Snakebite victim profles and treatment-seeking behaviors in two regions of Kenya: results from a health demographic surveillance system

Introduction: Snakebites are a major cause of permanent injury and death among poor, rural populations in developing countries, including those in East Africa. This research characterizes snakebite incidence, risk factors, and subsequent health-seeking behaviors in two regions of Kenya using a mixed methods approach.Methods: As a part of regular activities of a health demographic surveillance system, household-level survey on snakebite incidence was conducted in two areas of Kenya: Kwale along the Kenyan Coast and Mbita on Lake Victoria. If someone in the home was reported to have been bitten in the 5 years previous to the visit, a survey instrument was administered. The survey gathered contextual information on the bite, treatment-seeking behavior and clinical manifestations. To obtain deeper, contextual information, respondents were also asked to narrate the bite incident, subsequent behavior and outcomes.Results: 8775 and 9206 households were surveyed in Kwale and Mbita, respectively. Out of these, 453 (5.17%) and 92 (1.00%) households reported that at least one person had been bitten by a snake in the past 5 years. Deaths from snakebites were rare (4.04%), but patterns of treatment seeking varied. Treatment at formal care facilities were sought for 50.8% and at traditional healers for 53.3%. 18.4% sought treatment from both sources. Victims who delayed receiving treatment from a formal facility were more likely to have consulted a traditional healer (OR 8.8995% CI [3.83, 20.64]). Delays in treatment seeking were associated with signifcantly increased odds of having a severe outcome, including death, paralysis or loss of consciousness (OR 3.47 95% CI [1.56; 7.70]).Conclusion: Snakebite incidence and outcomes vary by region in Kenya, and treatment-seeking behaviors are complex. Work needs to be done to better characterize the spatial distribution of snakebite incidence in Kenya and eforts need to be made to ensure that victims have sufcient access to efective treatments to prevent death and serious injury

Indoor apparent temperature, cognition, and daytime sleepiness among low‐income adults in a temperate climate

The burden of temperature‐associated mortality and hospital visits is significant, but temperature’s effects on non‐emergency health outcomes is less clear. This burden is potentially greater in low‐income households unable to afford efficient heating and cooling. We examined short‐term associations between indoor temperatures and cognitive function and daytime sleepiness in low‐income residents of Detroit, Michigan. Apparent temperature (AT, based on temperature and humidity) was recorded hourly in 34 participant homes between July 2019‐March 2020. Between July‐October 2019, 18 participants were administered word list immediate (WLL) and delayed (WLD) recall tests (10‐point scales) and the Epworth Sleepiness Scale (24‐point scale) 2–4 times. We applied longitudinal models with nonlinear distributed lags of temperature up to 7 days prior to testing. Indoor temperatures ranged 8–34°C overall and 15–34°C on survey days. We observed a 0.4 (95% CI: 0.0, 0.7) point increase in WLL and 0.4 (95% CI: 0.0, 0.9) point increase in WLD scores per 2°C increase in AT. Results suggested decreasing sleepiness scores with decreasing nighttime AT below 22°C. Low‐income Detroit residents experience uncomfortably high and low indoor temperatures. Indoor temperature may influence cognitive function and sleepiness, although we did not observe deleterious effects of higher temperatures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171581/1/ina12972.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171581/2/ina12972_am.pd