Epidemiology of Paediatric Snakebites in Northeastern Nigeria: A Retrospective Single-Center Study

Epidemiology of Paediatric Snakebites in Northeastern Nigeria: A Retrospective Single-Center Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Epidemiology of Paediatric Snakebites in Northeastern Nigeria: A Retrospective Single-Center Study Nicholas Amani Hamman, Aashna Uppal, Ezra Garbeya Daniel, Nuhu Mohammed, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6037643/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Aug, 2025 Read the published version in BMC Pediatrics → Version 1 posted 4 You are reading this latest preprint version Abstract 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. Our study aims to bridge this knowledge gap by examining the characteristics and outcomes of paediatric snakebite in our setting. Methods This was a retrospective study conducted at the Snakebite Treatment and Research Hospital (SBTRH) in Kaltungo, Northeastern Nigeria. Ethical clearance was obtained from the Gombe State Hospital Services Management Board. Medical records of 384 patients aged 0 to 17 years treated at this facility between 1 January to 30 June 2024 were retrieved. Socio-demographic information and key clinical data were extracted using a digital proforma. The association between patient characteristics and likelihood of recovery without complications like amputation, debridement or death, was assessed using univariate and multivariate analyses. Associations were considered significant if the corresponding p-values were less than 0.05. Results There were 262 male patients (68%) and 29 patients under five years of age (7.6%). Snakebites in children were most common in April (n = 102, 27%). Over half of the participants (n = 230, 60%) took four hours or more to present to hospital after being bitten. Male patients were less likely than female patients to recover without complications (unadjusted odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.07–0.91). Further, patients that took four hours or more to arrive at hospital after being bitten were less likely to recover without complications than those who took less than four hours to arrive (unadjusted OR = 0.40, 95% CI = 0.22–1.02). Conclusions This study revealed key epidemiological characteristics and outcomes of paediatric snakebite patients in Northeastern Nigeria. It further showed the increased risk of complications among male patients and those presenting to hospital more than four hours after being bitten. We hereby recommend increased awareness and health education on early presentation after snakebites. Snakebites Paediatric Patients Nigeria Epidemiology Patient Outcomes Background Snakebite envenoming continues to remain a pressing public health challenge posing significant threat to vulnerable populations, particularly in the tropical and subtropical regions of the world [ 1 ]. The numerous challenges bedevilling the tropics like inadequate healthcare access, limited public awareness, and environmental and socio-economic challenges converge to exacerbate the risk of envenoming and its devastating consequences [ 1 , 2 ]. In 2017, the World Health Organization (WHO) re-classified snakebite as a neglected tropical disease, recognizing its substantial and disproportionate health burden in low- and middle-income countries, where a lack of resources and poverty is common [ 3 , 4 ]. Annually, an estimated 5.4 million individuals are bitten by snakes worldwide, with about 2.7 million cases resulting in envenoming and 138,880 fatalities [ 4 ]. Tragically, the incidence of amputations and other morbidities among survivors of snakebites is nearly three times the mortality figure [ 4 , 5 ]. Nigeria remains one of the highest burden bearers of snakebite envenoming with an estimated 43,000 cases occurring annually, leading to about 1,900 deaths [ 6 ]. While there are several species of snake within the region, carpet vipers account for over 66% of total snakebites and are of clinical importance due to their haematotoxic venom [ 23 ]. Even though adults account for a substantial number of snakebite victims, children under the age of 15 years represent 30% of snakebite cases in Nigeria [ 7 ]. Due to their unique physiological characteristics and body size, paediatric victims are at an elevated risk of distinct and/or severe presentation of envenomation compared to adults; this is despite the availability of antivenom and blood transfusion facilities [ 7 – 9 ]. This underscores the need for deliberate and improved research efforts and prevention, particularly for the paediatric age group. Further, in North-eastern Nigeria, where agricultural practice, livestock herding and outdoor play - especially during the dark hours - are common, children are frequently exposed to snakes [ 7 , 10 – 12 ]. Their vulnerability is often compounded by limited healthcare access, knowledge of snakebite first aid, and management among health care workers in rural settings where these bites occur [ 13 , 14 ]. This makes paediatric snakebite cases more challenging to manage, contributing to potentially higher morbidity and mortality rates compared to adult patients [ 12 , 14 ]. Children are uniquely more vulnerable to snakebite due to their small body size, higher metabolic rate, immature immune system and commonly unreliable recollection of incidents and events [ 12 , 15 ]. Their physiological factors lead to faster systemic spread of venom thereby exacerbating the severity [ 8 , 16 ]. As a result of this, paediatric victims often experience more pronounced symptoms such as shock, renal failure, haemolysis, and in severe cases, multiple organ failure [ 17 , 18 ]. Moreover, the clinical manifestation of snakebite can be difficult to predict as various species of snakes may cause different types of envenomation (e.g. haematotoxic, neurotoxic, or cytotoxic) and children are less likely to correctly identify snake species than adults [ 19 ]. It is, however, disheartening to note that despite the growing awareness of snakebite envenoming in adults, paediatric cases are often under-reported and understudied [ 14 ]. Additionally, there is a lack of data on the risk factors of both snakebite incidence and outcomes among paediatric age groups, with most studies focusing on the general population. This is especially true in snakebite endemic areas like our setting, which further complicates the development of evidence-based management protocols tailored towards children [ 4 , 14 ]. As a result, many healthcare providers rely on generalized snakebite prevention strategies, which may not account for the specific needs of paediatric patients. There remains a paucity of snakebite studies that focus on paediatric age groups, particularly in terms of clinical characteristics, outcomes, and possible long-term sequelae. This creates a gap in knowledge on the specific challenges and outcomes in paediatric snakebite patients, given the current focus on general or adult cases. Due to the unique challenges posed by paediatric snakebite envenoming, this study aims to bridge that gap in the knowledge by examining the characteristics and outcomes of paediatric snakebite cases treated at the Snakebite Treatment and Research Hospital (SBTRH) in Northeastern Nigeria. Specifically, we intend to investigate (1) the characteristics of children presenting at SBTRH and (2) the key associations between patient characteristics and envenoming outcomes. This will provide valuable insight into the management and peculiar outcomes of snakebite in children. The findings will contribute to the development of evidence-based management strategies and inform public health strategies aimed at reducing the burden of paediatric snakebites in Northeastern Nigeria. Methods This was a retrospective study conducted at SBTRH. This facility is located at the heart of Kaltungo Local Government Area (LGA), Gombe State, Northeastern Nigeria. It is a specialized hospital focused on the management of snakebite envenoming since the 1990s [ 20 – 22 ]. SBTRH provides both emergency and long-term care for victims of snakebite with a focus on treatment, training, clinical research, and public awareness campaigns. Interestingly, the hospital see cases from the all the six states of the Northeastern Nigeria, from the neighboring parts of the Northwest and Northcentral zone. Additionally, patients come from neighboring countries like Cameroon and the Republic of Chad. This hospital managed 1,022 snakebite patients between 1 January 2024 and 30 June 2024, out of which 384 were children 0 to 17 years of age. This time period covered the dry season and commencement of the rainy season. A digital study proforma was used to extract data from paper-based clinical records containing patient information. The following information was obtained from patient records and subsequently logged into an Excel document: month of snakebite occurrence, patient age, patient sex, patient state of origin, patient occupation, anatomical site of snakebite, species of snake, number of antivenom vials used, number of hours between snakebite and presentation to hospital, and patient outcome (death, amputation, debridement, or recovery). The data was then cleaned and analyzed using R software (version 4.3.1). One variable had missing data: snake species, as not every patient was able to identify the snake that bit them. We included only those aged 0 to 17 (inclusive) from this dataset, and then explored which patient characteristics were associated with patient outcomes. To note, we chose this age range as this is the most common age range for paediatric patients. Patient characteristics were summarized, separated by outcome (recovery versus amputation, debridement, and death). Because of low numbers, we grouped patients who experienced amputation, debridement or death. Associations between patient characteristics and outcomes were evaluated using a Chi-Squared or Fisher’s Exact test, and were considered to be statistically significant if the corresponding