Dr Winnie Bore is founder of the Snakebite Rescue, Rehabilitation and Research Centre in Kenya. She is principal investigator of an implementation research project studying community-based approaches that can improve identification and treatment outcomes for snakebite victims. This research was supported by TDR's Impact Grants for Regional Priorities in collaboration with WHO’s Regional Office for Africa.
Snakebites are a fact of life in many parts of Kenya and sub-Saharan Africa. Why is more implementation research needed today?
Myositis, the disease caused by snakebites, is among the top 20 neglected tropical diseases. But information about its causes and the need for specific public health interventions receive less attention, as bite victims are largely living in poor rural areas. Few public officials are bringing this concern to the table.
For example, the incidence of lymphatic filariasis is the same as snakebite, but receives much more funding and treatment infrastructure. The level of interest in these two diseases by decision-makers is quite different. Likewise, malaria patients at all levels of the health system benefit from well-organized and rapid diagnosis and treatment, which facilitates treatment and care. Snakebite victims need the same level of public health services.
If we can improve care and action at community level, we can save lives.- Dr Winnie Bore, Founder of the Snakebite Rescue, Rehabilitation and Research Centre, Kenya
Access to more precise information on snakebite incidence and treatment, especially at community level in rural areas, will significantly improve the lives of affected people in these locations. We have created guidelines to help caregivers quickly identify the type of snakebite, for rapid administration of the right anti-venom medicine. Until recently, bite victims were requested to carry the snake to the dispensary or try to describe it. As guidelines become used in more communities, care levels will continue to improve.
With a comprehensive national strategy extending from community to dispensary and health centre levels, many more lives will be saved. If a person is bitten in a rural area, and they have to wait to reach the sub-county hospital, it is too late. The victim
is already seriously affected.
What are the gaps in care and health services for treating snakebite? And how is your research helping to improve the situation?
Until 2019, Kenya did not have national guidelines for controlling and treating snakebite-related injuries. Public health officials gathered data from paper-based files in rural medical centres.
Rural centres need well-structured information collected in standardized data capture forms. These tools are lacking in most primary care facilities and are the entry point for better quality decisions. Standardized data collection will help the health system create a national database of snakebite victims in communities across the country.
Rural communities need to be prepared for immediate response. When a person is bitten, the first anti-venom dose should be given within 10-15 minutes to stabilize their condition before referral to more specialized health centres for further care.
Access to the right anti-venom medicine at the right time is also critical. These medicines should be part of the essential medicines package in rural and county health facilities. Today, many regional health facilities do not have anti-venom antidotes.
Access is complicated by treatment cost. Today, Kenya has four registered treatments for bites from a range of snakes. All are imported. At US$ 68 per vial, these drugs are costly for rural communities. Depending on the amount of venom injected, a patient’s body mass, immune system, and other variables, a patient may need between 4-10 vials in the first 24 hours.
In the Kenyan system, level 2 and 3 treatments (district centres and hospitals) are free of charge to patients. If affected rural people can reach level 2-3 rapidly, cost will not be an issue for low-income communities. But locally available treatments are not readily available across rural communities. So this is a serious obstacle. Our colleagues at the Kenya Medical Research Institute are developing a local anti-venom medicine that is suitable for most types of snakebite.
Who else can benefit from your research team’s findings?
The need for more practical information and access to data and guidelines at village level is probably universal across most snakebite-endemic countries. Our study results fill significant gaps in data and practices to address snakebite at community level in rural areas in in Kenya. Its findings can guide the Ministry of Health and its agencies to design community strategies that can change the way snakebite is handled. What we learned can benefit most countries in the world where snakebite is an issue – but especially in sub-Saharan and East Africa and Nigeria, where incidence is high.
What message do you have for public health decision-makers?
- Stress the need for available and affordable anti-venom, especially in remote areas
- Build skills of health care workers to communicate clearly with communities on snakebite and the efficacy of new medicines
- Emphasize village prevention practices to control snake populations
- Improve the referral system: ideally, dedicated ambulances for snakebite (as each bite is an emergency) and specialized treatment units
- Build caregiver skills for physical and mental rehabilitation and countering stigma when people return to their community
- Build a network of trained people across the health system, including in rural communities to ensure that victims receive first treatment within 15 minutes and are rapidly referred up the chain for further treatment.
...and for development partners and global health programmes?
Donors need to know this is a serious problem that receives little attention and funding and should be a priority. Most African countries face the same situation that we have in Kenya. But snakebite is not on the table as a public health issue.
For more information on the Impact Grants programme, please contact Dr Garry Aslanyan.