Snakebite in Tocantins: ecological analysis of determinants and risk areas, 2007- 2015

Feitosa, Shirley Barbosa; Mise, Yukari Figueroa; Mota, Eduardo Luiz Andrade

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLES • Epidemiol. Serv. Saúde 29 (4) • 2020 • https://doi.org/10.5123/S1679-49742020000400016 copy

Snakebite in Tocantins: ecological analysis of determinants and risk areas, 2007- 2015 ^* * Article derived from the Master’s Degree dissertation by Shirley Barbosa Feitosa, entitled ‘Epidemiological profile of people affected by snakebite accidents and their determinants in Tocantins’, defended at the Federal University of Bahia (UFBA) Public Health Postgraduate Program in 2017.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To investigate the epidemiological profile of snakebite accident cases, their determinants and risk areas in the state of Tocantins.

Methods

This was an ecological study using data from the Notifiable Health Conditions Information System, from 2007 to 2015. Multiple linear regression and the Mann-Whitney and Kruskal-Wallis tests were used.

Results

A total of 7,764 snakebite accidents were reported (incidence: 62.1/100,000 inhab.; lethality: 0.5%). The variables associated with snakebite were population density (Coeff.=1.36, 95%CI 0.72;1.99), farming work (Coeff.=0.02, 95%CI 0.01;0.03), municipal human development index (Coeff.=2.99 – 95%CI 0.60;5.38), area planted with cassava (Coeff.=8.49 – 95%CI 1.66;15.32), indigenous population (Coeff.=0,02 – 95%CI 0.00; 0.04), proportion of illiterate people (Coeff.=4.70 – 95%CI 0.61;8.79) and employed people (Coeff.=3.00 – 95%CI 0.93;5,06), which together accounted for 64.48% of the variation. The high-risk areas were Amor Perfect, Cantão, Cerrado Tocantins Araguaia and Mid-North Araguaia health regions.

Conclusion

Municipal socioeconomic and demographic aspects were associated with snakebites.

Snake Bites; Ecological Studies; Health Profile; Risk Zone

Health regions	APE	BCP	CAN	CPD	CTA	IBA	MNA	SUD	Risk classification	Incidence coefficient (per 100,000 inhab.)
APE	–	Different	Same	Different	Same	Different	Same	Different	High	80.9
BCP	Different	–	Different	Same	Different	Same	Different	Same	Low	43.9
CAN	Same	Same	–	Different	Same	Different	Same	Different	High	75.3
CPD	Different	Different	Different	–	Different	Same	Different	Same	Low	40.8
CTA	Same	Different	Same	Different	–	Different	Same	Different	High	89.1
IBA	Different	Same	Different	Different	Different	–	Different	Same	Low	48.4
MNA	Different	Different	Same	Different	Same	Different	–	Different	High	97.3
SUD	Different	Same	Different	Same	Different	Same	Different	–	Low	45.7

