Challenges in care of snake envenomation in rural Pakistan: a narrative review

Abstract

Snake envenomation remains a neglected tropical disease in Pakistan per the World Health Organization, with approximately 40,000 bites and 8,200 fatalities annually. To understand the factors leading to increased mortality, we performed a narrative review of the medical literature pertaining to snake envenomation in Pakistan and surrounding countries. Several factors have led to increased mortality in rural communities. First, geographical variations in snake venom composition between countries lead to a decreased efficacy of polyvalent antivenom in Pakistan that is produced using snake species from different areas. Geographical variations in snake venom composition between countries lead to a decreased efficacy of polyvalent antivenom in Pakistan. Furthermore, healthcare providers in rural communities are inadequately trained on antivenom dosing regimens or adverse reactions. Long transport times and the use of traditional healers lead to delays in administration of antivenom. Additionally, many types of antivenom must be stored at 2-8 degrees Celsius. Lack of refrigeration to store antivenom limits access in rural locations. Research advances are being developed to create new generations of antivenom that may be better suited for rural communities. Lastly, increased educational efforts may further reduce mortality.