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      Geographical distribution of health indicators related to snake bites and envenomation in Morocco between 1999 and 2013

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          Abstract

          OBJECTIVES

          Envenomation from snake bites is a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the epidemiological features of snake bites in Morocco and to evaluate time-space trends in snake bite incidence, the mortality rate, and the case-fatality rate.

          METHODS

          This is a retrospective study of snake bite cases reported to the Moroccan Poison Control Center between 1999 and 2013.

          RESULTS

          During the study period, 2,053 people were bitten by snakes in Morocco. Most victims were adults (55.4%). The average age of the patients was 26.48±17.25 years. More than half of the cases (58.1%) were males. Approximately 75% of snake bites happened in rural areas, and 85 deaths were recorded during this period. The incidence of snake bites remained generally steady over the 15-year period of this study, with a marked increase noted since 2012. The mortality rate has increased slightly, from 0.02 deaths per 100,000 inhabitants in 1999 to 0.05 in 2013. The geographical distribution of snake bite cases in the regions of Morocco showed that Tanger-Tétouan had the highest annual incidence of snake bites (1.41 bites per 100,000 inhabitants). However, the highest annual mortality rates were recorded in the Guelmim-Es Semara and Souss-Massa-Drâa regions (0.09 deaths per 100,000 inhabitants for both regions).

          CONCLUSIONS

          The geographical distribution of the incidence, mortality, and case-fatality rates of snake bites in Morocco showed large disparities across regions during the three 5-year periods included in this study, meaning that certain areas can be considered high-risk for snake bites.

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          Most cited references20

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          Snake envenomation in a north Indian hospital.

          To study the clinical profile of snake envenomation in a tertiary referral north Indian hospital. Retrospective case note analysis of all cases of snakebite admitted to the medical emergency from January 1997 to December 2001. Of a total of 142 cases of snakebite there were 86 elapid bites presenting with neuroparalytic symptoms and 52 viper bites having haemostatic abnormalities. Some 60.6% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.7 and male to female ratio was 4.25:1. Median time to arrival at our hospital after the bite was nine hours and mean duration of hospital stay was eight days. Twenty seven cases had acute renal failure and 75% of all elapid bites required assisted ventilation. Seventeen of 119 patients who received antivenom had an adverse event. The average dose of antivenom was 51.2 vials for elapid bites and 31 vials for viper bites. Overall mortality rate was 3.5%. Snakebites are common in the rural population of developing countries. There is a need to educate the public about the hazards of snakebite, early hospital referral, and treatment.
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            Ten years of snakebites in Iran.

            Many species of venomous snakes are found in Iran. The most medically important species which are responsible for the most snakebite incidents in Iran belong to the Viperidae family, including Vipera lebetina, Echis carinatus, Pseudocerastes persicus, Vipera albicornuta and the Elapidae family, especially Naja naja oxiana. At least one kind of venomous snake is found in each of the 31 provinces, and many provinces have more than one venomous species. As a result, snakebite is a considerable health hazard in Iran, especially in the rural area of south and south-west of Iran. A retrospective, descriptive study of snakebite in Iran during 2002-2011 was carried out in order based on data collected from medical records of bite victims admitted to hospitals and health centers. From 2002 to 2011, 53,787 cases of snake bites were reported by medical centers in Iran. The annual incidence of snake bites in 100,000 of population varied from 4.5 to 9.1 during this decade and the number of recorded deaths were about 67 cases. The highest rate of snakebite was found in provinces of south and southwest of Iran. We suggest that people, especially in the rural areas, need to be trained and educated about venomous snakes, their hazards, prevention of bite and the importance of early hospital referral and treatment of victims. Also adequate antivenins as the main life saving medicine should be made available based on the recorded numbers of victims in each area of the country. Copyright © 2014 Elsevier Ltd. All rights reserved.
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              Toxicovigilance Systems and Practices in Africa

              African consumers and citizens are growingly aware of the wide range of toxic poisoning scenarios from different products and hazards. Recurrent episodes on poisoning that have been reported in Africa include toxic hazards in consumers’ products ranging from food to herbal medicine, drugs, and cosmetics. Chemical poisoning remains an issue that is overlooked by public health stakeholders in Africa. Available information on toxicovigilance systems and practices in African countries is reviewed in terms of increasing development, organization and articulation levels. Less than nine out of 54 African countries have a legally recognized toxicovigilance system. Of these, the majority have created toxicovigilance systems recently, and are facing many challenges in developing them, at regional and country levels. Basic structures for a good toxicovigilance system include a phone line service (available 24/7), and hospital facilities. Pesticides emerge as the hazard recognized by all of the toxicovigilance systems, and may represent a prototypic toxicant towards a toxicovigilance system that is inclusive of a wider spectrum of toxicological hazards for the protection of community health. Toxicovigilance today is more reactive than preventive in Africa, but some milestones are present that constitute some promising seminal efforts.
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                Author and article information

                Journal
                Epidemiol Health
                Epidemiol Health
                EPIH
                Epidemiology and Health
                Korean Society of Epidemiology
                2092-7193
                2018
                16 June 2018
                : 40
                : e2018024
                Affiliations
                [1 ]Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, Kenitra, Morocco
                [2 ]Moroccan Anti-Poison and Pharmacovigilance Center, Rabat, Morocco
                [3 ]Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
                Author notes
                Correspondence: Faiçal El Hattimy  Laboratory of Genetics and Biometry, Faculty of Science, Ibn Tofail University, BP 133, Kenitra 14000, Morocco  E-mail: faical.el.hattimy@ 123456uit.ac.ma
                Author information
                http://orcid.org/0000-0002-0137-7251
                http://orcid.org/0000-0001-7163-6223
                http://orcid.org/0000-0002-1803-0115
                http://orcid.org/0000-0002-3319-1494
                http://orcid.org/0000-0002-0964-1029
                http://orcid.org/0000-0002-3764-3523
                Article
                epih-40-e2018024
                10.4178/epih.e2018024
                6178366
                29909610
                995f36a1-50b5-487a-95b5-b610571db28c
                ©2018, Korean Society of Epidemiology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 7 March 2018
                : 16 June 2018
                Categories
                Original Article

                Public health
                snake bites,epidemiology,morbidity,mortality,time-space trends,morocco
                Public health
                snake bites, epidemiology, morbidity, mortality, time-space trends, morocco

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