OA2 Outbreak of Snakebite in Plateau State-October 2015 Bello I. Umar 1, S. Aminu, J. Waziri 1, R. Mohammed 1, G. Itopa 1, O. Ajayi 1, P. Amaka 1, A. Abubakar 1, M. Dalhat 1, S. Gidado 1, A. Oladimeji 1, P. Nguku 1, K. Sabitu 2 1. Nigerian Field Epidemiology and Laboratory Training Program, Abuja 2. Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria 3. Ministry of Health, Jos, Plateau State
Slide 1 OA2 write your name in full Olufemi Ajumobi, 3/7/2016
Introduction 85% snakebite is caused by non-venomous snakes 3,000 known species of snakes found worldwide 15% are considered dangerous to humans The highest number of envenomation were recorded South Asia (121,000) Southeast Asia (111,000) Sub-Saharan Africa (43,000) In Nigeria the prevalence is 497/100,000 population annually with 12% mortality 2
Snakebite outbreak report On 19 th October, 2015, there was report of suspected snakebite outbreak From 2 LGAs in Plateau State (Kanam & Kanke) Rapid response team from: Federal Ministry of Health Plateau State Ministry of Health Nigeria FELTP 3
Objectives To confirm the outbreak of snakebite in affected LGAs To determine the magnitude of the outbreak in the affected LGAs To identify the risk factors of snakebite in the affected LGAs To institute control measures in the affected communities 4
Outbreak area: Study Area North central Nigeria Plateau State Kanam and Kanke LGAs ( Pop 286,000) Hills and mountains 5
Methods Quantitative method - Descriptive study - Analytical study Qualitative method - Focus group discussion (FGD) - Key informant interview (KII) Informed consent obtained from patients Ethical approval was obtained from Ministry of Health, Plateau State 6
Descriptive study Hospital records review Case definition: Any person with history of snakebite in the last two months (19th August 19th October 2015) Active case search in the communities 7
Analytical study Unmatched case-control study 54 (1) cases and 73 (2) controls Neighborhood controls recruited Questionnaires administered to assess risk factors 8
Qualitative Study We conducted 2 focus group discussions (FGDs) Adult males, aged 18-45 years Adult females, aged 18-45 years 6 Key informant interview (KIIs) Traditional leaders (2) Traditional healers (2) Health workers (2) 9
Data analysis Quantitative data - analysed using Epi info version 7.1.2 Qualitative data - Matrix table was used to analysed the focus group discussion - Content analysis for the KIIs 10
Results 11
Results 744 cases were line listed No mortality recorded within that period CHC Zamko recorded the largest number of cases 261 (79%). However most of the cases are from Kanam and Kanke L.G.As Cases are more in males than females No mortality reported within the period 12
Map showing the health facilities visited in the affected L.G.A 13
No of cases of snakebite in CHC Zamko,Sunnah clinic Dangi, and Miko memorial clinic in Langtan north, Kanam and Kanke LGAs in Plateau state respectively from Jan-Oct 2015 Number of ca ases 72 112 124 59 67 59 106 135 88 107 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT Months 14
Distribution of snakebite cases by age group in CHC Zamko, Sunnah clinic Dangi and Miko Memorial clinic Langtang north, Kanam and Kanke LGAs, in Plateau state respectively from Jan-Oct 2015 250 194 Number of cas ses 115 151 98 46 46 < 10 10-19 20-29 30-39 40-49 50-59 60 Age group (years) 15
Socio-demographic characteristic of cases and controls 16
Occupation of cases and controls No of cases & controls 45 40 35 30 25 20 15 10 5 0 Name of Occupation Cases Controls 17
Association of risk and protective factors with snakebite cases and controls Variables Cases Controls Odds ratio 95% C.I. N=54 N= 73 Sex (Female) 25/54 20/73 2.3 1.1-4.8 Kanam & Kanke LGA No formal education 31/54 29/73 2.1 1.1-4.2 Farming 29/54 30/73 0.9 0.5-1.9 Received information from a 21/54 20/72 0.9 0.4-1.8 formal source Any actions taken to 15/46 32/61 0.4 0.2-0.9 safeguard against snakebite -Use of rain boots in farms -Use of torchlight at night -Cut tree branches touching roof of home Household member 21/51 56/70 0.2 0.1-0.4 previously bitten by snake 18
Multivariate analysis of exposure factors Variables Adjusted OR 95% CI No formal education (Yes/No) 3.1 1.1-8.9 Household member bitten 0.2 0.1-0.4 (Yes/No) Sex (Male/Female) 0.5 0.2-1.5 Age group (20-29/0-19) 0.1 0.0-0.5 Age group (30-39/0-19) 0.1 0.0-0.5 Age group (40-49/0-19) 0.0 0.0-0.1 Age group (50-59/0-19) 0.0 0.0-0.5 Age group (60 above/0-19) 0.1 0.0-0.9 19
Respondents view on snakebite FGDs Themes KIIs The no of snakebite victims have increased compared to last raining season because in the village alone we have more than 20 victims Hmm.. If you use rain boots in farm and torchlight at night Farming and rearing of animals as you can most of us are agwai s and farmers 1. Problems and frequency of snakebites 2. Protection against snakebites 3. Exposure Yes, the no of victims have increased as you can see with your own eyes some of our patients are laying down on the floor of the hospital (In-charge Sunnah health clinic kanam) Well hmm I have more patients this year than previous years because now they use to bring 2-3 victims per day ( traditional healer) 20
Limitations Differential recall bias Cases more likely to recall than controls Incompleteness of data in the hospital records 21
Conclusion An outbreak of snakebite occurred in Plateau State, North central Nigeria Males were more affected than females Median age of cases was 28years (10-65 years) Lack of formal education was significantly associated with snakebite occurrence 22
Public health action Health education on the benefits of use of protective clothing and foot-ware (rubber boots) Community sensitization 23
Recommendations The State government should also support the provision of free anti-venom to referral centers Supply chain of ant-venom should be monitored Increase Community sensitization on protective measures against snakebite More awareness on radio and television on dangers associated with snakebite More transparency and accountability needed in the purchase, supply, administration and sales of anti-venom 24
Acknowledgement NFELTP Plateau State Ministry of Health Miko Memorial Clinic Amper, Kanke L.G.A, Plateau State Sunnah Clinic Dangi, Kanam L.G.A, Plateau State Federal Ministry of Health, Nigeria 25
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