# Pediatric snakebite in Sub-Saharan Africa: Clinical predictors, outcomes, and gaps in care—A systematic review

## TL;DR

Snakebites harm many children in sub-Saharan Africa due to delayed care and lack of proper treatment, leading to deaths and disabilities.

## Contribution

This study is the first systematic review to characterize pediatric snakebite envenomation in sub-Saharan Africa, highlighting clinical predictors and regional disparities.

## Key findings

- Most affected children are under 12 years old, with boys more commonly affected.
- Delayed hospital presentation and lack of antivenom are strongly linked to severe outcomes like death and amputation.
- Mortality rates vary widely, with higher rates in regions with limited access to emergency care and safe antivenom.

## Abstract

Snakebite envenomation (SBE) remains a significant but neglected public health problem among children in sub-Saharan Africa (SSA), with clinical predictors of severity and regional disparities in outcomes still poorly characterized.

We conducted a systematic review of peer-reviewed studies published from database inception to October 2024 on pediatric snakebite envenomation (SBE) in SSA, focusing on clinical and demographic predictors of severe outcomes. Data on study characteristics, SBE symptoms, risk factors, and outcomes were synthesized descriptively.

Eighteen studies from six SSA countries were included (totaling 2,687 pediatric patients). Children affected were predominantly under 12 years, with a male predominance. Severe outcomes including death, amputation, and permanent disability were closely associated with delayed hospital presentation (> 6–12 hours), certain traditional first aid practices, young age (<10 years old), severe local swelling, upper limb bites, and laboratory. Most identified SBE syndromes were cytotoxic or haematotoxic; neurotoxic cases were rarely reported. Antivenom availability and type varied by country and facility; adverse reactions were common (≈20–70%, definition-dependent; anaphylaxis up to ~57%). Mortality ranged from <5% in South Africa and Kenya to 14% in Gambia and 36% in Cameroon, correlating with both antivenom and essential emergency care access. Research gaps included limited data from several high-burden regions, lack of standardized pediatric protocols, and few long-term outcomes.

Pediatric SBE in SSA is characterized by substantial preventable morbidity and mortality, mainly due to delays in care and inconsistent access to essential emergency care and safe antivenom. Improved health system capacity, rapid referral, and standardized management are urgently needed.

Snakebite envenoming remains a major but under-recognized cause of illness and death among children in sub-Saharan Africa. Children are particularly vulnerable due to their smaller body size, increased exposure to outdoor environments, and limited access to timely and appropriate medical care. This review synthesized all published studies on pediatric snakebite in the region to describe the affected populations, clinical management, and outcomes. Most cases involved boys under 12 years of age, typically bitten by Echis ocellatus and Bitis arietans, which are associated with severe local tissue damage, swelling, and coagulopathy. Mortality ranged from 6% to 8%, while permanent disability most often limb amputation or contracture occurred in approximately 4% of children, particularly where medical care was delayed or antivenom was unavailable. Neurotoxic envenoming was rarely reported, likely reflecting diagnostic challenges, under-recognition, or pre-hospital mortality. These findings underscore the urgent need to strengthen early referral systems, ensure consistent access to safe and effective antivenoms, and expand community education to reduce preventable deaths and long-term disability from snakebite among African children.