title: Protocol and monitoring to improve snake bite outcomes in rural Ghana.
abstract: A study was conducted in Mathias Hospital, Yeji, an area of Ghana, where snake bite cases are an important cause of morbidity and mortality, with a case fatality rate of 11% (8/72). Case management difficulties included uncertainty about the assessment of the severity of envenoming, the dosage of antivenom, and the response to treatment. An intervention with several components was introduced: development of a treatment protocol, staff training, monitoring of compliance and patient education. During a 33-month post-intervention period there was excellent protocol compliance, fewer snake bite complications, and a fall in mortality rate to 1.3% (3/238) compared with a 15-month baseline review. There was a 50% increase in snake bite admissions and fewer delays. To improve snake bite outcomes in comparable settings, particularly if inexperienced staff are involved in care, we recommend a similar quality assurance project, involving case review and use of a treatment protocol with monitoring of compliance to sustain an improved approach.
authors.affiliation: Mathias Hospital, P.O. Box 43, Yeji, Brong Ahafo, Ghana. viss41@cs.com
authors.forename: L E
authors.initials: LE
authors.lastname: Visser
authors.forename: S
authors.initials: S
authors.lastname: Kyei-Faried
authors.forename: D W
authors.initials: DW
authors.lastname: Belcher
mesh_terms: D000328:Adult; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage* / Q000627:therapeutic use; D002985:Clinical Protocols; D003906:Developing Countries; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005869:Ghana; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012423:Rural Health; D012909:Snake Bites / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000997:Antivenins