Snake-bite poisoning in childhood: approach to diagnosis and management

Abstract

This review article examined the epidemiology, pathophysiology, a simple approach to a child allegedly bitten by a snake, and treatment and prevention of snake-bite poisoning. It aims at stimulating the interest of the general paediatrician and raising awareness of health-policy makers of this neglected but important public health issue. Snake bites are most common in tropical countries and in rural areas. Recently, they have been categorized as a Neglected Tropical Diseases (NTDs) to widen its recognition and, more importantly, to improve the allocation of resources given that death from snake-bite poisoning is preventable. The reported prevalence of snake bites in Nigeria is 5 per 1000 persons per year, with the majority of the bites by the African saw-scaled viper (Echis ocellatus). The key to minimizing mortality and severe morbidity is aggressive management of the ABCs of resuscitation, and timely and judicious administration of an adequate dose of antivenom. The health education campaign should emphasize immediate transportation of the victim to an equipped health facility, reassurance, immobilization of the bitten extremity and avoidance of harmful and time-wasting procedures. The paucity of data on the precise incidence of snake-bite poisoning and difficulties in snake identification have led to underestimation of antivenom needs, deficient distribution policies, low antivenom production with an increase in prices of available antivenom, and poor regulation and marketing of inappropriate antivenoms with a general erosion of confidence in antivenom therapy.