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Background: Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020. Methodology: This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment. Findings: The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post/center, or hospital), while 87% sought informal care (family/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom. Conclusions: This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies. Author summary: Snakebites can be life-threatening, especially in places like sub-Saharan Africa. In Rwanda, there haven't been any studies to understand how many snakebites happen and where they happen. This study wanted to find out two main things: first, how many snakebites happened in different parts of the Eastern Province of Rwanda in 2020, and second, where people who got bitten by snakes went for help—to doctors or traditional healers. The study involved 390,546 people across 763 villages. It found that each year, about 4.3 out of 1,000 people in the province get bitten by snakes, but the numbers vary in different areas. Surprisingly, only 13% of the victims initially consulted formal healthcare providers like community health workers, health centers, or hospitals. In contrast, a larger group, 87%, sought informal care from family, friends, pharmacists, or traditional healers first. About half of the people bitten by snakes experienced severe symptoms. Unfortunately, many people used unsafe methods to treat snakebites, like cutting or burning the skin, tying a tight band around the bitten area, using black stones, or trying to suck out the venom. Only a very small number of cases, just 24 out of all 1,098 victims, received anti-venom. The study suggests we need to make sure anti-venom is easier to get and teach communities about the risks of unsafe practices and why it's important to get formal healthcare quickly. It's important for doctors, traditional healers, community leaders, and government officials to work together to make sure people get safe and appropriate treatment and learn how to prevent snakebites. [ABSTRACT FROM AUTHOR]

Snakebite envenomation (SBE) is endemic to sub-Saharan Africa and generally over-represented in rural, remote, and impoverished agricultural communities. While poverty is an established risk factor, little research has been done to investigate the economic consequences of SBE. This cross-sectional, quantitative study aimed to measure out-of-pocket spending and lost income when a household member was bitten by a snake. In 2020, 732 snakebite survivors from Eastern Province (Rwanda) agreed to complete a survey administered by telephone. The survey focused on participant demographics, income, direct medical and non-medical costs, care-seeking decisions, and lost work during convalescence. Our results suggested that patients incurred the highest mean expenses when they sought care from hospitals (11 307 RWF or 12 USD) or traditional healers (5 836 RWF or 6 USD) but that the highest maximum cost was incurred from traditional healers (300 000 RWF or 313 USD). Across all victims, the total amount paid to traditional healers (3.4 million RWF or 3 537 USD) was 4.7 times higher than all other care providers combined. On average, families lost 111 814 RWF (117 USD) per snakebite in direct treatment costs and indirect productivity losses. Many victims sought care from traditional healers despite being eligible for free medical care. Altogether, this study serves as a reminder of the serious physical and financial consequences associated with SBE and provides justification for new investments into SBE prevention and care. Author summary: Snakebite is a life-threatening situation in sub-Saharan Africa, especially for rural and poor populations. Despite being preventable and treatable, it receives little attention from policymakers. The goal of this study was to estimate the financial losses experienced by snakebite victims due to treatment costs and lost work. Interviews with 732 snakebite victims from Eastern Province, Rwanda, indicated that a typical adult lost 12.0% of their annual income due to a single bite. Moreover, caregivers lost time and income when caring for a sick family member. Patients preferentially sought care from traditional healers rather than Community Health Workers, nurses or physicians, even when they qualified for free hospital care. Consequently, victims in our study group paid five times more to traditional healers (3.4 million RWF or 3 537 USD) than to all other care providers combined. Altogether, our analysis suggests that Rwandese lose 7.4 million USD each year in treatment costs and lost work due to snakebite. These results serve as evidence to policymakers that investments to prevention and treatment programs will not only reduce pain and suffering, but also contribute to national goals targeting poverty reduction. [ABSTRACT FROM AUTHOR]