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The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths.

Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, Savioli L, Lalloo DG, de Silva HJ - PLoS Med. (2008)

Bottom Line: Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used.These figures may be as high as 1,841,000 envenomings and 94,000 deaths.The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.

ABSTRACT

Background: Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burden due to snakebites.

Methods and findings: The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant country-specific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the Global Burden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deaths were estimated on the basis of observed mortality rates and the at-risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact that envenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually.

Conclusions: Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa.

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Related in: MedlinePlus

Schematic Diagram of the Steps of the Literature Review
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pmed-0050218-g001: Schematic Diagram of the Steps of the Literature Review

Mentions: The keywords used for this search were “snakebite and epidemiology,” “snakebite and incidence,” “snakebite and morbidity,” “snakebite and mortality,” “snakebite and envenomation,” “snakebite and envenoming,” and “snakebite and deaths.” The languages of publications included English, French, and Spanish. The process of the published literature review is shown in Figure 1. The original search, carried out at the Liverpool School of Tropical Medicine by a professional data retriever, generated 3,256 citations of publications relating to snakebite. The abstracts of these citations were downloaded and scrutinized by a snakebite expert (DGL) to select all the publications that were likely to be useful for the purpose of the study, considering its objectives. This step resulted in retrieval of 272 full papers. These papers were scrutinized by three independent researchers at the University of Kelaniya to select publications that contained information that would be useful for estimation of incidence and mortality rates of snakebite. Papers reporting extremely high rates from very small studies were not included because they were considered unreliable. This resulted in short-listing 158 original papers and two books.


The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths.

Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, Savioli L, Lalloo DG, de Silva HJ - PLoS Med. (2008)

Schematic Diagram of the Steps of the Literature Review
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2577696&req=5

pmed-0050218-g001: Schematic Diagram of the Steps of the Literature Review
Mentions: The keywords used for this search were “snakebite and epidemiology,” “snakebite and incidence,” “snakebite and morbidity,” “snakebite and mortality,” “snakebite and envenomation,” “snakebite and envenoming,” and “snakebite and deaths.” The languages of publications included English, French, and Spanish. The process of the published literature review is shown in Figure 1. The original search, carried out at the Liverpool School of Tropical Medicine by a professional data retriever, generated 3,256 citations of publications relating to snakebite. The abstracts of these citations were downloaded and scrutinized by a snakebite expert (DGL) to select all the publications that were likely to be useful for the purpose of the study, considering its objectives. This step resulted in retrieval of 272 full papers. These papers were scrutinized by three independent researchers at the University of Kelaniya to select publications that contained information that would be useful for estimation of incidence and mortality rates of snakebite. Papers reporting extremely high rates from very small studies were not included because they were considered unreliable. This resulted in short-listing 158 original papers and two books.

Bottom Line: Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used.These figures may be as high as 1,841,000 envenomings and 94,000 deaths.The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.

ABSTRACT

Background: Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burden due to snakebites.

Methods and findings: The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant country-specific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the Global Burden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deaths were estimated on the basis of observed mortality rates and the at-risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact that envenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually.

Conclusions: Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa.

Show MeSH
Related in: MedlinePlus