Clinical Presentation And Outcome Of Snake-Bite Patients At Zamko Comprehensive Health Centre, Langtang, Plateau State
AbstractObjective: To assess the pattern of clinical presentation and management outcome of snake bite victims treated in a comprehensive health centre in a rural setting in North-Central zone of Nigeria where snake bite morbidity and mortality are known to be unacceptably high.
Methods: All records of admission in the Comprehensive Health Centre from Jan to December 2001 were examined and all those admission due to snake bites were retrieved and carefully studied. Information on biodata, clinical presentation, clinical assessment, key investigations, type of treatment given and duration of admission were extracted, examined, computerized and analysed using the EPI info version 3.22 (CDC Atlanta). Differences among variables were subjected to statistical analysis and all P-values less than 5% were considered significant.
Findings: 103 of 620 admissions, constituting 16.6% were due to snake bites. Majority of patients were farmers (48.5%) and students (22.3%). Farming and walking along the bush-path carry equal risk of exposure and accounted for 70% of bites. In 96% (99) of cases the snake was identified as carpet viper (Echis carinatus).
87 patients (84.5%) had envenomation defined as whole blood clotting time of 20 minutes or more. There was no significant difference in the proportion of envenoming between those bitten on the leg (83.9%) and those bitten on the hand (16.1%). About eight out of every ten patients (81.6%) use a first aid measure and nine out of every ten patients that used a first aid measure used a tourniquet either alone or combined with other measures such as traditional medicine, incision of site. About 13% of those that employed first aid measures used the black stone.
The common presenting features on the site of bite were oedema (38.8%), oedema and bleeding (26.2%), fang marks and bleeding (16.5%) and tissue necrosis (3.9%). More than half of the patient with envenoming (52%) presented to health facility within 3 hours and 94% within 48 hours. All patients with envenoming had antivenom with the majority (69.7%) receiving between 20-30 mls. All patients did well on treatment and there were no deaths and no patient had permanent disability.
Conclusion: Snake bite is a common cause of preventable morbidity and mortality and the carpet viper is the most common specie responsible in Langtang and its environs. Farming and walking bare foot along the bush-paths carry equal level of risk of exposure to snake bite in these communities and people should be educated on the need to use protective clothing. Effective anti snake venom exist but its effectiveness in reducing the menace of snake bite could be greatly enhanced by education on the need to avoid the use of popular first aid measures of doubtful benefit.
Key words: Snake bite, pattern of clinical presentation; treatment outcome, Langtang.
Highland Medical Research Journal Vol.2(2) 2004: 61-68