Toxicon: X最新文献

{"title":"Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation","authors":"Romain Duda ,&nbsp;Wuelton M. Monteiro ,&nbsp;Tamara Giles-Vernick","doi":"10.1016/j.toxcx.2021.100077","DOIUrl":"10.1016/j.toxcx.2021.100077","url":null,"abstract":"<div><p>The WHO has identified the goal of halving deaths and disability from snakebite envenomation (SBE) by 2030 through a four-pillar program that promotes accessible and affordable treatments, strengthens health systems, promotes community and multi-level engagement, and mobilizes partnerships, coordination and resources to advocate for global action. This initiative could accelerate multi-disciplinary research and action in central Africa, a “hotspot” for SBE, but it offers little specific guidance about anthropological research to be conducted. This commentary develops that research agenda. It surveys anthropological, ethnohistorical investigations in the central African forest to elaborate the socio-cultural and historical significance and practices around snakes and snakebites. It draws from south and southeast Asian and Latin American literatures to illustrate anthropological contributions to SBE research. It then outlines a Central African research agenda employing ethnobiological investigation of snake ecologies, participatory evaluations of humans-snake contacts, and interviews and participant-observation of local prevention and treatment practices and knowledge. This research will co-develop policies and practices with forest communities and leaders and regional and national authorities to reduce the burden of SBE.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"11 ","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39303383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delays, fears and training needs: Perspectives of health workers on clinical management of snakebite revealed by a qualitative study in Kitui County, Kenya","authors":"Kieran Barnes ,&nbsp;Cecelia Ngari ,&nbsp;Stanley Parkurito ,&nbsp;Leo Wood ,&nbsp;Denis Otundo ,&nbsp;Robert Harrison ,&nbsp;George O. Oluoch ,&nbsp;Anna Trelfa ,&nbsp;Clare Baker","doi":"10.1016/j.toxcx.2021.100078","DOIUrl":"10.1016/j.toxcx.2021.100078","url":null,"abstract":"<div><p>Key aims of the WHO Strategy to halve snakebite morbidity and mortality include health system strengthening and training of health workers. This requires knowledge of local health system needs and capacity, health worker training needs, and factors influencing health worker decision-making in snakebite management. This study explored health worker experiences and perceptions of snakebite management, both individually and in the context of their local health system.</p><p>We used a qualitative study design with semi-structured interviews (n = 14) and focus group discussions (n = 4). We employed a combination of sampling strategies aiming to achieve maximum variation among key informants within resource limitations. We recruited health workers (n = 33) of varying roles from purposively selected tier 2, 3 and 4 health facilities (n = 12) and the community (tier 1) in four sub-counties in Kitui County, Kenya. We conducted inductive thematic analysis of all transcripts.</p><p>The results identified that health workers recognised snake envenoming as a time-critical emergency in which delay in care seeking, sometimes exacerbated by health system referral delays, was a major barrier to effective management of patients. Clinicians strongly voiced a need for training in snakebite management, diagnosis and antivenom administration. Unexpressed needs for training were demonstrated in traditional remedy ineffectiveness, syndromic management, and critical appraisal of treatment effectiveness. Under-resourcing in antivenom, other medication, equipment, infrastructure and staffing also challenged management. Fear of snakebite and fear of antivenom, both linked to past experiences, influenced clinical decision-making.</p><p>Our findings clearly indicate a need in Kitui County for training programmes that equip health workers for clinical decision-making in snakebite management. We further identify community intervention needs to facilitate prompt presentation to healthcare, including practical affordable transport solutions, and systematic health system resourcing needs. In addition, we recommend supportive supervision and further research in response to the emotional stress resulting from managing difficult cases in under-resourced settings.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"11 ","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/43/main.PMC8350493.