snakebite as a serious public health problem for nigeria ... · snakebite as a serious public...
TRANSCRIPT
![Page 1: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/1.jpg)
Snakebite as a serious Public Health problem for Nigeria and Africa
A. Nasidi, M.D, Ph.D., OON,Director, Special Duties,
Federal Ministry of Health/Project – Coordinator
EchiTAb Study Group, UK/Nigeria
Presented at WHO Consultative Meeting on Rabies and Envenomings:
A Neglected Public Health IssueGeneva, Switzerland
10th January 2007
![Page 2: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/2.jpg)
The EchiTAb Study Group (ESG)
Foundation and Purpose:A joint research and development project between EchiTAb
Study Group, Nigeria and EchiTAb Study Group, UK• Project formally established in June 2000• Chairman, Nigeria - Prof Lateef Salako, CON• Chairman, U.K. – Prof David Theakston• Clinical Consultant - Prof. David Warrel• Project Co-ordinator - Dr Abdulsalami Nasidi, OON• Co-Proj Coord - Prof John Landon • Finance/Admin Coordinator – Dr Nandul Durfa• Key collaborating organisations: FMOH, Nigeria, Liverpool
School Of Tropical Medicine, Oxford University and MicroPharm, UK
• A New MOU developed
![Page 3: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/3.jpg)
The Problem
![Page 4: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/4.jpg)
Africa and Nigeria Population
• Total Populaion Africa 890 mln• Total Pop West Africa 252 mln• *Total Pop Nigeria 140 mln• Attack rate About 170/100,000
• No of States 36 plus FCT• No. of Health Districts 7850
* From 2006 Census
![Page 5: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/5.jpg)
Africa Situation• No regional Strategy for Production• No Regional programme for training• Regional Management strategy now being
developed with assistance from the WHO (Nairobi meeting)
![Page 6: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/6.jpg)
The Main Problem for Nigeria• Estimated incidence in Nigeria –174
bites/100,000• This is I/5 of all African region cases• 90% of bites and 60% of deaths
caused by the most dangerous snake – E. Ocellatus
• Bites occurring mostly in very fertile areas of the country during planting and harvesting periods
![Page 7: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/7.jpg)
Importation of ASV /Affordability• Often in-appropriate ASV (Indian ASV versus our
snakes)• High cost – affected population poor• Expiry dates often unnecessarily early• Fake products in circulation• Poor or misleading inserts• Inappropriate dosage strategy• Liquid versus lyophilised (liquid very adequate)• Monospecific versus polyspecific (both needed)
![Page 8: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/8.jpg)
The Main Problem for Nigeria
Nigeria Echis with most potent venom
![Page 9: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/9.jpg)
Regional and National Needs for ASV
• Africa - 1.6 million vials is required annually • Nigeria: about 245,000 vials annually• Less than 100,000 vials distributed before 1994 for
the entire continent• Most effective in the region were the IPSER-Afrique,
SAIMR ASV, Berhinger-Werke products• Presently only South African ASV available in
Nigeria • Reasons for non-availability – Economic viability for
the develop country manufacturers• Traditional healing and fake products are the only
remedies available to snakenite victims
![Page 10: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/10.jpg)
Snakebite as medical emergency in rural Nigeria
• 12 States at particular risk(mountainous and rocky)
• 4 poisonous snakes identified with 3 major ones (Naja nigricolis, Bitis Arientas and Echis oceollatus) as main causes of envenomation
• Nigerian Echis – the most dangerous snake in the World
![Page 11: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/11.jpg)
Echis Ocellatus
![Page 12: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/12.jpg)
![Page 13: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/13.jpg)
The Sample Epidemiological Survey
• Objective– Assess magnitude and Distribution of Snakebites in
Nigeria– Ascertain types of Snakes prevalent in Nigeria– Quantify volume of ASV required
• Study Type–A 5-year Health facility reviews (1989-1993)–Cross sectional-community survey
![Page 14: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/14.jpg)
SAMPLING FRAME
• Country was divided into 2 areas of: – High Prevalent Areas (HP) and – Low Prevalent Areas (LP)
• Each area was stratified and selection was through randomization
• Pre-designed data collection formats used • 4,800 households involved (16,000 from HP
areas and 3,200 from LP areas)• Data retrieved from Health Institutions of all
identified areas
![Page 15: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/15.jpg)
Results(Frequency of bites by States)
0
100
200
300
400
500
600
700
800
900
TB BA RV KG JG KT EN
No of Cases
![Page 16: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/16.jpg)
Admissions due to Snakebites
0
5
10
15
20
JG TB BA RV EN OS KG KT
Cases SB/1000 admissions
![Page 17: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/17.jpg)
Time of Reporting to Treatment Centre after bite
49
2217
2
20
05
101520253035404550
1-6hrs 7-12hrs 13-24hrs
25-72hrs
>72hr
No. of Cases
![Page 18: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/18.jpg)
Case Fatality Rates due to Snake Bites by State
0
10
20
30
40
JG EN KG KT BA RV TR OS
CFR %
![Page 19: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/19.jpg)
Age Distribution of bites-National Survey
0
5
10
15
20
25
0-9 19-Oct20-2930-3940-4950-5960&>
% Cases
![Page 20: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/20.jpg)
Length of Stay in Hospital
05
1015202530
1-2 3-4 5-6 7-8 9-1011-1213-1415-16
% of total
![Page 21: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/21.jpg)
Direct Observation at the Kaltungo Hospital 1999 to 2006
![Page 22: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/22.jpg)
0
2
4
6
8
10
12
14
Number
Farming Cattle rearing House w ife Student/Pupils Others
Profession
DISTRIBUTION BY PROFESSION
![Page 23: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/23.jpg)
SEX DISTRIBUTION OF SNAKE BITE CASES IN GENERAL HOSPITAL, KALTUNGO
Male
Female
![Page 24: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/24.jpg)
050
100150200250300350400450500
0--10 11--20 21--30 31--40 41--50 51--60 >60AGE
AGE DISTRIBUTION OF SNAKE BITE PATIENTS IN GENERAL HOSPITAL KALTUNGO 199 - 2006.
