Perspectives from MSF snakebite programme implementation in Agok, Abyei region, South Sudan

Abstract

Introduction: Snakebite is a neglected tropical disease affecting around five million people, causing more than 100,000 annual deaths, as well as serious disabilities; however, access to antivenom and high-quality programmatic care remain a global challenge.
Objective: Due to the high burden of snakebite in South Sudan and the serious negative outcomes if left untreated, Médecins Sans  Frontières (MSF) integrated snakebite care for the first time among its priorities and consolidated a programme in Agok Hospital.
Method: We describe the history, implementation, and challenges of the MSF snakebite programme.
Results: The number of snakebite patients at MSF Agok Hospital has increased each year. From 2013 to 2019, MSF treated 2,005  snakebite patients. In 2019 there were 527 snakebite admissions, 47% presented with severe envenomation, and one death. Puff adders, vipers and various cobras were identified. Agok Hospital gained understanding on the barriers and facilitators for the population to access care after a snakebite. MSF developed “snakebite diagnosis and treatment” algorithms, and provided clinical  training, with the validation of national health authorities. Preventive activities were reinforced. Integration of surgical services was an essential programmatic aspect to monitor and treat complications. Challenges for implementation included a lack of easily available antivenoms in the international market. and the need of a strong supply chain and procurement systems.
Conclusion: The delivery of healthcare towards snakebite patients can be successfully implemented when prioritized. Global efforts to improve access and quality of antivenoms and snakebite care could help removing Snakebite Envenoming from the Neglected Tropical Diseases list.

Keywords: snakebite, snake, envenoming, antivenom, implementation, humanitarianism, secondary care, South Sudan