Snakebites: Africa’s silent assassin

Lazarus Sauti

Sixteen year old girl Tariro Bute was collecting firewood in a remote rural village in Buhera, eastern Zimbabwe, when she stepped on a puff adder well camouflaged in the brown fallen leaves and undergrowth.

Just an hour later, Bute was dead from the snakebite to her ankle. Her battle to live ended between her home and Chimombe Clinic – a primary health care facility more than 20km away.

Proximity to health care facilities continues to be the difference between life and death for many Zimbabweans in mountainous and bushy rural areas, the natural habitats of snakes.

In 2015, the country’s Ministry of Health and Child Care says 5 332 people were treated for snakebites – but 41 died. A year earlier, 3 195 snakebites were recorded with 39 fatalities.

Dr Isaac Phiri of the Ministry of Health and Child Care says majority of snakebites recorded in the country involved non-venomous snakes. He blames the deaths on delayed access to treatment due to poor transport and communication facilities.

The snake menace, described by one expert as a ‘cancer’, is being felt right throughout Sub-Saharan Africa – from Nigeria to Malawi.

In 2010, Nigeria recorded 2 000 deaths and 2 360 amputations from snakebites while Burkina Faso reports mortality rates of up to 75 for every 100 000 people a year.

“Rural Africa is facing a resurgence of an unrelenting plague that rarely makes headlines: snakebites,” says Nature, an international weekly journal of science.

It said snakebites, a neglected health crisis, are turning into a tragedy for Africa, by cautious estimates killing more than 100 000 people worldwide every year – more, on average, than those who lose their lives in natural disasters.”

Now the World Health Organisation (WHO) is urging African countries to act by improving primary health care for snakebites victims as well as aiding research into snake menace through collecting reliable data.

The United Nations agency, at its 69^th World Health Assembly in Geneva in May, said snakebite deaths are absolutely preventable, and challenged African governments to do more. This may come a bit late for Tariro, but WHO hopes to save thousands more lives every year by leaning on governments to step up snakebite treatment.

Professor David Warrell of the University of Oxford and a consultant for WHO, warns that snakebite mortality in Africa could be much higher than anecdotal reports suggest because for some countries, like the Democratic Republic of Congo (DRC) – home to an enormous number of venomous snakes, there are no reliable data.

“One reason for the discrepancy is that many victims of snakebites die before they reach a hospital or waste precious time with traditional healers before seeking more-conventional medical help,” he says.

Health systems in many countries where snake bites are common lack the infrastructure and resources to collect robust statistical data on the problem, adds WHO.

The United Nations health agency also said assessing the true impact of snakebites is further complicated by the fact that cases reported to health ministries by clinics and hospitals are often only a small proportion of the actual burden because many victims like Tariro never reach primary care facilities, and are therefore unreported.

Nevertheless, experts at the 69^th Geneva Assembly urged African governments to work harder to prevent and treat the one million snakebites that occur on the continent every year to prevent needless death and suffering.

“Governments should invest in science, as it can greatly address snakebites,” says Abdulrazaq Habib, professor of infectious and tropical diseases from Bayero University in Nigeria.

He said the policy makers, especially on the African continent, should back research into snakebites to effectively tackle the “cancer” that is stalking rural communities already burdened by poverty and economic exclusion.

Johan Marais of the African Snakebite Institute in South Africa, an organisation dedicated to promoting the understanding as well as the conservation of native reptiles, says there are about 7 000 serious snakebite cases in southern Africa annually.

These are mainly inflicted by the black mamba, the Cape cobra, the Mozambique spitting cobra, puff adder as well as stiletto snake.

“Remote areas account for at least 90 percent of snakebite cases,” according to Tim Reed, the executive director of Netherlands-based Health Action International, a not-for-profit organisation working to increase access to essential medicines and improve their use through research excellence and evidence-based advocacy.

Farmers and herdsmen, adds Reed, suffer the greatest burden, accounting for about 60 to 75 percent of cases, a fact supported by the World Health Organisation (WHO) in its Fact Sheet No. 337 (reviewed February 2015).

The fact sheet notes that agricultural workers as well as children are the most affected, and children often suffer more severe effects than adults due to their smaller body mass.

The WHO is calling for greater availability of snake antivenoms and adequate training of medical staff.

“Most deaths and serious consequences from snake bites are entirely preventable by making antivenom more widely available. Around three times as many amputations and other permanent disabilities in Africa are caused by snakebites annually,” says the WHO.

“Snake antivenoms, which are included in the WHO List of Essential Medicines, should be part of any primary health care package where snake bites occur. They are the only effective treatment to prevent or reverse most of the venomous effects of snake bites.”

The WHO is calling on researchers, clinicians, national and regional health authorities, international and community organisations to work together to improve the availability of reliable epidemiological data on snakebites, the regulatory control of antivenoms and their distribution policies.

Health Action International’s Reed says African governments also need support to introduce awareness-raising as well as community engagement in snakebite care.

“This, on the other hand, can only work alongside policies that ensure a reliable and predictable framework of treatment availability, which includes quality-assured and appropriate antivenom.”