Variables	2007-2009		2010-2012		2013-2015		2007-2015

	N (2,356)	(%)	N (2,991)	(%)	N (2,417)	(%)	N (7,764)	(%)
Sex
Male	1,839	78.1	2,275	76.1	1,856	76.8	5,970	76.9
Female	517	21.9	716	23.9	561	23.2	1,794	23.1
Age (years)
<15	404	17.1	566	18.9	436	18.0	1,406	18.1
15-34	926	39.4	1,078	36.0	815	33.8	2,819	36.3
35-54	691	29.3	893	29.9	743	30.7	2,327	30.0
≥55	335	14.2	454	15.2	423	17.5	1,212	15.6
Schooling
No schooling	139	5.9	145	4.8	111	4.6	395	5.1
Complete elementary education	1,639	69.6	1,812	60.6	1,330	55.0	4,781	61.7
Complete high school education	97	4.1	197	6.6	212	8.8	506	6.5
Complete higher education	13	0.6	23	0.8	29	1.1	65	0.8
Not applicable	114	4.8	142	4.7	127	5.3	383	4.9
No information	354	15.0	672	22.5	608	25.2	1,634	21.0
Occupation
Farming	750	31.8	969	32.4	693	28.7	2,412	31.1
Work in general	159	6.7	202	6.8	223	9.2	584	7.4
Other	556	23.6	674	22.5	576	23.8	1,806	23.3
No information	891	37.9	1,146	38.3	925	38.3	2,962	38.2
Race/skin color
White	278	11.8	245	8.2	178	7.4	701	9.0
Black	204	8.7	232	7.8	174	7.2	610	7.9
Yellow	40	1.6	30	1.0	34	1.4	104	1.3
Brown	1,724	73.2	2,330	77.9	1,895	78.4	5,949	76.6
Indigenous	87	3.7	123	4.1	107	4.4	317	4.1
No information	23	1.0	31	1.0	29	1.2	5,970	1.1
Snake genus
Bothrops	1,761	74.8	2,390	79.9	1,840	76.1	5,991	77.2
Crotalus	262	11.1	260	8.7	243	10.1	765	9.9
Micrurus	19	0.8	17	0.6	12	0.5	48	0.6
Lachesis	18	0.8	13	0.4	7	0.3	38	0.5
Not venomous	133	5.6	128	4.3	151	6.2	412	5.2
No information	163	6.9	183	6.1	164	6.8	510	6.6
Zone of occurrence
Urban	308	13.1	365	12.2	366	15.1	1,039	13.4
Rural	1,970	83.6	2,514	84.1	1,963	81.2	6,447	83.0
Peri-urban	42	1.8	54	1.8	38	1.6	134	1.7
No information	36	1.5	58	1.9	50	2.1	144	1.9
Climatic aspect – rainfall
More rain	1,480	62.8	2,009	67.2	1,582	65.5	5,071	65.3
Less rain	876	37.2	982	32.8	835	34.5	2,693	34.7
No information	–	0.0	–	0.0	–	0.0	–	0.0
Time elapsed between accident and care
Up to six hours	1,912	81.1	2,500	83.6	2,018	83.4	6,430	82.8
Over six hours	324	13.8	362	12.1	301	12.5	987	12.7
No information	120	5.1	129	4.3	98	4.1	347	4.5
Anatomic site of snakebite
Torso	22	0.9	33	1.1	29	1.2	84	1.1
Lower limbs	1,951	82.8	2,434	81.4	1,996	82.6	6,381	82.2
Upper limbs	358	15.2	480	16.0	361	14.9	1,199	15.4
No information	25	1.1	44	1.5	31	1.3	100	1.3
Stage
Mild	1,140	48.4	1,311	43.9	1,123	46.5	3,574	46.0
Moderate	947	40.2	1,361	45.5	1,012	41.9	3,320	42.8
Severe	169	7.2	160	5.3	166	6.9	495	6.4
No information	100	4.2	159	5.3	116	4.8	375	4.8
Clinical evolution
Cure	2,314	98.2	2,896	96.8	2,212	91.5	7,422	95.7
Death	17	0.7	11	0.4	14	0.6	36	0.5
No information	25	1.1	84	2.8	191	7.9	300	3.8
Work-related accident
Yes	687	29.2	906	30.3	542	22.4	2,135	27.5
No	1,574	66.8	1,926	64.4	1,644	68.0	5,144	66.3
No information	95	4.0	159	5.3	231	9.6	485	6.2

Variables	Coefficient	T-test	p-value >\| t \|^a	95%CI^b
Population density (inhab./km²)	1.36	4.23	0.001	0.72;1.99
Farming work	0.02	3.54	0.001	0.01;0.03
MHDI^c	2.99	2.47	0.015	0.60;5.38
Area planted with cassava (km²)	8.49	2.46	0.015	1.66;15.32
Indigenous population	0.02	2.32	0.022	0.00; 0.04
Illiteracy	4.70	2.28	0.024	0.61; 8.79
Employment	3.00	2.87	0.005	0.93;5.06
Constant (cases/100,000 inhab.)	-540.38	-4.39	0.001	-784.15;-296.60

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[1] Correspondence: Shirley Barbosa Feitosa – Quadra 210 Sul, Alameda 15, Lote 6 (Multifamiliar), casa 12, Palmas, TO, Brazil. Postcode: 77020-590 E-mail: shirleybiofeitosa@gmail.com