In an open randomized controlled trial, we compared one vial (10 mL) to two vials (20 mL) of EchiTAb-plus-ICP (EPI) antivenom among children with systemic carpet viper (Echis romani) envenoming of moderate severity in northeastern Nigeria. Systemic envenoming, presenting with incoagulable blood, was diagnosed using the 20-minute whole blood clotting test (20WBCT). Eligible patients with positive 20WBCT whose guardians assented were recruited and randomly allocated to receive either one vial or two vials of EPI administered either as a bolus or as a slow continuous infusion. The primary outcome was permanent restoration of blood coagulability 6 hours after the start of treatment, assessed by the 20WBCT and repeated at 6, 12, 24, and 48 hours after treatment. Secondary outcomes were the incidences of early adverse reactions to antivenom treatment. Initial doses permanently restored blood coagulability at 6 hours in 34/39 (87.2%) of those treated with one vial and 39/41 (95.1%) of those treated with two vials of EPI (P = 0.258). However, the proportion with permanent restoration of clotting at 6 hours among patients randomized to bolus administration was 41 of 42 (97.6%) patients compared with 32 of 38 (84.2%) patients randomized to slow infusion of EPI antivenom (P = 0.049); however, the difference was not sustained through the remaining time points. There was no difference in early adverse reactions between those treated with the two different doses or modes of delivery. We conclude that the one-vial dose compared favorably to two vials of EPI antivenom with regards to effectiveness and safety among children with carpet viper envenoming of moderate severity in Nigeria.

The Snakebite Treatment and Research Hospital (SBTRH) is a leading centre for snakebite envenoming care and research in sub-Saharan Africa, treating over 2500 snakebite patients annually. Despite routine data collection, routine analyses are seldom conducted to identify trends or guide clinical practices. This study retrospectively analyzes 1022 snakebite cases at SBTRH from January to June 2024. Most patients were adults (62%) and were predominantly male (72%). Key factors such as age, sex, and time between bite and hospital presentation were associated with outcomes, including recovery, amputation, debridement, and death. Adult males who took more than four hours to arrive to hospital were identified as a high-risk group for poor outcomes. Using patient characteristics, an XGBoost model was developed and was compared to Random Forest and logistic regression models. In general, all models had high positive predictive value and low sensitivity, meaning that if they predicted a patient to experience amputation, debridement, or death, that patient almost always actually experienced amputation, debridement, or death; however, most models rarely made this prediction. The XGBoost model with all features was optimal, given that it had both a high positive predictive value and relatively high sensitivity. This may be of significance to resource-limited settings like SBTRH, where antivenoms can be scarce; however, more research is needed to build better predictive models. These findings underscore the need for targeted interventions for high-risk groups, and further research and integration of machine-learning-driven decision support tools in low-resource-limited clinical settings.

Background: Nigeria remains one of the highest burden bearers of snakebite envenoming in sub-Saharan Africa. In Northeastern Nigeria, where agricultural practice, livestock herding and outdoor play—especially during the dark hours—are common, children are frequently exposed to snakes. Due to the unique challenges posed by paediatric snakebite envenoming and the paucity of data on paediatric snakebites, there is need for local research on this subject. The study aims to bridge this knowledge gap by examining the characteristics and outcomes of paediatric snakebites in our setting. Methods: This was a retrospective study conducted at the Snakebite Treatment and Research Hospital (SBTRH) in Kaltungo, Northeastern Nigeria. Medical records of 723 patients aged 0 to 17 years treated at this facility between 1 January to 31 December 2024 were retrieved. Socio-demographic information and key clinical data were extracted from paper-based records and recorded in a Microsoft Excel document. The association between patient characteristics and likelihood of recovery without complications like amputation, debridement or death, was assessed using univariate and multivariable regression analyses. Results: There were 480 male patients (66%) and the median age of patients was 12 (range 1 to 17). Within the study period, snakebites in children were most common in April ( n = 102, 14%). Nearly two-thirds of the participants ( n = 468, 65%) took four hours or more to present to hospital after being bitten. Indeed, patients who took four hours or more to arrive to hospital were less likely to recover without complications (Unadjusted odds ratio (OR) = 0.24, 95% confidence interval (CI) = 0.12–0.43). A sub-analysis among patients who received antivenom revealed that antivenom dose, time to antivenom administration, and antivenom cost were all significantly associated with likelihood of recovery without complications. Conclusions: This study found that some patient characteristics may contribute to poor outcomes among paediatric snakebite patients in Northeastern Nigeria. It demonstrated the increased risk of complications among those presenting to hospital more than four hours after being bitten, those without timely antivenom administration, and those who paid for antivenom. We hereby recommend increased awareness and health education on early presentation after snakebites.

Introduction: Pregnant women with neglected tropical diseases like snakebites are considered doubly neglected due to the intersection of multiple vulnerabilities, including compounded challenges stemming from socio-economic marginalization, inadequate healthcare access and most importantly, the lack of targeted public health interventions. Despite these concerns, there is a substantial gap in the literature regarding the presentation, management and outcomes of snakebites among pregnant women, especially in low-resource settings like northeastern Nigeria.Methods: Consequently, a retrospective observational study was conducted at the Snakebite Treatment and Research Hospital (SBTRH) in Kaltungo, Northeastern Nigeria. Six years of patient folders were searched to identify patients of all ages that were pregnant at the time of presentation.Results: Between 2019 and 2024, 77 pregnant women presented to SBTRH with snakebites. The median age among pregnant women presenting with snakebite was 26 [interquartile range (IQR) 20–30], and most had not completed any level of education (n = 70, 91%). On average, patients were not experiencing their first pregnancy (median gravidity 3, IQR 1–5), and the median gestational age at admission was 22 weeks (IQR 16–28 weeks). Most patients (n = 73, 95%) visited a traditional healer prior to arriving at SBTRH. All patients recovered from snakebite. Of the two women that gave birth prior to discharge, one underwent spontaneous vaginal delivery followed by neonatal death, and one underwent caesarean section, where both mother and child survived.Discussion: These findings underscore the urgent need to recognize and respond to the unique vulnerabilities of pregnant women affected by snakebite in northeastern Nigeria. There is a need to integrate snakebite education during antenatal care period, engaging traditional healers in referral networks, developing pregnancy-specific clinical protocols and strengthening surveillance systems to capture maternal and foetal outcomes comprehensively.

The Snakebite Treatment and Research Hospital (SBTRH) is a leading center for snakebite envenoming care and research in sub-Saharan Africa, treating over 2,500 snakebite patients annually. Despite routine data collection, routine analyses are seldom conducted to identify trends or guide clinical practices. This study retrospectively analyzed 1,022 snakebite cases at SBTRH from January to June 2024. Most patients were adults (62%) and were predominantly male (72%). Key factors such as age, sex, and time between bite and hospital presentation were associated with outcomes, including recovery, amputation, debridement, and death. Adult males who took more than four hours to arrive to hospital were identified as a high-risk group for poor outcomes. Using patient characteristics, an XGBoost model was developed, which achieved an area under the received-operator curve (AUROC) of 0.484 with all patient characteristics, and 0.529 when using a simplified subset of characteristics. Model performance was compared to random-forest and logistic regression models. In general, for all models, performance tended to increase slightly when using a simplified set of features, which may be of significance to resource-limited settings like SBTRH, however, more research is needed to build more robust models. These findings underscore the need for targeted interventions for high-risk groups, optimization of antivenom administration strategies and integration of machine learning-driven decision support tools in low-resource-limited clinical settings.