Confronting the Neglected Problem of Snake Bite Envenoming: The Need for a Global Partnership

E nvenoming resulting from snake bites is an important public health hazard in many regions, particularly in tropical and subtropical countries [1–3]. Although antivenoms are being produced by various laboratories in every continent, the burden of snake bite envenoming— causing both morbidity and mortality—still has a great impact on the population and on health-care systems, especially in Africa, Asia, Oceania, and Latin America [4]. Unfortunately, public health authorities, nationally and internationally, have given little attention to this problem, relegating snake bite envenoming to the category of a major neglected disease of the 21st century. In the tropical developing countries where snake bites occur most commonly, there are few reliable incidence data. One serious attempt to assess global snake bite mortality was the survey undertaken by Swaroop and Grabb in 1954, which was based largely on hospital admissions [3]. Subsequent work has revealed gross underreporting of deaths in this study—for example, in Nigeria [5] and Thailand [1,6]. One reason is that records of patients treated by traditional methods are missing from offi cial databased statistics, and deaths reported at the hamlet or district level may not be sent on to ministry headquarters. Accepting these limitations, the fragmentary evidence available suggests that several million bites and envenomings occur worldwide each year, with tens of thousands of deaths [2,3]. Properly designed population surveys are likely to give a far more accurate picture of snake bite incidence, morbidity, and mortality. In Asia, the highest recorded mortality was 162 snake bite deaths per 100,000 people per year, in the Eastern Terai of Nepal [7]. In Africa, for instance, the incidence of snake bites in the Benue Valley of northeastern Nigeria was 497 per 100,000 people per year, with a mortality of 12.2% [5]. The reasons for the high levels of snake bite mortality in tropical developing countries include scarcity of antivenoms, poor health services, and diffi culties with rapid access to health centres [8]. Large numbers of victims survive with permanent physical and psychological sequelae, mostly due to the tissue-damaging effects of snake venoms. Young agricultural workers, especially males, are the most highly affected group, making snake bite envenoming a truly occupational disease—a fact that is frequently overlooked by national authorities. Children are also common victims of snake bites. There is signifi cant seasonal variation in snake bite incidence that is attributable to climate, especially to rain fall and temperature, which determine annual cycles of …