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publicado em 05/08/2011 às 18h00:00
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Snakes are 1.5 million victims in Africa and are now a public health problem

According to report, annual rate of accidents with poisonous bites is neglected by the authorities in Sub-Saharan Africa

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A million and a half: This is the number of victims of poisoning caused by snake bites every year in sub-Saharan Africa, where they constitute a public health issue overlooked by health authorities. The researcher Jean-Philippe Chippaux, the Institut de Recherche pour le Développement (IRD), France, just look a hundred studies and medical reports published in the last 40 years. Until then no analysis had been carried out and the authorities underestimate the extent of the problem.

Today, only 10% of victims are treated due to lack of antivenoms and qualified medical personnel for these practices. Clinical complications can be serious or even fatal. A snake bite or mamba (the most poisonous snake in the world) can cause death by respiratory paralysis (choking) until 6 hours after the accident. The bite of Ocellée échide, a snake common in African savannas, can cause bleeding and lead to death within days. This new study provides data to the authorities more accurate and reliable, enabling a breakthrough in service closer to reality.

As recently demonstrated Chippaux, more than 300 000 people south of the Sahara are served annually as a result of a bite. But taking into account the difficulty of access to health services and the frequent use of traditional medicine, many cases are not mentioned. This number does not reflect all cases of poisoning. Experts believe that this represents between a third and a fifth of reality. According to this new study, there would be up to one and a half million victims a year. Deaths caused by bites - probably underestimated - arrived in 7000 and the number of limb amputations for 6000 was over 14 thousand per year.

Although several specific studies have been able to come up with some estimates, no large-scale test was carried out to date. To mitigate this shortage, Chippaux conducted a meta-analysis, ie, a critical review of existing scientific studies, taking into account the representativeness and heterogeneity of the results. For this, he examined one hundred scientific papers, acts of conferences and clinical reports published between 1970 and 2010. This advanced study allowed him to advertise much more reliable figures on the number of patients suffering from snakes.

<b> work in rural areas: a high risk activity </ b>

These studies also allowed to report the conditions that favor accidents: 95% of bites occur in rural areas, especially in plantations. People at greatest risk are farm workers. In Africa, agriculture is the main economic activity.

Cities are not free, although the incidence is about 10 to 20 times lower than in rural areas. In some regions during the rainy season, the poisoning is responsible for more than 10% of hospitalizations.

Biting <b> fulminating </ b>

Among the African species there are two most dangerous types of poisons: the Cobras and Mambas, which is neurotoxic, and the Vipers - échide ocellée of the most widespread in the savanna - and that is produces hemorrhagic necrosis. The first cause respiratory paralysis and asphyxiation up to 6 hours after the bite. The second involves the swelling and tissue death, and bleeding that can cause death within days. The only effective treatment remains the injection of anti-snakebite serum intravenously, as soon as possible after the bite in order to neutralize the poison.

A vicious circle <b> </ b>

As the availability of the serum is low, only 10% of poisonings are treated. Considering the lack of data yet, the problem came to be underestimated by health authorities. On the other hand, the high cost of medicines and the short shelf life - 3 to 5 years - upset the suppliers. In such conditions it is difficult to set budgets and allocate the necessary resources for the management of poisonings, the installation of necessary equipment and awareness of medical personnel.

In the absence of qualification to administer the serum, these treatments can produce disappointing results, discouraging reuse later. These chain reactions reduce orders. Manufacturers have problems in producing whey not sure they could sell it. Thus, there is a reduction in long-term accessibility: the number of doses sold fell 90% in Africa since the eighties, from about 200,000 per year to less than 20,000 in early 2000.

This study presents realistic figures on snake venom. Given the results, Chippaux believes that it would take 500 thousand doses annually. The health authorities of these countries may rely on this data the future to improve the quality of care for victims and to create a sense and device monitoring.

   Palavras-chave:   Snake bite    Poisoning    Snake venom    Ocellée échide    Mamba    Respiratory paralysis    Sub-Saharan Africa    Research    Jean-Philippe Chippaux   
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