Health Seeking Behavior Toward Snakes Bite Treatment

INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Snakebite envenoming is increasingly recognized as a major, deadly tropical disease of public health importance. Snakebite was re-included in the World Health Organization’s (WHO) list of Neglected Tropical Diseases (NTDs) in June 2017 [1,2], highlighting the lack of (i) epidemiological awareness, (ii) adequate prevention and medical training, and (iii) safe, affordable and polyvalent antivenoms in many regions. WHO estimates that yearly 4.5–5.4 million people are bitten by a snake, of which 1.8–2.7 million are envenomed [3,4], leading to about 400,000 amputations or lifelong disabilities, and 81,000–138,000 deaths. Snakebite is a major hazard in many tropical countries, where human activities and animal habitat often overlap [3,4]. Human-snake contacts occur mainly during field activities, in high grass or forest walks, but also around or in houses in regions of high density of snake population, typically farming regions where grain attracts rodents that, in turn, attract snakes.
In Cameroon, 150 snake species have been identified, more than 20% of which are potentially harmful to humans [5]. The northern regions are populated with deadly carpet vipers (Echis ocellatus). The humid equatorial climate of central Cameroon hosts different cytotoxic and haemotoxic vipers (Bitis gabonica, Bitis nasicornis and Atheris squamigera), whose venoms induce local tissue destruction that may lead to necrosis and amputation, or render blood noncoagulable, resulting in hemorrhagic shock [6]. The elapids endemic to this area are neurotoxic cobras and mambas (e.g. Naja melanoleuca and Dendroaspis jamesoni), whose venoms cause a flaccid paralysis of the cranial nerves, rapidly extending downwards to the respiratory muscles [6]. Elapids also include non-neurotoxic, cytotoxic, spitting cobras (e.g. Naja nigricollis). Snakes causing more moderate and local cytotoxic symptoms include burrowing asps (Atractaspis), some colubridae (Crotaphopeltis) and small adders (Causus spp.) [6].
The existing epidemiological estimations, globally [3,4], and in sub-Saharan Africa [7], are mainly hospital-based, underestimating the true incidence and the consequences of snakebite in the community. Some bites are rapidly lethal, so the victims die before reaching any health facility; out-of-hospital traditional treatment is also frequent, when antivenoms are not easily available, factors that all contribute to under-reporting. Out-of-hospital treatment is undergone by up to 80% of the victims, either practiced by themselves, by community members, or by traditional healers [8]. Tourniquets are often used to try to limit the spread of the venom, despite the dangerous risk of ischemia of the distal limb. WHO and some national guidelines have banned the practice [8–10]. The application of the very popular black-stone has been proven ineffective because insufficiently specific to venom proteins, although the absorbing capacity of some types of these “snake stones” has been observed [11,12]. Regarding any benefit of herbal traditional treatments, extensive research suggested encouraging local effects of many plants [13–17] but never when they are used in the raw manner in which they are used in communities [18].
Many snakebite survivors suffer life-long disabilities. Amputations described in a few studies in Sub-Saharan Africa [8–12] are among the many physical consequences of snakebite. Psychological stress and its impact on working capacities are not to be neglected. Up to 10% of victims stop working after the bite [19], and snakebites have cost over 290,000 Years of Life Lost and over 29,000 Years of Life with Disability in 16 countries of West Africa. Antivenom treatment has been proven cost-effective in West-Africa [20] and is the only recommended treatment to this day.
Sub-Saharan Africa is, along with Southern Asia, one of the most snakebite-affected regions in the world. In 2015, the Cameroonian Ministry of Public Health started reporting weekly snakebite hospital admissions at the health district level. This strong initiative is among the first, globally, at this frequency. In 2018 the Cameroon Society of Epidemiology reported more than 3,000 yearly victims of snakebite and a 2.5% lethality [21]. However, this estimate is based on hospital-provided data, excluding victims who could not consult or who died before reaching a health facility. An international workshop in Yaounde´ in November 2015 [22] brought together medical and traditional practitioners, as well as specialists in herpetology, snakebite clinical management, antivenoms, and public health authorities, to provide medical training to health professionals. This workshop highlighted clinical training and inclusive inter-disciplinary coordination as key priorities.

