Snakebite in Tanzania: The situation on the ground, by Professor Kim Howell

1. SNAKEBITE IN
TZ
The situation on the ground

2. A DEARTH OF
INFORMATION
IS THE NORM
 WHICH SPECIES?
 WHEN DID BITE TAKE PLACE?
 UNDER WHAT CIRCUMSTANCES?

3. MOST PEOPLE LACK
KNOWLEDGE OF
SNAKES
 THE BELIEF IS THAT ONLY GOOD
SNAKE IS A DEAD SNAKE
 AND ALL SPECIES OF SNAKES ARE
VENOMOUS AND DANGEROUS

4. FIRST EXAMPLE
 TANZANIAN STUDENT DIED IN
UDZUNGWA NATIONAL PARK AFTER
BEING BITTEN BY A SNAKE NEAR A
WATERFALL NOT FAR FROM PARK
HQ

5. 2 ND EXAMPLE
 BRITISH SAFARI/TOUR OPERATOR
BITTEN IN HIS SITTING ROOM AFTER
TRYING TO GRAB A SNAKE HE KNEW
TO BE “HARMLESS” CRAWLING
ACROSS THE FLOOR

6. 3 RD EXAMPLE
 FEMALE TANZANIAN ACADEMIC
STAFF MEMBER OF UDSM BITTEN IN
HER HOUSE WHEN SHE GOT UP AT
NIGHT TO USE THE TOILET

7. QUESTIONS
 EXAMPLE 1: WHAT SPECIES OF
SNAKE CAUSED THE DEATH? WHY
DID THE SNAKE BITE?
 NO DATA, PROBABLY A COBRA
(SPITTER OR FOREST COBRA) OR
MAMBA (EITHER BLACK OR GREEN IS
POSSIBLE)

8. QUESTIONS 2 ND
EXAMPLE
 WHY DID PERSON PICK UP THE
SNAKE? Thought he knew snakes,
thought it was harmless
 Species: Atractaspis sp. Burrowing Viper,
one of the few sp. of snakes that cannot
be handled safely

9. QUESTIONS, 2 ND CASE
CONTD
 When he described the situation, he
noted he (and friend who were
subsequently bitten trying to show that
HE knew how to handle snakes!) had
had “a few” (the number was not stated)
beers….

10. 3 RD EXAMPLE
 THE BODY OF THE SNAKE WAS
SAVED AND LATER IDENTIFIED AS A.
BIBRONII. (This species is well known
for getting under doors and into crevices
of blockwork.)

11. WHAT CAN WE LEARN?
 INFORMATION ON BITES IS UNDER
REPORTED AND MAY BE
INACCURATELY REPORTED
 MANY PEOPLE MAY NOT KNOW THE
CORRECT FIRST AID
 MANY HOSPITALS AND CLINICS MAY
INAPPROPRIATELY USE ANTIVENIN
(CASE 3)

12. ECOLOGY MATTERS

13. SNAKES ARE NOT
EQUALLY
DISTRIBUTED
 FEW PEOPLE IN TZ KNOW THE
VENOMOUS SNAKES OF THEIR AREA
 DRY AREAS FAVOUR COBRAS,
MAMBAS
 MOIST FOREST AREAS FAVOUR
DIFFERENT SPECIES
 SOME SPECIES SUCH AS SPITTING
COBRAS AND PUFF ADDERS ARE
WIDE SPREAD

14. NURSE-LED CLINIC-
MESERANI SNAKE PARK
ARUSHA
 BETWEEN APRIL 2007 AND 2009, 85 patients: 32
(37%) of the each unable to identify the snake that had
bitten them. The puff adder (Bitis arietans) caused
more bites (24) than any other snake.
 The 85 snakebite cases had a mean age of 23 years
and a male:female ratio of 1.4. Most of the bites
occurred in the evening or at night and most also
occurred during the rainy season. In some cases, the
seeking of treatment from traditional healers delayed
treatment at the clinic. After being bitten, the snakebite
cases travelled a mean of 82 km (range=2–550 km) to
reach the clinic

15. MESERANI
CONTINUING
 Forty-two of the snakebite cases received
antivenom. Only one patient (1%), a 12-year-
old girl, was believed to have died as the result
of a snakebite another six (7%) each required a
skin graft or the amputation of a limb or digit.

16. MESERANI
CONTINUING
 Establishment of the Snake Park clinic
appears to have improved access to
snakebite treatment, with cases of
snakebite travelling long distances to
reach the clinic (because of the lack of
any other source of antivenom in
Tanzania).

17. WHAT IS NEEDED?
 MORE INFORMATION!
STANDARDISED RECORDING OF
DATA FOR BITES