test’s p-value was less than 0.05, as per convention. Subsequently, we performed univariate and multivariable regression analysis to explore associations between patient characteristics and likelihood of recovery without complications, compared to amputation, debridement, or death. In regression analyses, we excluded the variable representing the number of antivenom vials used because of potential reverse causality (patients that experience more severe complications are often prescribed more antivenom). We reported both unadjusted and adjusted odds ratios and corresponding confidence intervals from the univariate and multivariable regression models, respectively. Ethical clearance was obtained from the Research and Ethics Committee, Gombe State Hospitals Services Management Board with reference number GS/HSMB/RES/S/05/VOL.59 Results Of the 384 paediatric patients’ records analysed, children aged 10 to 14 years made up the majority (n = 162, 42%). Over half of the patients were male (n = 262, 68%) and a minority were aged under five (n = 29, 7.6%). Nearly two-thirds took four hours or more to present to hospital after being bitten (n = 230, 60%). Further, most patients received a single dose of antivenom (n = 271, 71%), and about half of the patients resided within Gombe State (n = 184, 48%). Nearly one-third of the snakebites (n = 102, 27%) occurred in April, which is the start of the rainy season in several regions in Northeastern Nigeria. As these were pediatric patients, most either were either under care (n = 215, 56%) or were students (n = 91, 24%). Snakebites predominantly occurred on the patients’ upper limbs (n = 306, 80%), and most bites were due to carpet vipers (n = 295, 77%). Finally, nearly all patients recovered without complications (n = 361, 94%) (Table 1 ). Table 1 Sociodemographic and clinical characteristics of the patients Characteristic Frequency (%) n = 384 Age Group 10 to 14 162 (42%) 15 to 17 99 (26%) 5 to 9 94 (24%) 0 to 4 29 (7.6%) Sex Male 262 (68%) Female 122 (32%) Hours Between Bite and Hospitalization 4 hours or more 230 (60%) Less than 4 hours 154 (40%) Antivenom Dose (Number of Vials) 1 271 (71%) 2 or more 66 (17%) 0 47 (12%) State of Origin Outside of Gombe 200 (52%) Gombe 184 (48%) Month of Snakebite Occurrence April 102 (27%) March 81 (21%) May 64 (17%) June 59 (15%) February 47 (12%) January 31 (8.1%) Occupation Under Care 215 (56%) Student 91 (24%) Farmer 63 (16%) Other 15 (3.9%) Site of Snakebite Upper Limb 306 (80%) Lower Limb 76 (20%) Other 2 (0.5%) Snake Species Carpet Viper (Echis Romani) 295 (77%) Unidentifiable 83 (22%) Other 6 (1.6%) Patient Outcome Recovery 361 (94%) Amputation, Debridement, or Death 23 (6.0%) There were significantdifferences between patients who recovered without complications and those who did not. Proportionally more female patients recovered than male patients (p = 0.047). As well, albeit just short of statistical significance, there were proportionally more recoveries among patients who arrived at the hospital less than four hours after being bitten compared to those who took four hours or more to arrive (p = 0.064). As well, a significantly higher proportion of patients who were given a single dose of antivenom recovered without complications (p = 0.024). The relationship between various patient characteristics and outcome is presented in Table 2 . Table 2 Relationship between patient characteristics and outcome Variable Patient Outcome p-value 2 Amputation, Debridement, or Death , n = 23 1 Recovery , n = 361 1 Age Group 0.13 10 to 14 7 (4.3%) 155 (96%) 15 to 17 11 (11%) 88 (89%) 5 to 9 4 (4.3%) 90 (96%) 0 to 4 1 (3.4%) 28 (97%) Sex 0.047 Male 20 (7.6%) 242 (92%) Female 3 (2.5%) 119 (98%) Hours Between Bite and Hospitalization 0.064 4 hours or more 18 (7.8%) 212 (92%) Less than 4 hours 5 (3.2%) 149 (97%) Antivenom Dose (Number of Vials) 0.024 1 12 (4.4%) 259 (96%) 2 or more 9 (14%) 57 (86%) 0 2 (4.3%) 45 (96%) State of Origin 0.2 Outside of Gombe 15 (7.5%) 185 (93%) Gombe 8 (4.3%) 176 (96%) Month of Snakebite Occurrence 0.5 April 5 (4.9%) 97 (95%) March 9 (11%) 72 (89%) May 2 (3.1%) 62 (97%) June 3 (5.1%) 56 (95%) February 3 (6.4%) 44 (94%) January 1 (3.2%) 30 (97%) Occupation 0.8 Under Care 12 (5.6%) 203 (94%) Student 6 (6.6%) 85 (93%) Farmer 5 (7.9%) 58 (92%) Other 0 (0%) 15 (100%) Site of Snakebite 0.4 Upper Limb 21 (6.9%) 285 (93%) Lower Limb 2 (2.6%) 74 (97%) Other 0 (0%) 2 (100%) Snake Species 0.6 Carpet Viper (Echis Romani) 20 (6.8%) 275 (93%) Unidentifiable 3 (3.6%) 80 (96%) Other 0 (0%) 6 (100%) 1 n (%) 2 Fisher’s exact test; Pearson’s Chi-squared test Table 3 highlights the results of the univariate and multivariable regression analyses. According to univariate regression models, male patients were less likely than female patients to recover without complications (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.07–0.91). In addition, patients that took four hours or more to arrive at hospital after being bitten were less likely to recover without complications than those who took less than four hours to arrive (OR = 0.40, 95% CI = 0.22–1.02). However, neither variable remained nearly significantly associated with patient outcome in the multivariable model (p-value for sex = 0.12 and p-value for hours between bite and hospitalization = 0.3). Table 3 Likelihood of recovery without complications Characteristic Univariate Models Multivariable Model OR 1 95% CI 1 p-value Adjusted OR 1 95% CI 1 p-value Age Group 0 to 4 — — — — 5 to 9 0.80 0.04, 5.71 0.8 0.72 0.04, 5.44 0.8 10 to 14 0.79 0.04, 4.69 0.8 0.69 0.03, 4.77 0.7 15 to 17 0.29 0.02, 1.57 0.2 0.19 0.01, 1.62 0.2 Sex Female — — — — Male 0.31 0.07, 0.91 0.059 0.36 0.08, 1.18 0.12 Hours Between Bite and Hospitalization Less than 4 hours — — — — 4 hours or more 0.40 0.13, 1.02 0.072 0.46 0.10, 2.27 0.3 State of Origin Gombe — — — — Outside of Gombe 0.56 0.22, 1.32 0.2 1.07 0.24, 3.78 > 0.9 Month of Snakebite Occurrence January — — — — February 0.49 0.02, 4.03 0.5 0.45 0.02, 3.92 0.5 March 0.27 0.01, 1.51 0.2 0.34 0.02, 2.18 0.3 April 0.65 0.03, 4.22 0.7 0.66 0.03, 4.75 0.7 May 1.03 0.05, 11.2 > 0.9 1.32 0.06, 15.2 0.8 June 0.62 0.03, 5.10 0.7 0.49 0.02, 4.36 0.6 Occupation Under Care — — — — Student 0.84 0.31, 2.47 0.7 1.75 0.48, 7.00 0.4 Farmer 0.69 0.24, 2.23 0.5 1.90 0.50, 8.31 0.4 Other > 99.0 2 0.00, Inf > 0.9 > 99.0 2 0.00, Inf > 0.9 Site of Snakebite Upper Limb — — — — Lower Limb 2.73 0.78, 17.3 0.2 3.06 0.79, 20.4 0.2 Other > 99.0 2 0.00, Inf > 0.9 > 99.0 2 0.00, Inf > 0.9 Snake Species Carpet Viper (Echis Romani) — — — — Unidentifiable 1.94 0.64, 8.38 0.3 1.56 0.48, 7.01 0.5 Other > 99.0 2 0.00, Inf > 0.9 > 99.0 2 0.00, Inf > 0.9 1 OR = Odds Ratio, CI = Confidence Interval 2 An odds ratio of > 99.0 represents a very large odds ratio Discussion This study presents a comprehensive analysis of retrospective data of 384 paediatric snakebite cases treated at the SBTRH Kaltungo, Gombe State, from January to July 2024. Our study offers a valuable insight into the epidemiology, characteristics, outcome and factors influencing recovery among children who suffered snakebites in this high-risk region. To the best of our knowledge, this represents the largest number of patients in any single-site study. Further, the analysis of data covering demographic characteristics, time to presentation, snakebite species involved, antivenom administration and patient outcomes presents a broad view of the factors that influence the course and prognosis of snakebites in the paediatric age group. A key finding of the study is the male predominance among paediatric snakebite victims with 68% of the cases being male. This is consistent with many studies in sub-Saharan Africa [ 7 , 22 , 24 ] where male gender, particularly in rural and agricultural communities, are at greater risk of encountering snakes than women. This may be due to a higher exposure to outdoor environments, because males are more likely to engage in activities such as farming, livestock tending, outdoor play, errands at dark hours and other outdoor activities which put them in closer proximity to venomous snakes. Furthermore, the majority of the bites occurred during the early part of the rainy season (April-June), which highlights the seasonal variation in snakebite incidence. Snakebite incidence has been well documented in both tropical and subtropical regions to be linked to the rainfall pattern [ 22 , 25 – 27 ]. This seasonal peak implies that targeted interventions during these months could be particularly effective. These may include community education emphasizing the importance of protective hand- and foot-wear, and avoiding areas known to be predisposed to the presence of snakes such as holes and bushes. Moreover, a notable finding in this study is that female paediatric patients have higher likelihood of recovery without complications compared to male paediatric patients (unadjusted OR = 0.31, p = 0.059); however, this difference did not persist after adjusting for other variables. To our knowledge, there are no existing studies that specifically address the gender difference in outcomes among paediatrics patients. This may therefore represent a unique observation within the study and further research will be beneficial to explore potential biological, social or treatment related factors that could contribute to these differences in a prospective study. Additionally, given the importance of this finding, future studies should also investigate the influence of sociocultural determinants of healthcare access in shaping outcomes for paediatric victims of snakebite. Our study noted that about 60% of patients arrived four hours or more after being bitten. This may be due to the geographical distance from the site of the bite to the hospital, bearing in mind that these patients are not only from Gombe State, and may face several barriers such as poor transportation infrastructure or lack of awareness on the importance of early intervention in snakebite care. However, this delay is a key concern because snakebite