Tackling Snakebite Envenoming in Communities

Neglected Tropical Diseases (NTDs) affect over a billion people globally, with a significant burden falling on low-income regions. Among these, snakebite envenoming stands out as a critical public health issue, causing over 100,000 deaths and 400,000 disabilities annually. Vulnerable communities, often in rural areas, are disproportionately impacted. Despite its severity, snakebite envenoming remains under-prioritized in national and global health strategies.

In Kenya, snakebite envenoming is particularly neglected. Challenges such as perennial anti-venom stockouts, lack of budgets for anti-venom procurement, and limited healthcare worker training on snakebite management exacerbate the problem. Additionally, communities lack basic knowledge on prevention and first aid, relying instead on deeply entrenched traditional methods that often worsen outcomes.

Supported by Health Action International, Access to Medicines Platform(AtMP) implemented the snakebite project here in Kenya since 2019 and have been able to undertake various research projects in high-risk counties.

The research focused on Snakebite incidences, availability, affordability and stock outs of snakebite commodities, healthcare workers perspectives and knowledge on snakebites, community perspectives on snakebites and socio-economic consequences of snakebites. The evidence generated from these studies has shed light on harmful myths and practices that hinder effective snakebite management and the need for targeted interventions.

Common Myths and Traditional Beliefs

Snakebites as acts of Witchcraft: Many community members believe that snakebites are not accidental but are caused by witchcraft or jealousy. This misconception obscures the reality that snakebites follow clear patterns. Individuals working in natural areas without protection, such as closed-toe shoes, adequate housing, or flashlights, are at higher risk. Snakebites are preventable through simple safety measures and awareness.

“We believe in Masai that it does not just bite you. There must be a reason. This could be due to differences in the community, for example quarrels with an elder, neighbour, etc. Because at times we stay with them, yet they don’t bite us. At times they just pass on without biting.” – Focus Group Participant, Kajiado

• The “Black Stone” myth: A common belief is that placing a “black stone” on the bite site can suck out venom within 30 minutes. This practice is not only ineffective but also delays victims from seeking timely medical attention, increasing the risk of severe complications or death.

“As first aid we tied above the bitten part to prevent flow of poison, and cut the area and placed the black stone. The stone (…) helped a lot by sucking the poison. Later he was taken to hospital, but the first aid was so helpful. The stone fell off after 40 minutes and had sucked all the poison and he felt okay.” – Focus Group Participant, Kajiado

• Visiting witch doctors: In some cases, victims consult witch doctors, believing that the bite is a result of bewitchment. Traditional methods have no proven efficacy in treating snakebites and often lead to delays in accessing lifesaving medical care.

“l have witnessed a situation where the witch doctor was involved. He cut the victim’s skin and then told the people to cover the victim, he would return but he delayed, and the victim died. He was a very trusted witch doctor so from then on if anyone is bitten, the person will go to the hospital.” Community Beliefs on how to Prevent a Snakebite– Focus Group Participant, Kilifi

• Sucking out Venom: Some victims seek assistance from elders to suck out venom from the bite wound. However, venom enters the bloodstream quickly, making extraction impossible. This practice can harm both the victim and the person attempting to extract venom due to potential infections and exposure to venom residue.
• Tying a cloth on the bite: A popular first aid method involves tying a cloth above the bite to “stop venom from spreading.” While this might seem logical, venom travels swiftly through the bloodstream, and restricting blood flow can lead to tissue damage, increasing the likelihood of amputation.

“The only thing I did at home in haste is tying the bitten hand and travelled for approximately one hour to Ewaso where we got some first aid.” (FGD 1.1)

• Social Stigma Around Snakebite Victims: Some communities view snakebite victims as bad omens, leading to social exclusion. This belief stems from a lack of understanding of snake behavior. Snakes bite to defend themselves, not out of malice and victims pose no threat to others.
• Applying Kerosene: Another common practice is applying kerosene to the bite, believing it neutralizes venom. This is not only ineffective but also introduces foreign substances that can cause infections.

The reality of Snakebite Management

It is crucial to dispel myths and replace harmful practices with evidence-based strategies:

• Not all snakes are venomous: Most snakes are non-venomous, and even venomous snakes can deliver “dry bites” without injecting venom. However, all snakebites should be treated as medical emergencies.
• Seek medical attention immediately: Victims should go directly to a hospital for proper care. Delays caused by reliance on traditional remedies can be fatal.
• Educating communities: Community sensitization and awareness must focus on prevention, such as wearing protective footwear, using flashlights at night, clearing bushes and ensuring proper housing.
• Training Health Care Workers: Equipping healthcare providers with the knowledge and resources to manage snakebite cases, including the proper use of anti-venom, is critical.

Snakebite envenoming remains a silent but deadly challenge in Kenya, exacerbated by harmful myths and inadequate healthcare resources. Debunking misconceptions, promoting awareness, and strengthening health systems will significantly reduce the burden of this Neglected Tropical Disease. Community engagement, coupled with targeted interventions, holds the key to saving lives and improving outcomes for snakebite victims.