Impact of snake bites and determinants of fatal outcomes in southeastern Nepal
Impact of snake bites and determinants of fatal outcomes in southeastern Nepal
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DOI：
10.4269/ajtmh.2004.71.234
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发表时间：
2004-08-01
影响因子：
3.3
通讯作者：
Koirala, S
中科院分区：
文献类型：
--
作者：
Sharma, SK;Chappuis, F;Koirala, S
目前关于尼泊尔蛇咬伤的现有数据完全基于医院统计数据。这项以社区为基础的研究旨在评估蛇咬伤的影响，并确定与尼泊尔东南部致命结果相关的风险因素。经过培训的实地工作人员在五个村庄以随机比例抽样的方式共访问了1 817户家庭。记录和分析了前14个月被蛇咬伤的受害者的大量数据。报告了143例蛇咬伤，包括75例有毒液中毒迹象的咬伤（年发病率分别为1，162/100，000和604/100，000），导致20人死亡（年死亡率为162/100，000）。金环蛇咬伤的特征，如在室内发生的咬伤，休息时，午夜至早上6点之间，都是与死亡风险增加相关的因素，与传统治疗师的初步咨询，运输前的长时间延迟以及缺乏可用的运输。最初转移到专门的治疗中心和摩托车运输是强有力的保护因素。在123名幸存者中，分别有30名（24%）和10名（8%）受害者的伤口需要包扎和手术，平均无工作能力时间为15天，平均自付费用为69美元。蛇咬伤是尼泊尔东南部一个主要但被忽视的公共卫生问题。公共卫生干预措施应侧重于改善受害者快速获得抗蛇毒血清的机会，促进立即和快速地将受害者送往适当的治疗中心，特别是对于夜间发生的咬伤。
Current available data on snake bites in Nepal are based solely on hospital statistics. This community-based study aimed at evaluating the impact of snake bites and determining the risk factors associated with a fatal outcome in southeastern Nepal. A total of 1,817 households, selected by a random proportionate sampling method, were visited by trained fieldworkers in five villages. Extensive data from snake bite victims during the 14 previous months were recorded and analyzed. One hundred forty-three snake bites including 75 bites with signs of envenoming were reported (annual incidence = 1,162/100,000 and 604/100,000, respectively), resulting in 20 deaths (annual mortality rate = 162/100,000). Characteristics of krait bites such as bites occurring inside the house, while resting, and between midnight and 6:00 AM were all factors associated with an increased risk of death, as were an initial consultation with a traditional healer, a long delay before transport, and a lack of available transport. An initial transfer to a specialized treatment center and transport by motorcycle were strong protective factors. Among the 123 survivors, wounds required dressing and surgery in 30 (24%) and 10 (8%) victims, respectively, the mean working incapacity period was 15 days, and the mean out-of-pocket expense was 69 U.S. dollars. Snake bite is a major but neglected public health problem in southeastern Nepal. Public health interventions should focus on improving victims' rapid access to anti-snake venom serum by promoting immediate and fast transport to adequate treatment centers, particularly for bites occurring at night.