Introduction - Kingsnake.com

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Clinical Management of Snakebite in Papua New Guinea Chapter 1 120 100 Number of Admissions 80 60 40 20 0 Bereina Veifa'a Kwikila Kupiano Moreguina Iruna Sogeri Tapini Others Health Centre Locality FIGURE 1: Average annual admissions for snakebite at major health centres in Central province 1987-1991 (SOURCE: Lalloo et al, 1995) Not all snakebites resulted in envenomation. The average annual incidence rate for envenomation was 326.9 cases per 100,000 population; effectively 58.2% of snakebites resulted in the development of clinical envenoming. Annual mortality rates ranged from 7.5 to 19.3 cases per 100,000 population with an average mortality rate of 13.8 cases per 100,000 population. This is significantly higher than has been demonstrated in the past. Williams et al (2002) determined case fatality rates for 283 patients admitted to the Intensive Care Unit at Port Moresby General Hospital for the treatment of snakebite between January 1998 and December 2001. The overall case fatality rate was 9.54% but annual case fatality rates ranged from 4.4% to as high as 20.6%. Case fatality rates among males (7.7%) were significantly different (X 2 =24.6, P=
Clinical Management of Snakebite in Papua New Guinea Chapter 1 Hudson & Pomat (1988) examined 129 cases (83 males; 46 females) from Madang province for which medical records were available. There were 111 adults and 18 children under 12 years of age; however no further data on age distribution is given. Currie et al (1991) report that the mean age of 347 patients (215 males; 132 females) in their study was 24.5 years (SD=13.8 yrs), but give no sex-related data. The youngest patient was 2 years old and the oldest was 67 years of age. Ninety patients (25.9%) were under 15 years of age, and 69% of these were males. The overall male:female sex ratio was 1.6:1. Lalloo et al (1995) state that the mean age of patients in their study was 25.0 years; but, like Currie et al (1991), give no sex-related data. Of the admitted patients, 8.5% were children 10 years old or younger, and children <strong>com</strong>prised 16% of envenomed and 6.9% of non-envenomed patients. Lalloo et al (1995b) report an overall male:female sex ratio of 1.39:1 based on 1,421 admissions to Central province health centres and Port Moresby General Hospital between 1987 and 1991. At Veifa’a in the north-west of the province the male:female sex ratio was 0.87:1. The lack of sex-specific age data in both of these large recent studies is unfortunate. In Lalloo et al (1995b) the mean age of all admitted patients (25.0 years) differs from the mean (21.1 yrs, SD=17.7) and median (15.5 yrs) ages of 20 patients who died from snakebite in their study. Median ages of male (14 yrs, n=11) and female (16 yrs, n=9) fatalities are at variance with the mean age given for all admissions. However, it is not possible to <strong>com</strong>pare this data further as no sex-specific calculations are provided. Williams et al (2003) do give age-specific data for snakebite in Mekeo, with a mean age for males of 23.1 years and 22.7 years for females and a median age of 20 years for both sexes. There were a disproportionate number of 16-30 year old males and females bitten by snakes in Mekeo; 49.7% of all male snakebite victims and 53.6% of all female snakebite victims in Mekeo fell into this age range despite that fact that only 27.5% of males and 27.1% of females in Mekeo were aged between 16 and 30 years. Although 43.5% of the male population, and 41.1% of the female population were aged between 0-15 years old, snakebite victims of these ages were under-represented; 28.6% of males and 23.4% of females were 0-15 years old. 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 Males Females FIGURE 2: Age distribution of 336 male and 261 female patients admitted to health centres in Mekeo between 1997 and 2001 for whom actual age was recorded (SOURCE: Williams et al, 2003) - 1.10 -
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