Management of snakebites at a rural South African hospital

Abstract

Background: Snakebites remain a source of considerable morbidity and mortality in many countries, with an estimated global true incidence of envenomation exceeding five million a year, with about 100 000 of these cases developing severe sequelae. Despite the availability of polyvalent snake antivenom, inappropriate first aid, regional effects of envenomation and inappropriate use of antivenom result in significant and at times potentially avoidable morbidity and mortality, particularly in children. The study was undertaken in Lephalale (previously Ellisras) Hospital, Limpopo Province, due to the frequency of snakebites managed at the hospital. Methods: This was a record-based retrospective study in which patient files with the diagnosis of snakebite were reviewed. The objective of this study was to document the management of snakebites at Lephalale Hospital, a rural hospital in South Africa. The hospital files of all patients managed at the hospital for snakebites from 1 January 1998 to 31 December 2001 were reviewed. Results: Seventy patients were treated for snakebites during the study period. The results showed a male preponderance (60%) and a mean age of 27.3 years among the reported cases. Twenty-nine patients (41.1%) were bitten between dusk and dawn (18:00 and 06:00), 43 (61.4%) were bitten on the lower limb and the mean duration of admission in the wards was 4.2 days. Twenty-one bites (30%) were attributed to known poisonous snakes, 22 (31.4%) patients received polyvalent antivenom, 42 (60%) received promethazine, which has not been shown to prevent anaphylactic reactions, 12 (17.1%) developed complications and two died (a case fatality rate of 2.9%). None of the patients was given tetanus toxoid as prophylaxis, as no previous tetanus immunisation was documented. Conclusions: The findings of this study highlight gaps in the management of snakebites at this rural hospital where they were treated frequently. It is crucial for primary care physicians to be familiar with the most common venomous snakes in South Africa and the management of their bites in humans. Elevation of the affected limb, administration of intravenous fluids and administration of analgesia, with close monitoring of patients during and after antivenom administration, form the basis of most clinical protocols on the management of snakebites.