|
 
 |
| COMMENTARY |
|
| Year : 2019 | Volume
: 4
| Issue : 2 | Page : 33-34 |
|
Primary prevention of snakebite envenoming in resource-limited settings
Joel Noutakdie Tochie1, Frank-Leonel Tianyi2, Diego Nitcheu Tchouakam3, Armand Seraphin Nkwescheu4
1 Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
2 Sub-Divisional Hospital Mayo-Darle, Banyo, Adamawa Region, Cameroon
3 Bogo District Hospital, Bogo, Cameroon
4 Cameroon Society of Epidemiology, Yaoundé; Laboratory of Public Health Biotechnology and Research, Biotechnology Centre, University of Yaoundé 1; Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| Date of Submission | 04-May-2019 |
| Date of Acceptance | 22-May-2019 |
| Date of Web Publication | 17-Jun-2019 |
Correspondence Address:
Dr Joel Noutakdie Tochie
Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé
Cameroon
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ed.ed_17_19
How to cite this article:
Tochie JN, Tianyi FL, Tchouakam DN, Nkwescheu AS. Primary prevention of snakebite envenoming in resource-limited settings. Environ Dis 2019;4:33-4 |
The authors present a well-written narrative review on the primary prevention of snakebites in resource-limited settings.[1] The merit of these primary preventive measures is their cost-effectiveness.[1] This is a review of great public health priority as snakebites have recently be categorized as neglected tropical diseases by the World Health Organization.[2] It is worth mentioning that the study methods were made transperable through the description of the search strategy, the initial number of studies retrieved, and the final number of studies retained. Furthermore, the search strategy was quite exhaustive. This allowed a maximum number of studies on the topic to be included in the review.
The main objective of this commentary is to elaborate on some recommendations made by the authors. The authors stated that population education is important to raise awareness in communities with high prevalence of snakebites. However, we urge the authors to be more pragmatic through health education with pre- and post-evaluations to ascertain population comprehension. This is important as some studies[3] illustrated that before health education, there was inadequate and wrong knowledge regarding snakebite and care among health personnel. Knowledge on snakebites can tremendously be improved after training. Likewise, other studies in resource-challenged settings have shown that health providers are not well versed with case management of snakebites.[4],[5],[6] Hence, who will inculcate health education to the local population if the healthcare staff has poor knowledge on snakebite? To this end, regular refresher courses for healthcare providers should be emphasized. The trained health personnel will in turn identify key community leaders or representatives who will help facilitate population education on primary preventive measures. Wearing of thick long leather or rubber boots, trousers, and gloves by high-risk groups such as farmers should be compulsory given that the majority of snakebites occur during agricultural activities.[4] This is another cost-effective primary preventive strategy which should be encouraged as described in the review. The authors raised a very important point which is often overlooked; poking holes where snakes inhabit with sticks rather than with hands or foots would help reduce the incidence of snakebites. Moreover, children should be prohibited from playing in the bush or should be supervised when playing in this high-risk area.[5] Information on snake species in a community should be made available to locals and strangers alike. Several natives living in resource-constraint areas do not know the local snakes living in their community.[5] Labeled pictures describing the name, habitat, size, length, and color of local venomous snakes should be put at the disposal of the general population in order for them to take appropriate primary preventive measures. The effective implementation of a one health approach with the collaboration the ministries of health and wildlife of various resource-constraint countries would facilitate the identification of local snakes and the implementation of primary prevention initiatives. More still, trying to kill snakes without proper training has been associated with fatal outcomes in some case series.[5] Hence, this practice should be discouraged.
In addition to the points presented by the authors, we would like to propose the following. Studies still show that 50%–90% of snake-bitten patients in sub-Saharan Africa (SSA) still seek a traditional healer for first-line treatment after been bitten by a snake.[7] This has been shown to increase both morbidity and mortality related to snakebites.[7],[8] Hence, the sensitization of sub-Saharan Africans on good health-seeking behaviors such as timely presentation to health facilities is crucial. Second, since traditional healers are often the first to manage victims of snakebite in SSA, they could play a key role. For instance, training them to rapidly recognize signs of severe envenomation may help reduce delay in hospital presentation of snake-bitten patients, thereby reducing their risk of morbidity and mortality. Third, associating complementary and alternative medicine to modern medicine could be another solution to the problem of snakebite in resource-limited settings. However, randomized controlled trials are needed to assess the safety and efficacy of traditional medicine in this regard. Finally, although a secondary preventive measure, there is a need to build well-equipped health facilities with specialized services such as intensive care units and hemodialysis departments to manage severe envenomation complicated by acute respiratory distress or acute kidney injury warranting mechanical ventilation and hemodialysis, respectively.
In summary, the study of Godpower et al.[1] is a good contribution to the scarcity of data on primary preventive measures of snakebites in resource-limited settings. This work is a succinct summary of cost-effective and sustainable strategies to curb the burden of snakebites in resource-poor settings. Overall, the commentary we present is intended to boost the review and not to change its originality and merits.
| References | |  |
| 1. | Michael GC, Aliyu I, Grema BA. Primary prevention of snakebite envenoming in resource-limited settings: A narrative review. Environ Dis 2019;4:37-44.  [Full text] |
| 2. | |
| 3. | Taieb F, Dub T, Madec Y, Tondeur L, Chippaux JP, Lebreton M, et al. Knowledge, attitude and practices of snakebite management amongst health workers in Cameroon: Need for continuous training and capacity building. PLoS Negl Trop Dis 2018;12:e0006716. |
| 4. | Tochie JN, Temgoua MN, Njim T, Celestin D, Tankeu R, Nkemngu NJ. The neglected burden of snakebites in Cameroon: A review of the epidemiology, management and public health challenges. BMC Res Notes 2017;10:405. |
| 5. | Tianyi FL, Agbor VN, Tochie JN, Kadia BM, Nkwescheu AS. Community-based audits of snake envenomations in a resource-challenged setting of Cameroon: Case series. BMC Res Notes 2018;11:317. |
| 6. | Nkwescheu AS, Tonga C, Tchoffo D, editors. Report on Snakebites in Cameroon. Proceeding of the 6 th African Society of Venomology Conference. Abidjan; 2015. |
| 7. | Chippaux JP. [Evaluation of the epidemiological situation and management capabilities ophidian envenomations in french sub-Saharan Africa]. Bull Soc Pathol Exot 2005;98:263-8. |
| 8. | Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008;5:e218. |
|
![[JOURNAL_FULL_NAME]](images/logo.gif){kind=logo}
Search Pubmed for