www.udsspace.uds.edu.gh UNIVERSITY FOR DEVELOPMENT STUDIES RETROSPECTIVE STUDY OF SNAKEBITE CASES AT THE TAMALE TEACHING HOSPITAL AUSTIN GIDEON ADOBASOM-ANANE 2018 www.udsspace.uds.edu.gh UNIVERSITY FOR DEVELOPMENT STUDIES RETROSPECTIVE STUDY OF SNAKEBITE CASES AT THE TAMALE TEACHING HOSPITAL AUSTIN GIDEON ADOBASOM-ANANE (BSc. Community Nutrition) UDS/CHD/0057/12 A THESIS SUBMITTED TO DEPARTMENT OF PUBLIC HEALTH SCHOOL OF ALLIED HEALTH SCIENCES UNIVERSITY FOR DEVELOPMENT STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF MASTER OF PHILOSOPHY DEGREE IN COMMUNITY HEALTH AND DEVELOPMENT FEBRUARY, 2018 www.udsspace.uds.edu.gh DECLARATION Student I hereby declare that this thesis is the result of my original work and no part of this work has been submitted for a diploma or degree in this university or elsewhere. Name: AUSTIN GIDEON ADOBASOM-ANANE Signature: …………………………….. Date: ……………………… Supervisor I hereby declare that the preparation and presentation of the dissertation was supervised in accordance with the guidelines on supervision of thesis laid down by the University for Development Studies. Name: DR. PAUL ARMAH ARYEE (PhD.) Signature: ………………………… Date: …………................... i www.udsspace.uds.edu.gh ABSTRACT Snakebite poisoning is a public health concern to persons in agrarian environments and the northern region of Ghana is no exception. Youthful male agricultural and field workers have been reported to be at higher risk of snakebite, hence necessitating a study to determine the full extent of the snakebite problem in the Tamale Teaching Hospital. The objective of this study was to determine the epidemiological characteristics of the snakebite cases that were reported at the Tamale Teaching Hospital. A retrospective review of snakebite cases reported to the Tamale Teaching Hospital between January, 2013 and June, 2014 was carried out. A total of 150 cases were reviewed and the data analysed using SPSS version 20 with all chart drawn using Microsoft Excel 2013. The results of the study were, the prevalence of snakebite cases reported at the hospital was 89/100,000 population. Majority of the victims were between 15-59 years (65%). Males (64.7%) were the majority with farmers (46%) being the most affected. The majority of cases occurred in February, March and September mostly from the rural areas with the East Gonja district having the highest. The lower limbs were the commonly bitten site with most occurring during the daytime (68.67%) and outdoors (75.33%). Pain, swelling and bleeding were the commonest clinical presentations of the victims whiles 68.67% of them used first aid. The carpet viper was the only positively identified snake. Of the 78.67% of the victims who received ASV, 6.78% adversely reacted. The outcome of the cases were 84% cured, 12% discharged against medical advice and 4% dead. In conclusion, snakebite prevalence is high at the TTH, affecting mainly young agricultural male workers in the rural parts of the region. The carpet viper is responsible for most bites and ASV administration was the mainstay of snakebite management. ii www.udsspace.uds.edu.gh ACKNOWLEDGEMENTS My profound gratitude goes first of all to the Almighty God for His magnificent providence and protection throughout this work. To Dr. Paul Armah Aryee (my supervisor), I am profoundly grateful for the timely supervision, criticism, feedback and fine tuning this work. Dr. Adam Atiku, and Dr. Mumin have also helped with the conception of the research idea and provided immense support. For this I am most grateful. My next gratitude goes to my parents, Mr. Abraham Jude Anane and Madam Cecilia Akua Nsoah for the upbringing to be the independent and responsible person I have become. To my sweet and lovely wife, Eunice Acheampomaa Ameyaw, I am highly indebted for the love you have showered upon me and standing with me throughout this work. I am also ever grateful to the following persons for their contributions in diverse ways to this work; Kwaku Anane, Morgan Mensah, Mary Opoku, Mary Heera Dzaku, Ankamah Christian and finally Gideon Joshua Tia. iii www.udsspace.uds.edu.gh DEDICATION To my family and friends who have been with me through it all, I dedicate this work. This work is also dedicated to the various individuals who have survived snakebite in Ghana and all health professionals who in their diverse expertise are working to address this neglected public health challenge. iv www.udsspace.uds.edu.gh TABLE OF CONTENTS DECLARATION ............................................................................................................ i ABSTRACT................................................................................................................... ii ACKNOWLEDGEMENTS ...........................................................................................iii DEDICATION .............................................................................................................. iv TABLE OF CONTENTS............................................................................................... v LIST OF TABLES ......................................................................................................... x LIST OF FIGURES ...................................................................................................... xi LIST OF ABBREVIATIONS .......................................................................................xii DEFINITION OF TERMS ..........................................................................................xiv CHAPTER ONE ............................................................................................................ 1 INTRODUCTION TO THE STUDY ............................................................................ 1 1.0 INTRODUCTION................................................................................................ 1 1.1 BACKGROUND TO STUDY ............................................................................. 1 1.2 PROBLEM STATEMENT AND JUSTIFICATION .......................................... 4 1.3 RESEARCH QUESTIONS.................................................................................. 5 1.4 OBJECTIVES OF THE STUDY ......................................................................... 5 1.4.1 GENERAL OBJECTIVE .............................................................................. 5 1.4.2 SPECIFIC OBJECTIVES.............................................................................. 5 1.5 SIGNIFICANCE OF THE STUDY ..................................................................... 6 1.6 SCOPE OF THE STUDY .................................................................................... 7 1.7 CONCEPTUAL FRAMEWORK ........................................................................ 7 1.8 STRUCTURE OF THIS THESIS ........................................................................ 8 CHAPTER TWO ......................................................................................................... 10 LITERATURE REVIEW ............................................................................................ 10 2.0 INTRODUCTION.............................................................................................. 10 2.1 PREVALENCE OF SNAKEBITE..................................................................... 10 2.2 DISTRIBUTION OF SNAKEBITE................................................................... 16 2.2.1 SEX/GENDER DISTRIBUTION ............................................................... 16 2.2.2 AGE DISTRIBUTION ................................................................................ 18 2.2.3 OCCUPATIONAL DISTRIBUTION ......................................................... 21 2.2.4 RESIDENTIAL DISTRIBUTION .............................................................. 22 v www.udsspace.uds.edu.gh 2.2.5 SEASONAL/MONTHLY DISTRIBUTION .............................................. 23 2.2.6 SNAKE TYPES INVOLVED IN BITES .................................................... 25 2.3 CIRCUMSTANCES OF THE SNAKEBITES .................................................. 30 2.3.1 SITE OF BITE ............................................................................................. 30 2.3.2 PLACE OF BITE......................................................................................... 32 2.3.3 THE TIME OF BITE ................................................................................... 33 2.3.4 ACTIVITY DURING WHICH THE BITE WAS SUSTAINED................ 34 2.3.5 TIME LAG BETWEEN THE BITE AND HOSPITAL ADMISSION OF THE CASES ......................................................................................................... 34 2.4 MANAGEMENT OF SNAKEBITE CASES .................................................... 36 2.4.1 CLINICAL PRESENTATIONS OF SNAKEBITE CASES ....................... 36 2.4.1.1 CYTOTOXIC ENVENOMING ............................................................... 37 2.4.1.2 HAEMORRHAGIC ENVENOMING...................................................... 37 2.4.1.3 NEUROTOXIC ENVENOMING ............................................................ 39 2.4.1.4 MYOTOXIC ENVENOMING................................................................. 42 2.4.1.5 SHOCK (HYPOTENSION) - VIPER BITES .......................................... 44 2.4.1.6 ACUTE RENAL FAILURE ..................................................................... 45 2.4.2 FIRST AID METHODS SNAKEBITE VICTIMS USE ............................. 49 2.4.3 THE MANAGEMENT OF SNAKEBITE