of hospital beds and inhabitants. This study revealed 141,039 cases of snakebites, 598 deaths, and mortality rate of 3.13 per 1,000,000 inhabitants. Moreover, GWR presented the best fit (AIC = 55477.56; adjusted R2 = 0.55) and showed that illiteracy, income, percentage of urban population, percentage of antivenom, accessibility index for hospital beds with antivenom, proportion of cases with more than 3 hours to reach healthcare are correlated with the mortality rate by snakebite (p < 0.05). Conclusion This study identified regions affected by snakebite and how the accessibility to antivenom treatment plays an important role in the mortality in Brazil. Public interventions can located to those most vulnerable regions in order to improve the accident outcome.

Background Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. Methods We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. Results We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. Conclusion Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.