{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:50:08Z","timestamp":1787068208357,"version":"build-2736575974"},"update-to":[{"DOI":"10.1371\/journal.pntd.0011768","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000}}],"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000683","name":"Royal Society of Tropical Medicine and Hygiene","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000683","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CRI Foundation"},{"name":"University of Global Health Equity"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Snakebite envenomation (SBE) is endemic to sub-Saharan Africa and generally over-represented in rural, remote, and impoverished agricultural communities. While poverty is an established risk factor, little research has been done to investigate the economic consequences of SBE. This cross-sectional, quantitative study aimed to measure out-of-pocket spending and lost income when a household member was bitten by a snake. In 2020, 732 snakebite survivors from Eastern Province (Rwanda) agreed to complete a survey administered by telephone. The survey focused on participant demographics, income, direct medical and non-medical costs, care-seeking decisions, and lost work during convalescence. Our results suggested that patients incurred the highest mean expenses when they sought care from hospitals (11 307 RWF or 12 USD) or traditional healers (5 836 RWF or 6 USD) but that the highest maximum cost was incurred from traditional healers (300 000 RWF or 313 USD). Across all victims, the total amount paid to traditional healers (3.4 million RWF or 3 537 USD) was 4.7 times higher than all other care providers combined. On average, families lost 111 814 RWF (117 USD) per snakebite in direct treatment costs and indirect productivity losses. Many victims sought care from traditional healers despite being eligible for free medical care. Altogether, this study serves as a reminder of the serious physical and financial consequences associated with SBE and provides justification for new investments into SBE prevention and care.<\/jats:p>","DOI":"10.1371\/journal.pntd.0011768","type":"journal-article","created":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T13:36:35Z","timestamp":1700487395000},"page":"e0011768","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["\u201cI sold my towel and shoes to pay the traditional healer\u201d: Care-seeking costs and productivity losses among snakebite victims in Eastern Province, Rwanda"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6122-5332","authenticated-orcid":true,"given":"Janna M.","family":"Schurer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahlet Tadesse","family":"Admasu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihigo","family":"Bonaventure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieudonne","family":"Hakizimana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elijah","family":"Murara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E.","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Rafferty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,20]]},"reference":[{"key":"pntd.0011768.ref001","first-page":"50","volume-title":"Snakebite envenoming\u2014A strategy for prevention and control [Internet]","author":"World Health Organization","year":"2019"},{"key":"pntd.0011768.ref002","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3390\/toxins11040193","article-title":"Long-term effects of snake envenoming.","volume":"11","author":"S Waiddyanatha","year":"2019","journal-title":"Toxins"},{"key":"pntd.0011768.ref003","doi-asserted-by":"crossref","first-page":"e569","DOI":"10.1371\/journal.pntd.0000569","article-title":"Snake envenoming: a disease of poverty.","volume":"3","author":"R Harrison","year":"2009","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0011768.ref004","author":"World Health Organization","year":"2019","journal-title":"Snakebite envenoming [Internet]."},{"key":"pntd.0011768.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.toxicon.2018.12.002","article-title":"Snakebite burden in Sub-Saharan Africa: estimates from 41 countries","volume":"159","author":"S Halilu","year":"2019","journal-title":"Toxicon"},{"key":"pntd.0011768.ref006","doi-asserted-by":"crossref","first-page":"104729","DOI":"10.1016\/j.prevetmed.2019.104729","article-title":"Snakebite in domestic animals: First global scoping review","volume":"170","author":"I Bolon","year":"2019","journal-title":"Prev Vet Med"},{"issue":"6","key":"pntd.0011768.ref007","doi-asserted-by":"crossref","first-page":"e0009464","DOI":"10.1371\/journal.pntd.0009464","article-title":"Health and economic burden estimates of snakebite management upon health facilities in three regions of southern Burkina Faso.","volume":"15","author":"S Ahmed","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0011768.ref008","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.12688\/f1000research.20268.1","article-title":"Management and cost of snakebite injuries at a teaching and referral hospital in Western Kenya.","volume":"8","author":"M Okumu","year":"2019","journal-title":"F1000Research."},{"key":"pntd.0011768.ref009","article-title":"Snakebite in Rwanda: Care-seeking behaviour, anti-venom availability, and economic costs.","author":"J. 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