Snakebite prevalence, burden, healthcare-seeking behavior, and climate change awareness: a cross-sectional household survey in rural Gulu District, northern Uganda
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Background
Snakebite envenoming (SBE) is a WHO-listed neglected tropical disease affecting mainly rural communities in sub-Saharan Africa. Northern Uganda is a recognized high-burden area, but surveillance depends on health facility records, which cannot count victims who never reach care. Community-level data are therefore scarce, and awareness of climate change as a potential driver is unknown. We determined the household prevalence, health outcomes, socioeconomic burden, knowledge, attitudes, and climate change awareness of SBE in rural Gulu District.
Methodology/Principal findings
We conducted a cross-sectional household survey in Palaro Subcounty, Gulu District, using multi-stage cluster sampling. A structured questionnaire was administered to 244 consenting household heads or knowledgeable adults; estimates were design-weighted. Lifetime household prevalence was 36.9% (95% CI 20.0-57.7). Most bites occurred while walking or farming, on roads or in fields, and at night, peaking in May. Among the most recent events, 7/90 (7.8%) ended in death and 4 (4.4%) in permanent disability. Five of the seven deaths occurred before the victim reached a health facility. A traditional healer was the first source of care for 50.6% of victims, whereas only 2.2% presented first to a hospital. The median estimated cost per event (78,333 UGX) was about seven-tenths of mean monthly household income, yet the median direct cost was zero: the loss was almost entirely forgone labor (median 14 days lost). Awareness of climate change was high (91.5%), and 59.7% believed it affects snakebite.
Conclusions/Significance
More than a third of households have been affected by snakebite. Still, most of this burden is invisible to facility-based surveillance: deaths occur before arrival, first care is sought outside the formal system, and economic loss runs through forgone labor rather than medical fees. Antivenom access alone will be insufficient unless victims reach care sooner. High community awareness of climate change offers an entry point for integrated prevention.
Author summary
Snakebite is a neglected tropical disease that kills or disables mainly poor farming families. In much of Africa, we do not know how common it truly is, because most victims never reach a hospital. We visited 258 households in rural Gulu District, northern Uganda, and 244 agreed to take part. We asked about any snakebites the household had experienced, what happened during the most recent one, what it cost, and what people knew and believed about snakebite and their environment. More than a third of households had experienced a snakebite. Most bites happened while walking or farming, on roads or in fields, and at night, with a clear peak in May. Roughly one in thirteen victims died, and most of those deaths happened before the person reached a health facility. Half of victims went first to a traditional healer rather than to a clinic, and an episode cost close to a family’s whole monthly income. Larger and better-off households were more likely to be affected. Almost everyone had heard of climate change, and most thought it affected snakebite. Our results show a heavy, under-recognized burden and point to pre-hospital care, antivenom access, and community education as priorities.
