What the snake leaves in its wake: Functional limitations and disabilities among snakebite victims in Ghanaian communities

Abstract

Background The estimated five million snakebites per year are an important health problem that mainly affect rural poor populations. The global goal is to halve both mortality and morbidity from this neglected tropical disease by 2030. Data on snakebite morbidity are sparse and mainly obtained from hospital records. Methods This community-based study was conducted among 379 rural residents with or without a history of snakebite in the Ashanti and Upper West regions of Ghana. All participants in the snakebite group were bitten at least six months before the day of survey. The World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Buruli Ulcer Functional Limitation Score were used to obtain patient-reported measure of functioning and disability. Long-term consequences were evaluated based on the severity of the symptoms at the time of the snakebite. Findings The median (IQR) time since the snakebite was 8.0 (3.5–16.5) years. The relative risk of disability was 1.54 (95% CI, 1.17–2.03) in the snakebite group compared to the community controls. Among patients with clinical symptoms suggesting envenoming at the time of bite, 35% had mild/moderate disabilities compared to 20% in the control group. The disability domains mainly affected by snakebite envenoming were cognition level, mobility, life activities and participation in society. A combination of the severity of symptoms at the time of the bite, age, gender and region of residence most accurately predicted the odds of having functional limitations and disabilities. Conclusion The burden of snakebite in the community includes long-term disabilities of mild to moderate severity, which need to be considered when designing appropriate public health interventions. Estimating the total burden of snakebite is complicated by geographic differences in types of snakes and their clinical manifestations.

Uniting behind a common goal: Collaboration between traditional healers and allopathic health care workers to improve rural snakebite care

“…Snakebite envenoming is a neglected tropical disease that kills up to 94 000 people annually ( Kasturiratne et al, 2008 ). The number of patients incurring disability through snakebite is likely of similar magnitude ( Chippaux, 2011 ; Aglanu et al, 2022 ; Habib et al, 2015 ) if not higher, though reliable estimates are still outstanding. Regions where venomous snakebite is most endemic are South- and Middle America, Sub-Saharan Africa, India and the East and South-East Asia-regions ( Kasturiratne et al, 2008 ).…”

“…As a result, snakebite envenoming is frequently not perceived as a purely biomedical phenomenon, meaning spiritual interpretations often weigh heavily on the treatment-seeking process. In addition, the mental disease burden linked to snakebite, as identified in scientific literature appears to be substantial ( Aglanu et al, 2022 ; Vaiyapuri et al, 2013 ; Arias-Rodríguez and Gutiérrez, 2020 ; Muhammed et al, 2017 ; Wijesinghe et al, 2015 ; Williams et al, 2011 ). For example, levels of depression and post-traumatic stress disorder were found to be as high as 54% and 21%, respectively, among snakebite patients in Sri Lanka ( Williams et al, 2011 ).…”

“…In this vein, integrating THs into allopathic healthcare services offers opportunities for improving patient follow-up post-discharge in the outpatient setting. This is particularly relevant in the setting of snakebite envenoming, in which patients often struggle to afford prolonged hospital admissions ( Schioldann et al, 2018 ; Harrison et al, 2009 ; Steinhorst et al, 2021 ; Arias-Rodríguez and Gutiérrez, 2020 ; Brown, 2012 ) and in which long-term follow-up, especially with regard to disability and morbidity, is notoriously challenging ( Aglanu et al, 2022 ; Brenes-Chacon et al, 2020 ; Jayawardana et al, 2016 ; Kasturiratne et al, 2021 ). Many patients and THs see promise in therapies offered at the hospital, most notably antivenom ( Chuat et al, 2021 ; Vaiyapuri et al, 2013 ; Steinhorst et al, 2021 ; Schurer et al, 2022 ).…”

Medical Management after Lancehead Snakebite in North Amazon: A Case Report of Long-Term Disability

“…It is important to emphasize that the victim from this case presented both permanent anatomical and functional sequelae that will last throughout his life. Although snakebite numbers are often quantified, their severity, consequences (e.g., disabilities), and impacts are still unknown [ 22 , 30 , 31 ]. Recently, using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), Aglanu et al (2022) demonstrated that 35% of snakebite envenomings in regions of Ghana resulted in mild/moderate disabilities [ 32 ].…”

Community and health system factors influencing snake envenomation management practices in three districts of Ghana: a qualitative inquiry from health stakeholders and snakebite victims

“…Snakebite is a neglected public health issue affecting individuals of all ages in many tropical countries [1, 2]. Venom from snakebite is a potentially life-threatening disease associated with severe morbidities and mortalities [3, 4]. Among countries in the tropical and subtropical areas, snakebite has been regarded as a neglected public health issue necessitating rapid attention [1].…”