Worries over increase in snake bite deaths

Swaying to the hypnotic rhythm of the viper in front of him, Royjan Taylor, Watamu snake-venom milker shows no fear for the venomous fangs of this slithery reptile as he holds its mouth wide open with ease.

Taylor whose firm, Bio-Ken Snake Farm, makes antivenin for treating snake bites, captures the reptiles from the wild and brings them to this sanctuary.

A while back, a three-year-old boy from Kalabata village in Baringo North Sub-County died after being bitten by a poisonous snake.

He was playing with his siblings at home when he fell on the puff udder, which bit him four times on the waist. He died on the way to hospital as he father desperately sought help at several healthcare centres.

Mr John Rong’uno, the boy’s father, said they first rushed him to the nearest health facility but there was no health worker, so they cycled another 20 kilometres to Bartabwa Health Centre.

“At the facility, we waited for more than four hours for the nurse on duty to arrive. The child was not even given first aid and we were later referred to the Baringo County Referral Hospital in Kabarnet since there were no anti-venom drugs at the facility,” Mr Rong’uno explained. “The child died on the way to Kabarnet, more than 50 kilometres away.”

UNREPORTED CASES

The incident happened barely eight months after a seven-year-old boy died of a snake bite in Kapkoiwo, Baringo North Sub-county, after being bitten by a snake while herding cattle. He died while undergoing treatment at the Kabartonjo Sub-county Hospital.

Deaths from snake attacks have also been reported recently in Tharaka-Nithi and Lamu, but in most cases, such incidents go unreported.

The abundance of snakes in arid and semi-arid areas or during the rainy season, coupled with a chronically underfunded health system, means the snakebite mortality rate across the country is fairly high.

Cases of snake bites typically increase at the beginning of the rainy season, when the reptiles come out of their shelter to hunt and breed.

The snake bite menace is also prevalent in dry and arid areas like Baringo, Kitui, Kilifi, Wajir, Garissa, Machakos, Marsabit, Isiolo, Makindu, Mwingi, and Taveta as the snakes slither into homestead to seek water and shelter.

Baringo County Kenya Wildlife Service (KWS) Deputy Warden David Cheruiyot told DN2 that in 2017, for instance, more than four deaths and 13 injuries were reported, while in 2018, four deaths and 55 snakebite injuries were reported.

“The situation is worse during the dry spell, with snakes straying into homesteads in search of water. We have been advising people to put water outside their homes to reduce the chances of being bitten,” said Mr Cheruiyot.

SHORTAGE
The untimely deaths of the two children have sparked concerns over the rising number of deaths from snake bites in the Kerio Valley as the region grapples with an acute shortage of anti-venom.

Snake Bite Rescue Rehabilitation and Research Centre Kenya estimates that 300-500 people are admitted every month due to snake bites across the country. But many end up dying or losing their limbs because they cannot access antidotes.

It is estimated that between 15 and 25 people lose their lives every day to snake bites while more than 100 others have their limbs amputated, causing them permanent disability. The situation is especially dire in areas like Kerio Valley, where access to healthcare is a nightmare.

Although, the shortage of the anti venom is not uniquely a Kenyan problem, the government is on the spot for procuring anti-venoms that cannot treat bites by local snakes.

A shortage of antivenin supply across the continent began less than three years ago after the production of one of the continent’s most effective anti venoms was discontinued by its French manufacturers over low-profit claims.

Fav-Afrique, a polyvalent manufactured by French firm Sanofi Pasteur, was once considered one of the most powerful and reliable anti venom drugs and was used to treat bites by more than 10 types of snakes.

The withdrawal of the drug, dealt a massive blow aggravated an already bad situation, to the detriment of hundreds of snakebite victims in Kenya and beyond.

Pharmaceutical companies in South Africa, India, and the Americas are among those marketing cheaper anti venom, some of which are effective in their host nations. But their safety and effectiveness against the large variety of snake species in Africa have not been established in clinical trials, according to experts.

Anti venom is made from the serum of snake venom and is the most effective treatment for snake bites. But the drugs are in short supply in Sub-Saharan Africa, since they are expensive to manufacturing, and limited financial incentive holds the development of new anti venom.

In an effort to overcome the shortage of anti venom, the global community affected by snake bites drew the attention of private foundations, researchers, and the World Health Organisation to this neglected tropical problem.

About two months ago, the World Health Organisation added snakebite envenomation to the list of neglected tropical diseases, a move which experts say will boost funding for, and the treatment and control of, snake bites globally.

While the shortage of antivenins is common in most African countries, snakebite treatment in Kenya is faces numerous challenges, among them the procurement of ineffective drugs, lack of statistics to map out the snakebite burden to facilitate the distribution of drugs and a shortage of I medical expertise in the area.

ANTIDOTES

Some doctors now even fear administering the snake bite antidotes to patients since the drugs are ineffective.

Mr Taylor, a snake expert and director Bio-ken Snake Farm, attributes the ineffectiveness of some of the antidotes at government health facilities to the fact that they are not made from the venom of local snakes.

“Some of these drugs have been manufactured from snakes that are not found in Africa, so they cannot treat bites by African snakes or, in some cases, you need several doses instead of just one vial,” explained Mr Taylor.

He noted that the departure of Fav-Afrique now leaves South African vaccine producers as the leading manufacturers of the most effective anti venoms for treating bite by snakes found in Africa.

“Unfortunately, the anti venoms from South Africa are not sold in Kenya since they are yet to be registered here,” he added.

Dr Sultani Matendechero, the head of Neglected Tropical Diseases at the Ministry of Health, says the government has also begun paying considerable attention to snake bite treatment and control.

Dr Matendechero, who says that unreported snakebite cases deny them vital statistics, notes that the government will soon review the list of anti venom drugs sold locally to weed out the ineffective ones.

“There are various antivenins currently being sold but we have received reports that some of them are not effective. We are reviewing all the licensed antivenins and those that are not effective will be weeded out, “he said, adding that the country plans to produce its own anti venom from local snakes in the future.

The expert also noted that a technical team set up by the government has developed new data collection tools and national guidelines for treating snake bites.

“Right now we have a map that identifies snakebite hotspots and the snakebite burden of key areas, which will help us distribute the anti venom,” Dr Matendechero said.

“There are bizarre cases where health facilities refer snakebite victims to village herbalists because they don’t know how to handle them. The national treatment guideline will teach nurses to hand snake bites,” he added.