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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

Regional Estimates of Envenomings Due to Snakebite (Low Estimate)
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pmed-0050218-g005: Regional Estimates of Envenomings Due to Snakebite (Low Estimate)

Mentions: Of the 227 countries, 58 were identified as countries where venomous snakebites do not occur. Data useful for calculation of the incidence of snakebite in 62 countries were found in 40 publications [9–60]. The review of grey literature resulted in two Web sources [82,83] and 13 communications that generated data for 15 more countries. Data thus obtained for 77 countries were used for the estimation of the number of snakebite envenomings in 92 countries without data (Figure 4; Table S1). The estimated number of snakebite envenomings by region is shown in Figure 5 and Table 1. In our most conservative estimate, the highest number of envenomings were estimated for South Asia (121,000) followed by Southeast Asia (111,000), and East Sub-Saharan Africa (43,000). The lowest numbers were estimated for Central Europe and Central Asia. We estimate that, globally, at least 421,000 envenomings occur annually; this figure may be as high as 1,841,000. According to our most conservative country estimates, which were used to calculate the regional estimates, India had the most envenomings at 81,000 per year. Sri Lanka (33,000), Viet Nam (30,000), Brazil (30,000), Mexico (28,000), and Nepal (20,000) were the other countries that had a high estimated number of envenomings annually.


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)

Regional Estimates of Envenomings Due to Snakebite (Low Estimate)
© Copyright Policy
Related In: Results  -  Collection

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

pmed-0050218-g005: Regional Estimates of Envenomings Due to Snakebite (Low Estimate)
Mentions: Of the 227 countries, 58 were identified as countries where venomous snakebites do not occur. Data useful for calculation of the incidence of snakebite in 62 countries were found in 40 publications [9–60]. The review of grey literature resulted in two Web sources [82,83] and 13 communications that generated data for 15 more countries. Data thus obtained for 77 countries were used for the estimation of the number of snakebite envenomings in 92 countries without data (Figure 4; Table S1). The estimated number of snakebite envenomings by region is shown in Figure 5 and Table 1. In our most conservative estimate, the highest number of envenomings were estimated for South Asia (121,000) followed by Southeast Asia (111,000), and East Sub-Saharan Africa (43,000). The lowest numbers were estimated for Central Europe and Central Asia. We estimate that, globally, at least 421,000 envenomings occur annually; this figure may be as high as 1,841,000. According to our most conservative country estimates, which were used to calculate the regional estimates, India had the most envenomings at 81,000 per year. Sri Lanka (33,000), Viet Nam (30,000), Brazil (30,000), Mexico (28,000), and Nepal (20,000) were the other countries that had a high estimated number of envenomings annually.

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