1.2 STATEMENT OF PROBLEM
Snakebite is a common and neglected public health problem in tropical and subtropical region affecting people mostly of lower socioeconomic group. It mostly affects the farmers and those who work in the fields and thus one of the occupational injury. The public health issues of snakebite is neglected globally [1], and it has only been added to WHO’s list of neglected tropical diseases in June 2017. The annual incidence of snake bites in Nepal is 15,000 and 10% of them are with envenomation with 10% mortality rate among the bite by poisonous snakes. There might be under reporting of the snakebite cases from Nepal and in the latest time, the actions have been taken by increasing supervisory visit to the reporting sites to overcome it [2]
In many rural communities in low- and middle-income countries, including Sri Lanka, vic- tims traditionally favour indigenous treatments for snakebites. In rural Bangladesh, Nigeria and Kenya, only 3%, 8.5% and 27% of snakebite victims respectively, sought hospital treatment [7–9]. This pattern of health seeking behaviour may be due to a combination of socio-cultural factors and poor access to often sub-optimal health care in these countries. Two qualitative studies investigating beliefs regarding snakebite and their influence on health seeking behaviour in four rural communities in Sri Lanka found that people firmly believed that Ayurvedic treatment was effective for snakebite [9,10]. Traditional healers were respected and although many victims finally sought allopathic treatment, they often initially consulted a traditional practitioner [10]. There were also common misconceptions about harms of hospital treatment, based mainly on misinformation regarding antivenom therapy [11]. However, in some middle-income countries, such as Costa Rica, most of the population affected by snakebites seeks treatment in health posts where free allopathic treatment is provided [12].
Outcomes of snakebites could be associated with the health seeking behavior of victims following the bite, and the decision on health seeking behavior can be influenced by the victims’ social and natural environment [1,13]. Information on health seeking behavior from hospital-based studies is bound to be biased and cannot be generalized to a community [14,15]. This study reports health seeking behavior following snakebite and factors influencing the decisions regarding health seeking among the individuals bitten by snakes.

1.3 RESEARCH OBJECTIVES
The main objective of this study was to assess the health seeking behavior toward snake bite treatment in Bikwin community, Karim-Lamido LGA, Taraba State. The specific objectives are as follows;
1 To identify the predisposing factors influencing health seeking behavior towards snake bite treatment in Bikwin community
2 To determine the enabling factors influencing health seeking behavior towards snake bite treatment in Bikwin community
3 To investigate the need factors that shape health seeking behavior towards snake bite treatment in Bikwin community

1.4 RESEARCH QUESTIONS
To realize the objectives of the study, the researcher posed the following research questions:
1 What are the predisposing factors influencing health seeking behavior towards snake bite treatment in Bikwin community?
2 What are the enabling factors influencing health seeking behavior towards snake bite treatment in Bikwin community?
3 What are the need factors that shape health seeking behavior towards snake bite treatment in Bikwin community?

1.5 RESEARCH HYPOTHESES
In line with the above stated objectives of this study, the following hypotheses are postulated:
Ho: There is no significant difference in health seeking behaviour towards snake bite treatment in Bikwin community,Karim-Lamido LGA, Taraba State

1.6 SIGNIFICANCE OF THE STUDY
This research work would have a practical significance of determining the factors responsible for the health seeking behaviour towards snake bite treatment in Bikwin community. The study will also reveal how health seeking behaviour of individuals impact on their health outcomes. More so, the research will provide insight and guidance to government and other health care providers to design a good health framework that will promote good attitude towards health care seeking towards snake bite treatment in Bikwin community.
On the other hand, this study will serve as a reference to students and researchers who will further carry out study on health seeking behaviour towards snake bite treatment. It will also contribute to available literature on health seeking behaviour towards snake bite treatment in Bikwin communityand Nigeria in general.

1.7 DEFINITION OF TERMS
HEALTH-SEEKING BEHAVIOUR: refers to any action or inaction undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy

1.8 ORGANIZATION OF STUDY
The study comprises of 5 chapters. In chapter one, the concepts are introduced and the problem of the study is established with the research objectives and questions. Chapter two presents the literature review while chapter three presents the research methodology. The fourth chapter presents the results and discussion, and the last chapter presents the conclusion and recommendation.