envenomation can progress rapidly, leading to complications when definitive intervention is not applied as early as possible. Interestingly, the study found that patients who took four hours or more to arrive at hospital after being bitten were less likely to recover without complications than those who took less than four hours to arrive (OR = 0.40, 95% CI = 0.13–1.02) which implies that early intervention is still critical in improving recovery rate. Delay in seeking medical treatment has long been recognized as a major factor in poor outcomes for snakebite victims, particularly in rural settings where healthcare access is limited [ 11 – 13 , 20 , 28 ]. However, this association was no longer significant in the multivariate model. This underlines the need for creating more awareness and health education on the importance of early medical care, as well as improvement in accessibility to healthcare, especially in rural areas. Community level interventions such as mobile health services and improving transport options may help to mitigate the delay in care, thereby improving patient outcomes. Unexpectedly, the study also finds that hands were the commonly affected site (80%) which is a significant departure from global, regional and even local studies [ 29 – 33 ], which consistently report that lower extremities are more frequently affected. This finding is intriguing and raises important questions about the contextual factors influencing snakebite patterns among paediatric patients in North-eastern Nigeria. The higher number of bites to the upper extremities may be linked to particular behavioural and environmental factors such as children's outdoor activities, like farming, gathering dried grass during bush clearing and weeding, as well as the dipping of hands into holds to look for small animals like rats for consumption. Interestingly, hands are typically the first point of contact when a child encounters animals like snakes whether while playing, working, or performing other tasks. Such a finding challenges conventional assumptions and calls for further research into the specific local dynamics and regional practices that could influence snakebite patterns, particularly prospective studies, which we intend to undertake to confirm our findings. These insights may be crucial for adapting preventive measures and clinical interventions in the region. The study found that most of the patients (71%) received a single vial of antivenom while 17% received two vials. The associations between the number of vials administered and outcomes revealed that patients who received only a single vial were overrepresented among those who recovered without complications (p = 0.024). However, this might have been explained by the fact that severely envenomed patients often require higher doses of antivenom and patients who experience severe envenomation are often those at risk of amputation or death. Accordingly, we excluded the number of antivenom vials used from regression analysis due to concerns of reverse causality. However, this finding points to the importance of early recognition of envenoming severity and the need for tailored treatment protocols that consider the specific venom profile and clinical presentation in pediatric patients. Finally, a majority of the cases (77%) were attributed to the carpet viper (Echis occellatus) which has been documented to be responsible for most snakebites in this region [ 7 , 23 , 34 , 35 ]. This further emphasizes the need for effective and affordable antivenoms that target this species specifically. Given that 21% of cases were unidentifiable, this underscores the challenges of accurately identifying snakes in emergency settings, particularly in rural areas and among paediatric patients, where snake identification may not be a priority for affected individuals. Despite its unique and valuable findings, this study is not without limitations. The retrospective design, which relied on paper-based records, might have introduced biases related to data accuracy and completeness. Although the study was conducted at a single-centre hospital, it serves as a regional referral facility for all states of North-eastern Nigeria and parts of North-western, North central Nigeria, Cameroon and Chad. This broad catchment area partially mitigates concerns about the generalizability of the findings. However, to build on these results and gain a more comprehensive understanding of the new and unique findings in paediatric snakebite epidemiology and outcomes, future research should aim to conduct single-centre prospective or multi-center prospective studies with standardized data collection protocols. Such studies would offer a more detailed and representative picture of the factors influencing outcomes in paediatric snakebite envenomation across diverse settings in the region. Conclusions This study which is a pilot analysis that is part of a broader effort to digitize five years’ worth of paediatric snakebite data in the facility provided a comprehensive analysis of 384 paediatric snakebite cases from a referral facility in Northeastern Nigeria, highlighting key findings that contributed significantly to the understanding of snakebite epidemiology and recovery outcomes in the region. A critical takeaway from the study is the significant delay in seeking medical treatment among patients which was associated with poorer outcomes. This finding emphasizes the need for improved advocacy and healthcare access particularly in rural areas and the importance of early intervention in snakebite cases. The study also noted better chances of recovery associated with female gender - a finding that warrants further investigation, the predominance of upper extremity bites - which challenges global trends, and the predominance of carpet viper bites - which underscores the need for effective and species-targeted antivenoms. Overall, this study is crucial in informing public health strategies, improving treatment protocols, and guiding future research to reduce the burden of snakebite envenomation in North-eastern Nigeria and similar regions where snakebite is common. Abbreviations CI Confidence Interval LGA Local Government Area OR Odds Ratio SBTRH Snakebite Treatment and Research Hospital WHO World Health Organization Declarations Ethics approval and consent to participate: Ethical clearance was obtained from the Research and Ethics Committee, Gombe State Hospitals Services Management Board with reference number GS/HSMB/RES/S/05/VOL.59. As this was retrospective and routinely collected data, individual consent from participants was not needed. Consent for publication: Not applicable. Availability of data and materials: The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at the Snakebite Treatment and Research Hospital, Kaltungo. Competing interests: We declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper Funding: Aashna Uppal acknowledges the receipt of studentship awards from the Health Data Research UK-The Alan Turing Institute Wellcome PhD Programme in Health Data Science (Grant Ref: 218529/Z/19/Z). No other author received funding for this work. Clinical trial number: Not applicable. Authors' contributions: AJD and EWI provided supervision and project conceptualisation. NAH and AU drafted the initial manuscript. NAH, AU, and NM conducted analysis and interpretation. NN, ASB, NB, BA, and BL provided key guidance and ensured smooth data acquisition and project administration. EGD, AJD, and EWI provided critical revision of the manuscript. All authors reviewed the manuscript prior to submission. Acknowledgements: We would like to acknowledge the key guidance of the Gombe State Hospital Management Board and the Gombe State Ministry of Health. In addition, this work would not have been possible without the Snakebite Treatment and Research Hospital Kaltungo’s medical records team, led by Suleiman Ahmadu. References Gopal G, Muralidar S, Prakash D, Kamalakkannan A, Indhuprakash ST, Thirumalai D, et al. The concept of Big Four: Road map from snakebite epidemiology to antivenom efficacy. Vol. 242, International Journal of Biological Macromolecules. Elsevier B.V.; 2023. 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Abdullahi A, Yusuf N, Debella A, Eyeberu A, Deressa A, Bekele H, et al. Seasonal variation, treatment outcome, and its associated factors among the snakebite patients in Somali region, Ethiopia. Front Public Health. 2022 Sep 27;10. Musah Y, Ameade EPK, Attuquayefio DK, Holbech LH. Epidemiology, ecology and human perceptions of snakebites in a savanna community of northern Ghana. PLoS Negl Trop Dis. 2019;13(8). Padidar S, Monadjem A, Litschka-Koen T, Thomas B, Shongwe N, Baker C, et al. Snakebite epidemiology, outcomes and multicluster risk modelling in Eswatini. PLoS Negl Trop Dis. 2023 Nov 1;17(11 November). Mahendra M, Mujtaba M, Mohan CN, Ramaiah M. Study of Delayed Treatment Perspective of Snake Bites and Their Long-Term Effects in a Tertiary Care Hospital in Balgalkot District of Karnataka. APIK Journal of Internal Medicine. 2021 Jul;9(3):153–8. Tekin R, Sula B, Cakirca G, Aktar F, Deveci Ö, Yolbas I, et al. Comparison of snakebite cases in children and adults. Eur Rev Med Pharmacol Sci. 2015;19:2711–6. Karunanayake RK, Dissanayake DMR, Karunanayake AL. A study of snake bite among children presenting to a paediatric ward in the main Teaching Hospital of North Central Province of Sri Lanka. BMC Res Notes. 2014 Jul 29;7(1). Kshirsagar VY, Ahmed M, Colaco SM. Clinical Profile of Snake Bite in Children in Rural India [Internet]. Vol. 23, Iranian Journal of Pediatrics. 2013. Available from: http://ijp.tums.ac.ir Sanni UA, Lawal TO, Musa TL, Alege A, Na’uzo AM. Prevalence and Outcome of Snake Bites Among Children Admitted in the Emergency Pediatric Unit, Federal Medical Centre, Birnin Kebbi, Nigeria. Cureus. 2021 Aug 24; Ndu I, Edelu B, Ekwochi U. Snakebites in a Nigerian children Population: A 5-year review. Sahel Medical Journal. 2018;21(4):204. Hamza M, Idris MA, Maiyaki MB, Lamorde M, Chippaux JP, Warrell DA, et al. Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa. PLoS Negl Trop Dis. 2016 Mar 30;10(3). Manjur M, Bala A, Tukur Z. Survey of Snakes Bites among Snake Endemic Communities in North Eastern Nigeria. Snake Venom and Ecology [Internet]. 2019; Available from: www.intechopen.com Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Aug, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 21 Feb, 2025 Editor assigned by journal 19 Feb, 2025 Submission checks completed at journal 19 Feb, 2025 First submitted to journal 15 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6037643","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":418898112,"identity":"50fd1c77-9c34-458b-80a1-8a4b1e3fb1db","order_by":0,"name":"Nicholas Amani Hamman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYDACZgY2BoYCGM+AjYEfRCcU4NYB0WIA18LHINkA0mKAWwcQIGthkGMwOADWi1u9OTvzswcfDOzsGdhPJ34uKDBL3Hx+deKHBwYM8vxiB7BqsWxmMzecYZCc2MCTu1l6hkFa4rYbbzdLAB1mOHN2AlYtBod52KR5DJiBsrkbgIxjQC1nN4C0JBjcxqul3p6B/+3m3zwG/xM3zzi7+QcRWg4zNkjkbgMy2BI38PduI2ALm5nkDIPjiW0Sb7dZA7UYz7jBu80iwUACt1/OH34m8aGi2p6fP3fzbZ4/bLL9/Wc33/xRYSPPL41dCxywwVkSYJUS+JWjAv4DpKgeBaNgFIyCEQAArg1W2dMfIuQAAAAASUVORK5CYII=","orcid":"","institution":"Snakebite Treatment and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"Nicholas","middleName":"Amani","lastName":"Hamman","suffix":""},{"id":418898113,"identity":"0921eeec-e4a6-4274-b890-7ddaffae2a9e","order_by":1,"name":"Aashna Uppal","email":"","orcid":"","institution":"The Global Health Network, Centre for Global Health and Tropical Medicine, Nuffield Department of Medicine, University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Aashna","middleName":"","lastName":"Uppal","suffix":""},{"id":418898114,"identity":"8c0f759a-5587-4a2b-9694-3198d6299cb4","order_by":2,"name":"Ezra Garbeya Daniel","email":"","orcid":"","institution":"Department of Paediatrics, Federal Teaching Hospital Gombe","correspondingAuthor":false,"prefix":"","firstName":"Ezra","middleName":"Garbeya","lastName":"Daniel","suffix":""},{"id":418898115,"identity":"2e3dd43f-383c-4bcf-8c6f-4f3376287c39","order_by":3,"name":"Nuhu Mohammed","email":"","orcid":"","institution":"Snakebite Treatment and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nuhu","middleName":"","lastName":"Mohammed","suffix":""},{"id":418898116,"identity":"8bbe99b3-48ad-4249-a196-dcacdeea8951","order_by":4,"name":"Nicholas Nyadah","email":"","orcid":"","institution":"Gombe State Hospital Services Management Board","correspondingAuthor":false,"prefix":"","firstName":"Nicholas","middleName":"","lastName":"Nyadah","suffix":""},{"id":418898117,"identity":"34d93659-9b39-4d5a-ac59-660aebc12f04","order_by":5,"name":"Abubakar Saidu Ballah","email":"","orcid":"","institution":"Snakebite Treatment and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abubakar","middleName":"Saidu","lastName":"Ballah","suffix":""},{"id":418898118,"identity":"a60a667a-e80a-4512-bc74-c8bca53e3f8e","order_by":6,"name":"Nasiru Bappayo","email":"","orcid":"","institution":"Gombe State Hospital Services Management Board","correspondingAuthor":false,"prefix":"","firstName":"Nasiru","middleName":"","lastName":"Bappayo","suffix":""},{"id":418898119,"identity":"188843f3-ad93-4df4-b0a0-65edc9a6a5f2","order_by":7,"name":"Bello Abdulkadir","email":"","orcid":"","institution":"Gombe State Hospital Services Management Board","correspondingAuthor":false,"prefix":"","firstName":"Bello","middleName":"","lastName":"Abdulkadir","suffix":""},{"id":418898120,"identity":"23dd29c1-7fcf-469f-9479-0a1d8da421ac","order_by":8,"name":"Bala Lawan","email":"","orcid":"","institution":"Gombe State Hospital Services Management Board","correspondingAuthor":false,"prefix":"","firstName":"Bala","middleName":"","lastName":"Lawan","suffix":""},{"id":418898121,"identity":"3c3fdf28-1783-4c60-ba76-c47526819bbc","order_by":9,"name":"Abubakar Joshua Difa","email":"","orcid":"","institution":"Department of Community Medicine and Public Health, Gombe State University","correspondingAuthor":false,"prefix":"","firstName":"Abubakar","middleName":"Joshua","lastName":"Difa","suffix":""},{"id":418898122,"identity":"1ae209ca-8dbd-4b58-b8d8-ddc43c0dbbcd","order_by":10,"name":"Elon Warnnow Isaac","email":"","orcid":"","institution":"Department of Paediatrics, Gombe State University","correspondingAuthor":false,"prefix":"","firstName":"Elon","middleName":"Warnnow","lastName":"Isaac","suffix":""}],"badges":[],"createdAt":"2025-02-15 16:38:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6037643/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6037643/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-05910-3","type":"published","date":"2025-08-29T15:57:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90344874,"identity":"e3fa0434-7c57-48a2-b5a9-d6a146a0e495","added_by":"auto","created_at":"2025-09-01 16:07:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1145295,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6037643/v1/6d1f99ab-0e87-491d-9e7a-da8a8a96245f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiology of Paediatric Snakebites in Northeastern Nigeria: A Retrospective Single-Center Study","fulltext":[{"header":"Background","content":"\u003cp\u003eSnakebite envenoming continues to remain a pressing public health challenge posing significant threat to vulnerable populations, particularly in the tropical and subtropical regions of the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The numerous challenges bedevilling the tropics like inadequate healthcare access, limited public awareness, and environmental and socio-economic challenges converge to exacerbate the risk of envenoming and its devastating consequences [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In 2017, the World Health Organization (WHO) re-classified snakebite as a neglected tropical disease, recognizing its substantial and disproportionate health burden in low- and middle-income countries, where a lack of resources and poverty is common [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Annually, an estimated 5.4\u0026nbsp;million individuals are bitten by snakes worldwide, with about 2.7\u0026nbsp;million cases resulting in envenoming and 138,880 fatalities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Tragically, the incidence of amputations and other morbidities among survivors of snakebites is nearly three times the mortality figure [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Nigeria remains one of the highest burden bearers of snakebite envenoming with an estimated 43,000 cases occurring annually, leading to about 1,900 deaths [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. While there are several species of snake within the region, carpet vipers account for over 66% of total snakebites and are of clinical importance due to their haematotoxic venom [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEven though adults account for a substantial number of snakebite victims, children under the age of 15 years represent 30% of snakebite cases in Nigeria [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Due to their unique physiological characteristics and body size, paediatric victims are at an elevated risk of distinct and/or severe presentation of envenomation compared to adults; this is despite the availability of antivenom and blood transfusion facilities [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This underscores the need for deliberate and improved research efforts and prevention, particularly for the paediatric age group. Further, in North-eastern Nigeria, where agricultural practice, livestock herding and outdoor play - especially during the dark hours - are common, children are frequently exposed to snakes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Their vulnerability is often compounded by limited healthcare access, knowledge of snakebite first aid, and management among health care workers in rural settings where these bites occur [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This makes paediatric snakebite cases more challenging to manage, contributing to potentially higher morbidity and mortality rates compared to adult patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChildren are uniquely more vulnerable to snakebite due to their small body size, higher metabolic rate, immature immune system and commonly unreliable recollection of incidents and events [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Their physiological factors lead to faster systemic spread of venom thereby exacerbating the severity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. As a result of this, paediatric victims often experience more pronounced symptoms such as shock, renal failure, haemolysis, and in severe cases, multiple organ failure [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Moreover, the clinical manifestation of snakebite can be difficult to predict as various species of snakes may cause different types of envenomation (e.g. haematotoxic, neurotoxic, or cytotoxic) and children are less likely to correctly identify snake species than adults [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is, however, disheartening to note that despite the growing awareness of snakebite envenoming in adults, paediatric cases are often under-reported and understudied [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, there is a lack of data on the risk factors of both snakebite incidence and outcomes among paediatric age groups, with most studies focusing on the general population. This is especially true in snakebite endemic areas like our setting, which further complicates the development of evidence-based management protocols tailored towards children [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As a result, many healthcare providers rely on generalized snakebite prevention strategies, which may not account for the specific needs of paediatric patients.