A contextual approach to managing snake bite in Pakistan: snake bite treatment with particular reference to neurotoxieity and the ideal hospital snake bite kit.

Although the snakebite mortality numbers for Pakistan are over estimated, snakebite remains a significant problem of rural areas. Significant improvements are possible with locally developed protocols incorporating the latest research. The use of simple reliable diagnostic tools in managing viperine envenomation and the introduction of monitoring cycles based on physiological criteria can greatly improve outcome. The acquisition by hospitals, even the most basic, of inexpensive drugs and simple readily improvisable equipment can dramatically improve patient survival in neurotoxic, particularly cobra envenomation. Basic hospitals can intervene in snakebite management and this is essential if envenomed victims are to be treated early. This paper makes recommendations as to the basic drug and equipment profile to enable all hospitals to successfully manage snakebite in Pakistan.

Incidence, patterns and severity of reported unintentional injuries in Pakistan for persons five years and older: results of the National Health Survey of Pakistan 1990-94.

BACKGROUND: National level estimates of injuries are not readily available for developing countries. This study estimated the annual incidence, patterns and severity of unintentional injuries among persons over five years of age in Pakistan. METHODS: National Health Survey of Pakistan (NHSP 1990-94) is a nationally representative survey of the household. Through a two-stage stratified design, 18, 315 persons over 5 years of age were interviewed to estimate the overall annual incidence, patterns and severity of unintentional injuries for males and females in urban and rural areas over the preceding one year. Weighted estimates were computed adjusting for complex survey design using surveyfreq and surveylogistic option of SAS 9.1 software. RESULTS: The overall annual incidence of all unintentional injuries was 45.9 (CI: 39.3-52.5) per 1000 per year; 59.2 (CI: 49.2-69.2) and 33.2 (CI: 27.0-39.4) per 1000 per year among males and females over five years of age, respectively. An estimated 6.16 million unintentional injuries occur in Pakistan annually among persons over five years of age. Urban and rural injuries were 55.9 (95% CI: 48.1-63.7) and 41.2 (95% CI: 32.2-50.0) per 1000 per year, respectively. The annual incidence of injuries due to falls were 22.2 (95% CI: 18.0-26.4), poisoning 3.3 (95%CI: 0.5-6.1) and burn was 1.5 (95%CI: 0.9-2.1) per 1000 per year. The majority of injuries occurred at home 19.2 (95%CI: 16.0-22.4) or on the roads 17.0 (95%CI: 13.8-20.2). Road traffic/street, school and urban injuries were more likely to result in handicap. CONCLUSION: There is high burden of unintentional injuries among persons over five years of age in Pakistan. These results are useful to plan further studies and prioritizing prevention programs on injuries nationally and other developing countries with similar situation.