Snakebite as a neglected disease in indonesia

Abstract

This is an open access article distributed under the terms of the Creative Commons At-tribution-NonCommercial 4.0 International Licence (http:// creativecommons.org/licences/ by-nc/4.0/). 1 N eglected Tropical Diseases (NTDs) are widespread in the world's poorest areas, where access to safe clean water, sanitation and health services is substandard. 1 NTDs affect more than 1 billion people worldwide and are mostly caused by a wide variety of pathogens including viruses, bacteria, parasites, fungi and toxins. 2 These diseases are "neglected" because they are virtually missing from the world health agenda, receive minimal funding, and are associated with stigma and social exclusion. 3 These diseases rarely get public attention and are commonly experienced by disadvantaged populations who have low education and limited employment opportunities. In May 2017, the Director-General of the WHO accepted the recommendation of the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases (STAG) to add snake bites to the list of neglected tropical diseases. 1 Snake bites are predominantly found in low-and middle-income countries in Asia, Africa, Central and South America. An improvement in medical care would prevent the majority of the approximately 100,000 deaths each year and permanent physical damage in 400,000 people. In addition, there is a lack of antivenins (medicines to neutralize the effects of the poison) in sufficient quantity and quality, and adequate training of the medical staff at all levels of health care. Venomous snakebites are a little-recognized and underestimated public health threat in countries with tropical climates and subsistence-based populations. 4 Epidemiological estimates published by the WHO in 1998 assume that about 5.4 million people are bitten by venomous snakes each year, of which about 125,000 die and an unknown number suffer significant physical disability. 5 These data suggest a worldwide incidence of about 90-130 venomous snakebites per 100,000 population with a mortality rate of about 2%. 6 However, the data is uncertain because these estimates are largely based on hospital statistics, but the vast majority of victims of venomous snake bites are treated with traditional healing methods in their villages or die on route to a medical facility and thus escape such statistical recording. 7 Not surprisingly, the few studies in which a randomized proportion of a country's population was surveyed showed a far higher incidence than the hospital-based epidemiological estimates: A nationwide survey in Bangladesh, for example, revealed an incidence of about 623 snake bites per 100,000 inhabitants per year 6.7 and a study from Nepal found an incidence of about 1162/100,000 with a mortality of about 14%. 8 A national representative survey of causes of death from India found 45,900 deaths from venomous snakebites per year in that country, which corresponds to a mortality rate of 4.1/100,000 population. 9 Such solid epidemiological data are urgently needed in order to understand the real extent of this serious public health problem and then to be able to respond in a targeted and cost-effective manner. In particular, to estimate the need for snake venom antiserum, robust data on the absolute and seasonal frequency of snake bites are needed. It is also important to know which species of venomous snakes' cause envenomation with what frequency, how the snakes and the specific envenomation syndromes can be distinguished and which antisera should therefore be used in a particular region. How about snakebite in Indonesia? With a population of over 250 million people, possessing over