\u003c/p\u003e \u003cp\u003eThere remains a paucity of snakebite studies that focus on paediatric age groups, particularly in terms of clinical characteristics, outcomes, and possible long-term sequelae. This creates a gap in knowledge on the specific challenges and outcomes in paediatric snakebite patients, given the current focus on general or adult cases. Due to the unique challenges posed by paediatric snakebite envenoming, this study aims to bridge that gap in the knowledge by examining the characteristics and outcomes of paediatric snakebite cases treated at the Snakebite Treatment and Research Hospital (SBTRH) in Northeastern Nigeria. Specifically, we intend to investigate (1) the characteristics of children presenting at SBTRH and (2) the key associations between patient characteristics and envenoming outcomes. This will provide valuable insight into the management and peculiar outcomes of snakebite in children. The findings will contribute to the development of evidence-based management strategies and inform public health strategies aimed at reducing the burden of paediatric snakebites in Northeastern Nigeria.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a retrospective study conducted at SBTRH. This facility is located at the heart of Kaltungo Local Government Area (LGA), Gombe State, Northeastern Nigeria. It is a specialized hospital focused on the management of snakebite envenoming since the 1990s [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. SBTRH provides both emergency and long-term care for victims of snakebite with a focus on treatment, training, clinical research, and public awareness campaigns. Interestingly, the hospital see cases from the all the six states of the Northeastern Nigeria, from the neighboring parts of the Northwest and Northcentral zone. Additionally, patients come from neighboring countries like Cameroon and the Republic of Chad.\u003c/p\u003e \u003cp\u003eThis hospital managed 1,022 snakebite patients between 1 January 2024 and 30 June 2024, out of which 384 were children 0 to 17 years of age. This time period covered the dry season and commencement of the rainy season. A digital study proforma was used to extract data from paper-based clinical records containing patient information. The following information was obtained from patient records and subsequently logged into an Excel document: month of snakebite occurrence, patient age, patient sex, patient state of origin, patient occupation, anatomical site of snakebite, species of snake, number of antivenom vials used, number of hours between snakebite and presentation to hospital, and patient outcome (death, amputation, debridement, or recovery).\u003c/p\u003e \u003cp\u003eThe data was then cleaned and analyzed using R software (version 4.3.1). One variable had missing data: snake species, as not every patient was able to identify the snake that bit them. We included only those aged 0 to 17 (inclusive) from this dataset, and then explored which patient characteristics were associated with patient outcomes. To note, we chose this age range as this is the most common age range for paediatric patients.\u003c/p\u003e \u003cp\u003ePatient characteristics were summarized, separated by outcome (recovery versus amputation, debridement, and death). Because of low numbers, we grouped patients who experienced amputation, debridement or death. Associations between patient characteristics and outcomes were evaluated using a Chi-Squared or Fisher\u0026rsquo;s Exact test, and were considered to be statistically significant if the corresponding test\u0026rsquo;s p-value was less than 0.05, as per convention.\u003c/p\u003e \u003cp\u003eSubsequently, we performed univariate and multivariable regression analysis to explore associations between patient characteristics and likelihood of recovery without complications, compared to amputation, debridement, or death. In regression analyses, we excluded the variable representing the number of antivenom vials used because of potential reverse causality (patients that experience more severe complications are often prescribed more antivenom). We reported both unadjusted and adjusted odds ratios and corresponding confidence intervals from the univariate and multivariable regression models, respectively.\u003c/p\u003e \u003cp\u003e Ethical clearance was obtained from the Research and Ethics Committee, Gombe State Hospitals Services Management Board with reference number GS/HSMB/RES/S/05/VOL.59\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 384 paediatric patients\u0026rsquo; records analysed, children aged 10 to 14 years made up the majority (n\u0026thinsp;=\u0026thinsp;162, 42%). Over half of the patients were male (n\u0026thinsp;=\u0026thinsp;262, 68%) and a minority were aged under five (n\u0026thinsp;=\u0026thinsp;29, 7.6%). Nearly two-thirds took four hours or more to present to hospital after being bitten (n\u0026thinsp;=\u0026thinsp;230, 60%). Further, most patients received a single dose of antivenom (n\u0026thinsp;=\u0026thinsp;271, 71%), and about half of the patients resided within Gombe State (n\u0026thinsp;=\u0026thinsp;184, 48%). Nearly one-third of the snakebites (n\u0026thinsp;=\u0026thinsp;102, 27%) occurred in April, which is the start of the rainy season in several regions in Northeastern Nigeria. As these were pediatric patients, most either were either under care (n\u0026thinsp;=\u0026thinsp;215, 56%) or were students (n\u0026thinsp;=\u0026thinsp;91, 24%). Snakebites predominantly occurred on the patients\u0026rsquo; upper limbs (n\u0026thinsp;=\u0026thinsp;306, 80%), and most bites were due to carpet vipers (n\u0026thinsp;=\u0026thinsp;295, 77%). Finally, nearly all patients recovered without complications (n\u0026thinsp;=\u0026thinsp;361, 94%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and clinical characteristics of the patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (%)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;384\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 to 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162 (42%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15 to 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (26%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 to 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 to 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (7.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e262 (68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHours Between Bite and Hospitalization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 hours or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230 (60%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 4 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntivenom Dose (Number of Vials)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e271 (71%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (17%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eState of Origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutside of Gombe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200 (52%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGombe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184 (48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonth of Snakebite Occurrence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApril\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (21%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (17%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJune\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFebruary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJanuary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e215 (56%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSite of Snakebite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e306 (80%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnake Species\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarpet Viper (Echis Romani)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e295 (77%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnidentifiable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient Outcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecovery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e361 (94%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmputation, Debridement, or Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were significantdifferences between patients who recovered without complications and those who did not. Proportionally more female patients recovered than male patients (p\u0026thinsp;=\u0026thinsp;0.047). As well, albeit just short of statistical significance, there were proportionally more recoveries among patients who arrived at the hospital less than four hours after being bitten compared to those who took four hours or more to arrive (p\u0026thinsp;=\u0026thinsp;0.064). As well, a significantly higher proportion of patients who were given a single dose of antivenom recovered without complications (p\u0026thinsp;=\u0026thinsp;0.024). The relationship between various patient characteristics and outcome is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between patient characteristics and outcome\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePatient Outcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAmputation, Debridement, or Death\u003c/b\u003e, n\u0026thinsp;=\u0026thinsp;23\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRecovery\u003c/b\u003e, n\u0026thinsp;=\u0026thinsp;361\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 to 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155 (96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15 to 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 to 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 to 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (7.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e242 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHours Between Bite and Hospitalization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 hours or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e212 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 4 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntivenom Dose (Number of Vials)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259 (96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eState of Origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutside of Gombe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185 (93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGombe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176 (96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonth of Snakebite Occurrence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApril\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJune\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFebruary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJanuary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e203 (94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSite of Snakebite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285 (93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnake Species\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarpet Viper (Echis Romani)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e275 (93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnidentifiable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;Fisher\u0026rsquo;s exact test; Pearson\u0026rsquo;s Chi-squared test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e highlights the results of the univariate and multivariable regression analyses. According to univariate regression models, male patients were less likely than female patients to recover without complications (odds ratio (OR)\u0026thinsp;=\u0026thinsp;0.31, 95% confidence interval (CI)\u0026thinsp;=\u0026thinsp;0.07\u0026ndash;0.91). In addition, patients that took four hours or more to arrive at hospital after being bitten were less likely to recover without complications than those who took less than four hours to arrive (OR\u0026thinsp;=\u0026thinsp;0.40, 95% CI\u0026thinsp;=\u0026thinsp;0.22\u0026ndash;1.02). However, neither variable remained nearly significantly associated with patient outcome in the multivariable model (p-value for sex\u0026thinsp;=\u0026thinsp;0.12 and p-value for hours between bite and hospitalization\u0026thinsp;=\u0026thinsp;0.3).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLikelihood of recovery without complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate Models\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable Model\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOR\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eAdjusted OR\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 to 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 to 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04, 5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04, 5.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10 to 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.04, 4.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03, 4.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15 to 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02, 1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01, 1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.07, 0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.08, 1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHours Between Bite and Hospitalization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 4 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 hours or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13, 1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.10, 2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eState of Origin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGombe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutside of Gombe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.22, 1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.24, 3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonth of Snakebite Occurrence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJanuary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFebruary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02, 4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02, 3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01, 1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02, 2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApril\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03, 4.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03, 4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05, 11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.06, 15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJune\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03, 5.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02, 4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnder Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.31, 2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48, 7.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.24, 2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.50, 8.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;99.0\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00, Inf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;99.0\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00, Inf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSite of Snakebite\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper Limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower Limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78, 17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.79, 20.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;99.0\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00, Inf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;99.0\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00, Inf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnake Species\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarpet Viper (Echis Romani)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnidentifiable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.64, 8.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48, 7.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;99.0\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00, Inf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;99.0\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00, Inf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;OR\u0026thinsp;=\u0026thinsp;Odds Ratio, CI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/p\u003e \u003cp\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e An odds ratio of \u0026gt;\u0026thinsp;99.0 represents a very large odds ratio\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study presents a comprehensive analysis of retrospective data of 384 paediatric snakebite cases treated at the SBTRH Kaltungo, Gombe State, from January to July 2024. Our study offers a valuable insight into the epidemiology, characteristics, outcome and factors influencing recovery among children who suffered snakebites in this high-risk region. To the best of our knowledge, this represents the largest number of patients in any single-site study. Further, the analysis of data covering demographic characteristics, time to presentation, snakebite species involved, antivenom administration and patient outcomes presents a broad view of the factors that influence the course and prognosis of snakebites in the paediatric age group.\u003c/p\u003e \u003cp\u003eA key finding of the study is the male predominance among paediatric snakebite victims with 68% of the cases being male. This is consistent with many studies in sub-Saharan Africa [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] where male gender, particularly in rural and agricultural communities, are at greater risk of encountering snakes than women. This may be due to a higher exposure to outdoor environments, because males are more likely to engage in activities such as farming, livestock tending, outdoor play, errands at dark hours and other outdoor activities which put them in closer proximity to venomous snakes.\u003c/p\u003e \u003cp\u003eFurthermore, the majority of the bites occurred during the early part of the rainy season (April-June), which highlights the seasonal variation in snakebite incidence. Snakebite incidence has been well documented in both tropical and subtropical regions to be linked to the rainfall pattern [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This seasonal peak implies that targeted interventions during these months could be particularly effective. These may include community education emphasizing the importance of protective hand- and foot-wear, and avoiding areas known to be predisposed to the presence of snakes such as holes and bushes.\u003c/p\u003e \u003cp\u003eMoreover, a notable finding in this study is that female paediatric patients have higher likelihood of recovery without complications compared to male paediatric patients (unadjusted OR\u0026thinsp;=\u0026thinsp;0.31, p\u0026thinsp;=\u0026thinsp;0.059); however, this difference did not persist after adjusting for other variables. To our knowledge, there are no existing studies that specifically address the gender difference in outcomes among paediatrics patients. This may therefore represent a unique observation within the study and further research will be beneficial to explore potential biological, social or treatment related factors that could contribute to these differences in a prospective study. Additionally, given the importance of this finding, future studies should also investigate the influence of sociocultural determinants of healthcare access in shaping outcomes for paediatric victims of snakebite.