Mapping snakebite epidemiology in Nicaragua--pitfalls and possible solutions

Area of Science:

• Epidemiology
• Public Health
• Geographic Information Systems

Background:

• Snakebites pose a significant public health challenge in Nicaragua, a tropical developing country.
• Existing healthcare data may underestimate snakebite incidence due to underreporting.
• Accurate snakebite data is essential for effective resource allocation and public health interventions.

Purpose of the Study:

• To create an incidence map of snakebites in Nicaragua.
• To identify municipalities with likely underreporting of snakebite cases.
• To improve the accuracy of snakebite surveillance for better resource distribution.

Main Methods:

• Categorized Nicaraguan municipalities by precipitation, altitude, and geographical location.
• Developed an underreporting index using socio-economic and healthcare variables.
• Employed Poisson regression to model municipality-level snakebite incidence, incorporating environmental, underreporting, and demographic factors.

Main Results:

• Identified a non-linear association between the underreporting index and snakebite incidence, suggesting higher underreporting in deprived areas.
• Highlighted municipalities with high underreporting scores, low reported incidence, and large rural populations.
• Reported 3,286 snakebite cases from 2005-2009, with a 5-year incidence of 56 per 100,000 inhabitants.

Conclusions:

• Successfully identified areas with likely snakebite underreporting using publicly available data.
• The findings can help mitigate the impact of case detection bias on resource allocation for snakebites.
• This low-cost methodology offers a model for investigating snakebite epidemiology in similar global settings.