Situation of snakebite, antivenom market and access to antivenoms in ASEAN countries.

INTRODUCTION: Snakebite envenoming is a neglected tropical disease posing public health challenges globally. The Association of Southeast Asian Nations (ASEAN) countries are among the tropical regions with disproportionately high incidence of snakebite. Hence, this study aimed to review the situation of snakebite, antivenom market and access to antivenoms in ASEAN. METHODS: This mixed-methods study included comprehensive literature review and in-depth interviews with key informants to assess the situation of management system of snakebite, antivenom market and access to antivenoms in seven ASEAN countries, including Malaysia, Thailand, Indonesia, Philippines, Vietnam, Lao PDR and Myanmar. Data were analysed by a framework method. RESULTS: ASEAN have developed various strategies to improve outcomes of snakebite victims. Five domestic antivenom manufacturers in the region produce up to 288 375 vials of antivenoms annually with the value of US$13 058 053 million which could treat 42 213 snakebite victims. However, there remain challenges to be addressed especially the lack of snakebite-related informatics system, inadequate antivenoms at the healthcare facilities and when the majority of snakebite victims seek traditional healers instead of conventional treatment. CONCLUSION: Improving the situation of snakebite and antivenom is not only about the availability of antivenom, but the whole landscape of surrounding management and supporting system. The assessment of the situation of snakebite and antivenom is crucial for countries or regions where snakebites are prevalent to recognise their current standpoint to inform the development of strategies to achieve the goal set by the WHO of halving the global burden of snakebite by 2030.

Acute Kidney Injury following Ingestion of Henna Leaf Extract: A Case Report from Myanmar.

Alternative medicine is gaining popularity worldwide. In Asia, particularly Southeast Asia, herbal medicine plays an important role in healthcare. A 34-year-old man from Yangon, Myanmar, was admitted to the medical ward of our hospital after ingesting a herbal remedy of boiled henna leaves (Dan Ywet in Burmese). He developed hemoglobinuria leading to acute kidney injury (AKI). The insult was severe, and he underwent 5 sessions of hemodialysis. His condition improved and within 7 weeks of injury, he made a full recovery. However, he was lost to follow-up when renal function became normal. Our diagnosis was AKI from hemoglobinuria secondary to henna leaf extract nephrotoxicity in G6PD deficiency. This case highlights the steps required to achieve the International Society of Nephrology's goal of 0 preventable deaths from AKI by 2025 and the efforts needed to increase public knowledge about herbal remedies and AKI, medication adherence, and compliance with follow-up.