Clinical features, first aid practices, and hospital management of snakebites in Northern Uganda: a multi-facility cross-sectional study
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Snakebite envenoming is a neglected tropical disease with a disproportionate burden in sub-Saharan Africa, where weak surveillance, limited antivenom availability, and reliance on traditional remedies compound morbidity and mortality. Evidence on how snakebite cases are clinically managed in routine practice in Uganda remains scarce. We conducted a facility-based cross-sectional study with retrospective abstraction of records from four purposively selected health facilities in Gulu and Arua districts of Northern Uganda. Snakebite case records from outpatient, inpatient, paediatric, and intensive-care service points covering the period 2017–2021 were reviewed using a standardised abstraction tool. Descriptive statistics were computed in Stata version 14, with frequencies and proportions for categorical variables and medians with interquartile ranges (IQR) for continuous variables. A total of 227 snakebite case records were analysed, of which 58.6% were female, a median age of 21 years (IQR 13–38), and 31.3% were students. Most bites involved the lower limb (85.9%) and occurred in the second and third quarters of the year (59.9%). Snake species was undocumented in 76.2% of records. Pre-hospital first aid was either undocumented (59.1%) or inappropriate such as applying tourniquets (29.3%) and herbal remedies (8.9%). The dominant clinical manifestations were pain (60.8%), swelling/blisters (58.7%), and fang marks (26.9%), while 18.5% had features suggesting envenomation, of whom only 33.3% received antivenom. Overall, only 15.0% of cases received antivenom, while supportive care predominated (intravenous fluids 68.1%, analgesics 64.2%, antibiotics 53.1%). Coagulation testing was rare (20-minute whole blood clotting test 17.3%; INR 12.0%). Overall, 93.4% of patients recovered, 3.1% died, 0.9% were referred to other healthcare facilities, and the rest (2.6%) had missing information on the outcomes. Snakebite management in Northern Uganda is largely symptomatic, with critical gaps in species identification, syndromic assessment, coagulation testing, antivenom utilisation, and pre-hospital first aid practices. Strengthening health-worker training, improving documentation and surveillance, and community education on appropriate first aid are urgently needed to reduce preventable morbidity and mortality.
Author summary
Snakebite envenoming is one of the most neglected of the tropical diseases, and its burden falls heaviest on poor, rural communities in sub-Saharan Africa. In Uganda, we know that many people are bitten each year, but very little is known about what actually happens to them once they reach a health facility. We reviewed the records of 227 people treated for snakebite at four hospitals in the Gulu and Arua areas of Northern Uganda between 2017 and 2021. We found that most of those bitten were young people, students and farmers, usually bitten on the leg. Before reaching hospital, many had received harmful first aid such as tight tourniquets or herbal remedies. In hospital, staff rarely recorded which snake was involved, seldom used the simple bedside blood-clotting test recommended by the World Health Organization, and gave the life-saving antivenom to only a small minority of patients, relying instead on painkillers, fluids and antibiotics. Most patients recovered, but some died. Our findings show where care can be improved — through training, better record-keeping, a reliable supply of antivenom, and community education on safe first aid — to prevent needless death and disability from snakebite.
