Pediatric snakebite in Sub-Saharan Africa: Clinical predictors, outcomes, and gaps in care-A systematic review.

BACKGROUND

Snakebite envenomation (SBE) remains a significant but neglected public health problem among children in sub-Saharan Africa (SSA), with clinical predictors of severity and regional disparities in outcomes still poorly characterized.

METHODS

We conducted a systematic review of peer-reviewed studies published from database inception to October 2024 on pediatric snakebite envenomation (SBE) in SSA, focusing on clinical and demographic predictors of severe outcomes. Data on study characteristics, SBE symptoms, risk factors, and outcomes were synthesized descriptively.

RESULTS

Eighteen studies from six SSA countries were included (totaling 2,687 pediatric patients). Children affected were predominantly under 12 years, with a male predominance. Severe outcomes including death, amputation, and permanent disability were closely associated with delayed hospital presentation (> 6-12 hours), certain traditional first aid practices, young age (<10 years old), severe local swelling, upper limb bites, and laboratory. Most identified SBE syndromes were cytotoxic or haematotoxic; neurotoxic cases were rarely reported. Antivenom availability and type varied by country and facility; adverse reactions were common (≈20-70%, definition-dependent; anaphylaxis up to ~57%). Mortality ranged from <5% in South Africa and Kenya to 14% in Gambia and 36% in Cameroon, correlating with both antivenom and essential emergency care access. Research gaps included limited data from several high-burden regions, lack of standardized pediatric protocols, and few long-term outcomes.

CONCLUSIONS

Pediatric SBE in SSA is characterized by substantial preventable morbidity and mortality, mainly due to delays in care and inconsistent access to essential emergency care and safe antivenom. Improved health system capacity, rapid referral, and standardized management are urgently needed.