\u003c/p\u003e \u003cp\u003eOur study noted that about 60% of patients arrived four hours or more after being bitten. This may be due to the geographical distance from the site of the bite to the hospital, bearing in mind that these patients are not only from Gombe State, and may face several barriers such as poor transportation infrastructure or lack of awareness on the importance of early intervention in snakebite care. However, this delay is a key concern because snakebite envenomation can progress rapidly, leading to complications when definitive intervention is not applied as early as possible. Interestingly, the study found that patients who took four hours or more to arrive at hospital after being bitten were less likely to recover without complications than those who took less than four hours to arrive (OR\u0026thinsp;=\u0026thinsp;0.40, 95% CI\u0026thinsp;=\u0026thinsp;0.13\u0026ndash;1.02) which implies that early intervention is still critical in improving recovery rate. Delay in seeking medical treatment has long been recognized as a major factor in poor outcomes for snakebite victims, particularly in rural settings where healthcare access is limited [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, this association was no longer significant in the multivariate model. This underlines the need for creating more awareness and health education on the importance of early medical care, as well as improvement in accessibility to healthcare, especially in rural areas. Community level interventions such as mobile health services and improving transport options may help to mitigate the delay in care, thereby improving patient outcomes.\u003c/p\u003e \u003cp\u003eUnexpectedly, the study also finds that hands were the commonly affected site (80%) which is a significant departure from global, regional and even local studies [\u003cspan additionalcitationids=\"CR30 CR31 CR32\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], which consistently report that lower extremities are more frequently affected. This finding is intriguing and raises important questions about the contextual factors influencing snakebite patterns among paediatric patients in North-eastern Nigeria. The higher number of bites to the upper extremities may be linked to particular behavioural and environmental factors such as children's outdoor activities, like farming, gathering dried grass during bush clearing and weeding, as well as the dipping of hands into holds to look for small animals like rats for consumption. Interestingly, hands are typically the first point of contact when a child encounters animals like snakes whether while playing, working, or performing other tasks. Such a finding challenges conventional assumptions and calls for further research into the specific local dynamics and regional practices that could influence snakebite patterns, particularly prospective studies, which we intend to undertake to confirm our findings. These insights may be crucial for adapting preventive measures and clinical interventions in the region.\u003c/p\u003e \u003cp\u003eThe study found that most of the patients (71%) received a single vial of antivenom while 17% received two vials. The associations between the number of vials administered and outcomes revealed that patients who received only a single vial were overrepresented among those who recovered without complications (p\u0026thinsp;=\u0026thinsp;0.024). However, this might have been explained by the fact that severely envenomed patients often require higher doses of antivenom and patients who experience severe envenomation are often those at risk of amputation or death. Accordingly, we excluded the number of antivenom vials used from regression analysis due to concerns of reverse causality. However, this finding points to the importance of early recognition of envenoming severity and the need for tailored treatment protocols that consider the specific venom profile and clinical presentation in pediatric patients.\u003c/p\u003e \u003cp\u003eFinally, a majority of the cases (77%) were attributed to the carpet viper (Echis occellatus) which has been documented to be responsible for most snakebites in this region [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This further emphasizes the need for effective and affordable antivenoms that target this species specifically. Given that 21% of cases were unidentifiable, this underscores the challenges of accurately identifying snakes in emergency settings, particularly in rural areas and among paediatric patients, where snake identification may not be a priority for affected individuals.\u003c/p\u003e \u003cp\u003eDespite its unique and valuable findings, this study is not without limitations. The retrospective design, which relied on paper-based records, might have introduced biases related to data accuracy and completeness. Although the study was conducted at a single-centre hospital, it serves as a regional referral facility for all states of North-eastern Nigeria and parts of North-western, North central Nigeria, Cameroon and Chad. This broad catchment area partially mitigates concerns about the generalizability of the findings. However, to build on these results and gain a more comprehensive understanding of the new and unique findings in paediatric snakebite epidemiology and outcomes, future research should aim to conduct single-centre prospective or multi-center prospective studies with standardized data collection protocols. Such studies would offer a more detailed and representative picture of the factors influencing outcomes in paediatric snakebite envenomation across diverse settings in the region.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study which is a pilot analysis that is part of a broader effort to digitize five years\u0026rsquo; worth of paediatric snakebite data in the facility provided a comprehensive analysis of 384 paediatric snakebite cases from a referral facility in Northeastern Nigeria, highlighting key findings that contributed significantly to the understanding of snakebite epidemiology and recovery outcomes in the region. A critical takeaway from the study is the significant delay in seeking medical treatment among patients which was associated with poorer outcomes. This finding emphasizes the need for improved advocacy and healthcare access particularly in rural areas and the importance of early intervention in snakebite cases. The study also noted better chances of recovery associated with female gender - a finding that warrants further investigation, the predominance of upper extremity bites - which challenges global trends, and the predominance of carpet viper bites - which underscores the need for effective and species-targeted antivenoms. Overall, this study is crucial in informing public health strategies, improving treatment protocols, and guiding future research to reduce the burden of snakebite envenomation in North-eastern Nigeria and similar regions where snakebite is common.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLocal Government Area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBTRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSnakebite Treatment and Research Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e Ethical clearance was obtained from the Research and Ethics Committee, Gombe State Hospitals Services Management Board with reference number GS/HSMB/RES/S/05/VOL.59. As this was retrospective and routinely collected data, individual consent from participants was not needed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at the Snakebite Treatment and Research Hospital, Kaltungo.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e We declare that the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Aashna Uppal acknowledges the receipt of studentship awards from the Health Data Research UK-The Alan Turing Institute Wellcome PhD Programme in Health Data Science (Grant Ref: 218529/Z/19/Z). No other author received funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e AJD and EWI provided supervision and project conceptualisation. NAH and AU drafted the initial manuscript. \u0026nbsp;NAH, AU, and NM conducted analysis and interpretation. NN, ASB, NB, BA, and BL provided key guidance and ensured smooth data acquisition and project administration. EGD, AJD, and EWI provided critical revision of the manuscript. All authors reviewed the manuscript prior to submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We would like to acknowledge the key guidance of the Gombe State Hospital Management Board and the Gombe State Ministry of Health. In addition, this work would not have been possible without the Snakebite Treatment and Research Hospital Kaltungo\u0026rsquo;s medical records team, led by Suleiman Ahmadu.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGopal G, Muralidar S, Prakash D, Kamalakkannan A, Indhuprakash ST, Thirumalai D, et al. The concept of Big Four: Road map from snakebite epidemiology to antivenom efficacy. Vol. 242, International Journal of Biological Macromolecules. Elsevier B.V.; 2023. \u003c/li\u003e\n\u003cli\u003eLongbottom J, Shearer FM, Devine M, Alcoba G, Chappuis F, Weiss DJ, et al. Vulnerability to snakebite envenoming: a global mapping of hotspots. The Lancet. 2018 Aug 25;392(10148):673\u0026ndash;84. \u003c/li\u003e\n\u003cli\u003eThe Lancet. Snake-bite envenoming: a priority neglected tropical disease. Vol. 390, The Lancet. Lancet Publishing Group; 2017. p. 2. \u003c/li\u003e\n\u003cli\u003eChippaux JP. Snakebite envenomation turns again into a neglected tropical disease! Vol. 23, Journal of Venomous Animals and Toxins Including Tropical Diseases. BioMed Central Ltd.; 2017. \u003c/li\u003e\n\u003cli\u003eWord Health Organization. Snakebite envenoming Key facts Overview [Internet]. 2023 [cited 2024 Nov 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming\u003c/li\u003e\n\u003cli\u003eGuti\u0026eacute;rrez JM, Maduwage K, Iliyasu G, Habib A. Snakebite envenoming in different national contexts: Costa Rica, Sri Lanka, and Nigeria. Toxicon X. 2021 Jul 1;9\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eIliyasu G, Dajel TB, Abubakar SB, Azi NA, Danamarya NM, Obateru OA, et al. Comparison of snakebite in children and adults in Nigeria. Toxicon. 