02332nas a2200217   4500000000100000008004100001653003900042653001500081653001700096653001900113653001300132100001400145700001200159700001300171700001300184245014500197300001100342490000800353520173900361022001402100       2010                            d10aNeglected tropical diseases (NTDs)10aSnakebites10aRural clinic10aFree antivenom10aTanzania1 aYates V M1 aLebas E1 aOrpiay R1 aBale B J00aManagement of snakebites by the staff of a rural clinic: the impact of providing free antivenom in a nurse-led clinic in Meserani, Tanzania.  a439-480 v1043 a<p>In Tanzania, the impact, on clinical outcomes and treatment-seeking behaviour, of a rural, nurse-led clinic that provides free, antivenom-based treatment of snakebite envenomation was recently assessed. Data on all 85 patients who, between April 2007 and the end of 2009, received treatment for snakebite envenomation at the Snake Park clinic in Meserani, Tanzania, were collected prospectively. Although only four cases of snakebite envenomation were treated in the last 9 months of 2007, 34 such cases were treated in 2008 and 47 in 2009. The 85 snakebite cases had a mean age of 23 years and a male:female ratio of 1.4. Most of the bites occurred in the evening or at night and most also occurred during the rainy season. In some cases, the seeking of treatment from traditional healers delayed treatment at the clinic. After being bitten, the snakebite cases travelled a mean of 82 km (range=2-550 km) to reach the clinic. Thirty-two (37%) of the cases were each unable to identify the snake that had bit them. Of the bites in which the snake was identified, the puff adder (Bitis arietans) caused more (24) than any other snake. Forty-two of the snakebite cases received antivenom. Only one patient (1%), a 12-year-old girl, was believed to have died as the result of a snakebite but another six (7%) each required a skin graft or the amputation of a limb or digit. Establishment of the Snake Park clinic appears to have improved access to snakebite treatment, with cases of snakebite travelling long distances to reach the clinic (because of the lack of any other source of antivenom in Tanzania). Although the clinic is nurse-led, treatment outcomes among the snakebite victims who attend the clinic appear to be good.</p>
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