ISBAD 2022: Challenges and Barriers in Accessing Effective Snakebite Treatment

Research topic: Development of a diagnostic biosensor for snakebite envenoming in Brazil

Why did you choose to do research in snakebite?

I believe that snakebite diagnostics have the potential to help a lot of people. They could help bring treatment closer to snakebite victims by empowering people at remote locations to more confidently determine what type of antivenom to administer, thereby supporting efforts to decentralise antivenoms in the Brazilian Amazon. They could also help ensure that sparse antivenoms are not wasted on bites caused by nonvenomous snakes or on bites for which they are not indicated. Finally, they could aid healthcare providers in deciding which antivenoms to procure and where to deploy them as well as inform the design of future antivenoms.

What Challenges and Barriers in Accessing Effective Snakebite Treatment have you seen?

During a research stay at a hospital in Manaus, I had a conversation with a snakebite victim that made a big impression on me. The man described how he had been bitten by a snake and how a friend had treated the bite wound with traditional medicine before they had left for the hospital.

The traditional medicine (a sort of paste made from meat from the biting snake and applied to the bite site) had caused an infection, which was now being treated in addition to the envenoming. Another person in the room asked the snakebite victim if he would use traditional medicine in the future if he were to ever be bitten again, and to my surprise, he said “yes, because I live very far from the hospital, and it’s the only remedy we have”.

To me, this drove home the point that sometimes the biggest barrier to accessing effective snakebite treatment is not the issues my colleagues and I grapple with in the laboratory, but simply getting the treatment closer to the people who need it most.

Wellcome Trust/RSTMH Small Grant awardee 2021

Research topic: Epitope characterisation and mapping of venom cytotoxin to develop next-generation toxin targeted biotherapeutics.

Why did you choose to do research in snakebite?

Why do I choose to pursue research in the snakebite area? As a toxinologist, I have always been very excited to study venom toxins, which are diverse and fascinating. My interests focus on toxins which cause irreversible local envenomation. I study the immunological properties of venom toxins using a combination of mass-spectrometry and computational approaches. The ultimate goal is to develop an enriched tool for next-generation biotherapeutics for snakebites. 

What Challenges and Barriers in Accessing Effective Snakebite Treatment have you seen?

My research primarily focuses on looking for affordable and effective biotherapeutics to mitigate local symptoms due to envenomation, which often leave sequelae and morbidity in affected victims. The roadblocks in accessing effective therapies motivate and inspire me to stay focused in this area, and I hope my research can one day provide a solution to relieve the suffering of snakebite victims.

Wellcome Trust/RSTMH Small Grant awardee 2021

Research topic: Understanding perspectives of rural communities in the management of snake bit envenoming: A participatory research approach in Kamuli district.

Why did you choose to do research in snakebite?

Snakebites remain one of the neglected tropical diseases in Uganda. Rural areas are highly affected especially during the rainy season amidst challenges in accessing health care. Households mainly rely on traditional remedies for management of snakebites, which are not effective always and can lead to disability and sometimes death. We explored and learnt from the knowledge, perspectives, and healthcare seeking practices related to snake bites in Kamuli Eastern Uganda using the participatory research appraisal approach.

We found both individual/community specific and health system challenges to access and proper management of snakebite victims. Community challenges included; lack of knowledge about treatment remedies, poor communication among community members, and poverty. Health system challenges included: lack of antivenoms, means of emergency transport, poor road network, poor attitudes of health workers, and high cost of care. 

What Challenges and Barriers in Accessing Effective Snakebite Treatment have you seen?

There is general lack of knowledge on first aid care, and treatment of snakebite victims. There were no community sensitization and awareness campaigns targeting snakebites even when contradictions in approaches for management of snakebites existed. Snakebite events were always characterised by confusion, fear and anxiety which always frustrated communication and decision making for first aid. Limited finances for both traditional and biomedical treatment as well as transport frustrated community members whose household incomes were low. They consequently had to incur out of pocket expenses hence pushing them further in poorer state than they were. There is need for community sensitization and awareness programs and community response groups for snakebites.

