I will continue with the transcription of the 38 minutes talk given by Dr. Robert Harrison, from the Liverpool School of Tropical medicine on February 4th, 2016.
First part stops when Dr. Harrison pointed at the big crisis that happened with the sudden cessation of anti-venom supply in year 2000.
On the second part Dr. Harrison explain the reasons behind the crisis, the consequences and the measures that were taken to overcome it and the role of political and civil movements.
Cont. 11:15
AV CRISIS IN NIGERIA. WAYS TO SOLVE IT.
Why? what happened? what happened was this: an accumulation of facts. Antivenom (AV) is extremely expensive. It is not uncommon a course of AV treatment to cost between 400 and 700 dollars. That is a lot of money for people earning less than a dollar a day. It is a lot of money for hospitals that have very limited drug budgets. AV also causes adverse effects, that's because you are giving horse or sheep IgG directly into the blood stream of a human, you are going to have adverse effects. In fifty percent of the patients this is mild. AV is also ineffective against this tissue destructive effects of the venom. You are loosing now the confidence not only the physician who is treating the patient but the victim themselves. And that confidence, loss of confidence has ramifications but is also compounded by economic factors. Africa is the only continent worldwide that is completely dependent upon the manufacture, delivery of the AV from commercial supplies. South America, more o less without exception, have governments that sponsor AV production and sponsor AV delivery and provide it free. At that is why the case-fatality rate in south, latin america is so much lower.
THE REASONS BEHIND THE CRISIS
AV is expensive to manufacture, the demands of government are poor for all the reasons described up here and so the production of this two really good AV out of Europe stopped. Two companies decided they were not going to continue the manufacture of the AV because there were such loss makings. And so the AV supply to Nigeria came to nil. One of the ramifications of this lack of supply was the influx of a number of AV that where manufactured with venom of snakes that were "non-african snakes" and so they were 1/10th of the price of FAV-Afrique which is a very good AV but this cheap AV where ineffective and all that they did was to increase the case-fatality from 1.8% to 12.1%. This report was from Ghana and we have seen that in Nigeria, we have seen that in Tanzania and just two weeks ago we saw it in Kenya. This highly dangerous AV, because the physician thinks is effective, is very very dangerous and it is flooding sub-saharian Africa. So there is a great need, an urgent need quality control regulations of the AV before they a used in humans throughout sub-saharian Africa.
INTERNATIONAL RESPONSE TO DEVELOP A NEW AND EFFECTIVE AV
In response to request from the Nigerian Federal Ministry of Health, in collaboration with groups, two doctors in Syria, Ministry of Health in Nigeria, we in Liverpool and Dr. David Warrel in Oxford we responded to this crisis of AV supply in Nigeria. What we did is we imported the three most important medical snakes from Nigeria into our facility in Liverpool, we extracted venom from those animals, we provided venom stocks to five different groups worldwide who very generously agreed to their spare manufacturing capacity to see if they can make AV for Nigeria, and it was worldwide: UK, Costa Rica, Egypt, Mexico and Colombia. We pre-clinically tested all of this in a mouse model to determine efficacy, three of those AV then were forward into the largest Human Clinical Trial of AV ever conducted, supervised by Dr. Habib and Prof. David Warrel, one AV was withdrawn rapidly because of the adverse effects and that left us with two AV: one a poly-specific against three snakes and one mono-specific against saw scaled viper.
THE NEED FOR EXPERT PHYSICIANS TO TREAT SB / SUCCESSFUL MEASURES
We created all those AV, we tested them, they were effective and we decided that it was really not enough, so this is Kaltungo Hospital in Gombe State, we constructed snakebite wards, this was important because that meant that the training of physicians is proof wall in the process of discussing a case with Dr. Abubaku that we trained and... so the training of physicians mean that those physicians trained in an expert management of SB will stay in the SB ward, they would not get lost elsewhere in the hospital, and it was also not only the clinical management of SB but also the surgical management of SB that is quite specific. We also purchased two ambulances to accelerate the SB victims to hospital. There is a very clear association between rapidity of treatment and the outcome of AV treatment. We provided those, while we had the founding, free to patients and the AV was very effective and had very few adverse effects relative to other AV and that word got out, it spread as I said before, people came in from Camerun, from Chad, from all over north-east and North-Nigeria together. So this figures are .... now, we were getting over 3.000 patients per year, in Kaltungo and .... hospitals and sometimes there were 35 to 40 patients admitted per day into this hospitals. We have delivered in the last between 2006 and 2011, 37.000 vials, equating to 18.500 life saving treatments, which has substantially reduced deaths without doubt and morbidity.
WHEN GOVERNMENT AND CIVIL MOVEMENTS ARE THE OBSTACLES.
The problem is that there was major political changes in Nigeria, in 2012, in the ministry, the new minister was reluctant to continue with this program despite its successes and also the terrorist activities of "Boka Haram" (https://en.wikipedia.org/wiki/Boko_Haram) had a massive effect on the continue the operation. So, civil changes, political changes can make an enormous difference as have done to this project. There is therefore a need, and urgent need for effective advocacy to improve the recognition of the SB public health burden by International Heath Agencies and governments, to effect policy change and also for research, to develop better tools. By that I think, I mean there is a enormous opportunity to improve the ways antivenoms are manufactured.
Minute 17:59, I would stop here for today as the rest of the talk is on the role of research in snakebite treatment, and in particular about the challenges on improving AV.
I've been goggling about the nowadays situation at Kaltungo hospital....
You may read this news from may, 2016
News on Gombe State snakes infestation one year ago on the news.
ॐ लोकाः समस्ताः सुखिनो भवन्तु ॥
Om Lokah Samasthah Sukhino Bhavantu
May all beings everywhere be happy and peaceful.
No comments:
Post a Comment