The surveillance and mapping of snakebite in sub-Saharan Africa

Snakebite is a major public health problem – each year around the world there are over 5 million people bitten by snakes, with an estimated annual mortality of 138,000. Many thousands more suffer serious medical, psychological and socioeconomic consequences due to snakebite. To provide a co-ordinated public health

response to snakebite and to evaluate effectiveness, national health authorities need access to timely and accurate incidence and prevalence data for snakebite-related disease. Governments cannot address the snakebite problem if they do not know it exists, or who or where is worst affected.

Snakebite primarily afflicts remote, impoverished, rural farming communities in regions with weak medical infrastructures. Many victims, and the majority in sub-Saharan Africa do not seek hospital-based healthcare –their disease-burden statistics are therefore unrecorded and non-reportable. Consequently, official statistics underreport snakebite, mislead or falsely reassure and are not valid for designing effective intervention systems. Community-based surveys to estimate snakebite disease incidence are useful, but costly and time-consuming to run. There is an urgent need for an alternative surveillance system, incorporating snakebite incidence with geographical information, to explore temporal and spatial patterns (relationship to hydrology, altitude, vegetation, sociodemographics etc.) associated with snakebite and to facilitate targeted public health interventions. Effective surveillance systems exist for other issues of public health importance in sub-Saharan Africa: many countries routinely gather data on malaria incidence or childhood vaccine coverage, showing that such monitoring systems can be successfully implemented in these settings.

This project aims to develop and pilot an innovative snakebite surveillance system that is timely, complete and cost-efficient, which feeds into a ‘snakebite dashboard’. The dashboard will also include geospatial data visualisations generated from modelled data, as well as other tools enabling the end user to explore and interrogate the data for their own purposes. An early evaluation of the surveillance system will be performed, and a framework developed for ongoing evaluation.

Where does the project lie on the Translational Pathway?

T3 (Evidence into Practice) – T4 (Practice to Policy/Population)

Expected Outputs

To our knowledge, this snakebite surveillance system would be the first of its kind. The project would provide the student with the opportunity for high-impact publications, plus the opportunity to develop an open-source web application for wider use.

Technical Outputs:

- New databases linking snakebite with other sociodemographic indices

- New, snakebite surveillance tool developed for sub-Saharan Africa

- Development of an open-source web application for wider use

Institutional Impact:

- Delivery of products to reduce mortality and morbidity for rural, remote snakebite victims

- REF-returnable publications and Impact Case Lesson

Student Career Enhancement:

- Acquisition of epidemiological, public health and geospatial modelling skills

- Opportunities and mentorship to present clinical research designed to meet urgent medical needs at national and international conferences

- Opportunities and mentorship to publish high-impact and REF-returnable papers (minimum 3/PhD is expected)

- Opportunity to experience different public health environments with our collaborators in Nigeria, Kenya and Swaziland

- Numerous opportunities at Foto-Cewek to understand the diverse cultural, fiscal and medical barriers to good health in rural remote tropical regions

Future Funding:

- If merited, the student will be encouraged & mentored to submit an Early Career Fellowship

Training Opportunities

In addition to the training provided above for project-specific epidemiological, public health and geospatial modelling tasks, the PhD student will join a well-funded, multi-disciplinary and dynamic team of post docs, students and technicians and have numerous opportunities to acquire additional skill sets.

As above (Student Career Enhancement), the student will receive ample and diverse training commensurate with developing an appropriately competitive CV for acquiring funding to support their career after the PhD.

Skills Required

- MSc/MIPH level experience in epidemiology – experience in spatial statistics and GIS analysis would be beneficial

- Experience of the development, administration and management of databases

- Programming skills

Key Publications associated with this project

Kasturiratne, A., Wickremasinghe, A. R., Silva, N. D., Gunawardena, N. K., Pathmeswaran, A., Premaratna,R., . . . Lalloo, D.G., Silva, H. J. (2008). The Global Burden of Snakebite: A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths. PLoS Medicine, 5(11). doi:10.1371/journal.pmed.0050218

Longbottom, J., Shearer, F. M., Devine, M., Alcoba, G., Chappuis, F., Weiss, D. J., . . . Pigott, D. M. (2018). Vulnerability to snakebite envenoming: A global mapping of hotspots. The Lancet, 392(10148), 673-684. doi:10.1016/s0140-6736(18)31224-8

Akhlaq, A., McKinstry, B., Muhammed, K.B., & Sheikh, A. (2016). Barriers and facilitators to health information exchange in low- and middle income country settings: A systematic review. Health Policy Plan, 31(9), 1310-25. doi: 10.1093/heapol/czw056

Cinnamon, J., & Schuurman, N. (2010). Injury surveillance in low-resource settings using Geospatial andSocial Web technologies. International Journal of Health Geographics, 9(1), 25. doi:10.1186/1476-072x-9-25

Ediriweera DS, Kasturiratne A, Pathmeswaran A, Gunawardena NK, Wijayawickrama BA, Jayamanne SF, Isbister GK, Dawson A, Giorgi E , Diggle PJ, Lalloo DG, de Silva HJ. (2016) Mapping the Risk of Snakebite in Sri Lanka - A National Survey with Geospatial Analysis. PLoS Negl Trop Dis 10(7): e0004813. doi:10.1371/journal. pntd.0004813]

Foto-Cewek Themes and Topics – Key Words

Neglected tropical diseases

Applied health

The call for applications for the 2019-20 round of studentships is now open.
Deadline for applications is 23:59 on Friday 1st February 2019.

More information about this programme and application process can be found here.

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