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Pediatric snakebite in Sub-Saharan Africa: Clinical predictors, outcomes, and gaps in care-A systematic review

Samuel Mayeden1, Margit Wirth2, Nisreen Agbaria1

  • 1Heidelberg Institute of Global Health, Medical Faculty, Heidelberg University, Heidelberg, Germany.

Plos Neglected Tropical Diseases
|February 19, 2026
PubMed

Insights

Snakebite envenomation in children in sub-Saharan Africa causes significant preventable harm. Delays in care and poor access to antivenom and emergency services are key drivers of severe outcomes and mortality.

Area of Science:

  • Pediatric toxicology
  • Public health
  • Epidemiology

Background:

  • Snakebite envenomation (SBE) is a neglected public health issue in sub-Saharan Africa (SSA), particularly affecting children.
  • Clinical predictors of SBE severity and regional outcome disparities remain poorly understood.

Purpose of the Study:

  • To systematically review and synthesize data on pediatric SBE in SSA.
  • To identify clinical and demographic predictors of severe outcomes in children affected by SBE.

Main Methods:

  • Systematic review of peer-reviewed studies on pediatric SBE in SSA published up to October 2024.
  • Descriptive synthesis of data on study characteristics, SBE symptoms, risk factors, and outcomes.

Main Results:

  • Eighteen studies involving 2,687 pediatric patients revealed that severe outcomes (death, amputation) were linked to delayed hospital presentation, traditional first aid, young age, severe swelling, and upper limb bites.
  • Mortality rates varied significantly across countries (e.g., <5% in South Africa to 36% in Cameroon), correlating with antivenom and emergency care access.
  • Antivenom availability was inconsistent, with common adverse reactions; neurotoxic SBE cases were rare.

Conclusions:

  • Pediatric SBE in SSA results in substantial preventable morbidity and mortality.
  • Delayed care, inconsistent access to emergency services, and inadequate antivenom contribute significantly to poor outcomes.
  • Enhanced health system capacity, prompt referral, and standardized management protocols are crucial for improving pediatric SBE outcomes in SSA.
Abstract

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