Snakebite epidemiology among rural communities in Nepal and Cameroon: random multicluster surveys with a One Health approach

Regarding our pilot study and “novel methodology” study, we confirmed through community members and expert consultations that geospatial sampling and large-scale household random cluster surveys were urgently needed, feasible, and we could obtain reliable accuracy and representativity. Sample sizes were optimized for this NTD, and for reducing inter-/intra-cluster correlation issues in two-stage cluster studies. Interpolation methods allowed to extend incidence estimates to the entire rural population of both countries.

Regarding Nepal, we provided the first epidemiological estimates of snakebite envenoming in humans and domestic animals across the entire Terai lowlands. It was also the first research study using a communitybased, transdisciplinary, and One Health design. The findings call for a strengthening of preventive measures and better access to life-saving treatments.

Regarding Cameroon, we reported the first nationwide epidemiologic estimates of snakebite envenoming in humans and domestic animals in Africa. Considering the alarming rates found, household risks, and several access issues, we suggest preventive measures, training of health professionals and improved supply of safe antivenoms.

In conclusion the four studies provided evidence of feasibility, cost-effectiveness, accuracy and robustness of an innovative method to conduct cross-sectional studies on Snakebite among humans and domestic animals in rural and remote areas. In both Cameroon and Nepal, we showed high snakebite incidence and death rates in humans and animals, as well as disability, inability to work, and gaps in access to treatments. These epidemiological data provide a solid basis for implementing primary prevention of bites at household level, and prevention of deaths and complications at the health system level in Asian and African rural habitats and ecosystems.