Article type
Abstract
Background: Snakebite envenoming is a Neglected Tropical Disease that prevails among the most vulnerable populations living in tropical and subtropical countries, such as Brazil (27,673 cases and 109 deaths in 2022). The availability of guidelines for the management of snakebite envenoming, along with early treatment, is core to prevent death and disability, and ultimately meet the World Health Organization (WHO) cross-target goals regarding 2030 Agenda.
Objectives: To present challenges in the development of a national guideline for the management of snakebite envenoming.
Method: Medline and EMBASE were systematically searched from January/2017 to July/2023 as a first step to map recommendations. Manual search for technical documents was carried out to improve the understanding of the context, followed by an expert panel to discuss current needs and gaps that require evidence synthesis.
Results: 247 studies were identified, but only one met the inclusion criteria. It addressed general principles of snakebite management, but treatment recommendations were limited to Micrurus envenoming. Twenty-three documents published by WHO, Brazilian Ministry of Health and international government bodies (i.e. Australia, India, Sri Lanka, Malaysia) added with the compilation of current practices. Even so, the specialist panel raised issues that lack evidence-based recommendations: strategies for rational use of antivenom during shortages, additional antivenom doses, hours for observation that improve hospital performance indicators without compromising safety and need for advanced laboratory screening in emergency care (i.e. venom detection and quantification in serum, fibrinogen to diagnose and monitor coagulopathy). It highlights the complexity to standardize recommendations given the variety of snake species and broad regional health system inequalities in Brazil, mainly among riverside communities, requiring local adaptations to implementation feasibility.
Conclusion: Despite challenges in developing a guideline with high methodological quality for snakebite envenoming, sharing best practices and ensuring that interventions adequately cater to patient needs in South America is imminent. As a reference in Health Technology Assessment in South America, Brazil can play a pioneer role. As it shares fauna and flora characteristics with border countries, recommendations provided might be useful in foreign health systems.
Objectives: To present challenges in the development of a national guideline for the management of snakebite envenoming.
Method: Medline and EMBASE were systematically searched from January/2017 to July/2023 as a first step to map recommendations. Manual search for technical documents was carried out to improve the understanding of the context, followed by an expert panel to discuss current needs and gaps that require evidence synthesis.
Results: 247 studies were identified, but only one met the inclusion criteria. It addressed general principles of snakebite management, but treatment recommendations were limited to Micrurus envenoming. Twenty-three documents published by WHO, Brazilian Ministry of Health and international government bodies (i.e. Australia, India, Sri Lanka, Malaysia) added with the compilation of current practices. Even so, the specialist panel raised issues that lack evidence-based recommendations: strategies for rational use of antivenom during shortages, additional antivenom doses, hours for observation that improve hospital performance indicators without compromising safety and need for advanced laboratory screening in emergency care (i.e. venom detection and quantification in serum, fibrinogen to diagnose and monitor coagulopathy). It highlights the complexity to standardize recommendations given the variety of snake species and broad regional health system inequalities in Brazil, mainly among riverside communities, requiring local adaptations to implementation feasibility.
Conclusion: Despite challenges in developing a guideline with high methodological quality for snakebite envenoming, sharing best practices and ensuring that interventions adequately cater to patient needs in South America is imminent. As a reference in Health Technology Assessment in South America, Brazil can play a pioneer role. As it shares fauna and flora characteristics with border countries, recommendations provided might be useful in foreign health systems.