Case fatality rate and burden of snakebite envenoming in children - A systematic review and meta-analysis

Snakebite is a major public health problem with an estimated global burden of 5 million people per annum. Data on snakebite envenoming in children are very limited and is unclear whether there is a significant difference in severity between adults and children. We therefore conducted a meta-analysis of observational studies on snakebite in children to obtain a more precise estimate of case fatality rate (CFR) as well as to explore the differences in outcome between children and adults. Studies from all over the world reported until the end of February 2023 were included. Analysis was conducted consistent with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria. Estimates were obtained from Random Effects Model (REM). Sub-analysis was conducted for studies from sub-Saharan Africa (SSA) to provide estimates for the continent. Adverse out-comes comprising composite endpoints (CE), defined as fatality and or complications, were compared between children and adults in sub-analysis of studies reporting on both groups. The annual burden and fatality of snakebite envenoming were derived based on lifetime prevalence of bite, meta-analysis estimates, and other data inputs. The pooled estimate of the CFR from 35 studies included worldwide was 1.98% [95%CI:1.38-2.58%] while the estimates from 6 studies within SSA was 2.43% (95%CI:0.67-4.20%). The odds of adverse outcomes were 2.52 times higher in children compared to adults. The estimated annual burden was 178,491 cases with 4346 deaths among children in SSA. These estimates compare favorably to those reported in the literature.