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Snakebite epidemiology and health-seeking behavior in Akonolinga health district, Cameroon: Cross-sectional study.

ABSTRACT: BACKGROUND:Snakebite envenoming causes 81,000-138,000 annual human deaths and pain, terror, or disability in 4.5-5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon. METHODS:We conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using probability-proportional-to-size, 20 villages were randomly selected, then, all inhabited households were systematically selected. Annual incidence and adjusted odds-ratio for predictors were estimated. FINDINGS:Among the 9,924 participants, 66 suffered a snakebite during the past year: the resulting incidence is 665 (95%CI: 519-841) per 100,000 inhabitants per year. Victims were aged 5-75y (median: 34y), 53% were male and 57% farmer-cultivators. Two children died (case-fatality rate: 3%); 39 (59%) presented severity signs, including 2 (3%) neurotoxic syndromes, 20 (30%) systemic digestive syndromes, and 17 (26%) severe cytotoxic syndromes. Non-severe cases included 20 (30%) mild cytotoxic syndromes and 7 (11%) dry bites. Only two victims (3%) received antivenom. 59 (89%) used family traditional practices, 25 (38%) traditional healers, and 31 (47%) consulted health facilities. Median delays to these three care-options were 5, 45, and 60 minutes, respectively. Traditional treatments included incisions (n = 57; 86%), tourniquets (n = 51; 77%) and black-stones (n = 44; 67%). The two last procedures were also used in health facilities (n = 18). Consulting traditional healers was associated with severity (adjusted-OR: 19.6 (2.5-156), p = 0.005) and complications (aOR: 17.3, 2.4-123, p = 0.004). Long-term disabilities were subjective psychological trauma (n = 47; 71%), finger amputation (n = 1; 2%), ankylosis (n = 1; 2%) and chronic pain (n = 1; 2%). CONCLUSIONS:We observed alarming levels of snakebite incidence, mortality, antivenom scarcity, and use of traditional medicine. It could represent several thousands of victims at national level. We suggested conducting a country-wide study, and improving antivenom supply, first-aid training, for traditional healers and health professionals.

SUBMITTER: Alcoba G

PROVIDER: S-EPMC7343182 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Snakebite epidemiology and health-seeking behavior in Akonolinga health district, Cameroon: Cross-sectional study.

Alcoba Gabriel G Chabloz Manon M Eyong Justin J Wanda Franck F Ochoa Carlos C Comte Eric E Nkwescheu Armand A Chappuis François F

PLoS neglected tropical diseases 20200625 6

<h4>Background</h4>Snakebite envenoming causes 81,000-138,000 annual human deaths and pain, terror, or disability in 4.5-5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon.<h4>Methods</h4>We conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using ...[more]

PMID: 32584806

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Project description:BackgroundDigital media are increasingly abundant and used to seek health information, however, to date very little is known on parents' seeking behavior in the context of child's health and development outside English-speaking and Scandinavian countries. By investigating the prevalence of, and reasons for use, we studied parents' perception of the Internet as a resource for improving their health-related knowledge.MethodsThe survey was conducted in a random sample of 2573 Swiss-German parents with at least one child aged less-than 2?years old. Parents received a mailed invitation to fill in an online questionnaire. Two reminders were sent, the later with a paper questionnaire attached. The questionnaire included questions on use of print, digital, and personal information sources, as well as different information situations: general health and development or illness. We ran descriptive analyses on information seeking behavior, type of digital media used, reasons of use. We also conducted regression analyses to explore factors associated with parental perceptions with regard to the Internet's utility as a source for health information.ResultsA total of 769 questionnaires were returned (response rate 30%). Nearly all parents (91%) used digital media for seeking information on their child's health and development, and the main reason for use was indicated as being the 24/7 availability of information. Search engines (55%) and webpages for parents (47%) were by far the most frequently used digital media. Generally, the internet is perceived as a good resource, especially by fathers (OR?=?1.80, 95% CI: 1.03-3.16). However, a large percentage of parents are skeptical about the correctness of online info (91%), are unsure about their interpretive understanding, and ask for guidance from their pediatrician (67%).ConclusionsThe Internet has become a highly frequented source of information for Swiss-German parents on children's health with largely valuable perceptions of its utility. Digital media are used in addition to and not in replacement of print media and personal contacts. Increasing parental guidance by health and public health professionals could improve parental digital health utilization and empower parents in the new role they adopt.

