The persisting utilisation of ineffective prehospital care for venomous snakebites: Implications and the way forward

Sir,

We have read the interesting paper by Singaravelu et al., ¹ which highlighted the association between pre-hospital care and snakebite victims’ clinical outcomes in South India (Asia). They demonstrated that the risk of complications increased with tourniquet application, incision on bite area, topical herb application at the bite site and delayed hospital presentation. However, despite differences in culture, religion and geography, a similar study in northern Nigeria conducted in 2006 showed that besides following similar prehospital practice, snakebite victims also applied blackstone and suctioned the bite site, with similar deleterious effects. ²

Snakebite envenomation remains a common medical emergency in many tropical, rural, agrarian and resource-limited communities worldwide. ³ Many victims resort to different traditional, though often ineffective, practices and only decide to go to the hospital when these treatments fail to produce the desired result. By then, the risks of complications and death have increased. Singaravelu et al. ¹ suggest that persistence in such practice continues at a time when the World Health Organization has categorised snakebite envenomation as a category A neglected tropical disease. Reduction of the utilisation of these traditional practices for snakebite ⁴ and elimination of the drivers, through first aid education campaigns in affected areas, if present, have been ineffective.

Therefore, there is a need to galvanise stakeholders’ efforts to reduce inappropriate delays for snakebite envenomation in resource-limited settings. Individuals, governments, non-governmental agencies and bodies such as national toxicology societies, including the International Society on Toxinology, must promote pressure immobilisation of a bitten limb, one of the few first-aid practices recommended for delaying venom spread before reaching a medical facility. However, this method requires technical expertise, which, if lacking, results in poor application and outcome. ⁵ Hence, further campaigning is needed to modify current behaviours in rural communities. Furthermore, research into new methods of delaying venom dissemination in snakebite victims is needed.