Polyvalent Antivenom Use and Predictors of Mortality from Paediatric Snakebite at a Tertiary Centre in Northwestern Nigeria

Snakebite envenomation is a neglected tropical disease and a significant public health concern in the tropics, especially in sub-Saharan Africa. Children are particularly vulnerable due to their smaller body mass and exposure to high-risk environments. This study aimed to evaluate the use of polyvalent anti-snake venom (PASV) and identify risk factors for mortality from snakebites among children treated at a tertiary hospital in Northwestern Nigeria. A 5-year retrospective review was conducted at the Emergency Pediatric Unit (EPU) and Accident & Emergency (A/E) Department of Federal Teaching Hospital, Katsina. Data from 2019 to 2023 were extracted from medical records, including demographic details, clinical features, treatment received (including PASV), time to hospital presentation, severity of envenomation, and outcomes. Statistical analyses included chi-square tests, t-tests, and logistic regression. Twenty-six children (aged 18 years or less) were treated for snakebite during the study period, with a male predominance (M:F = 11.9:1). Pain (96.2%) and swelling (38.5%) were the most common symptoms. Severe envenomation was recorded in 19.2%, with systemic effects including heamatotoxicity (7.7%), neurotoxicity (3.8%), and respiratory failure (3.8%). PASV was administered to 61.5% of patients, with adverse reactions in 25%, including one fatal case. There were four deaths among the 26 subjects, giving a mortality rate of 15.4%. Univariate analysis showed that younger age, severe envenomation, non-use of PASV, adverse PASV reactions, and delayed presentation were associated with mortality. Firth penalized logistic regression showed that the presence of severe envenomation (aOR: 6.129, 95% CI: 2.576-10.999, p-value = <0.001) and delayed presentation at the hospital (aOR: 4.547, 95% CI: 0.144-8.419, p-value = 0.032) were independent predictors of mortality. Snakebite envenomation in children carries a significant risk for morbidity and mortality. Severe envenomation and delayed presentation are independent predictors of poor outcomes. The use of PASV is beneficial but requires timely administration and preparation for potential adverse effects. Public health education, early referral, and standardized treatment protocols are critical to improving outcomes in pediatric snakebite victims.