From the health systems’ perspective, it was often hard for victims to reach the health facilities because of lack of an emergency modes of transport after receiving first aid. This was worsened by the long distances to the health facilities and the poor road network connecting to them. Even when the victims of snakebites made it to the health facilities, antivenoms were often not available; and would require one to spend out of pocket access treatment in private health facilities. Additionally, there is low capacity to manage snake bites explained by no guidelines on snakebite management, lack of/inadequate snake bite treatments such as antivenoms and steroids, and limited number of staff skilled in snakebite management. Advocating for provision of antivenoms and other emergency treatment remedies in the health facilities, emergency means of transport in form of motorcycles and motor vehicles is vital in snake bite management.

Some of the participants’ quotations from our work below:

“The health centres are far away, so if the snake has bitten you from the swamp, you have to move from the swamp to home, then from home to a health facility. Sometimes, even transport may not be available; you might be using a bicycle to [nearby trading center] where there are reasonable health facilities…” (Male 28 years)

 “…what stops people from going there [health facility], is just because they know even if they go they won’t find snakebite treatment.” (Male 42 years)

Wellcome Trust/RSTMH Small Grant awardee 2020

Research topic: Assessment of the availability of snakebite antivenom in Ndola district, Zambia.

Why did you choose to do research in snakebite?

Despite the high number of notified snakebites leading to disabilities and death, access to lifesaving antivenom is limited. I decided to investigate the availability of snakebite antivenom in hopes of providing baseline information which could be crucial to inform policy and contribute to understanding some barriers to access.

What Challenges and Barriers in Accessing Effective Snakebite Treatment have you seen?

Snakebites are rising as snakes migrate with climate change, but availability of quality, affordable and effective antivenom remains a barrier to effective snakebite treatment in poor, rural regions globally.

NIHR/RSTMH Small Grant awardee 2020

Research topic: Neutralization of coral snake neurotoxins using recombinant human oligoclonal antibodies.

Why did you choose to do research in snakebite?

I started working on snakebite because I am fascinated by venomous snakes and their toxins. But more importantly, the study of their venoms is a field that can lead to antivenom improvement and therefore great benefit for snakebite victims around the world. Also, understanding venomous snakes and their role in ecosystems can promote the conservation of these beautiful and misunderstood creatures.

What Challenges and Barriers in Accessing Effective Snakebite Treatment have you seen?

In the context of snakebite care, I believe education is the first problem that needs to be addressed. To provide the access to treatment that is lacking in many regions of the world, physicians must be trained to deliver correct and efficient care, authorities need to be made aware of the needs of their communities, and potential victims must be instructed in snakebite prevention. 

Wellcome Trust/RSTMH Small Grant awardee 2020

Research topic: The epidemiological survey & knowledge, attitude & practice (KAP) of health care professionals at Somalia against venomous snakebite in Ethiopia.

Why did you choose to do research in snakebite?

Snakebite envenoming is a neglected  tropical  disease  (NTD)  that  is  a  major  public  health  problem which affects mostly community live in rural area of the country. It causes high mortality and morbidity in people, mainly due to acute injury and permanent sequel, and has substantial financial consequences associated with its clinical management and wage losses due to absenteeism. It is often described as an occupational disease, particularly affecting farmers, cattle herders, and other agricultural workers in poor rural communities. Globally, mortality has been shown to be strongly correlated with the percentage of workforce in agriculture. 

Most of Ethiopian population lives in rural area of the country which depends on agriculture and facing a high incidence of snakebites and low access to treatment. There are no specific resources allocated in this area to dealing with this problem. The number of snakebite victims arriving at health facilities is not recorded that making it impossible to know the national health burden of snakebites. Nationally there is no/poor awareness of community on snake bite and its treatment. Health care professional’s also have poor knowledge, attitudes and practice against snake bite treatment. These are all problems which initiated me to research on epidemiological and knowledge, attitudes and practice of health care professionals in selected regions of the country.

Wellcome Trust/RSTMH Small Grant awardee 2021

Research topic: Access and availability of Snake Antivenom in Health Facilities, Volta Region, Ghana

Why did you choose to do research in snakebite?

