Predicting challenges and opportunities in improving snakebite envenoming management in Ghana

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not reported in abstract; no MaxDiff utility scores, relative importance weights, or odds ratios provided

• Primary Outcome: Ranked identification of challenges and opportunities in SBE management: primary barrier identified as 'delayed health-seeking behaviour by patients', followed by 'high cost of treatment' and 'inadequacy/shortage of antivenom'; primary opportunity identified as 'increasing public awareness and knowledge about snakebite prevention and initial management'

• Nnt Or Sensitivity: ML model performance metrics (AUC, sensitivity, specificity, F1 score) not reported in abstract; five-fold cross-validation methodology described but outcomes not quantified

• Confidence Interval: Not reported

Clinical Application

The policy recommendations derived — promoting health-seeking behaviour, subsidising antivenom costs, improving healthcare worker training, and increasing public awareness — are feasible and align with WHO's Global Snakebite Initiative targets. However, implementation feasibility depends on health system financing and political will, which are not assessed in this study Snakebite envenoming in Australia presents a distinct epidemiological and clinical profile. Australia has some of the world's most venomous snakes (Eastern Brown Snake, Taipan, Tiger Snake), with CSL Seqirus producing species-specific antivenoms listed on the PBS for hospital use. The TGA regulates antivenom supply, and RCPA/ACEM guidelines govern clinical management. The barriers identified in this Ghanaian study — antivenom shortage, treatment cost, delayed presentation — are less prominent in the Australian context due to universal healthcare (Medicare), established antivenom distribution networks, and Poisons Information Centre (13 11 26) availability. However, the finding regarding delayed health-seeking is relevant to remote and Indigenous Australian communities where geographic access to emergency care remains a significant challenge. The study's health systems framing may inform advocacy for improved SBE resources in Australia's remote north. Healthcare workers and health system planners in resource-limited settings in sub-Saharan Africa managing snakebite envenoming, particularly in Ghana's Eastern Region; findings have limited direct applicability to individual patient care decisions

Abstract

BACKGROUND: Snakebite envenoming (SBE) is a neglected tropical disease and a major public health crisis in Africa. We integrated a maximum difference experimental design and machine learning (ML) models to predict challenges and opportunities for improving SBE management in Ghana. METHODS: This cross-sectional study included 137 healthcare workers, identified through multistage sampling, from August to December 2024 in two districts of the Eastern Region, Ghana. We employed five-fold cross-validation and analysed the dataset using 12 ML models. RESULTS: The most significant obstacle to managing SBE was 'delayed health-seeking behaviour by patients', followed by 'high cost of treatment' and 'inadequacy/shortage of antivenom'. On the opportunity side, 'increasing public awareness and knowledge about snakebite prevention and initial management before reaching a healthcare facility' was deemed crucial. Other opportunities such as 'conducting research into alternative management for snakebite to complement or replace antivenoms' and 'increasing awareness and knowledge about snakebite management among healthcare workers' were also recognized as trade-offs. CONCLUSIONS: This study significantly contributes to the existing research on artificial intelligence/ML, as previous studies have not quantified the challenges and opportunities in managing SBE. Policymakers and healthcare providers can use these findings to implement strategies such as promoting better health-seeking behaviours, subsidizing treatment costs, ensuring access to effective antivenom and raising public awareness about snakebite prevention and initial care.

References

1. 1.Nyarko, E., Siiba, U., Uppal, A., Hamman, N. A., Mohammed, N., Kingpriest, P., & Lang, T. (2026). Predicting challenges and opportunities in improving snakebite envenoming management in Ghana. Transactions of the Royal Society of Tropical Medicine and Hygiene. https://doi.org/10.1093/trstmh/trag043