A walk in the Park

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This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

Feedback is crucial for the success of this endeavour, so you are encouraged to comment and criticize if you cannot understand something.

If you want a topic to be discussed sooner rather than later, please let me know via

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A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

If something doesn’t seem right:

a. Write to me about it (at communitymedicine4asses@yahoo.com), and

b. Cross check with another source (textbook, expert, etc.)

I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

Note 1. Those who wish to contact me on facebook are requested to kindly send a personal message introducing themselves along with the request. This will help save time and effort of all concerned. Please do not expect me to visit your page to try and identify you/ your areas of work/ interest, etc. It is common courtesy to introduce oneself to another when interacting for the first time. I am merely requesting that the same civil courtesy be extended here, too. Henceforth, I may not accept any friend requests/ requests to join the group on facebook unless accompanied by a note of introduction (except when I already know the sender).  

Note 2. Please understand that this blog (and the corresponding facebook page/ group) is maintained in my spare time. I have a full time job, and am available to pursue these activities only after regular working hours (after 5 pm Indian Standard Time). However urgently you may wish to receive a response from me, I will be able to respond only upon returning home from work (I am offline the rest of the time).

Note 3. Please mind your language when interacting with me/ in the group linked to this blog. Rude/ offensive language will result in expulsion from both my friends list and the said group.

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WHO updates fact sheet on snake antivenoms (18 September 2017)

The World Health Organization (WHO) has recently updated its fact sheet on snake antivenoms.

Key Messages:

Though the exact number of snake bites is unknown, an estimated 5.4 million people are bitten each year with up to 2.7 million envenomings.

81 000 to 130 000 people die each year as a result of snake bites, and around three times as many amputations and other permanent disabilities are caused by snakebites annually.

Bites by venomous snakes can cause

  • paralysis that may prevent breathing,
  • bleeding disorders that can lead to a fatal haemorrhage, irreversible kidney failure and
  • tissue damage that can cause permanent disability and limb amputation.

Agricultural workers and children are the most affected. Children often suffer more severe effects than adults, due to their smaller body mass.

A significant challenge in manufacturing of antivenoms is the preparation of the correct immunogens (snake venoms). At present very few countries have capacity to produce snake venoms of adequate quality for antivenom manufacture, and many manufacturers rely on common commercial sources.

In addition, lack of regulatory capacity for the control of antivenoms in countries with significant snake bite problems results in an inability to assess the quality and appropriateness of the antivenoms.

Poor data on the number and type of snake bites have led to difficulty in estimating needs, and deficient distribution policies have further contributed to manufacturers stopping production or increasing the prices of antivenoms.

Under-reporting of snake bite incidence and mortality is common:

  • In Nepal, for example, where 90% of the population lives in rural areas, the Ministry of Health reported 480 snake bites resulting in 22 deaths for the year 2000, yet figures for the same year collected in a community based study of one region (Eastern Nepal) detailed 4078 bites and 396 deaths.
  • Likewise, a very large community- level study of snakebite deaths in India gave a direct estimate of 45 ,900 (99% CI: 40,900-50,900) deaths in 2005, which is over 30 times higher than the Government of India’s official figure.

Poor regulation and the marketing of inappropriate or poor quality antivenoms has also resulted in a loss of confidence in some of the available antivenoms by clinicians, health managers, and patients, which has further eroded demand.

Given low demand, several manufacturers have ceased production, and the price of some antivenom products have dramatically increased in the last 20 years, making treatment unaffordable for the majority of those who need it.

Following a request by several UN member states, WHO formally listed snakebite envenoming as a highest priority neglected tropical disease in June 2017.

Two tools to help guide the development of appropriate antivenoms have been launched:

These tools will assist:

  • public health officials in determining what antivenoms are needed in their country and in drafting relevant national public health policies;
  • national regulators in prioritizing antivenoms for registration and assessing safety, quality, and efficacy of antivenoms to meet national public health needs;
  • procurement agencies in selecting appropriate antivenoms for national treatment needs;
  • antivenom manufacturers in developing plans for production and sale of appropriate antivenoms;
  • clinicians and health care professionals in treating snakebites; and
  • general population in knowing and being able to identify which venomous snakes live in their area.

Useful Links:

Link to the updated fact sheet:

http://who.int/mediacentre/factsheets/fs337/en/

Link to WHO’s snake antivenom database:

http://apps.who.int/bloodproducts/snakeantivenoms/database/

Link to WHO page on snake bites:

http://who.int/snakebites/en/

Link to WHO page on snake antivenoms:

http://who.int/bloodproducts/snake_antivenoms/en/

Link to WHO photo gallery on envenoming snakes:

http://who.int/snakebites/resources/photo_gallery_snakes/en/

Link to Guidelines for the Clinical Management of Snake Bites in the South East Asia Region (English) [PDF]:

http://apps.who.int/iris/bitstream/10665/205171/1/B0241.pdf?ua=1

Link to WHO document ‘Rabies and Envenomings- a Neglected Public Health Issue’ (English) [PDF]:

http://apps.who.int/iris/bitstream/10665/205171/1/B0241.pdf?ua=1

Link to WHO’s Frequently Asked Questions (FAQ) page on snake bites:

http://www.who.int/snakebites/snakebites_FAQ/en/

Link to WHO document ‘WHO Guidelines for the Production, Control and Regulation of Snake Antivenom Immunoglobulins’ (English) [PDF]:

http://who.int/bloodproducts/snake_antivenoms/snakeantivenomguideline.pdf?ua=1

Link to the website ‘Minutes to die’:

http://minutestodie.com/

Link to the official trailer of documentary ‘Minutes to die’: