Managing snake bites in Africa: Nigeria as a case in point

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Managing snake bites in Africa Nigeria as a case
in point

• Dr John Garnvwa
• (EchiTAb Study Group UK/Nigeria)
• for Dr Abdulsalami Nasidi
• Federal Ministry of Health, Nigeria

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Medically important snakes in Nigeria

• Carpet Viper - Echis ocellatus

• Responsible for more than 90 of bites

• 174 snakebites/100,000/ population (Theakston)

• 497 snake bites/100,000 population (Pugh)

• 60 of deaths

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Medically important snakes in Nigeria

• Carpet Viper - Echis ocellatus
• Responsible for more than 90 of bites
• 174 snakebites/100,000/ population (Theakston)
• 497 snake bites/100,000 population (Pugh)
• 60 of deaths

Puff Adder - Bitis arietans
Spitting cobra - Naja nigricollis
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Snake bite is a major problem to rural
communities

• Rural communities in Africa are primarily
  subsistence farmers with insufficient income to
  purchase antivenom
• Example Kaltungo, Gombe State, Eastern Nigeria
• remote access to health care
• homes are constructed of natural material
• often without electricity
• sited near vegetation and crops

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Housing and snake bite risk

• These homes attract snakes because
• storage of food attracts rodents
• rodents lure snakes close to and inside homes
• thatched roofs
• sleeping on floor mats
• no nets or other protection

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Snake bite is seasonal in Nigeria

• coincident with rain seasons
• crops are planted during the rain
  seasons

Shaded - snake bite incidence Clear greenness
of vegetation determined by satellite imaging
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Farmers are the highest risk group - 2007
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Farmers are the highest risk group

• Non-mechanised farming
• Inadequate protection
• Snake bite mostly affects
• feet
• hands
• legs
• arms

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Farmers are the highest risk group

• Agricultural plots attract snakes because
• grain stores attract rodents
• rodents lure snakes
• snakes are difficult to see

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Bite incidence is highest in first three decades
of life

• It is these groups that contribute most to the
  rural community
• Therefore snake bite has a long term community
  impact
• long term disability
• loss of income
• loss of schooling

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Human activity and snake bite children

• Snake bite in children
• children are bitten when playing (rat catching)
• or carrying out chores (helping mother in
  kitchen)

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Envenomed children admitted to Kaltungo Hospital
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Snake Bite is Unavoidable in Communities like
Kaltungo

• People are bitten when
• Farming
• Walking
• Playing
• Cooking
• Sleeping
• 20 mortality without treatment

The Federal Ministry of Health, Nigeria
instigated provision of antivenom the EchiTAb
Study Group
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Liverpool School Tropical Medicine D. Theakston,
G. Laing, P. Rowley

• The Government of Nigeria
• Management A. Nasidi
• L. Salako
• N. Durfa, J. Garnvwa
• Habib, B. Abubaker, I. Sadeeq

University of Oxford D. Warrell
EchiTAb Study Group
Venom Stocks
Antivenom Production MicroPharm Ltd, London, UK
Antivenom Delivery
Preclinical testing of Antivenom
Clinical testing of Antivenom in Nigeria
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Liverpool School Tropical Medicine Management
J. Hemingway E. Holland Consultants
D. Theakston D. Warrell Venom
Research Unit R. Harrison G. Laing, P.
Rowley, J. Garnvwa

• The Government of Nigeria
• Management A. Nasidi
• L. Salako
• Clinical Team N. Durfa
• Habib, B. Abubaker, I. Sadeeq

EchiTAb Study Group
Venom Stocks
Antivenom Production MicroPharm Ltd, London,
UK ICP, San Jose, Costa Rica VacSera, Cairo,
Egypt BioClon, Mexico City, Mexico
Antivenom Delivery
Preclinical testing of Antivenom
Clinical testing of Antivenom in Nigeria
Technology Transfer for sustained production of
antivenom in Nigeria
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EchiTAb Antivenoms

• Fab - EchiTAb
• F(ab/)2 - EchiTAb2
• IgG - EchiTAbG, EchiTAb

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ETSG (UK) Ltd production of snake antivenom

• EchiTAbG
• E. ocellatus monospecific antivenom
• Ovine IgG
• EchiTAb
• E. ocellatus/B arietans/N nigricollis
  polyspecific AV
• Equine IgG

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Kaltungo Hospital, Gombe State

• EchiTAb Study Group Antivenoms
• Free
• Effective against local snake bite
• Few adverse effects

• MORE PATIENTS SEEKING TRATMENT

Prof Warrell, Dr Abubacker in snake bite ward
EchiTAb Study Group ambulance
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Frequency of Snakebite Admissionsto Kaltungo
Hospital Jan - Oct 2007
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EchiTAb Antivenom treatment
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Liverpool School Tropical Medicine Management
J. Hemingway E. Holland Consultants
D. Theakston D. Warrell Venom
Research Unit R. Harrison G. Laing, P.
Rowley, J. Garnvwa

• The Government of Nigeria
• Management A. Nasidi
• L. Salako
• Clinical Team N. Durfa
• Habib, B. Abubaker, I. Sadeeq

EchiTAb Study Group (UK) Ltd Chairman
RDGT Directors AN, JH, RH Participants DW,
GL, JG Secretary EH
Venom Stocks
Antivenom Production ICP, San Jose, Costa
Rica MicroPharm Ltd, London, UK
Antivenom Delivery
Preclinical testing of Antivenom
Clinical testing of Antivenom in Nigeria
Technology Transfer for sustained production of
antivenom in Nigeria
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Many thanks to Federal Ministry of Health,
Nigeria Liverpool School of Tropical
Medicine University of Oxford MicroPharm Ltd,
UK Instituto Clodomiro Picado, Costa Rica Prof.
David A Warrell Dr. Nick Brown Organisers of
GICT conference
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THE END