Snakebite envenomations and access to treatment in communities of two indigenous areas of the Western Brazilian Amazon: A cross-sectional study

PLoS Negl Trop Dis. 2023 Jul 13;17(7):e0011485. doi: 10.1371/journal.pntd.0011485. eCollection 2023 Jul.


Background: The indigenous populations of Brazil present poor health indicators and a disproportionate prevalence and case-fatality rate of neglected tropical diseases, including snakebite envenomations (SBEs). This study aims to estimate access to medical care for SBEs and analyze the barriers that prevent victims from accessing healthcare in indigenous communities in two health districts located in the Western Brazilian Amazon.

Methodology/principal findings: This cross-sectional study used semi-structured interviews to collect data from individuals who experienced SBEs in the Upper Rio Solimões and Upper Rio Negro indigenous health districts. Of the 187 participants, 164 (87.7%) reported that they had access to healthcare and received assistance in a hospital in the urban area of the municipalities. Frequency was 95.4% in the Upper Rio Solimões SIHD, and 69.6% in the Upper Rio Negro SIHD (P<0.0001). The study found that the availability of indigenous medicine as the only choice in the village was the main reason for not accessing healthcare (75%), followed by a lack of financial resources and means of transportation (28.1%). Four deaths were reported from SBEs, resulting in a case-fatality rate of 2.1%.

Conclusions/significance: In the study areas, there are records of SBE patients who did not receive medical attention. Availability of pre-hospital emergency transport using motorboats, a greater number of hospitals and better navigability of the Solimões River and its tributaries would make access easier for indigenous people living in the region of the Upper Solimões River. The implementation of cross-cultural hospital care needs to be considered in order to reduce the resistance of indigenous populations in relation to seeking treatment for SBEs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brazil / epidemiology
  • Cross-Sectional Studies
  • Health Services Accessibility
  • Humans
  • Medicine, Traditional
  • Snake Bites* / therapy

Grants and funding

J.S. and W.M. are funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq productivity scholarships). W.M. and J.S. were funded by Fundação de Amparo à Pesquisa do Estado do Amazonas (PRÓ-ESTADO, call 011/2021 - PCGP/FAPEAM, call 010/2021 - ÁREAS PRIORITÁRIAS, call 023/2022 - INICIATIVA AMAZÔNIA +10) and by the Ministry of Health, Brazil (proposal No. 733781/19-035). A.S.F. and F.M. are funded by Fiocruz (Inova scholarships). A.S.F., F.M. and M.L. and F.M. were funded via Programa Inova Fiocruz and VPAAPS/Fiocruz, project “Contribuição para o desenvolvimento de estratégias para o fortalecimento do SasiSUS, considerando as vulnerabilidades emergentes e reemergentes em saúde”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.