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39320202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical management of snakebite envenoming: Future perspectives","authors":"Muhammad Hamza ,&nbsp;Cecilie Knudsen ,&nbsp;Christeine Ariaranee Gnanathasan ,&nbsp;Wuelton Monteiro ,&nbsp;Matthew R. Lewin ,&nbsp;Andreas H. Laustsen ,&nbsp;Abdulrazaq G. Habib","doi":"10.1016/j.toxcx.2021.100079","DOIUrl":"10.1016/j.toxcx.2021.100079","url":null,"abstract":"<div><p>Snakebite envenoming is a major cause of morbidity and mortality in rural communities throughout the tropics. Generally, the main clinical features of snakebites are local swelling, tissue necrosis, shock, spontaneous systemic hemorrhage, incoagulable blood, paralysis, rhabdomyolysis, and acute kidney injury. These clinical manifestations result from complex biochemical venom constituents comprising of cytotoxins, hemotoxins, neurotoxins, myotoxins, and other substances. Timely diagnosis of envenoming and identification of the responsible snake species is clinically challenging in many parts of the world and necessitates prompt and thorough clinical assessment, which could be supported by the development of reliable, affordable, widely-accessible, point-of-care tests. Conventional antivenoms based on polyclonal antibodies derived from animals remain the mainstay of therapy along with supportive medical and surgical care. However, while antivenoms save countless lives, they are associated with adverse reactions, limited potency, and are relatively inefficacious against presynaptic neurotoxicity and in preventing necrosis. Nevertheless, major scientific and technological advances are facilitating the development of new molecular and immunologic diagnostic tests, as well as a new generation of antivenoms comprising human monoclonal antibodies with broader and more potent neutralization capacity and less immunogenicity. Repurposed pharmaceuticals based on small molecule inhibitors (e.g., marimastat and varespladib) used alone and in combination against enzymatic toxins, such as metalloproteases and phospholipase A₂s, have shown promise in animal studies. These orally bioavailable molecules could serve as early interventions in the out-of-hospital setting if confirmed to be safe and efficacious in clinical studies. Antivenom access can be improved by the usage of drones and ensuring constant antivenom supply in remote endemic rural areas. Overall, the improvement of clinical management of snakebite envenoming requires sustained, coordinated, and multifaceted efforts involving basic and applied sciences, new technology, product development, effective clinical training, implementation of existing guidelines and therapeutic approaches, supported by improved supply of existing antivenoms.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"11 ","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39342043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Snakebite envenoming in different national contexts: Costa Rica, Sri Lanka, and Nigeria","authors":"José María Gutiérrez ,&nbsp;Kalana Maduwage ,&nbsp;Garba Iliyasu ,&nbsp;Abdulrazaq Habib","doi":"10.1016/j.toxcx.2021.100066","DOIUrl":"10.1016/j.toxcx.2021.100066","url":null,"abstract":"<div><p>Snakebite envenoming is a neglected tropical disease that predominantly affects impoverished rural communities in sub-Saharan Africa, Asia, and Latin America. The global efforts to reduce the impact of this disease must consider the local national contexts and, therefore, comparative studies on envenomings in different countries are necessary to identify strengths, weaknesses and needs. This work presents a comparative analysis of snakebite envenomings in Costa Rica, Sri Lanka, and Nigeria. The comparison included the following aspects: (a) burden of envenomings, (b) historical background of national efforts to confront envenomings, (c) national health systems, (d) antivenom availability and accessibility including local production, (e) training of physicians and nurses in the diagnosis and management of envenomings, (f) prevention campaigns and community-based work, (g) scientific and technological platforms in these topics, and (h) international cooperation programs. Strengths and weaknesses were identified in the three contexts and several urgent tasks to improve the management of this disease in these countries are highlighted. This comparative analysis could be of benefit for similar studies in other national and regional contexts.