Clinical Management and Outcomes of snakebite victims at a rural hospital in Ghana: An analysis using the Bayesian Framework

Snakebite is a neglected tropical disease that presents a huge burden to victims, and the healthcare systems, especially in LMICs. Progress in reducing the mortality and morbidity worldwide has been inadequate and failed to reach the most vulnerable. Life-threatening effects of snakebite envenoming include shock, and spontaneous systemic bleeding. Amputations, disfigurement, and tissue necrosis are common complications. We reviewed clinical records of snakebites victims from 2016 to 2019 available on an Electronic Data Capture (EDC) platform from the Baptist Medical Center in the North East region of Ghana. We used the Bayesian Analysis framework to model the predictors of death and the Length of Stay (LoS). Records of 346 snakebite victims were included in the analysis. The median age of the victims was 19, with majority male (72%) and insurance coverage among the victims was low (26%). A median of 4 victims per month reported to the hospital. Farmers accounted for 50% of the victims. Most (68%) bites were on the lower limbs, and 48.8% of the victims received an anti-snake venom while 53.2% of the victims were given antibiotics. The mortality rate was 3.4%. Bleeding and Length of Stay showed significant statistical association with the odds of death (OR = 3.17 and 0.47 respectively). With the deaths recorded occurring within 2 days of admission, spending a longer time on admission was associated with a decreased probability of death. The association between the length of admission and death may be suggestive either delays to reporting of venomous bites or admission of non- venomous bite victims. There appears to be adequate management of snakebites victims at the hospital. There is a potential inappropriate use of antibiotics in the management of snakebites at the hospital. There is also the immediate need for an intervention by the local and central authorities to assist or provide protective gear (wellington boots) to farmers especially. The distribution and availability of ASVs at the hospital also needs to be reviewed and the health authorities must intensify efforts towards improving NHIS enrollment.