A comprehensive approach to managing a neglected, neglected tropical disease; The Myanmar Snakebite Project (MSP)

• DOI: 10.1016/j.toxcx.2018.100001
• Publication Date: 2018-12-13T01:30:48Z
• Authors: Julian White; Mohammad Afzal Ma...; Sam Alfred; Khin Thida Thwin; Khin Maung Kyaw; Aung Zaw; David Warrell; Robert Cumming; John Moody; Debbie Eagles; Keiran Ragas; Nathan Dunstan; David Bacon; Plinio Hurtado; Chen Au Peh
• Keywords: Antivenom; Neglected Tropical Diseases; Tropical disease; Snake bites

Snakebite is predominantly an occupational disease affecting poor rural farmers in tropical regions and was recently added to the World Health Organisation list of Neglected Tropical Diseases (NTD). We document overview methodologies developed deployed Myanmar Project, a foreign aid project largely funded by Australian Government, with core aim "improve outcomes for snakebite patients". A multidisciplinary team experts assembled that worked collaborative manner colleagues Myanmar, first identify problems related managing then develop interventions aimed improve selected problem areas. broad approach adopted, covering antivenom production, distribution health system management snakebite. Problems identified production included snake husbandry resulting survival captive specimens, lack geographical diversity; horse husbandry, high mortality, inadequate stock acquisition protocols data collection, inappropriate immunisation bleeding techniques; capacity freeze dried antivenoms quality control systems. These were addressed various ways, some substantial improvements. Antivenom being reorganised achieve better availability utilisation stock. assessed across all levels within area study, Mandalay region. comprehensive community survey indicated hospital statistics substantially underestimated burden, access care local villagers delayed transport cost issues compounded at most peripheral level service. confirmed under-resourcing village level. Prospective case collection initiated tertiary hospitals extent burden on resources. Interventions or planned include training staff, development senior trainers who can "train trainers" nationwide sustainable way, deployment guidelines algorithms solar powered fridges remote facilities allow storage prompt treatment cases before transfer major hospitals, thereby reducing "bite needle" time.