![Page 25: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/25.jpg)
365 14436 40443 10539 18566 14987 17
1543 131711 17
SNAKE BITE GENERAL HOSPITAL- 1999 - 2006, KALTUNGO.
0200400600800
10001200140016001800
1999 2000 2001 2002 2003 2004 2005 2006
010203040
1999 2000 2001 2002 2003 2004 2005 2006S1
DEATH FROM SNAKE BITE 1999-2006 IN GENERAL HOSPITAL KALTUNGO.
![Page 26: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/26.jpg)
0 50 100 150 200 250
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Mon
th
Monthly distribution of snake bite patients in general hospital Kaltungo 2006.
![Page 27: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/27.jpg)
Product Development
![Page 28: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/28.jpg)
Objectives• Key Objectives:
– Develop robust and inexpensive techniques and design pilot production facilities to manufacture effective, safe and affordable anti-venoms
– Employ such techniques to provide a minimum of 10,000 treatments per year
– Train staff and transfer the techniques and facilities to Nigeria
– Finalise patenting and other documentation for the commercialisation of EchiTAb
– Completion of clinical trials and registration of EchiTAb by NAFDAC
![Page 29: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/29.jpg)
Snakes fromNigerian
Fields
PilotProduction
Wales
QC and QA at
Liverpool
ClinicalTrial inNigeria
Product Development/Production in
Wales
Liverpool School of Tropical
MedicineHerpertarium
Concept Design
OBTAIN FUND AND ESTABLISH PRODUCTION LINE (MONO/POLYSPECIFIC)IN NIGERIA
OBTAIN FUND AND ESTABLISH PRODUCTION LINE (MONO/POLYSPECIFIC)IN NIGERIA
MicroPharmLondon/Wales
EchiTAb Echi
TAb
Product back to the Needy in affected areas of NigeriaProduct back to the Needy in affected areas of Nigeria
![Page 30: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/30.jpg)
Achievement of Set Objectives
– Complete clinical trials and obtained registration of EchiTAb by NAFDAC – COMPLETED 2003
– Use robust and inexpensive techniques and facilities to manufacture effective, safe and affordable antivenoms – COMPLETED (Wales project)
– Employ such techniques to provide a minimum of 10,000 treatments per year – on going
– Train staff and transfer the techniques and facilities to Finalise patenting and other documentation for the commercialisation of EchiTAb – Patenting concluded commercialization yet to start
– Develop a poly-specific (polyvalent) ASV for West Africa – the Colombian/Egyptian/Nigerian/UK collaboration – on going
![Page 31: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/31.jpg)
Clinical Evidence of Efficacy
![Page 32: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/32.jpg)
Results• 500mg dosage works, particularly in early
reporters• More doses required to treat late reporters• Could be effective against puff adder bite• Restores coagulation within 6-12 hours• No serious side effects reported so far• Doctors pleased but suggested improvements
due reversal of coagulation (recrudescence)
![Page 33: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/33.jpg)
Preliminary conclusions
• EchiTAb liquid is efficacious• Dosage to be reviewed• Relatively safe• Easy to handle and administer• Relatively Stable• Go for IgG (EchiFab G now suggested
instead of EchiTAb)
![Page 34: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/34.jpg)
CFR at Treatment Centres• Cases in one year – 3,780
• Deaths - 23
• CFR - 0.63%
• CFR before Treat with EchiTAb – 35% – 45%
![Page 35: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/35.jpg)
Conclusion
• The ESG has made significant progress in establishing a secured supply of antivenom for the FMOH and establishing the foundations for the transfer of the technology fro ASV production to Nigeria
• Establishing an antivenom manufacturing unit in Nigeria will provide Nigeria with a secure supply of high quality affordable antivenom and transfer valuable antibody technology and pharmaceutical manufacturing expertise to Nigeria
• An antivenom manufacturing unit will provide Nigeria with a commercial opportunity to manufacture antivenoms for export to other countries in West Africa
• The facility will meet the national need for ASV and even have sufficient to export to all West African countries and entire Africa, subsequently
![Page 36: Snakebite as a serious Public Health problem for Nigeria ... · Snakebite as a serious Public Health problem for Nigeria and Africa A. Nasidi, M.D, Ph.D., OON, Director, Special Duties,](https://reader033.vdocuments.mx/reader033/viewer/2022041501/5e21d4fad044f5667706520b/html5/thumbnails/36.jpg)
EchiTAb Study Group (Bearing the Burden)