title: [Ophidian envenomations and emergencies in Sub-Saharan Africa].
abstract: In West Africa, the ophidian envenomations constitute a frequent medico-surgical emergency that has been identified both by health officers and the patients themselves or their circles. Yet, their management is highly insufficient. The impact of this event is extremely underestimated. A compilation of recent studies has allowed the assessement of the annual number of snakebites at more than one million among which 500,000 envenomations. There would be about 20,000 deaths each year among which only a small part is reported by the national health departments. The circumstances and context of the accidents do not favor a care management of these cases. The bites often occur in remote countryside, far from dispensaries and even more from hospitals. The consultation delays are very important, between 4 and 48 hours. In addition, the patients are often reluctant to choose the therapeutic course: 50 to 90% of them are willing to consult a traditional practitioner first. The clinical table, in theory relatively simple, is not correctly analyzed by health officers: the respiratory distress after a cobra envenomation is only treated exceptionally by an artificial respiration although life-saving and haemorrhagic syndromes are only diagnosed after the haemorrhages externalisation. The treatment is ill-codified and still remains unknown by most of health officers. The antivenom, which is the only efficient etiologic treatment, is not available. Less than 1% of the needs are now covered and the treatment cost corresponds to several months of a farmer family's income. Three important issues prevail now in West Africa:--A more precise epidemiological evaluation of the envenomation accidents would help to identify the needs;--A better availability of drugs and particularly of antivenom would significantly reduce the mortality;--An appropriate training of health staff, particularly those working in peripheral health centres, would lead to the development of intensive cares. Thus, it is expected to reduce by 90% the mortality rate in the next ten years.
authors.affiliation: IRD, Dakar, Sénégal. chippaux@ird.sn
authors.forename: J P
authors.initials: JP
authors.lastname: Chippaux
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D004630:Emergencies; D006801:Humans; D012909:Snake Bites / Q000453:epidemiology*