RESUMEN
BACKGROUND: Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020. METHODOLOGY: This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment. FINDINGS: The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post/center, or hospital), while 87% sought informal care (family/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom. CONCLUSIONS: This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies.
Asunto(s)
Aceptación de la Atención de Salud , Mordeduras de Serpientes , Mordeduras de Serpientes/epidemiología , Mordeduras de Serpientes/terapia , Humanos , Rwanda/epidemiología , Estudios Transversales , Incidencia , Aceptación de la Atención de Salud/estadística & datos numéricos , Femenino , Masculino , Adulto , Adulto Joven , Persona de Mediana Edad , Adolescente , Niño , Preescolar , Agentes Comunitarios de Salud , Lactante , Anciano , Antivenenos/uso terapéuticoRESUMEN
INTRODUCTION: Due to the COVID-19 pandemic teleconsultation was allowed as an insured service in the province of Quebec, Canada. We assessed the preferences of vasectomized patients for a pre-vasectomy consultation conducted in-person or by telephone. MATERIALS AND METHODS: In September 2021, we sought the participation of 214 men who had their pre-vasectomy consultation over the phone to complete an anonymous three-item survey on their preferred modality for pre-vasectomy consultation. They completed their questionnaire in the waiting room of the vasectomy clinic just after the surgical procedure. We calculated the proportion and 95% confidence interval [CI] of patients preferring each modality. We assessed the difference in preference according to the distance between hometown and vasectomy clinic (< 25 km, 25-50 km, and > 50 km) with Fisher's exact test. RESULTS: Participation rate was 98% (n = 209/214). Most patients would have preferred telephone over in-person pre-vasectomy consultation if they had been given a choice (96%; 95% CI 92% to 98%), if they had had to recommend a modality to a friend (95%; 95% CI 91% to 98%), and if they had had to do a pre-vasectomy consultation again (prefer or no preference; total 97%; 95% CI 94% to 99%). Distance between hometown and vasectomy clinic did not significantly influence their preferences (p > 0.29 for each of the three items). CONCLUSIONS: Vasectomized men preferred having pre-vasectomy consultation by telephone instead of in person. If maintained as an insured service after the COVID-19 pandemic, Canadian physicians offering vasectomy services should consider making this service available to their patients.