Snakebite epidemiology and health-seeking behavior in fringe communities of the Kakum Conservation Area in Ghana

BACKGROUND: Snakebite envenomation (SE) is a significant yet under reported public health challenge, especially in rural and forest-fringe communities in sub-Saharan Africa. Despite its recognition by the World Health Organization (WHO) as a Neglected Tropical Disease (NTD), epidemiological data on SE remain scarce in Ghana, particularly in communities fringing protected forest areas such as the Kakum Conservation Area (KCA). OBJECTIVE: This study sought to examine snakebite epidemiology in the fringe communities of the Kakum Conservation Area (KCA) in the Central region of Ghana. METHODS: A cross-sectional household survey was conducted between April and May 2024 in 18 communities fringing the KCA in Ghana's Central Region. The data collection instrument was pretested in a non-study community (n = 30), with Cronbach's alpha ranging from 0.72 to 0.86 for key scales, indicating acceptable internal consistency. A two-stage sampling approach was employed to enumerate a total of 1,445 households for snakebite victims. Descriptive statistics included frequencies, proportions, means, and standard deviations with 95% confidence intervals calculated using binomial approximation. Inferential statistics included chi-square tests for bivariate associations and multivariable logistic regression to calculate adjusted odds ratios (AOR) with 95% confidence intervals. RESULTS: In this study, the reported lifetime occurrence of snakebites was 394/8,518 (4.63%, 95% CI: 4.18-5.07), compared with 164/8,518 (1.93%, 95% CI: 1.63-2.22) and 41/8,518 (0.48%, 95% CI: 0.33-0.63) in the preceding five years and one year, respectively. The mean age of victims was 44.69 (SD ± 18.64) years. Most victims were female (212/394, 53.81%), married (231/394, 58.63%) and engaged in farming (289/394, 73.35%). Most bites occurred in farms/forests (258/394, 65.48%) and affected the lower limbs (345/394, 87.56%). First aid was applied by 295/394 (74.87%) victims, predominantly involving tourniquets (103/295, 34.92%). Overall, 239/394 (60.66%) sought treatment, of whom 170/239 (71.13%) accessed formal healthcare facilities. Among treatment seekers, 124/239 (51.88%) travelled by motor vehicle, while 97/239 (40.59%) travelled on foot. Additionally, 92/239 (38.49%) waited at least one hour before seeking care, while 89/239 (37.24%) spent at least one hour travelling for care. Following snakebite, 373/394 (94.67%) victims recovered, 15/394 (3.81%) experienced disability and 6/394 (1.52%) died. Compared with victims aged under 20 years, those aged 30-39 years had higher adjusted odds of experiencing snakebite in farm/forest settings (AOR = 3.39, 95% CI: 1.07-10.67). Farming was also associated with increased odds of farm/forest snakebite (AOR = 1.88, 95% CI: 1.04-3.40). Regarding facility-based care, victims aged 20-29 years (AOR = 0.20, 95% CI: 0.05-0.88) and ≥60 years (AOR = 0.11, 95% CI: 0.02-0.69) had lower adjusted odds of seeking care compared with those aged under 20 years. CONCLUSION: Snakebites constitute a major public health concern in communities fringing forested conservation areas, especially for people whose livelihood activities revolve around agricultural activities. Overall, the study underscores the need to establish and strengthen collaborative efforts among primary health authorities, forest conservation managers, and community leaders in the design and implementation of effective interventions to avert snakebite incidents and improve outcomes for victims.