Boosting treatment centres for snakebite victims in Nigeria

Annually, Nigeria records 15,000 snakebite cases, with only 5,000 anti-venom doses available living 10,000 victims to their fate.

Revealing this at a two-day media dialogue in Ibadan, Oyo state, the Deputy Director and Head, Snakebite Division Envenoming Unit, Neglected Tropical Diseases Division, Fatai Oyediran explained that, "snakebite is an injury caused by a bite from a snake, often resulting in puncture wounds inflicted by the snake’s fangs and sometimes envenomation. The outcome depends on factors which include the species of snake involved, area of the body bitten, amount of venom injected and the health condition of the victim."

According to WHO, high-risk groups of snakebite in Africa, Nigeria inclusive are; poor rural dwellers, agricultural workers, herders, fishermen, hunters, working children (aged 10–14 years), people living in poorly constructed housing, and people with limited access to education and healthcare.
 

These rural dwellers especially, find it difficult to access treatment centres that cater for snakebite victims. Distance to an available centre sometimes affects efforts towards rescuing these victims.

 
Stating the danger of this scenario, Oyediran revealed that, " for instance, in Gombe State, most times all beds are occupied by patients of snakebite victims."
 

The media dialogue organised by the United Nations Children's Fund, UNICEF in collaboration with the Federal Ministry of Information is targeted at bringing Neglected Tropical Diseases to the attention of government, policymakers, stakeholders and revealing the setback it portends to the development of Nigeria if not attended to.

Oyediran stated that " just like COVID-19, the health status of victims is crucial. I am sure that most of us contracted Covid and survived it, some had it within two days it was gone. Resistance and immunity built against such also play a part. Some people can resist the venom for up to 72 hours but there are other things you can do even without the anti-venom. You can keep giving blood to neutralise the venom."

 
The Deputy Director and Head, Snakebite Division, explained that, snakebite was a neglected public problem in the rural communities of Africa and Nigeria in particular, stated that it remains a major medical problem in rural communities of the Savannah Region of West Africa.

While listing some of the affected countries to include Nigeria, Senegal, Ghana, Togo, Benin, Burkina-Faso, Niger, Mali and Cameron, Oyediran stated that the three most medically important snakes in Nigeria are Naja nigricolis (Cobra), Bitis arietans (Puff Adder) and Echis ocellatus (Carpet Viper) which is the world’s most dangerous snake, causing more deaths than any other snake on the African continent.
 

Reeling out surveys done on snakebites, he said the estimated incidence of snakebites in Nigeria was put at 174 bites per 1000 according to a 1994 Sample Epidemiological survey by the Federal Ministry of Health, FMoH and that the most recent estimated incidence of snakebites in Nigeria was 497 per 100,000 humans per year according to a 2013 epidemiological survey (Habib 2013).

To control snakebite, Oyediran encouraged Nigerians to plant species of plants that repel snakes, discouraged the dumping of refuse near homes, rearing of animals and birds that are known to eat snakes.

He also recommended the need to close up all unnecessary holes and set traps to suspected holes in and around the house, eliminate snake habitat and hiding places (wood piles, garden debris, cracks and holes) in living houses, keeps rodents (rats and mice) and other household pests which snake prey on under control, erect snake-proof fences 2-3 ft high wire meshes have been found to be effective and the use of snake repellants.
 

Oyediran also stated that naphthalene (camphor)  can be spread around the perimeter of the house and in the event of snake threat,  individuals should make noise that can scare off a snake.

To resolve the problem in Nigeria, he identified inadequate funding and release, low awareness, lack of political will, poor data collection, and inadequate partner’s support, apart from WHO, N-SRIC, UNICEF among others as some of the challenges affecting proper control of the problem.

Oyediran warned that victims of snakebites should avoid the use of a tourniquet to avoid complete shortage of blood supply to the brain.

According to him, "the issue of a tourniquet is not right. It is better to use an ordinary handkerchief to allow some blood to flow to the brain. If you tie a tourniquet and blood is not circulating and going to the brain that will kill the victim or induce a coma.

"The brain needs oxygen which is in the blood. That is why we say don’t knot and don’t use your mouth to suck the venom because there have been instances where somebody accidentally swallowed the venom.  Don’t put incision or put a black stone, there is no scientific proof that they  work."

To harness the various claims, Oyediran disclosed that currently, the Division is working with traditional medicine practitioners for the various cure claims and subject them to scientific proof even as he lamented the lack of funding.
 

He said that "we have a lot to do but there is no fund. After the discovery of the anti-venom, there is no substantial funding again for more research on these claims.

"We had a meeting with the traditional medicine practitioners on harnessing all these local claims of leaves and black stones, garlic and onions and to send to NIPRID, NAFDAC and NIMR for analysis.
We are working to see that all 774 LGAs have a centre where victims can be treated."
 

Oyediran said lemongrass is one of the plants that repel snakes from our homes and surroundings.

While there are so many beliefs, he, however, debunked that a person bitten thrice will not survive another snakebite urging that people keep their environment clean, use nets on their windows as well as beam lights in their toilet sinks before using them.

He said, "people should clean and also use camphor in their surroundings, fumigate every three months with snake repellent or normal chemical. The normal chemical can drive them away but will not kill them. Don’t put remnants of food close to your house because rats will come and the snakes will come to eat the rats. It is the balance of the ecosystem."

WHO says, despite the shortfall in data, globally, there is evidence that 4.5–5.4 million people a year are bitten by snakes, that 1.8–2.7 million of them develop clinical illness (envenoming) after snakebite, and that the death toll could range from 81,000 to 138,000. Improving the quality and resolution of the data is essential.

The health body also said, the distribution of envenoming and mortality worldwide is variable; while numerically lowest in Europe, Australia and North America, it is highest in sub-Saharan Africa, South Asia and South-East Asia. This is also where most of the world’s population lives, bringing humans and snakes into direct conflict.