2023 Jun 1;228. \u003c/li\u003e\n\u003cli\u003eMahadevan S, Kumar RR. Snake envenomation in children. In: Toxinology: Clinical Toxinology in Asia Pacific and Africa. Springer Netherlands; 2015. p. 357\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eZdenek CN, Rodrigues CFB, Bourke LA, Tanaka-Azevedo AM, Monagle P, Fry BG. Children and Snakebite: Snake Venom Effects on Adult and Paediatric Plasma. Toxins (Basel). 2023 Feb 1;15(2). \u003c/li\u003e\n\u003cli\u003eAhmed SD, Agodzo SK, Adjei KA, Deinmodei M, Ameso VC. Preliminary investigation of flooding problems and the occurrence of kidney disease around Hadejia-Nguru wetlands, Nigeria and the need for an ecohydrology solution. Ecohydrology and Hydrobiology. 2018 Apr 1;18(2):212\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eIliyasu G, Tiamiyu AB, Daiyab FM, Tambuwal SH, Habib ZG, Habib AG. Effect of distance and delay in access to care on outcome of snakebite in rural north-eastern Nigeria. Rural Remote Health [Internet]. 2015 Nov;(2496). Available from: http://www.rrh.org.auAvailable:http://www.rrh.org.au\u003c/li\u003e\n\u003cli\u003eWood D. Clinical Risk Factors Associated with Poor Outcomes in Snake Envenoming: A Narrative Review. Vol. 15, Toxins. Multidisciplinary Digital Publishing Institute (MDPI); 2023. \u003c/li\u003e\n\u003cli\u003eFaust A, Ray N. Consequences of geographical accessibility to post-exposure treatment for rabies and snakebite in Africa: a mini review. Vol. 4, Frontiers in Health Services. Frontiers Media SA; 2024. \u003c/li\u003e\n\u003cli\u003eGuile L, Lee A, Gutirrez JM. Factors associated with mortality after snakebite envenoming in children: a scoping review. Trans R Soc Trop Med Hyg. 2023 Sep 1;117(9):617\u0026ndash;27. \u003c/li\u003e\n\u003cli\u003eBanner Jr W. BITES AND STINGS IN THE PEDIATRIC PATIENT. Curr Probl Pediatr. 1988 Jan;1(18):9\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eO. Cavazos MED la, Trevio C, Guajardo-Rodrguez G, Hernndez-Montelongo BA, Montes-Tapi FF. Snake Bites in Pediatric Patients, a Current View. In: Complementary Pediatrics. InTech; 2012. \u003c/li\u003e\n\u003cli\u003eMujtaba MBR. STUDY OF CLINICAL FEATURES OF SNAKE BITE AND ITS PROGNOSIS. Bagalkot; 2019. \u003c/li\u003e\n\u003cli\u003eGuti\u0026eacute;rrez JM, Calvete JJ, Habib AG, Harrison RA, Williams DJ, Warrell DA. Snakebite envenoming. Nat Rev Dis Primers. 2017 Sep 14;3(1). \u003c/li\u003e\n\u003cli\u003eWolfe AK, Fleming PA, Bateman PW. What snake is that? Common Australian snake species are frequently misidentified or unidentified. Human Dimensions of Wildlife. 2020;25(6):517\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eHabib AG, Abubakar SB. Factors affecting snakebite mortality in north-eastern Nigeria. Int Health. 2011 Mar;3(1):50\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eMustapha SK. SNAKE BITE IN GOMBE. Highland Medical Research Journal. 2003 Dec;1(4):22\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eChippaux JP. Snakebite in Africa. Current Situation and Urgent Needs. In: Reptile venoms and toxins [Internet]. Boca Raton: Taylor, Francis/CRC Press; 2009. p. 445\u0026ndash;65. Available from: https://www.researchgate.net/publication/281528924\u003c/li\u003e\n\u003cli\u003ePugh RNH, Theakston RDG. Incidence and mortality of snake bite in savanna Nigeria. The Lancet. 1980;43(3C):1181\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eVariawa S, Buitendag J, Marais R, Wood D, Oosthuizen G. Prospective review of cytotoxic snakebite envenomation in a paediatric population. Toxicon. 2021 Jan 30;190:73\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAbdullahi A, Yusuf N, Debella A, Eyeberu A, Deressa A, Bekele H, et al. Seasonal variation, treatment outcome, and its associated factors among the snakebite patients in Somali region, Ethiopia. Front Public Health. 2022 Sep 27;10. \u003c/li\u003e\n\u003cli\u003eMusah Y, Ameade EPK, Attuquayefio DK, Holbech LH. Epidemiology, ecology and human perceptions of snakebites in a savanna community of northern Ghana. PLoS Negl Trop Dis. 2019;13(8). \u003c/li\u003e\n\u003cli\u003ePadidar S, Monadjem A, Litschka-Koen T, Thomas B, Shongwe N, Baker C, et al. Snakebite epidemiology, outcomes and multicluster risk modelling in Eswatini. PLoS Negl Trop Dis. 2023 Nov 1;17(11 November). \u003c/li\u003e\n\u003cli\u003eMahendra M, Mujtaba M, Mohan CN, Ramaiah M. Study of Delayed Treatment Perspective of Snake Bites and Their Long-Term Effects in a Tertiary Care Hospital in Balgalkot District of Karnataka. APIK Journal of Internal Medicine. 2021 Jul;9(3):153\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eTekin R, Sula B, Cakirca G, Aktar F, Deveci \u0026Ouml;, Yolbas I, et al. Comparison of snakebite cases in children and adults. Eur Rev Med Pharmacol Sci. 2015;19:2711\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eKarunanayake RK, Dissanayake DMR, Karunanayake AL. A study of snake bite among children presenting to a paediatric ward in the main Teaching Hospital of North Central Province of Sri Lanka. BMC Res Notes. 2014 Jul 29;7(1). \u003c/li\u003e\n\u003cli\u003eKshirsagar VY, Ahmed M, Colaco SM. Clinical Profile of Snake Bite in Children in Rural India [Internet]. Vol. 23, Iranian Journal of Pediatrics. 2013. Available from: http://ijp.tums.ac.ir\u003c/li\u003e\n\u003cli\u003eSanni UA, Lawal TO, Musa TL, Alege A, Na\u0026rsquo;uzo AM. Prevalence and Outcome of Snake Bites Among Children Admitted in the Emergency Pediatric Unit, Federal Medical Centre, Birnin Kebbi, Nigeria. Cureus. 2021 Aug 24; \u003c/li\u003e\n\u003cli\u003eNdu I, Edelu B, Ekwochi U. Snakebites in a Nigerian children Population: A 5-year review. Sahel Medical Journal. 2018;21(4):204. \u003c/li\u003e\n\u003cli\u003eHamza M, Idris MA, Maiyaki MB, Lamorde M, Chippaux JP, Warrell DA, et al. Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa. PLoS Negl Trop Dis. 2016 Mar 30;10(3). \u003c/li\u003e\n\u003cli\u003eManjur M, Bala A, Tukur Z. Survey of Snakes Bites among Snake Endemic Communities in North Eastern Nigeria. Snake Venom and Ecology [Internet]. 2019; Available from: www.intechopen.com\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Snakebites, Paediatric Patients, Nigeria, Epidemiology, Patient Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-6037643/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6037643/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNigeria 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. Our study aims to bridge this knowledge gap by examining the characteristics and outcomes of paediatric snakebite in our setting.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a retrospective study conducted at the Snakebite Treatment and Research Hospital (SBTRH) in Kaltungo, Northeastern Nigeria. Ethical clearance was obtained from the Gombe State Hospital Services Management Board. Medical records of 384 patients aged 0 to 17 years treated at this facility between 1 January to 30 June 2024 were retrieved. Socio-demographic information and key clinical data were extracted using a digital proforma. The association between patient characteristics and likelihood of recovery without complications like amputation, debridement or death, was assessed using univariate and multivariate analyses. Associations were considered significant if the corresponding p-values were less than 0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were 262 male patients (68%) and 29 patients under five years of age (7.6%). Snakebites in children were most common in April (n\u0026thinsp;=\u0026thinsp;102, 27%). Over half of the participants (n\u0026thinsp;=\u0026thinsp;230, 60%) took four hours or more to present to hospital after being bitten. Male patients were less likely than female patients to recover without complications (unadjusted odds ratio (OR)\u0026thinsp;=\u0026thinsp;0.31, 95% confidence interval (CI)\u0026thinsp;=\u0026thinsp;0.07\u0026ndash;0.91). Further, patients that took four hours or more to arrive at hospital after being bitten were less likely to recover without complications than those who took less than four hours to arrive (unadjusted OR\u0026thinsp;=\u0026thinsp;0.40, 95% CI\u0026thinsp;=\u0026thinsp;0.22\u0026ndash;1.02).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study revealed key epidemiological characteristics and outcomes of paediatric snakebite patients in Northeastern Nigeria. It further showed the increased risk of complications among male patients and those presenting to hospital more than four hours after being bitten. We hereby recommend increased awareness and health education on early presentation after snakebites.\u003c/p\u003e","manuscriptTitle":"Epidemiology of Paediatric Snakebites in Northeastern Nigeria: A Retrospective Single-Center Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-17 06:05:37","doi":"10.21203/rs.3.rs-6037643/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-21T06:30:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-20T04:47:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-20T04:46:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-02-15T16:23:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5524cfd4-a586-4862-808d-c07cd9bc760e","owner":[],"postedDate":"March 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:00:14+00:00","versionOfRecord":{"articleIdentity":"rs-6037643","link":"https://doi.org/10.1186/s12887-025-05910-3","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-08-29 15:57:17","publishedOnDateReadable":"August 29th, 2025"},"versionCreatedAt":"2025-03-17 06:05:37","video":"","vorDoi":"10.1186/s12887-025-05910-3","vorDoiUrl":"https://doi.org/10.1186/s12887-025-05910-3","workflowStages":[]},"version":"v1","identity":"rs-6037643","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6037643","identity":"rs-6037643","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}