The Global Snakebite Crisis-A Public Health Issue Misunderstood, Not Neglected
ABSTRACT The global problem of venomous snakebite continues to attract attention despite it being described as a "neglected" issue. The current focus of the World Health Organization (WHO) remains anti-snake venom quality, although "availability and sustainability" of supply are consistently described as the key issues. Sustainability of antivenom supply has been elusive, with cost and pricing in developing countries being cited as the major reasons. The current WHO approach fails to explore the cost issue, but rather focuses on quality improvements, which may well adversely affect the costs of a product already perceived to be 'unaffordable.' The reference to cost and price indicates a marketing-based perspective may well give more relevant solutions to the snakebite crisis. This paper introduces a marketing model to examine global snakebite and to identify if the current approach is relevant and effective. The "4 Ps" model examines if the correct products are available, whether sufficient information exists concerning estimated market size, whether the assumptions frequently made about the costs of the product are correct and fully understood, if the product is promoted properly, and whether the method by which the product reaches the end user is optimum. The resulting analysis demonstrates that the current approach is characterized by a misunderstanding of the nature of the global snakebite problem. Further, a lack of implementation of key solutions, such as training doctors in developing countries with relevant protocols, has inevitably led to a lack of improvement in the snakebite arena over the last 30 years.
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- "occupation could reduce snake abundance (Ali and Begum, 1990; Simpson and Norris, 2009). This concerns both denominator figures and catchment areas for health facilities that change over time (see below). "
ABSTRACT: Snakebites represent an important neglected public health problem in many developing countries. There is a lack of epidemiological data, which would be very useful for the organisation of snakebite management and provision of antivenom. An extensive literature search for the years 1970-2010 was performed. Data were analysed using meta-analysis to take into account the heterogeneity between the studies and their respective weight. Incidence, mortality and population at risk were estimated after stratification according to the environment (urban or rural) and survey methodologies (national, hospital or community studies). The incidence of snakebite was inversely correlated with population density. The number of envenomings was estimated at 314,078 [CI95% = 251,513-377,462], of which 95% occurred in rural areas. The remainder occurred in cities. The annual mortality was estimated at 7,331 [5,148-9,568], of which 97% occurred in a rural environment. The annual number of amputations ranged from 5,908 to 14,614. The population most at risk was young men engaged in agricultural or pastoral labours. Household surveys indicated that actual incidence and mortality were likely 3-5 times higher. The difference maybe explained by treatment seeking behaviour. However, incidences and mortalities reported here reflect the number of patients who attend modern health facilities, giving underestimated figures of the burden of snakebites in sub-Saharan Africa but realistic current requirements for antivenoms.Toxicon 03/2011; 57(4):586-99. DOI:10.1016/j.toxicon.2010.12.022 · 2.58 Impact Factor
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- "These enzymes hydrolyze the sn-2 ester bond of membrane glycerophospholipids generating fatty acids such as, arachidonic acid and lysophospholipids participating in inflammatory process (Six & Dennis, 2000). To treat the effects caused by snakebites, intravenous administration of equine or ovine immunoglobulins constitutes the main treatment (Simpson & Norris, 2009). However, it has been demonstrated that such antivenoms generally have a limited efficacy against the damaging activities of the venoms in the local tissue (Gutiérrez et al., 1998). "
ABSTRACT: Snakebite continues to be a significant health problem in many countries of Latin America. Even though, there has been an improvement in the antivenom therapy, the local effects caused by myotoxic phospholipases A2 (PLA2) present in the venoms, still persist. In search for alternatives to antagonize the PLA2 activity of Bothrops asper's venom, 36 extracts belonging to seventeen families of vascular plants and bryophytes were screened. A significant inhibition of the enzymatic activity of PLA2 present in B. asper's whole venom was seen in eleven of these extracts. In addition, the antioxidant activity of all the extracts was evaluated. The results evidenced a significant statistical correlation between extracts with an inhibitory effect against PLA2 and those with an antioxidant activity. Moreover, the amount of phenols was quantified finding a relationship between the bioactivity and the presence of these compounds. Nine extracts were screened against a fraction of the venom rich in basic PLA2 (Fx-V B. asper), exhibiting an inhibitory effect on PLA2 activity of this fraction in a range from 30-80%. This activity was supported by the inhibition that these extracts presented on the cytotoxicity caused by Fx-V B. asper on murine skeletal muscle C2C12 myoblasts. The results obtained, could point to minimize efforts in the search of PLA2 inhibitors by focusing in samples with known antioxidant properties.Revista Brasileira de Farmacognosia 12/2010; 20(6):910-916. DOI:10.1590/S0102-695X2010005000030 · 0.80 Impact Factor
Article: Clinical ToxicologyAcademic Medicine 12/1964; 40(1):69. · 3.47 Impact Factor