Leaving no one behind in reducing deaths due to snakebite envenoming in Eswatini

Eswatini

Photo: WHO Eswatini The Eswatini Antivenom Foundation demonstrating snake species found in Eswatini to health workers.

Reducing deaths from snakebite envenoming

Snakebite envenoming, a neglected tropical disease, is a prominent public health issue in Eswatini, a country with a predominantly rural populace residing near venomous snake habitats. This disease, causing 200 to 400 cases annually in the country, results in substantial suffering, disability, and premature death. The issue was compounded by Eswatini's health workers' limited technical capacity for clinical management. In response, WHO Eswatini partnered with the Government of Eswatini and the Eswatini Antivenom Foundation to execute WHO's global snakebite envenoming strategy[1], aimed at reducing snakebites and snakebite-related fatalities in Eswatini. This approach targeted community empowerment, accessibility to safe and effective treatments, reinforcement of the health system, and enhanced cooperation and coordination amongst stakeholders. As a result, between 2021 and 2022, interventions led to a 30 percent reduction in snakebite envenoming and deaths, with the number of snakebites falling from 477 in 2021 to 332 in 2022. These positive results support the World Health Organization's aim to improve health systems, offer specific services, and eliminate neglected tropical diseases, moving towards universal health coverage.

WHO’s Key Contributions

Drawing attention and resources to the issue of snakebite envenoming through its classification as a Category A Neglected Tropical Disease.
Collaborating with the government to develop a monitoring framework to facilitate progress tracking.
Formulating global snakebite prevention guidelines, and then adapting them into effective local strategies.
Establishing local treatment guidelines for the training of healthcare professionals.
Creating a global communications toolkit and then tailoring Information Education Communication materials to the local context in Eswatini, empowering the community with knowledge on snakebite prevention

“Thanks to the Ministry of Health and the World Health Organization, Eswatini is among few countries globally to make snakebite envenoming, a notifiable condition.”

- Thea Litschka-Koen, Eswatini Antivenom Foundation

How did Eswatini, with the support of WHO, achieve this?

In 2017, to ameliorate access to safe and affordable snakebite envenoming treatments, the World Health Organization (WHO) classified snakebite envenoming as a neglected tropical disease (NTD). Then in 2018, WHO opted to include it in its category A NTDs. In 2019, WHO set forth a global strategy that aimed to halve the number of snakebite-induced deaths and disabilities by 2030.[2] This strategy was trialed in 10-12 high snakebite-burden countries during 2019-2020, including Eswatini. The approach was based on the conviction that empowered communities possessing effective health systems and access to safe, effective medicines can effectively prevent and manage snakebite envenoming.

Eswatini's government, in collaboration with partners, employed multi-faceted strategies to prevent snake bites. To effectively integrate prevention, treatment, and management of snakebite envenoming into the country’s national health systems, plans, and policies, WHO Eswatini offered technical and financial assistance to enable the translation of global guidelines into local strategies. With WHO’s technical assistance, the government developed outcome-based plans supplemented by a monitoring framework with specified indicators, to facilitate progress tracking through various data sources. With baseline data requirements established, a framework for regular data collection, aggregation, and analysis was then put into place, enabling comprehensive evaluations of progress and achievements from November 2021. In October 2022, the Government also designated snakebite envenoming as a notifiable condition to enhance the understanding of its epidemiology and health impact in Eswatini. This led to a marked improvement in surveillance and response, with snakebite incidents reported within 24 hours through the country’s existing Immediate Disease Notification System (IDNS).

“As WHO, we would like to applaud the collaboration we have with the Eswatini Antivenom Foundation and the Ministry of Health, in making snakebite envenoming neglected no more, saving lives and limbs.”

-Dr Cornelia Atsyor, WHO Country Representative

In 2019, the Swaziland Antivenom Foundation to prevent snakebites had established 11 antivenom banks to secure sufficient supplies for snakebite treatment.[3] Despite this, continuous human-snake conflict led to a persistently high annual demand of 2000 - 4000 antivenom vials, often exceeding available supplies in Eswatini. Community education was crucial for empowering communities in snake-prone areas with knowledge on snake avoidance and safe cohabitation, leading to life preservation and disability reduction.[4] WHO headquarters had developed a global communications toolkit to ensure a unified message. Subsequently, WHO Eswatini adapted the global Information Education Communication (IEC) materials to align with the local context.

In an effort to enhance treatment procedures, the Ministry of Health, in coordination with the Eswatini Antivenom Foundation and WHO, developed treatment guidelines for snakebite envenoming. This aimed to bolster the capacity of health workers in managing snakebite cases. In November 2021, 6 snakebite assistants adept in local snake species, their behaviors, snake handling, and managing snake bites, were mobilized. WHO covered their salaries for a 3-month period, enabling them to be stationed in high-risk clinics. They alerted the Eswatini Antivenom Foundation to snakebite cases, guided healthcare teams on antivenom use, assisted in inpatient stabilization for hospital transfers, and implemented community outreach activities using WHO guidance and IEC materials. By working alongside healthcare workers in the identification and clinical management of snakebites, they ensured improved first aid, effective treatment, and patient rehabilitation.

^{A symposium was conducted to raise awareness of snakebite envenoming.}Photo credit: WHO Eswatini

To mobilize partners, stakeholders, and necessary resources, and to raise awareness about the disease for sustainable change, a symposium was conducted with WHO’s financial and technical support. Organizing the symposium and covering accommodation and meals for the participants. At this event, attended by 200 healthcare professionals in December 2021, the newly established guidelines were disseminated in order to enhance case management strategies, including the application of antivenom and supportive care.

Eswatini serves as a compelling example of how a community-centric approach can effectively mitigate the impact of snakebites. Given its demonstrable success in reducing snakebites, this strategy serves as a replicable model for other countries facing similar challenges.

References

World Health Organization. Snakebite envenoming -- A strategy for prevention and control (https://www.who.int/publications/i/item/9789241515641, accessed 15 February 2024)
World Health Organization. WHO launches global strategy for prevention and control of snakebite envenoming [news] (https://www.who.int/news/item/23-05-2019-who-launches-global-strategy-for-prevention-and-control-of-snanebite-envenoming, accessed 8 February 2024).
Eswatini antivenom foundation [web portal] (https://eswatiniantivenom.org/, accessed 8 February 2024).
World Health Organization. Community engagement drives snakebite control in Eswatini (https://www.who.int/news-room/feature-stories/detail/community-engagement-drives-snakebite-control-in-eswatini, accessed 8 February 2024).