New publication! Snakebite victim profiles and treatment-seeking behaviors in two regions of Kenya: results from a health demographic surveillance system in Tropical Medicine and Health (BMC)
Permanent injury from a puff adder bite, Kenya, 2016
Back in 2016 or so, I nearly stepped on a headless and very dead spitting cobra on an island in Homa Bay, Kenya. The locals apparently weren’t satisfied with simply decapitating it, but smashed the head to bits presumably so it couldn’t come back to life and bite someone. That gave me a hair brained idea to do a research project on snakebites and I’m proud to say that the results of that work have been published today.
This work was a team effort under the auspices of the Nagasaki University Institute of Tropical Medicine. It couldn’t have happened without the incredible contributions of researchers, students and local partners,in Kenya, Japan and the United States.
Snakebites are a major cause of permanent injury and death among poor, rural populations in developing countries, including those in East Africa. This research characterizes snakebite incidence, risk factors, and subsequent health-seeking behaviors in two regions of Kenya using a mixed methods approach.
As a part of regular activities of a health demographic surveillance system, household-level survey on snakebite incidence was conducted in two areas of Kenya: Kwale along the Kenyan Coast and Mbita on Lake Victoria. If someone in the home was reported to have been bitten in the 5 years previous to the visit, a survey instrument was administered. The survey gathered contextual information on the bite, treatment-seeking behavior and clinical manifestations. To obtain deeper, contextual information, respondents were also asked to narrate the bite incident, subsequent behavior and outcomes.
8775 and 9206 households were surveyed in Kwale and Mbita, respectively. Out of these, 453 (5.17%) and 92 (1.00%) households reported that at least one person had been bitten by a snake in the past 5 years. Deaths from snakebites were rare (4.04%), but patterns of treatment seeking varied. Treatment at formal care facilities were sought for 50.8% and at traditional healers for 53.3%. 18.4% sought treatment from both sources. Victims who delayed receiving treatment from a formal facility were more likely to have consulted a traditional healer (OR 8.8995% CI [3.83, 20.64]). Delays in treatment seeking were associated with significantly increased odds of having a severe outcome, including death, paralysis or loss of consciousness (OR 3.47 95% CI [1.56; 7.70]).
Snakebite incidence and outcomes vary by region in Kenya, and treatment-seeking behaviors are complex. Work needs to be done to better characterize the spatial distribution of snakebite incidence in Kenya and efforts need to be made to ensure that victims have sufficient access to effective treatments to prevent death and serious injury.”
The risks of covid19 are well known at this point. While we all need to be sympathetic to the need for people to earn a livelihood, a living should not come at the expense of public health and worker safety. This should be a given.
I have seen some businesses who are doing quite well right now. While my sample size is certainly small and my observations subject to my own biases, it is easy to tell apart the businesses who make an effort and the ones who do not.
We should support businesses who 1) require masks without fail, 2) offer masks and gloves to both workers and customers, 3) limit the number of customers in the store at any given time and 4) build plexiglass shields to separate customers and workers.
We should not support businesses who take a lax approach to masks, do not offer masks to customers who don’t have them, allow large numbers of people in the store proportional to size and do not have plexiglass shields in front of the register.
All of these modifications are easy and cheap to implement. There are few occasions where there is any valid excuse for not doing all of them in normal retail and food service industries.
Which bring me to the the point of this post. How can customers know how seriously businesses are taking covid19? Certainly, online review sites like Yelp or Google are going to be helpful, but these do not provide any indication of progress that businesses might make (“evolution”) or provide standards so that we can easily compare one business with another.
Many municipalities provide public record of compliance with health regulations. The New York City Health Department performs unannounced inspections of all restaurants in the five boroughs at least once an year and makes the data public. The public can search for any food provider in the city for any type of violation and even has a grading system. The Washtenaw County Health Department and the Michigan Department of Agriculture and Rural Development conduct regular inspections of food service establishments within their jurisdictions and publish the results online. The worst offenders often make the papers.
We need such a system for all businesses to make sure that they comply with efforts to contain the spread of covid19. Consumers have a right to know whether a business is compliant or not BEFORE they make the decision to visit that business. While the logistics of such a system are complicated and likely expensive, they are necessary.
Will this be on our legislature’s agenda? Do local health departments already have the authority to implement such a system? Would businesses push back against cheap masks and plexi? Certainly, there are challenges to implementation, but it isn’t impossible.
Currently, I am a part of a project looking at climate change impacts on the distribution of tree and grass pollens in the US and associations with allergy and asthma related emergency room visits
As part of that, we are collecting baseline data on symptomatic profiles of patients who are sensitive to tree and grass pollens and are currently undergoing immunotherapy in local clinics.
Our survey is two fold, the first a baseline survey of types of demographics, types of allergies, seasonal sensitivities, general symptoms and lifestyle impacts, the second a three week survey of sleep quality and allergy and asthma related events.
We hope to gather data to see how the ragweed season might impact general health and well being using a coarse raster of predicted pollen distribution.
The survey is being conducted at the University of Michigan Allergy Specialty Clinic and Food Allergy Clinic at Domino’s Farms and will include approximately 50 people.