Snakebites are a significant burden in Nigeria. Many rural communities’ dwellers in Nigeria are often at risk of snakebites, with access to treatment almost practically inaccessible in impoverished rural settings.
The WHO calls snakebites “arguably the world’s biggest hidden health crisis”, with one person dying from a bite every four minutes. Hundreds of thousands of others are left seriously disfigured, physically disabled or sometimes requires amputation.
Snakebites hit the poorest of the poor; farmers, herders, and hunters who constitute the greater percentage of victims of snakebites, but they are major contributors to our GDP through farming, cattle rearing and mining, which now enjoys government patronage under its economic diversification agenda.
Although, recently there have been outcry at homes, about snakebite, especially from toilets. On Saturday, I was at the emergency section of a tertiary health institution to see a patient; who was bitten on his foot by a snake. My friend asked him what the issue was and he answered “I was bitten by a snake which was why I’ve been here since morning, but it’s evening now and I was just offered a drug which was paracetamol only and haven’t been attended to…”
At the same moment I was watching this patient, I was imagining a situation whereby if I’m bitten by a snake, I feel the pain and venom spread through my body – knowing it may kill me and there is no treatment available. This is what victims of snakebite go through and often do not get the treatment they need in time, if at all.
Also, last week, a husband narrated how he lost his wife who was 8-months pregnant due to a untimely and ineffective care. He revealed how she couldn’t access treatment due to lack of anti-venom serum (ASV) in the hospital in good time, and thereafter, she died. Just like these cases, snakebites victims are thought to suffer life-changing injuries such as amputation and permanent disability.
Anti-venom is the medicine of choice for treating snakebites. It is made using the venom of the snake it is designed to treat. Anti-venom treatment is made in the same way that it has been for more than 100 years. The costly and laborious processes see antibodies harvested from horse blood to make anti-venom. But even so, it is estimated that the world produces only a third of the anti-venom that it needs.
We have anti-venom at our hospitals, which is not commonly stocked in public facilities in Nigeria; still, it would be difficult to get to a hospital more than a few kilometers away in time for treatment which means time spent transporting a victim to a hospital located far away from his home can be fatal. Lack of treatment and even the wrong medicine is also a challenge.
Aside of the scarcity of anti-snake venom and lack of suitable anti-venoms, difficulty in accessing health facilities is another challenge for victims of snakebite in many parts of the country, which has made patient care challenging. One of the various reasons for this is that they cannot access – let alone afford – conventional medical treatment.
Anti-venom remains the only way to envenoming management as it confers protection against mortality. But the situation has allowed weak or inappropriate medicine to flood the market over the past decades, particularly in Africa. An SAV against one snake specie is “monovalent”, while a mixture of two or more SAVs is “polyvalent”, which we use in Nigeria due to the variety of so many venomous snakes found here. Europe uses the monovalent, as they have only one specie of venomous snake.
Sometime in March last year, Nigerians were alarmed when reports in the media indicated scarcity of Anti-Snake Venom (ASV) in the country. Although, going through some public and private facilities shows ASV is more available in private facilities in Nigeria.
These anti-venoms often cost a huge sum of money ranging from N4,000-8000 ($11-20) per 10ML vial, of different brand (produced in UK, India and some other parts of the Europe), with three to 5 vials usually required to save a victim’s life, which cost almost the new minimum wage. Although, in some tertiary hospitals, the cost is a bit less but the availability is the problem. Meaning many victims either seek no treatment at all or go to a local witch doctor or herbalist.
Since most snakebite victims currently cannot afford the anti -snake venom, the solution lies in preventive measures and manufacturing ASV locally since there are snake farms in the country with our local snake charmers engaged to make the job easier instead of spending millions of naira to import antidotes for snakebites, which will make it available, affordable, accessible and saving a lot of cost. Communities should be sensitized about snakebite risks, local first aid, timely treatment of snakebite, and victims should be offered realistic solutions that mitigate the hazards.
The Ministry of Health must ensure primary healthcare centres and other hospitals across the country should be properly equipped for this purpose with quality anti-venoms that are effective against local snake species and safe when administered, need to be made available free of charge or at a price that everyone can afford in public hospitals. At the same time, improved emergency transportation system in remote areas is needed, training more clinicians and healthcare workers on how to effectively treat snakebite victims’ will safe more lives.
Yusuf Writes from Usmanu Danfodiyo University Sokoto. He can be reached at firstname.lastname@example.org