Évaluation de la disponibilité et l’utilisation du sérum antivenimeux dans le district de Bamako, Mali, Afrique de l’Ouest

Abstract

The aim of this study is to describe the difficulties related to problems of supply and use of antivenom serum (SAV) in the district of Bamako. A retrospective study over a span of five years (January 1998-December 2002) and an interview with the staff of various facilities were conducted. The study included 2 wholesalers of pharmaceuticals, 20 private pharmacies, and 2 hospital pharmacies as they were involved in antivenom trades. A market-driving ability survey of driving practice was conducted in 37 community health centers (CHCs) and 4 dispensaries because they performed antivenom treatments during the study period. A total of 3,318 doses of antivenom were bought, including 84.4% by the People Pharmacy of Mali (PPM), a public organization, and 15.6% by Laborex, a private company. These were out of stock in 1999. Three kinds of SAV were ordered: the polyvalent IPSER Africa (1,200 vials or 36.2%), FAV Africa (318 vials or 9.6%), and Sii anti-snake venom polyvalent serum (1,800 vials or 54.2%). Orders from PPM involved IPSER Africa (Pasteur Mérieux Serum & Vaccines) and Sii anti-snake venom polyvalent serum (Serum Institute of India), and those from Laborex involved IPSER Africa and FAVAfrica (Aventis Pasteur). Onehalf of private pharmacies (54.3%) had made at least one order of SAV. The PPM lost 50% of 2,000 vials of SAV in 1996 due to the expiration of vials that were bought. Private pharmacies lost 3.6% of stocks due to expiration. Prices varied depending on the type of service and the point of sale. Costs of vials were 19,440-35,000 CFA francs (29.6-53.4 euros) for Sii antivenom and 50,200-63,000 CFA francs (76.5-96.1 euros) for FAV Africa antivenom. In CHCs, 59.5% of prescribers were unaware of the indications and methods of proper administration of the SAV, 32.3% ignored the existence of SAV, and 30.9% were skeptical about its effectiveness in treatment of envenomation by snakebite.

Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa

“…We estimated a cost/DALY averted ranging from $73 in Benin to $247 in Sierra Leone if the cost input of antivenom is reduced to $125 per dose as obtained in Mali [ 30 ]. Doubling the cost of antivenom for patients requiring more than a dose still yielded ICERs that remain cost effective ranging from $136/DALY averted in Benin to $464/DALY averted in Sierra Leone.…”

“…The cost of the full antivenom treatment regimen was modeled as US$153 [ 29 , 30 , 31 ]. The cost of care, ten 20WBCT measurements in 7 days, transportation to-and-from hospital and feeding for 7 days, shipping and freezing of antivenom, management of EAR, supportive care (such as pain relief, blood transfusion, medications, fluid replacement and wound management) were obtained from series of envenomed patients admitted to Kaltungo General Hospital in Nigeria Table 2 [ 33 ].…”

“…Both types of formulations have been produced for the sub-region [ 6 , 27 , 28 ]. The average cost per treatment of antivenom was reported as US$124 (range US$55–$640) although a median price of US$153 was also reported for Sub-Saharan Africa [ 29 , 30 , 31 ]. The few effective antivenoms in the sub-region generally have been scarce, locally unaffordable and inaccessible where they are most needed.…”

Hémorragie cérébrale post envenimation par morsure de serpent responsable d’une cécité irréversible chez un enfant de 6 ans au Mali

“…L'osmothérapie avec le mannitol permet de lutter contre l'oedème péri-lésionnel ce qui permet de diminuer l'hypertension intracrânienne. L'immunothérapie antivenimeuse, qui est un pilier dans la prise en charge de l'envenimation systémique, n'est malheureusement pas toujours disponible dans les centres de santé de référence et des hôpitaux, et encore moins dans les milieux ruraux au Mali [ 3 , 8 ]. Le retard de prise en charge, pour des raisons diverses, comme l'éloignement du lieu de morsure ou le passage chez un tradipraticien, explique fréquemment les complications graves, notamment hémorragiques, qui surviennent chez ces patients et qui mettent en jeu le pronostic vital ou entraînent des séquelles fortement pénalisantes.…”

African polyvalent antivenom can maintain pharmacological stability and ability to neutralise murine venom lethality for decades post-expiry: evidence for increasing antivenom shelf life to aid in alleviating chronic shortages

“…Sub-Saharan Africa is the most notable example of this, with several antivenom market failures and frequent product stockouts, leading to extremely limited to no antivenom provision in large swathes of the continent 8–10. However, despite the shortfall in overall doses available, substantial quantities (up to 50% in one reported locale) of antivenom actually exceed their expiry dates and are subsequently discarded 11–13. The cause of this waste of critically precious antivenom is mainly due to difficulties in the national and regional antivenom inventory management, due to a lack of research and information around national requirements, weak infrastructure and financial inaccessibility, issues which are being actively addressed by various stakeholders 14–16…”