Expanding access to anti-venom in the Brazilian Amazon is a worthwhile investment, study finds

Making antivenom more widely available across a network of hospitals and community health centers in Brazil’s Amazon region could significantly reduce deaths and disabilities from venomous snakebites, a new study finds. did.

Brazil’s Amazonas state has one of the highest snakebite rates in the world, with 45 to 235 venomous snake bites per 100,000 people per year. Timely treatment with antivenom is very effective for most bites.

But in Brazil, antivenom is typically only available in large urban hospitals, and many people bitten by venomous snakes in remote parts of the state suffer serious complications or receive no treatment. It may even lead to death.

This new study was conducted by scientists and physicians at Duke University and two institutions in Brazil to evaluate the cost-effectiveness of making antivenom available to more hospitals and community health centers in the region. The results were published in the January 2024 issue. Lancet Community Medicine – Americashowing that such a step is a worthwhile investment.

“We believe our study is the first to evaluate the health and economic benefits of increasing the availability of snake antivenoms in Latin America,” said Duke University Translational Division of Emergency Medicine. said Dr. João Ricardo Nickenig-Visossi, Director of . Health Sciences and Research Lead Author.

Researchers evaluated three strategies to expand access to snake antivenoms in Amazonas state. One model tested availability of antivenom in 95% of hospitals in the state, and a second model tested availability in 95% of community health centers, which are widely distributed in rural areas. The third model expanded access to both hospitals and community health centers.

All three models deliver millions of dollars worth of net economic benefits, as measured by disability-adjusted life years (DALYs), which count the years of life affected or lost due to illness or injury. created and prevented death and disability. . The study shows that expanding access to both hospitals and community health centers provides the greatest benefits, avoiding up to 3,922 DALYs and delivering up to US$8.98 million in economic benefits. The cost of expanding access was approximately $328 per DALY avoided.

Despite Brazil’s strong production of antivenoms, the results of this study show that lack of access to antivenoms can have a major impact in the regions where most snakebites occur. There is. “Policies that promote access to snake antivenoms should be a priority for countries where the venom burden from snakebites is increasing,” said Visossi, who is also a member of the Duke Global Health Institute.

The researchers’ next step is to begin a trial to make the antivenom available at community health centers in Amazonas state. Researchers say community health care providers can be trained to administer antivenom safely and effectively.

This new study is in line with the recommendations of the World Health Organization’s Working Group on Envenomation of Snakebites, which stressed that sustainable strategies for dealing with snakebites rely on more than therapeutic drugs. , said Charles J. Gerald, MD, interim director of Duke University’s Division of Emergency Medicine. and co-senior author of the study. “It depends on decentralized distribution of treatment and the infrastructure and knowledge to deliver it.”