Snakes slither to global attention

By Gatonye Gathura

Snakebite, normally a low priority health issue, this week received top treatment at the World Health Assembly in Geneva.

For the first time the assembly, the top decision-making body of the World Health Organisation (WHO) recognized snakebite as a health issue of global concern.

Member States, at the annual meeting which ends today (Saturday 26th May) endorsed a 2017 resolution listing snake bite as a neglected tropical disease.

“We are very excited about this development,” said the NGO Doctors Without Borders (MSF) in a statement soon after the resolution had been passed.

“This is an opportunity to finally get serious about tackling snakebite,” said Julien Potet, Policy Advisor on Neglected Tropical Diseases for MSF’s Access Campaign.

About 20 health conditions fall in the WHO list of Neglected Tropical Diseases found in 149 countries and affecting more than one billion people but attracting little financial or research attention.

In 2012 the WHO published a roadmap targeting at eliminating 17 of these diseases by 2020. Last week Kenya was celebrated globally for eliminating guinea worm one of the neglected diseases.

The adoption of snakebite, while not a candidate for elimination, Potet says will galvanize the world into mobilizing resources to respond to an estimated 2.7 million snake poisonings annually.

In the resolution WHO says it has already developed a strategic roadmap for confronting snake poisoning to reduce an estimated 79 000 deaths caused by venomous snaked in 2016.

The WHO Roadmap is estimated to cost about She1.6 billion ($16 m) up to the end of next year.

WHO also estimated about 400 000 people a year face permanent disabilities, including blindness, extensive scarring, restricted mobility and amputation following snakebite poisoning.

Last year MSF admitted 3,000 patients for snakebite mainly in Africa despite lack of good quality medicines also called antivenin.

The largest number of patients, MSF says was from Central African Republic, South Sudan, Ethiopia and Yemen.

 

Other countries with significant number of cases admitted in MSF clinics were Tanzania, Kenya, Cameroon, Sudan and Sierra Leone.

 

Many people who cannot afford quality medicines, where they are available, MSF said turn to local healers or substandard products.

 

WHO has blamed the lack of quality antivenin to weak regulatory systems that allow the entry of unsafe and ineffective products into the markets.

Such products, the health body says enter the market with no preclinical or clinical evaluation before registration.

For example, last year it took the efforts of several foreign institutions to establish that all antivenins sold in Kenya were ineffective.

Researchers from UK, and Costa Rica who roped in the Kenya Snakebite Research & Intervention Centre found the antivenins being stocked in Kenya were not meant for this market and hence ineffective.

“The fact that none of the six anti-venoms is effective against all the East African snake poisons was of greatest concern,” says the report appearing in the journal Plos: Neglected Tropical Diseases.

However it was only in March this year that the Pharmacy and Poisons Board moved to warn Kenyans of the presence of irregular antivenins in the local market.

A study published last month (April) on snake bites in Kabarnet, Kakamega, Kapenguria and Makueni, areas estimated to have high rates of poisonous snake bites in Kenya, recorded poor availability of antivenins.

A team from several local universities led by Mitchel Otieno Okumu, of Jaramogi Oginga Odinga Teaching and Referral Hospital says antivenin was rarely available in hospitals in the study areas.

The study published in the Pan African Medical Journal and the latest on snakebites in Kenya  attributed the lack of antivenin to delayed procurement and supply shortages.

But even when the medicines are available the team says victims, majority aged 1-15 are first likely be  presented to local healers before  going to the hospital if at all.

The investigators recorded a total of 176 bites in all the study sites over the three-year study period. Most of the bites, the report shows occurred in the 1-15 year age group.

Puff adders, black spitting cobras, black mambas and the pretty faced boomslang were the main snake species associated with the bites in the study area.

Most of the bites the report shows to have been on the lower limbs, during the dry season and most likely in the evenings with patients reaching the hospital two to six hours after the bite.

“But it is not uncommon for victims to present 24 years later due to the long distances from the hospital,” says the study.

www.rocketscience.co.ke

Estimates from: Snake Bite Rescue Rehabilitation and Research Centre Kenya

  1. 300-500 Kenyans admitted with snakebites monthly
  2. 15 people lose their lives daily from snake bites
  3. 100 people are amputated of limbs
  4. Victims travel for 30 to 50 kilometers for hospital treatment
  5. Unpaid compensation from snake bites stands at Sh 4.5 billion
  6. Snake venom can cause death in 15 minutes to half hour
  7. 68 per cent of bitten persons resort to traditional healers
  8. 32,000 people die from snake bit in sub-Saharan
  9. 100,000 survivors permanently disabled annually is SS Africa

 

Global (WHO)

4.5 million snake bites (poisonous or not) annually

2.7 million snake poisonings annually

79 000 deaths annually

400 000 people a year face permanent disabilities

Sh 1.6 billion ($16 m) budgeted for Snakebite Roadmap

 

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