My initial exposure to the issues of snakebites and its consequential effects on not just the health and wellbeing of the victim, but also their livelihoods, began when people in my community shared their experiences of being bitten by one snake or another. Snake bites in my community is considered inevitable by the community folk. This belief may be due to the fact that most of them are farmers who regularly encounter snakes, hence have accepted that snake bites will occur at one point in the farming season or another. What was even more interesting was the remedy for the treatment of snakebites. It was linked to the herbalist who prepares concoctions which you apply to the bite area. There was also the chewing of particular herbs, drinking of palm oil or attaching a black stone (snakestone) to the bite area as it is thought to draw the venom from the wound. These were the known treatments by the community folk and the outcomes of these treatments were not assured. In some cases, snake bite victims recovered and in other cases they didn’t. Nonetheless most of the community folk have for a long time considered these treatment regimens as the only option for the treatment of snakebites. 

As I trained and worked in the field of public health, I developed an interest in understanding snakebites with a focus on treatment. Traditional treatment has been identified to lead to deteriorating conditions of snakebite victims and in some cases severe health and wellbeing complications. Snake antivenom is recommended and known to considerably improve the chances of an envenomed patients’ survival and prevent detrimental effects. However, there still exist constraints to accessing this form of treatment. This led me to research on, Access and Availability of Snake Antivenom in Health Facilities in the Volta and Oti Regions of Ghana.

What Challenges and Barriers in Accessing Effective Snakebite Treatment have you seen?

This year’s theme is very relevant and hopefully will create greater awareness related to snakebite treatment issues. 
With majority of snakebites affecting rural populations engaged in agricultural activities, I continue to be motivated to pursue snakebite research to contribute to interventions which are aimed at making treatment readily available and accessible. This in turn can reduce the risk of injury and death our community folk face as they go about their routine activities. 

One of the barriers identified during the course of my research was the poor road networks in rural communities. This is a critical cause of delays to accessing treatment. Most snakebites occur in the raining season which is the peak season for farming activities and these communities are only accessible by foot or motorbikes. The constant rainfall during this season either washes away makeshift bridges or submerges them. There are also the issues of rainwater flooding access routes preventing snakebite victims from getting to health facilities and also health workers from getting to the communities. 

Another key issue was the irregular supply of antivenom and sometimes the unavailability of different types of antivenom in health facilities for the various types of snake species found in these communities. In cases where antivenom was not available at the health facilities, patients had to find ways to buy from other sources at a very high cost. 

With some of these findings, I am of the view that an increased advocacy on the poor road networks in our rural communities and the effects it has on the health and livelihood of snakebite victims will go a long way to improving accessibility to health facilities and in effect snakebite treatment. Also, improving health facilities’ data management procedures and systems will help predict the antivenom needs of these communities and will also go a long way to improving  availability of supplies for treatment.

Wellcome Trust/RSTMH Small Grant awardee 2021

Research topic: Challenges for pastoralist communities to access effective treatment for snake bite envenoming in Northern Tanzania

What Challenges and Barriers in Accessing Effective Snakebite Treatment have you seen?

The burden of snakebite envenoming and its consequences in Tanzania is an under-researched area. The challenges faced by victims to receiving treatment are largely unknown as well as the challengesto providing treatment by health care professionals. In an attempt to explore the current situation and map a path towards change, we embarked on a pilot research project on “Risks of snakebite and challenges to seeking and providing treatment for agro-pastoral communities in Tanzania”. Snakebite victims report their desperate struggle to receive health care in time and their reliance on traditional medicine while the nurses of the only clinic with available antivenom in the district told us about their difficulties in providing adequate treatment.

We learnt that “it’s not just about arriving in time at a hospital – it’s much more complicated than that”. In order to investigate risks of snakebite and the challenges and barriers to treatment, we have to look at both sides – the treatment seeking and the treatment providing side.

Wellcome Trust/RSTMH Small Grant awardee 2020

Research topic: Production of neutralizing antibodies against the medically important snakes in Sudan.

Why did you choose to do research in snakebite?

Working in the field of snakebite envenomation have been a great chance for me to help in resolving the problem in my home country in which snakebite research in very limited. Many farmers and children dead due to snakebite accidents in the agricultural fields while practicing manual planting and harvesting.

What Challenges and Barriers in Accessing Effective Snakebite Treatment have you seen?

In Sudan, the availability of effective antivenom stay the most prominent barrier facing snakebite victims along with the lack of trained medical staff especially in the remote areas. Not to miss the difficulty in accessing medical centers. Also, like many other African countries, most of the victims believe on traditional hailers and folk medicine.

Wellcome Trust/RSTMH Small Grant awardee 2020