Project description:BackgroundBuruli ulcer (BU) is a chronic, indolent necrotizing disease of the skin and underlying tissues caused by Mycobacterium ulcerans, which may result in functional incapacity. In 2002, Médecins Sans Frontières (MSF) opened a BU programme in Akonolinga Hospital, Cameroon, offering antibiotic treatment, surgery and general medical care. Six hundred patients have been treated in the project to date. However, due to the nature of the disease and its stigmatization, determining the exact prevalence and burden of disease is difficult and current estimates may not reflect the magnitude of the problem. The objectives of this survey were to estimate the prevalence of BU in the health district of Akonolinga, describe the geographic extension of the highly endemic area within the health district, and determine the programme coverage and its geographical distribution.Methodology/principal findingsWe conducted a cross-sectional population survey using centric systematic area sampling (CSAS). A 15x15 km grid (quadrats of 225 km(2)) was overlaid on a map of Akonolinga district with its position chosen to maximize the area covered by the survey. Quadrats were selected if more than 50% of the quadrat was inside of the health district. The chiefdom located closest to the centre of each quadrat was selected and Buruli cases were identified using an active case finding strategy (the sensitivity of the strategy was estimated by capture-recapture). WHO-case definitions were used for nodules, plaque, ulcer, oedema and sequelae. Out of a total population of 103,000 inhabitants, 26,679 were surveyed within the twenty quadrats. Sensitivity of the case finding strategy was estimated to be 84% (95%CI 54-97%). The overall prevalence was 0.47% (n = 105) for all cases including sequelae and 0.25% (n = 56) for active stages of the disease. Five quadrats had a high prevalence of >0.6% to 0.9%, 5 a prevalence >0.3% to 0.6% and 10 quadrats <0.3%. The quadrats with the high prevalence were situated along the rivers Nyong and Mfoumou. Overall coverage of the project was 18% (12-27%) for all cases and 16% (9-18%) for active cases, but was limited to the quadrats neighbouring Akonolinga Hospital.Conclusions/significancePrevalence was highest in the area neighbouring the Nyong River. Coverage was limited to the area close to the hospital and efforts have to be made to increase access to care in the high prevalence areas. Use of the CSAS method was particularly useful for project planning and to identify priority areas of intervention. An added benefit of the method is that the survey procedure incorporated an awareness campaign, providing information about the disease and treatment to the population.

Project description:BackgroundWorldwide, it is estimated that snakes bite 4.5-5.4 million people annually, 2.7 million of which are envenomed, and 81,000-138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the "Snake-Byte" project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal.Methodology/principal findingsWe compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility.Conclusions/significanceThis novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases.

Project description:BackgroundSubstantial progress has been made in reducing child mortality over the last decades, however the magnitude of the problem is yet high globally Appropriate health care-seeking behavior of mothers/guardians for common childhood illnesses could prevent a significant number of child deaths and complications due to childhood illnesses, currently, there is few of studies in Ethiopia. Therefore, this study aimed to assess mothers/caregivers health care seeking behavior for their children in Northwest Ethiopia.MethodsCommunity based cross-sectional study of rural mothers living in Aneded district from February to March 2016. Data were collected using structured questionnaire by an interviewer. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with health care seeking behavior. Variables having P value ≤0.2 in the bivariate analysis were considered for multivariable analysis. P-value less than 0.05 was used to declare that there was statistically significant association. Odds Ratio (OR) with 95% confidence interval (CI) was used to determine the strength and direction of association.ResultA total of 410 mothers participated in this study. Among 48.8% (95% CI: 44, 53.6%) had sought health care, only 27% sought health care within a day. Having awareness of childhood illness (AOR = 3.8, 95% CI: 2.18-6.72), perceived importance of early treatment (AOR = 3.5, 95% CI: 2.00-6.07) and child age < 24 months (AOR = 1.7, 95% CI: 1.08-2.68) and illness not being perceived as severe (AOR:= 0.17, 95% CI: 0.09-0.30) were all factors associated with mothers healthcare seeking behavior during their child illness.ConclusionOverall health care seeking behavior level was low. Awareness, perceived illness severity, perceived early treatment and having young children were predictors of mothers' health care seeking behavior. The Woreda health office administrators and health professionals should work to improve mothers' awareness and perception towards childhood problems and the importance of early seeking appropriate health care using the existed structures (one-to-five women networking and health developmental army).

Dataset Information

Snakebite epidemiology and health-seeking behavior in Akonolinga health district, Cameroon: Cross-sectional study.

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Snakebite epidemiology and health-seeking behavior in Akonolinga health district, Cameroon: Cross-sectional study.

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