Clinical presentation and management of snakebite envenoming in northern Ghana

Snakebite envenoming is among the top five emergency health conditions in northern Ghana. Among the four genera of snake species classified to be of highest medical importance, species with haemotoxic venom are responsible for about 90% of all snakebite case presentations in the region. However, there is a dearth of clinical data on signs and symptoms of envenoming, treatment practices and health outcomes. We examined the signs and symptoms of envenoming and clinical management practices at referral hospitals in northern Ghana.

Medical records of patients reporting on account of snakebite between 2016 and 2020 at the Wa Municipal Hospital in the Upper West region and the Baptist Medical Centre in the North East region of Ghana were reviewed. Demographic characteristics, patients' clinical data and management practices were analysed and evaluated taking into consideration the national standard treatment guideline.

A total of 2,684 records of patients reporting on account of snakebite were accessed at both health facilities over the five-year period. 91% of the patients were admitted to the ward. Swelling, severe pain and bleeding were the most common clinical signs upon presentation. A total of 1,670 (64.7%) of all the patients tested had at least one abnormal blood clotting result suggesting haemotoxicity. Antivenom was administered to 84.3% of the patients. Antibiotics were administered to 70.5% with amoxicillin with clavulanic acid, flucloxacillin and metronidazole accounting for 59.2% of all antibiotics administered. The recorded case-fatality rate was 1.9%.

The annual hospital attendance rate on account of snakebite to the Wa Municipal Hospital and the Baptist Medical Centre is estimated at 55 persons per 100,000 population per year. Mortality was low, with antivenom available to most of the patients. More evidence is needed on the indication and dosing of antivenom and to improve appropriate ancillary care.