The embarrassment of snakebite deaths
The reports by the World Health Organisation (WHO) that 174 snakebites per 100,000 population are reported per year in Nigeria and that the saw-scaled or carpet viper is responsible for 90 per cent of bites and 60 per cent of deaths is an embarrassment. To some extent, the African cobras and puff adders have also proven to be the cause of mortality and morbidity. In the Benue Valley, where most of these tragedies occur, the incidence of snakebite was found to be 497 per 100,000 persons per year with a mortality rate of 12.2 per cent. This is worrisome and shows that snakebite envenoming is a major public health problem in rural communities of the Nigerian savannah.
Some of the main clinical features of envenoming are systemic haemorrhage, shock, swelling, bleeding and, occasionally, necrosis. Bites may lead to amputation, blindness, disability, disfigurement, mutilation, tissue destruction and enduring trauma.
Common in rural areas of Nigeria, snakebites mainly affect farmers, herdsmen and their rural-dwelling families, thus, reaffirming its status as a disease of the rural dwellers.
Although, the burden of human suffering caused by snakebites has been greatly underestimated, ignored and neglected for far too long, snakebites have socio-economic impacts on citizens. Therefore, given that the high-risk group is the economically active population, prolonged or short-term incapacitation at periods of the most intense farming activities can lead to a fall in agricultural production and low economic performance. Even the fear of snakebite keeps many people away from economic activities. Furthermore, snake envenoming is negatively associated with governmental expenditure on health, especially at the local level. This ugly reality is currently haunting Gombe and Plateau states with the recent reported death of over 91 people as a result snakebite in the two states within three weeks. This has led to a blame game between the Federal Government and affected states.
The Federal Ministry of Health blamed State Ministries of Health (SMoH) for the increase in snake bite-related deaths in the country, insisting that FMoH has some vials of anti-snake venoms which were procured in 2016. FMoH noted that the anti-snake venom is always issued on request by the states, but most of the states failed to come forward to request for the drugs. The FMoH further asserted that “the states in question have refused to comply with the new procedure of request, hence, their inability to access the product from the ministry.”
So, while anti-venom remains the only way to envenoming management as it confers protection of over 80% against mortality, the availability, distribution and utilization of such anti-venom remain challenging. The poor state of anti-venom supply in state health facilities has therefore led to rising snakebite mortality and morbidity. Also, most snakebite victims use unorthodox methods because they can hardly afford the anti-snake venom which costs an average of N27,000 a vial. The blame game between the federal and the state governments is certainly unnecessary. What is needed are solutions to envenoming! And a major route to reduction in envenoming is prevention. As a preventive measure, protective clothing, including boots and long trousers, should be worn whilst working in snake-infested areas. Furthermore, communities should plant shrubs that dislodge snakes from farms and surroundings.
For cure, there are local and orthodox drugs and the people should be educated on how to use them. In some rural Nigerian communities, certain herbs are found to act on snake venoms but their use as accessory and supplementary agents need to be evaluated further, which calls for research and development. In addition, first aid administrators should hasten the transfer of patients to a hospital along with the dead snake if found. As such, communities should be sensitised about snakebite risks, local first aid and be offered realistic solutions that mitigate the hazards. The people should also be empowered to help manage the problem in practical and sustainable ways.
Since most snakebite victims currently cannot afford the anti-snake venom (ASV), the solution lies in manufacturing ASV locally. Both the federal and state governments cannot continue to procure and distribute ASV free indefinitely as currently practised. Besides, Nigeria has the capacity to solve this problem with local production of ASV, which will make it available affordable and accessible. Achieving this requires research institutes and universities to see an opportunity in the current threat as scientists can collect the venoms, and use them to produce anti- snakebite venom instead of importing. This calls for a multidisciplinary problem-solving collaboration among zoology, botany and forestry researchers as well as pharmacists.
Furthermore, anti-venom manufacturers must be helped in order to improve the safety and efficacy of their products. This requires the design and implementation of long-term technology transfer programs involving collaborations between institutions in developed and developing countries and South-South partnerships or collaborations between institutions in the developing world such as between institutions in Nigeria and Brazil. This is informed by the fact that sometime in the past, Brazil gave aid to the National Veterinary Research Institute (NVRI), Vom in Plateau State for the production of anti-venom. Therefore, local manufacturing of ASV is possible if the government provides support for research and development.
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