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"9 ","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39091636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of global environmental change for the burden of snakebite","authors":"Gerardo Martín ,&nbsp;Carlos Yáñez-Arenas ,&nbsp;Rodrigo Rangel-Camacho ,&nbsp;Kris A. Murray ,&nbsp;Eyal Goldstein ,&nbsp;Takuya Iwamura ,&nbsp;Xavier Chiappa-Carrara","doi":"10.1016/j.toxcx.2021.100069","DOIUrl":"10.1016/j.toxcx.2021.100069","url":null,"abstract":"<div><p>Snakebite envenoming is a set of intoxication diseases that disproportionately affect people of poor socioeconomic backgrounds in tropical countries. As it is highly dependent on the environment its burden is expected to shift spatially with global anthropogenic environmental (climate, land use) and demographic change. The mechanisms underlying the changes to snakebite epidemiology are related to factors of snakes and humans. The distribution and abundance of snakes are expected to change with global warming via their thermal tolerance, while rainfall may affect the timing of key activities like feeding and reproduction. Human population growth is the primary cause of land-use change, which may impact snakes at smaller spatial scales than climate via habitat and biodiversity loss (e.g. prey availability). Human populations, on the other hand, could experience novel patterns and morbidity of snakebite envenoming, both as a result of snake responses to environmental change and due to the development of agricultural adaptations to climate change, socioeconomic and cultural changes, development and availability of better antivenoms, personal protective equipment, and mechanization of agriculture that mediate risk of encounters with snakes and their outcomes. The likely global effects of environmental and demographic change are thus context-dependent and could encompass both increasing and or snakebite burden (incidence, number of cases or morbidity), exposing new populations to snakes in temperate areas due to “tropicalization”, or by land use change-induced snake biodiversity loss, respectively. Tackling global change requires drastic measures to ensure large-scale ecosystem functionality. However, as ecosystems represent the main source of venomous snakes their conservation should be accompanied by comprehensive public health campaigns. The challenges associated with the joint efforts of biodiversity conservation and public health professionals should be considered in the global sustainability agenda in a wider context that applies to neglected tropical and zoonotic and emerging diseases.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"9 ","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39181245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unique venom proteins from Solenopsis invicta x Solenopsis richteri hybrid fire ants","authors":"Steven M. Valles ,&nbsp;Jason B. Oliver ,&nbsp;Karla M. Addesso ,&nbsp;Omaththage P. Perera","doi":"10.1016/j.toxcx.2021.100065","DOIUrl":"10.1016/j.toxcx.2021.100065","url":null,"abstract":"<div><p>The Solenopsis venom protein 2 transcript was amplified, sequenced, probed, and analyzed from <em>Solenopsis invicta</em> x <em>Solenopsis richteri</em> hybrid ant colonies (hybrids) collected from across Tennessee to determine the extent of introgression of each parent allele (<em>Solenopsis invicta</em> venom protein 2 [Soli2] and Solenopsis richteri venom protein 2 [Solr2]). Chemotaxonomic analyses of venom alkaloids and cuticular hydrocarbons were used to categorize hybrid colonies and their relative relatedness to each parent species. Hybrid colonies were chosen randomly from each chemotaxonomic hybridization category, including “very near <em>S. richteri</em>,” “near <em>S. richteri</em>,” “near <em>S. invicta</em>,” and “very near <em>S. invicta</em>.” Lateral flow immunoassays for detection of the Soli2 and Solr2 venom proteins were largely in agreement with the chemotaxonomic analyses for the very near <em>S. richteri</em> (100% Solr2) and very near <em>S. invicta</em> (80% Soli2, 20% Soli2 + Solr2 detected in the sample) groups, while Soli2 and Solr2 were reported in 60% and 40% in the near <em>S. invicta</em> and near <em>S. richteri</em> chemotaxonomic groups. Analysis of transcripts from the hybrid colonies revealed a sequence with 100% identity to Soli2 (GenBank Accession L09560) and three unique sequences, which we identify as Solenopsis hybrid venom protein 2 (Solh2; GenBank Accession MT150127), Solenopsis hybrid truncated venom protein 2 (Solh2^Tr97; Genbank Accession MT150129), and Solenopsis richteri venom protein 2, D to A change at position 69 (Solr2^A69; GenBank Accession MT150128). The predicted open reading frame for Solh2 and Solh2^Tr97 revealed sequences unique to hybrid ants, with Solh2^Tr97an alternatively spliced form. A third unique sequence, Solr2^A69, is likely the correct sequence for Solr2, which appears to have been published previously with a sequencing error (GenBank Accession P35776).