Presentation and management of snakebite envenomation at a District Hospital in the north-east of South Africa

Abstract

Background

Snakebites have been recognised as a neglected tropical disease by the World Health Organization and remain a potentially preventable cause of morbidity around the world, particularly in Africa. South Africa (SA) has a well-documented prevalence of snakebites, and there has been a recent surge in attention on snakebite due to dwindling antivenom stocks. uMkhanyakude District in the far northeast of SA has one of the highest incidences of snakebite and uses more antivenom than elsewhere in SA, and the impact of antivenom shortages and the high prevalence of disease has not been assessed recently.

Methods

A descriptive, retrospective, observational study was undertaken to describe victims of snakebites presenting from 1 September 2019 to 31 August 2022 to a district hospital, Mosvold Hospital. Data were manually extracted from patients’ medical records. Information about demographics, clinical presentations, treatments and outcomes was collected and analysed.

Results

A total of 155 snakebite cases presented, with an incidence rate of 58 snakebite cases per 100 000 people per year. Most patients were young, with a median age of 19 years (range 0–94 years), and most bites occurred outdoors (75/155, 48.4 %). Patients were most often bitten on the lower limbs (107/155, 69.0 %), and most presented with minimal swelling (117/155, 75.5 %). Antivenom was administered to 33 patients (33/155, 21.3 %), and 24 (24/33, 72.7 %) of those who received antivenom experienced some form of post-antivenom reaction. Three patients died during their hospital stay, resulting in a mortality rate of 1.2 deaths per 100 000 people per year. Antivenom shortages contributed to the outcomes of several patients.

Conclusion

Cytotoxic snakebites are a not infrequent presentation, many requiring admission, antivenom and subsequent management. Emergency personnel need to be familiar with local protocols for snakebite management, and have the resources to manage severe envenomation, including access to antivenom. Expanding knowledge and education about snakebites provided to community members might also improve outcomes and prevent bites.