03244nas a2200289   4500000000100000008004100001260003700042653003300079653001100112653002400123100001700147700001700164700001500181700001800196700001400214700001300228700001300241700001300254700001500267700001400282245011000296856009900406300000900505490000700514520241900521022001402940       2024                            d  bPublic Library of Science (PLoS)10aHealthcare-seeking behaviour10aRwanda10aSnakebite incidence1 aHakizimana D1 aMacDonald LE1 aKampire HT1 aBonaventure M1 aTadesse M1 aMurara E1 aDusabe L1 aIshema L1 aSchurer JM1 aBhaumik S00aSnakebite incidence and healthcare-seeking behaviors in Eastern Province, Rwanda: A cross-sectional study  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0012378&type=printable  a1-190 v183 a<p><strong>Background:</strong> Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020.</p>

<p><strong>Methodology:</strong> This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment.</p>

<p><strong>Findings:</strong> The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post/center, or hospital), while 87% sought informal care (family/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom.</p>

<p><strong>Conclusions: </strong>This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies.</p>
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