{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:31:26Z","timestamp":1789777886248,"version":"4.0.1"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,21]],"date-time":"2024-08-21T00:00:00Z","timestamp":1724198400000},"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:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methodology<\/jats:title>\n<jats:p>This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Findings<\/jats:title>\n<jats:p>The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post\/center, or hospital), while 87% sought informal care (family\/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting\/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0012378","type":"journal-article","created":{"date-parts":[[2024,8,21]],"date-time":"2024-08-21T23:48:59Z","timestamp":1724284139000},"page":"e0012378","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Snakebite incidence and healthcare-seeking behaviors in Eastern Province, Rwanda: A cross-sectional study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5379-4129","authenticated-orcid":true,"given":"Dieudonne","family":"Hakizimana","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren E.","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Happy Tahirih","family":"Kampire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihigo","family":"Bonaventure","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahlet","family":"Tadesse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elijah","family":"Murara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Dusabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandre","family":"Ishema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janna M.","family":"Schurer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,21]]},"reference":[{"issue":"9708","key":"pntd.0012378.ref001","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0140-6736(09)61159-4","article-title":"The Global Snake Bite Initiative: an antidote for snake bite","volume":"375","author":"D Williams","year":"2010","journal-title":"Lancet"},{"issue":"12","key":"pntd.0012378.ref002","doi-asserted-by":"crossref","first-page":"e569","DOI":"10.1371\/journal.pntd.0000569","article-title":"Snake envenoming: a disease of poverty.","volume":"3","author":"RA Harrison","year":"2009","journal-title":"PLoS Negl Trop Dis."},{"key":"pntd.0012378.ref003","volume-title":"Snakebite envenoming","author":"World Health Organization","year":"2019"},{"issue":"10","key":"pntd.0012378.ref004","doi-asserted-by":"crossref","first-page":"100068","DOI":"10.1016\/j.toxcx.2021.100068","article-title":"What is the impact of snakebite envenoming on domestic animals? A nation-wide community-based study in Nepal and Cameroon","volume":"9","author":"I Bolon","year":"2021","journal-title":"Toxicon X"},{"key":"pntd.0012378.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"},{"issue":"1","key":"pntd.0012378.ref006","doi-asserted-by":"crossref","first-page":"316","DOI":"10.4269\/ajtmh.20-0976","article-title":"Snakebite Envenomation in Rwanda: Patient Demographics, Medical Care, and Antivenom Availability in the Formal Healthcare Sector","volume":"104","author":"R Nduwayezu","year":"2021","journal-title":"Am J Trop Med Hyg"},{"issue":"7","key":"pntd.0012378.ref007","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1093\/trstmh\/trab187","article-title":"Knowledge, attitudes, and practices: a quantitative assessment of hospital physicians and medical interns treating snakebite envenomation in Rwanda","volume":"116","author":"JM Schurer","year":"2022","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0012378.ref008","doi-asserted-by":"crossref","first-page":"107292","DOI":"10.1016\/j.toxicon.2023.107292","article-title":"Antivenom for sale? Availability and affordability of snakebite medicines across public and private health facilities in Rwanda","volume":"234","author":"JM Schurer","year":"2023","journal-title":"Toxicon"},{"key":"pntd.0012378.ref009","doi-asserted-by":"crossref","first-page":"100100","DOI":"10.1016\/j.toxcx.2022.100100","article-title":"At the hospital they do not treat venom from snakebites\u201d: A qualitative assessment of health seeking perspectives and experiences among snakebite victims in Rwanda","volume":"14","author":"JM Schurer","year":"2022","journal-title":"Toxicon X"},{"issue":"4","key":"pntd.0012378.ref010","first-page":"e0009298","article-title":"The medicine is not for sale\u201d:","volume":"15","author":"J Steinhorst","year":"2021","journal-title":"Practices of traditional healers in snakebite envenoming in Ghana. 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In: Handbook of venoms and toxins of reptiles 2nd ed"},{"key":"pntd.0012378.ref024","first-page":"h5378","article-title":"Snake bite: a global failure to act costs thousands of lives each year. Vol. 351, BMJ (Clinical research ed.).","author":"DJ Williams","year":"2015","journal-title":"England"},{"issue":"1","key":"pntd.0012378.ref025","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s41182-022-00421-8","article-title":"Snakebite victim profiles and treatment-seeking behaviors in two regions of Kenya: results from a health demographic surveillance system","volume":"50","author":"PS Larson","year":"2022","journal-title":"Trop Med Health"},{"issue":"3","key":"pntd.0012378.ref026","doi-asserted-by":"crossref","first-page":"828","DOI":"10.4269\/ajtmh.21-0266","article-title":"The Burden of Snakebite in Rural Communities in Kenya: A Household Survey","volume":"105","author":"GI Ooms","year":"2021","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0012378.ref027","doi-asserted-by":"crossref","first-page":"100086","DOI":"10.1016\/j.toxcx.2021.100086","article-title":"Access to antivenoms in the developing world: A multidisciplinary analysis","volume":"12","author":"J Potet","year":"2021","journal-title":"Toxicon X"},{"issue":"4","key":"pntd.0012378.ref028","article-title":"Snakebite: When the Human Touch Becomes a Bad Touch.","volume":"10","author":"BG Fry","year":"2018","journal-title":"Toxins (Basel)."},{"issue":"2","key":"pntd.0012378.ref029","doi-asserted-by":"crossref","DOI":"10.4103\/ed.ed_11_19","article-title":"Primary prevention of snakebite envenoming in resource-limited settings: A narrative review.","volume":"4","author":"GC Michael","year":"2019","journal-title":"Environ Dis"},{"key":"pntd.0012378.ref030","article-title":"Priority Actions and Progress to Substantially and Sustainably Reduce the Mortality, Morbidity and Socioeconomic Burden of Tropical Snakebite.","volume":"8","author":"RA Harrison","year":"2016","journal-title":"Toxins. 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