ABSTRACT
Envenomation represents a neglected health problem in Africa characterized by an amazing heterogeneity of factors, related to the great diversity of environments, snake comportment and human activities. Important anthropogenic changes – increasing tremendously over the last 30 years – have led to rearrangements in the composition of species and the demography of snake populations. Some species are attracted to human-modified environments, such as industrial plantations, while others are deterred. Several epidemiologic methods are used to evaluate the quantitative and qualitative importance of snakebites, mainly retrospective or prospective investigations in health centers. However, a major underestimation of snakebite incidence occurs as a consequence of poor attendance at health centers. Household surveys, which consist of questioning the population directly, correct the estimate of the incidence and mortality and give a more realistic evaluation of snakebite importance. Moreover, they allow evaluation of the level of reliance on traditional medicine, which involves 40–80% of bites. Late treatment is also characteristic of African snakebites and frequently exceeds 24 hours post bite. This is the consequence of complex treatment-seeking behavior, health center scarcity, and the lack of confidence of African populations in the equipment and capacity of health centers, which they consider inappropriate for treating snakebites. The actual incidence of snakebite varies from 100 to 650 bites per 100,000 inhabitants per year, and annual mortality can exceed 10 deaths per 100,000 inhabitants in rural areas, 594resulting in an estimation of more than 1 million bites and 25,000 deaths per year for the whole of sub-Saharan Africa. Viper bites are more common than elapid bites, unless the latter are underestimated because of a rapid death that prevents the patient from arriving at the hospital. Antivenom is typically of limited availability, leading to unsatisfactory use. In addition, symptomatic and palliative treatments are insufficient. The recent addition by the World Health Organization of snakebite envenomation into Category A of the Neglected Tropical Diseases and the subsequent strategy for prevention and control should lead to a significant improvement in this important health issue.
