Oral Presentation: 20 minutes 11th Asia-Pacific Congress of the International Society on Toxinology 2021

Comparing access to care and health outcomes for women and men and for different age group victims bitten by snakes in Myanmar  (#14)

Mohammad Afzal Mahmood 1 , Caitlyn Rogers 1 , Julian White 2 , Myat Thet Nwe 3 , Suzanne Edwards 4 , David Warrell 5 , Khin Thida Thwin 3 , Sam Alfred 6 , Chen Au Peh 7
  1. University of Adelaide, Adelaide
  2. Women's & Children's Hospital, Adelaide
  3. Myanmar Australia Snakebite Project, Mandalay
  4. School of Public Health, University of Adelaide, Adelaide
  5. Nuffield Department of Clinical Medicine, University of Oxford, Oxford
  6. Royal Adelaide Hospital, Adelaide
  7. Royal Adelaide Hospital, Adelaide

There are estimated 1.8 to 2.7 million snakebite envenomings and between 81,000 and 138,000 deaths annually; mostly in developing countries where many victims have difficulty accessing adequate care. Women, children and the elderly may suffer the greatest neglect, considering these groups’ overall inadequate access to care. This paper reports research that assessed relative access to healthcare and outcomes in snakebite victims of different age groups and genders.   

Data of 4455 patients were collected from patients admitted, between March 2016 and December 2018, to seven hospitals in Mandalay and Yangon regions of Myanmar. Logistic regression models were applied to assess association between ‘Death’ and ‘Age’ and ‘Gender’. 

Statistically significantly more men than women received antivenom. However, there was no statistically significant difference in risk of death. A population-based study in Myanmar showed that case fatality ratio for women snakebite victims was higher than for men. Hence, there is a probability that some women develop severe envenoming but do not have access to hospital-based care and die.

There is a statistically significant association between age and death. Children aged<15 had 2.5 times higher odds of death than those aged 20-49. This association was confirmed after controlling many variables including gender, time from bite to first healthcare facility, and whether antivenom was received. Higher fatality among children could be attributable to biological differences and challenges in clinical management.  

A comprehensive understanding of comparative health outcomes for women and men and for various age groups is needed for provision of effective care. While our study found no statistically significant difference in case fatality for women and men, women did have slightly poorer access to healthcare. The higher case-fatality among younger victims points to the need for further research to clearly define changes required for effective clinical care.