title: Using geographical information systems to identify populations in need of improved accessibility to antivenom treatment for snakebite envenoming in Costa Rica.
abstract: BACKGROUND
  Snakebite accidents are an important health problem in rural areas of tropical countries worldwide, including Costa Rica, where most bites are caused by the pit-viper Bothrops asper. The treatment of these potentially fatal accidents is based on the timely administration of specific antivenom. In many regions of the world, insufficient health care systems and lack of antivenom in remote and poor areas where snakebites are common, means that efficient treatment is unavailable for many snakebite victims, leading to unnecessary mortality and morbidity. In this study, geographical information systems (GIS) were used to identify populations in Costa Rica with a need of improved access to antivenom treatment: those living in areas with a high risk of snakebites and long time to reach antivenom treatment.
  
  
  RESULTS
  Populations living in areas with high risk of snakebites were identified using two approaches: one based on the district-level reported incidence, and another based on mapping environmental factors favoring B. asper presence. Time to reach treatment using ambulance was estimated using cost surface analysis, thereby enabling adjustment of transportation speed by road availability and quality, topography and land use. By mapping populations in high risk of snakebites and the estimated time to treatment, populations with need of improved treatment access were identified.
  
  
  CONCLUSIONS
  This study demonstrates the usefulness of GIS for improving treatment of snakebites. By mapping reported incidence, risk factors, location of existing treatment resources, and the time estimated to reach these for at-risk populations, rational allocation of treatment resources is facilitated.
authors: Occupational and Environmental Medicine, Lund University, Lund, Sweden. erik.hansson@med.lu.se
authors: Erik
authors: E
authors: Hansson
authors: Mahmood
authors: M
authors: Sasa
authors: Kristoffer
authors: K
authors: Mattisson
authors: Arodys
authors: A
authors: Robles
authors: José María
authors: JM
authors: Gutiérrez
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003364:Costa Rica / Q000453:epidemiology; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012909:Snake Bites / Q000453:epidemiology* / Q000628:therapy*; D012910:Snake Venoms / Q000633:toxicity*; D019371:Topography, Medical; D055815:Young Adult
chemical_list: D000997:Antivenins; D012910:Snake Venoms
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