In June 2020, a new WHO Roadmap for Neglected Tropical Diseases (NTDs) will be launched for 2021 - 2030 to end these diseases and meet the Sustainable Development Goals. In 2017, snakebite envenoming was included in the WHO NTD portfolio, a key milestone for those working to tackle the global problem of snakebite. Every year there are 1.8 - 2.7 million cases of envenoming and 130 000 deaths.
For snakebite, as with other NTDs, operational research can be critical in improving the programme outcomes, by boosting local research capacity and improving the collection and utilization of data. TDR’s Structured Operational Research and Training IniTiative (SORT IT) programme aims to make countries “data rich, information rich and action rich” - collectively, these can transform health care delivery and improve public health.
The Kenya Snakebite Research and Intervention Centre (KSRIC) has been using the SORT IT approach to tackle the burden and management of snakebite in Kenya, and improve community engagement – both of which have been identified as key in reducing the burden of snakebite by 2030.
Dr George O. Oluoch, who heads KSRIC, and Ms Cecilia Wairimu Ngari, lead research nurse at the centre, are champions for tackling snakebite and are passionate about the SORT IT approach.
Dr Oluoch says that the WHO’s decision to prioritize snakebite as an NTD in 2017 encouraged policymakers to take it more seriously and led to the UK National Institute for Health Research funding that helped set up the centre. This was followed closely by funding for new snakebite therapies from the UK Department for International Development.
Challenges exist though. “The actual burden of snakebite in Kenya, as is in most of sub-Saharan countries, has not been fully described – snakebite data is key in convincing policy makers,” says Dr Oluoch. “Secondly, deep cultural beliefs prevent communities from seeking medical attention – here, snakebite victims are as a result thought of as cursed. Thirdly, people think hospitals can’t do much in saving lives and limbs, as most often than not, the health facilities lack crucial antivenom.”
"Another complicating factor", says Ms Ngari, "is that venomous snakes sometimes resemble non-venomous snakes".
The team recently concluded a data collection exercise on the socioeconomic impact of snakebite to the communities and healthcare facilities. “Our data is showing that in areas we have invested in community engagement, more people are seeking health care for snakebite,” says Dr Oluoch.
K-SRIC operates a community-based model consisting of motorcycle ambulances, community health volunteers and paramedics trained in first aid and management of snakebite. In the event of a snakebite, these units are deployed for the rapid transfer of snakebite victims to hospitals while they undergo first aid.
Ms Ngari says that the Snakebite Emergency Response System is having a positive impact in the rural areas where they are operated as antivenoms are only accessible in referral hospitals as compared to community-level hospitals.
Currently, the K-SRIC team - in collaboration with the Liverpool School of Tropical Medicine - is measuring outputs from operating the motorcycle ambulances towards assessing the cost-effectiveness of the motorcycle ambulances versus no intervention at all or with 4x4 vehicles. This model could then be adopted for use in other parts of rural sub-Saharan Africa.
The SORT-IT training is the first that anyone at K-SRIC has had. The training that Ms Ngari and the others at the centre have received “gave them an inquisitive mind to put procedures in place to enable their research,” says Dr Oluoch. “They are looking at things differently and this is key.”
Ms Ngari says “SORT IT played a significant role in helping to establish a framework for handling snakebite challenges. For instance, we have now identified and are working on more areas of research that need to be addressed in order to successfully achieve our organisations objectives in preventing and managing snakebites, both at the community and hospital level.”
Gathering baseline data on snakes, snakebite prevalence and management practices is key to initiating robust programmes that can set the foundation for surveillance” says Dr Mwelecele Ntuli Malecela, Director, WHO Department of Control of Neglected Tropical Diseases, Geneva. “We need to know the regions and areas where most snakebites occur to be able to contextualise distribution of snakes, develop appropriate antivenoms and identify vulnerable populations at risk of envenoming.”
As nurses such as Ms Ngari are already based in health facilities, they can become “trainers of trainers” to diffuse their knowledge to the rest of the health care workers, says Dr Oluoch. “When we started off the snakebite project, we conducted a short survey that showed that most health workers have no idea on how to identify different species of snakes and how to efficiently manage a snakebite. We have since embarked on addressing this challenge and have since trained over 800 health workers,” adds Ms Ngari.
Dr Oluoch believes that operational research is very important because ultimately, what will be needed is the identification of long-lasting interventions that work for snakebite.
Photo credits for all photos: KSRIC