</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"9 ","pages":"Article 100065"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38929845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Citizen science and online data: Opportunities and challenges for snake ecology and action against snakebite","authors":"Andrew M. Durso ,&nbsp;Rafael Ruiz de Castañeda ,&nbsp;Camille Montalcini ,&nbsp;M. Rosa Mondardini ,&nbsp;Jose L. Fernandez-Marques ,&nbsp;François Grey ,&nbsp;Martin M. Müller ,&nbsp;Peter Uetz ,&nbsp;Benjamin M. Marshall ,&nbsp;Russell J. Gray ,&nbsp;Christopher E. Smith ,&nbsp;Donald Becker ,&nbsp;Michael Pingleton ,&nbsp;Jose Louies ,&nbsp;Arthur D. Abegg ,&nbsp;Jeannot Akuboy ,&nbsp;Gabriel Alcoba ,&nbsp;Jennifer C. Daltry ,&nbsp;Omar M. Entiauspe-Neto ,&nbsp;Paul Freed ,&nbsp;Isabelle Bolon","doi":"10.1016/j.toxcx.2021.100071","DOIUrl":"10.1016/j.toxcx.2021.100071","url":null,"abstract":"<div><p>The secretive behavior and life history of snakes makes studying their biology, distribution, and the epidemiology of venomous snakebite challenging. One of the most useful, most versatile, and easiest to collect types of biological data are photographs, particularly those that are connected with geographic location and date-time metadata. Photos verify occurrence records, provide data on phenotypes and ecology, and are often used to illustrate new species descriptions, field guides and identification keys, as well as in training humans and computer vision algorithms to identify snakes. We scoured eleven online and two offline sources of snake photos in an attempt to collect as many photos of as many snake species as possible, and attempt to explain some of the inter-species variation in photograph quantity among global regions and taxonomic groups, and with regard to medical importance, human population density, and range size. We collected a total of 725,565 photos—between 1 and 48,696 photos of 3098 of the world's 3879 snake species (79.9%), leaving 781 “most wanted” species with no photos (20.1% of all currently-described species as of the December 2020 release of The Reptile Database). We provide a list of most wanted species sortable by family, continent, authority, and medical importance, and encourage snake photographers worldwide to submit photos and associated metadata, particularly of “missing” species, to the most permanent and useful online archives: The Reptile Database, iNaturalist, and HerpMapper.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"9 ","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39197182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic health effects and cost of snakebite","authors":"Anuradhani Kasturiratne ,&nbsp;David G. Lalloo ,&nbsp;H. Janaka de Silva","doi":"10.1016/j.toxcx.2021.100074","DOIUrl":"10.1016/j.toxcx.2021.100074","url":null,"abstract":"<div><p>The burden of disability among survivors and the socio-economic impact of snakebite have not been adequately researched. We reviewed original research articles, case reports and small case series relating to chronic physical, mental and psycho-social disability and economic burden of snakebite. Both physical and psychological health problems seem common in snakebite survivors and can lead to disability and loss of productivity. Chronic physical health effects, musculoskeletal disability being the commonest, can be largely attributed to limited and delayed access to optimal treatment of acute envenoming. The economic burden is considerable, and includes health system costs, out-of-pocket expenditure and opportunity costs, with regional variations. Health systems should be more responsive to needs and circumstances of bite victims, and a more holistic approach should be developed in the treatment of snakebite which incorporates the management of chronic health effects.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"9 ","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39281142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mutual enlightenment: A toolbox of concepts and methods for integrating evolutionary and clinical toxinology via snake venomics and the contextual stance","authors":"Juan J. Calvete ,&nbsp;Bruno Lomonte ,&nbsp;Anthony J. Saviola ,&nbsp;Fabián Bonilla ,&nbsp;Mahmood Sasa ,&nbsp;David J. Williams ,&nbsp;Eivind A.B. Undheim ,&nbsp;Kartik Sunagar ,&nbsp;Timothy N.W. Jackson","doi":"10.1016/j.toxcx.2021.100070","DOIUrl":"10.1016/j.toxcx.2021.100070","url":null,"abstract":"<div><p>Snakebite envenoming is a neglected tropical disease that may claim over 100,000 human lives annually worldwide. Snakebite occurs as the result of an interaction between a human and a snake that elicits either a defensive response from the snake