The prevalence and morbidity of snake bite and treatment-seeking behaviour among a rural Kenyan population.

Snake-bite mortality among a rural population in Kenya was estimated to be 6.7/100,000 people each year, representing 0.7% of all deaths. A community-based retrospective survey of 4712 households provided estimates of the incidence of snake bite in this population. Although 151/100,000 people are bitten each year, only 19% of these are bitten by potentially venomous snakes. When those who had been bitten were shown photographs of a range of locally prevalent snakes, most indicated that both venomous and non-venomous snakes were capable of causing death. Most (68%) of bite cases sought treatment from a traditional healer who invariably used local herbal preparations applied to the bite site and/or in a ring around the bitten limb. Local skin incisions were also commonly practised. The use of traditional medicine for snake bite is a feature of most areas of the developing world where venomous snakes are prevalent. Improvements in early referral and appropriate care will only occur when traditional healers are integrated into primary health care and hospital-based health systems.

Maternal recall of symptoms associated with childhood deaths in rural east Africa.

Verbal autopsies (VA) are frequently used to determine causes of death for individuals for whom there is no reliable clinical information regarding the terminal illness. VA interviews are used to note key symptoms and signs recalled by relatives of the deceased and diagnoses ascribed according to the symptom complexes. The VA technique assumes that individual disease entities have discrete symptom complexes and that these can be accurately recognized and recalled by the interviewees. We have examined the accuracy with which specific symptoms are recalled over time by mothers or normal guardians of 491 children who died on the paediatric wards of two district hospitals in East Africa. Kwashiorkor, measles, trauma, generalized convulsions and neonatal tetanus were all reported with a high degree of accuracy for children who died of these conditions and had low false positive rates for children without these conditions. Recall was similar within 1 month of death compared to recall after 6 months for most symptoms and signs except neonatal tetanus where false positive reports by mothers increased with time since death. Symptoms and signs commonly used to describe malaria, respiratory tract and diarrhoea-related deaths were reported by mothers to have been present during the terminal illness in 43% of cases where these features were absent. Recall abilities differed between the two communities studied for some symptoms and signs highlighting the importance of such studies in every setting where VA are applied.

PIP: Verbal autopsies (VA) are widely used by population and health scientists to determine individual causes of death in areas where most deaths occur at home and well-documented clinical data on cause of death are usually unavailable. VA interviews are based upon key symptoms and signs recalled by relatives of the deceased. In order to assess the reliability of the technique, the accuracy with which mothers and normal guardians recognize and recalled specific symptoms and clinical signs over time was assessed in the cases of 491 children who died on the pediatric wards of 2 district hospitals in Ifakara, Tanzania, and Kilifi, Kenya. The bereaved were interviewed 3 days to 24 months after child death. Recall after 1 month was similar to recall after 6 months for most signs and symptoms except neonatal tetanus for which false positives reported by mothers increased with time after death. Kwashiorkor, measles, trauma, generalized convulsions, and neonatal tetanus were reported with a high degree of accuracy. Symptoms and signs commonly used to describe malaria, respiratory tract and diarrhea- related deaths, however, were reported by mothers to have been present during terminal illness in 43% of cases where the features were absent. Finally, recall abilities differed between the 2 communities studied.