A long-term observational study of paediatric snakebite in Kilifi County, south-east Kenya
Michael Abouyannis1,2, Mwanamvua Boga1, David Amadi1
1KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
Insights
Paediatric snakebite in sub-Saharan Africa is a significant health issue, with incidence rising alongside population growth. This study identified key predictors of severe local tissue damage in children, aiding future research.
Area of Science:
- Tropical Medicine
- Paediatric Epidemiology
- Toxicology
Background:
- Snakebite envenoming disproportionately affects children in sub-Saharan Africa, posing a high risk of severe outcomes.
- Limited data exist on the incidence, clinical presentation, and risk factors for severe outcomes in paediatric snakebite cases in the region.
Purpose of the Study:
- To determine the population-incidence and mortality rate of hospital-attended paediatric snakebite in Kilifi County, Kenya.
- To describe the clinical syndromes associated with paediatric snakebite envenoming.
- To identify predictors of severe local tissue damage following snakebite in children.
Main Methods:
- Prospective registration of all paediatric snakebite cases at Kilifi County Hospital, Kenya, from 2003-2021.
- Utilized the Kilifi Health and Demographic Surveillance System (KHDSS) for population-incidence and mortality calculations.
- Multivariate logistic regression analysis was employed to identify predictors of severe local tissue damage.
Main Results:
- 584 paediatric snakebite cases were admitted to the paediatric high dependency unit (HDU) over 19,606 admissions.
- Population-incidence rates were 11.3/100,000 person-years for children ≤5 years and 29.1/100,000 person-years for children 6-12 years.
- Low hemoglobin, high white blood cell count, low serum sodium, high systolic blood pressure, and upper limb bite-site were associated with severe local tissue damage.
Conclusions:
- Paediatric snakebite represents a substantial disease burden in the study area, with incidence increasing with population growth.
- A low mortality rate was observed, potentially influenced by local snake species.
- Identifying predictors of severe local tissue damage is crucial for advancing research into this complication.
Introduction:
Estimates suggest that one-third of snakebite cases in sub-Saharan Africa affect children. Despite children being at a greater risk of disability and death, there are limited published data. This study has determined the: population-incidence and mortality rate of hospital-attended paediatric snakebite; clinical syndromes of snakebite envenoming; and predictors of severe local tissue damage.
Methods:
All children presenting to Kilifi County Hospital, Kenya with snakebite were identified through the Kilifi Health and Demographic Surveillance System (KHDSS). Cases were prospectively registered, admitted for at least 24-hours, and managed on a paediatric high dependency unit (HDU). Households within the KHDSS study area have been included in 4-monthly surveillance and verbal autopsy, enabling calculation of population-incidence and mortality. Predictors of severe local tissue damage were identified using a multivariate logistic regression analysis.
Results:
Between 2003 and 2021, there were 19,606 admissions to the paediatric HDU, of which 584 were due to snakebite. Amongst young children (≤5-years age) the population-incidence of hospital-attended snakebite was 11.3/100,000 person-years; for children aged 6-12 years this was 29.1/100,000 person-years. Incidence remained consistent over the study period despite the population size increasing (98,967 person-years in 2006; and 153,453 person-years in 2021). Most cases had local envenoming alone, but there were five snakebite associated deaths. Low haemoglobin; raised white blood cell count; low serum sodium; high systolic blood pressure; and an upper limb bite-site were independently associated with the development of severe local tissue damage.
Conclusion:
There is a substantial burden of disease due to paediatric snakebite, and the annual number of cases has increased in-line with population growth. The mortality rate was low, which may reflect the species causing snakebite in this region. The identification of independent predictors of severe local tissue damage can help to inform future research to better understand the pathophysiology of this important complication.
