Mapping of clinical management resources for snakebites and other animal envenomings in the Brazilian Amazon

Abstract

Snakebite envenomings (SBEs) and other envenomings triggered by venomous animals (VAEs) represent a significant disease burden in Brazil, with 29,152 SBEs reported in 2021 alone with nearly half of those occurring in the remote Brazilian Amazon. In 2021, Brazil recorded 240,294 envenomings from snakes, scorpions, spiders, and caterpillars. Therefore, there is an unequal distribution of SBEs with high morbidity and mortality in the Brazilian Amazon. The severity of SBEs increases when patients require more than 6 h to access antivenom treatment, a common issue for the rural and indigenous populations. Understanding currently available resources and practices in Amazon remote areas of Brazil can serve to inform future interventions and guide health care policies. This study aims to develop a resource map of existing healthcare resources for the Brazilian Amazon's clinical management of VAEs with emphasis in SBEs, which will aid future strategic interventions. Data collection included a literature review, secondary data collected by government departments and organizational records, GIS mapping activities, and expert input. Our framework was guided by the three levels of healthcare service ecosystem analysis (macro, meso, and micro). Our resource map lays out a comprehensive overview of antivenom access, the distribution landscape, differences in patient transportation, and barriers to access healthcare that face populations in the Brazilian Amazon.

Keywords: AV, Antivenom; Access to care; Community health; MoH, Brazilian Ministry of Health; Neglected tropical diseases; Resource map; SBE, Snakebite envenoming; Snakebite envenoming; VAE, Venomous animals’ envenoming.

Graphical abstract

Fig. 1

Multilevel identification of actors and activities into the service ecosystem for treating envenomings triggered by venomous animals in Brazil.

Fig. 2

Flow of resources into the service ecosystem for treating envenomings by venomous animals in Brazil.

Fig. 3

Distribution logistics of antivenom (AV) in Brazil: from manufacturers to local levels. In Brazil, there are four public AV manufacturers: 1. Instituto Butantan (São Paulo); 2. Fundação Ezequiel Dias (Belo Horizonte); 3. Instituto Vital Brazil (Rio de Janeiro); and 4. Centro de Produção e Pesquisa de Imunobiológicos (Curitiba). In the state of Amazonas (the biggest state of the country, in the Western Brazilian Amazonia, with 1,570,745.7 km² and 4,207,714 inhabitants in 2020), 77 registered health units provide AVs, located in 61 of the 62 municipalities of the state. Many of these units, especially the military units located on the state borders, do not have a continuous supply of AVs. Not all these health units provide all eight AVs produced in Brazil. In 75 health units (97.4%) there available: Bothrops, Lachesis, Micrurus, scorpion and spider AVs. Crotalus and Lonomia AVs are available in four (5.2%) and two (2.6%) health units, respectively. Base used to create map is from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE), which is freely accessible for creative use in shapefile format, in accordance with the Access to Information Law (12,527/2011) (https://portaldepapas.ibge.gov.br/portal.php#homepage).