or, more rarely, a feeding response as the result of mistaken identity. Snakebite envenoming is therefore a biological and, more specifically, an <em>ecological</em> problem. Snake venom itself is often described as a “cocktail”, as it is a heterogenous mixture of molecules including the toxins (which are typically proteinaceous) responsible for the pathophysiological consequences of envenoming. The primary function of venom in snake ecology is pre-subjugation, with defensive deployment of the secretion typically considered a secondary function. The particular composition of any given venom cocktail is shaped by evolutionary forces that include phylogenetic constraints associated with the snake's lineage and adaptive responses to the snake's ecological context, including the taxa it preys upon and by which it is predated upon. In the present article, we describe how conceptual frameworks from ecology and evolutionary biology can enter into a mutually enlightening relationship with clinical toxinology by enabling the consideration of snakebite envenoming from an “ecological stance”. We detail the insights that may emerge from such a perspective and highlight the ways in which the high-fidelity descriptive knowledge emerging from applications of -omics era technologies – “venomics” and “antivenomics” – can combine with evolutionary explanations to deliver a detailed understanding of this multifactorial health crisis.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"9 ","pages":"Article 100070"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39124906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dealing with snakebite in rural Cameroon: A qualitative investigation among victims and traditional healers","authors":"Manon Chuat ,&nbsp;Gabriel Alcoba ,&nbsp;Justin Eyong ,&nbsp;Franck Wanda ,&nbsp;Eric Comte ,&nbsp;Armand Nkwescheu ,&nbsp;François Chappuis ,&nbsp;Patricia Hudelson","doi":"10.1016/j.toxcx.2021.100072","DOIUrl":"10.1016/j.toxcx.2021.100072","url":null,"abstract":"<div><h3>Background</h3><p>Snakebite is a neglected tropical disease (NTD) affecting rural and remote populations globally, who are additionally burdened by poverty and the lack of effective healthcare systems. Delayed healthcare and use of traditional treatments are very frequent. The purpose of our study was to explore perceptions of snakes, impact of snakebite, and knowledge and opinions of different snakebite treatments with the aim of identifying opportunities for improving snakebite management.</p></div><div><h3>Methods</h3><p>This is a qualitative descriptive study based on semi-structured interviews with 21 snakebite victims and 4 traditional healers in 4 villages of Akonolinga health district, Center Region, Cameroon. Analysis focused on describing participants' perceptions of snakes, the impact of snakebite on the victims’ lives, and their opinions of different treatment options.</p></div><div><h3>Results</h3><p>Respondents were fearful of snakes and knowledgeable about envenoming symptoms and treatments. The experience of snakebite led to increased vigilance and avoidance behaviours, which sometimes resulted in financial loss for the victims. A range of traditional treatments were described, including tourniquets, black-stone application and medicinal plant decoctions. However, opinions were ambivalent regarding their efficacy, depending especially on previous personal experiences. Still, traditional treatments were said to be more available and cheaper than hospital care, and in particular, than antivenom. Nevertheless, most victims preferred hospital treatment if the financial and transportation barriers were lifted. Both snakebite victims and traditional healers were of the opinion that collaboration between health services and traditional healers could help to improve snakebite management and outcomes.</p></div><div><h3>Conclusion</h3><p>Our study shows that snakebite victims are in favour of using antivenom for the treatment of snakebite and would welcome better access to it. However, its current unavailability and high cost pushes them to turn to traditional treatments. On the other hand, traditional healers are in favour of collaborating with health facilities. These results are very encouraging for the improvement of snakebite management in Cameroon along the lines of the WHO Snakebite Envenoming Strategy for Prevention and Control: ensuring access to safe and effective treatment, and increasing partnership and coordination between communities, traditional healers, and conventional caregivers.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"9 ","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39266777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}