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School of Public Health
College of Health Sciences, Makerere University

Makerere Study Edges to Close Critical Data gaps on Uganda’s snakebite burden and incidence

Posted on : Saturday, February 20, 2021

James Ntulume Snakes Uganda

Uganda integrated snakebite envenoming into the country’s neglected tropical disease (NTD) program and drafted the first national snakebite prevention and management strategy in 2018.

But, the implementation of the strategy is taking a snail pace owing to serious gaps relating to the absence of country baseline data on snakebite burden and incidence, the snakes involved and their distribution, characteristics of the bites, community knowledge and practices, and health facility capacity to manage snakebites. 

Inspired by this, a team of scientists from Makerere University School of Public Health led by Dr. John Bosco M Ddamulira set out to conduct a study to determine the burden of snakebites in Uganda in order to generate information for the Ministry of Health to design responses for its control and prevention.

Between July and August 2020, the researchers collected data through interviews with 1,080 household heads and 41 Key Informants (Health workers, District health team members, and Community resource persons). They also reviewed medical records from 29 health facilities across six districts of Arua, Gulu, Kamuli, Kasese, Nakapiripirit, and Mubende.

The findings show that there is a relatively high burden of snakebites in the study districts in Uganda with 82.8% of the snakebites said to have occurred more than 12 months back while 12.7% occurred within the last 12 months.  5% of the victims said they were not certain of the exact period when it had occurred.

A Black-necked cobra
Black-necked spitting cobra, found mostly in sub-Saharan Africa

While sharing the findings of this study on February 17, Dr. Ddamulira observed that most of the snakebites in Uganda are managed at regional referral hospitals at a rate of 48%, yet Health Centre IIIs see relatively most of the cases at a rate of 20% while private health facilities receive very few patients due to the costs of anti-venoms.

Results from health facility data revealed that for the period January to December 2019 a total of 736,580 patients attended the 29 health facilities in the six study districts, 536 (72/100,000 population) were cases of snakebites. The findings also discovered that there were more cases of snakebites reported in the health facilities in Gulu and Nakapiripirit districts with 104 snakebites per 100,000 population, followed by Arua districts with 84 snakebites per 100,000 population compared to facilities in other districts.

The study was made possible with funding from the Government of Uganda through the Makerere University Research Fund Mak-RIF. The findings show that the overall knowledge among household heads on snakebites across the selected districts was inadequate, with 88.2 percent having low knowledge on First Aid for snakebites, leading to harmful such as application of herbs, tourniquet and making cuts on bite areas in the treatment of the bites.

Globally, 2.7 million people are bitten by snakes, and 125,000 dies of snakebites annually. The majority of these medical emergencies occur in Sub-Saharan Africa and Asia.

James Ntulume, Snakes Uganda showing a sample of Anti-Venom
James Ntulume, Snakes Uganda showing a sample of Anti-Venom 

According to Dr. Ddamulira, medical personnel must ascertain the type of venom that was injected by the snake before any treatment can be given to a victim. Scientists advise the government to partner with pharmaceutical companies to ensure anti-venom vaccines are manufactured from the country to suit the types of snakes here.

James Ntulume, a snake expert on the study notes that Uganda has more than 80 species of snakes but only 5% are venomous. Some of the venous snakes found in Uganda include Egyptian Cobra, Black Mamba, Black Forest Cobra, Blanding tree snake with acute levels of venom toxicity. Others are the Gabon Viper, puff adder, black-necked spitting cobra, vine tree/twig snake, and rhinoceros viper. Some of the non-venomous snakes in Uganda include; blind snake, spotted bush snake, rock python, Battersby, house snake all largely distributed in all regions across the country.

The researchers recommended that the Ministry of Health should develop and distribute guidelines and protocols on management of snakebites in Uganda, including emergency first aid care and treatment kits in hospitals, training health care providers on snakebites and snakebite management, and review the supply chain management for anti-venoms and the other drugs used for supportive management snakebite victim to address the frequent stock-outs of drugs and also non-stocking of anti-venoms by lower-level facilities which receive a relatively high number of snakebites as compared to regional referral facilities.

The study further recommended the development and dissemination of IEC materials on snakebites to communities and also health care providers – the messages should particularly address the current harmful practices related to the management of snakebite victims.

The study team is composed of Dr. John Bosco M. Ddamulira, Principal Investigator; Dr. Simon Kasasa, Co-Principal Investigator/Statistician; Dr. Susan Kizito, Co-investigator/Study coordinator; Dr. Alfred Mubangizi, Co-investigator/MOH Study Technical Advisor; Dr. Julius Kyaligonza, Co-investigator; Mr. Ssenyonga Ronald, Research officer/Data administrator and Mr. James Ntulume, a Snake expert.  

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