We live on opposite sides of the African continent, but we have both recently witnessed the tragedy of snakebite.
In Siaya, Kenya, just a few weeks ago, Akoth (not her real name) a 9-year-old girl, was bitten by a rhombic night adder. Because of childrens’ small body mass, they are far more likely to die from a bite from this species and if it doesn’t kill, the bite often causes permanent disability and limb amputation.
Suffering from pain and swelling, the girl needed urgent medical attention, but the two closest clinics had no antivenom and the district hospital was 35 kms away. The cost of transport, treatment and hospital admission was around 10,000 shillings (about USD 100) – a massive sum for rural families living on less than a dollar a day. She was at risk of death, but after two days in hospital was discharged with instructions to take a further course of injectable medication. This required travel to a clinic 15 km away for three consecutive days, incurring another $25 for transportation. She has recovered but now limps slightly.
A few months earlier, in Shipadna in Niger State, Nigeria, Gunduma was bitten by a snake but was first treated at home with herbs. As in Kenya, the cost of antivenom in Nigeria is high, at around 30,000 naira (about 75 USD) per dose with most cases requiring 3 or 4 doses as well as a blood transfusion. The 20-year-old was only taken to hospital after several days when he started bleeding from his nose and mouth. He received antivenom and a blood transfusion, but died a week later. The delay in seeking treatment cost him his life.
Snakebite is an age-old public health problem across Africa. In 2017 the World Health Organization added snakebite to its list of Neglected Tropical Diseases, estimating that 5.4 million people are bitten each year with up to 2.7 million developing clinical illness and up to 138,000 dying. Around 30,000 of those deaths are in Sub-Saharan Africa, with a further 60,000 people left disfigured in some way. It is estimated that around 1,000 of those deaths are in Kenya and about 2,000 are in Nigeria. Many countries in Africa record similar numbers but these figures are highly likely to be underreported.
Communities in poor rural areas are at greatest risk. Farmers, fishers, rural workers and children walking barefoot to school live in constant fear. However, droughts, deforestation, rising temperatures and economic activity are leading to changes in snakes’ distribution patterns, meaning some venomous snakes are venturing into new areas, potentially posing greater risks to humans.
Because of the wide range of snake species in Africa, it is not always simple to treat snakebite and data is not regularly collected. In Nigeria, three snakes are known to be poisonous: the viper, cobra and puff adder, with most deaths attributed to the carpet viper. In Kenya, puff adders are the main cause of injuries and deaths because they are nocturnal and well camouflaged. Injuries often occur when people are coming home or visiting outdoor bathrooms at night. The black mamba, also native to Kenya, is considered the world’s largest and fourth most-venomous snake. Its bite can kill within half an hour by injecting a neurotoxin that paralyzes its victims. The third most dangerous species in Kenya is the cobra, with several sub-species including the black-necked spitting cobra which is relatively common and spits venom into the eyes of its victim causing pain, swelling, blistering and tissue damage.
Myths and misinformation surround snakes in Africa. It is not unusual to hear stories of bad omens or claims of witchcraft attributed to snakebite patients. Being bitten by a snake often begets stigma and victims can become social outcasts. What to do if bitten is also linked to myths, leading many snake bite patients to rely on traditional or herbal medicine rather than seeking clinical treatment.
A major obstacle to tackling snakebite deaths is the lack of a global focal point to coordinate efforts. This focal point should be created within the World Health Organization (WHO) which should also require cases of snakebite to be made notifiable – as is the case with rabies and other neglected tropical diseases. By collecting accurate data we can begin to ensure that the correct antivenom is available and affordable in the areas where it is needed most – and that communities are educated about what to do if they are bitten. These steps would reduce fatalities significantly.
Snakebite victims are largely the poorest communities who are often burdened with many other diseases. They are also more likely to suffer the impact of climate change – which is changing snakes’ habitats and distribution. As increased risk of snakebite is a foreseeable consequence of climate change, it should also be included in remedial measures under the UN Climate Change Conference commitments (COP26) made in Glasgow late last year. As we write, a person or child somewhere in a remote village in Africa is fighting for their lives or dying from a poisonous snakebite – all of which can be prevented if we act now.
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Roseline Orwa and Tijani Salami are 2021 Aspen New Voices Fellows. Roseline Orwa is the founder and Director of the Rona Foundation, a grassroots organization in Kenya that works to advance and protect widows' rights, as well as provide support to orphans and vulnerable children. Twitter: @RoselineOrwa. Dr Tijani Salami is a physician, sexual and reproductive health expert and founder of Sisters Caregivers Project Initiative which provides medical and social support for women, and advocates for an end to child marriage and maternal malnutrition. Twitter: @DrSalamiTijani1.
