Background

Introduction
The management of snakebites in rural sub-Saharan Africa is problematic as obtaining anti-venom is expensive and often beyond the capacity of health facilities. In this study, we report the intensive care management and outcomes of 174 snakebite victims who were treated largely with the use of basic intensive care interventions in a rural sub-Saharan African hospital lacking adequate doses of antivenom.

Objectives

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Methods

Method
This cohort study was designed as a retrospective analysis of a prospectively collected database which included all patients admitted to the intensive care unit (ICU) of St. Mary’s Hospital Lacor, Gulu, Northern-Uganda between January, 2006 and November, 2017. No exclusion criteria were applied. The study protocol was approved by the institutional review board of the hospital. Due to the retrospective design of the study, written consent was waived.

Results

Sixty-seven study patients (38.5%) were children (<18 years). Sixty (36.5%) patients required invasive mechanical ventilation. Neurotoxicity was the most common indication for mechanical ventilation (87.5%). Antivenom (at low and probably inadequate doses) was administered to 12.6% of study patients. The median ICU length of stay was 3 days (interquartile range, 2-5) and mortality 8%. The ICU mortality of patients requiring mechanical ventilation was 16.7%.

Conclusion

Our results suggest that provision of basic intensive care interventions including mechanical ventilation to critically ill snakebite victims in a rural sub-Saharan African hospital is feasible and results in a low mortality rate even when adequate antivenom doses are unavailable. The international focus is currently based on the acquisition of antivenom as the main treatment of snake bite victims. However, building basic ICU capacity in rural sub-Saharan Africa should be an essential element of a more comprehensive strategy to tackle the mortality of snakebite envenomation.