Predictors of Mortality among Paediatric Snakebite Patients in Northeastern Nigeria: A Survival Analysis Study

Abstract

Abstract Background Paediatric patients of snakebite envenoming are particularly vulnerable to severe complications, however, risk factors for mortality remain largely unexamined in pediatric populations, particularly within rural Nigerian settings, where snakebite envenoming is prevalent. Methods A retrospective study was conducted using medical records at the Snakebite Treatment and Research Hospital (SBTRH) in Northeastern Nigeria, including paediatric patients aged 0 through 17 who presented with a snakebite from January through December 2024. We used descriptive statistics to summarize patient characteristics grouped by outcome at the end of hospitalization (death versus discharge alive). Subsequently, we estimated cumulative survival probability over time using Kaplan-Meier curves and identified predictors of mortality using multivariable Cox proportional hazards models. Results SBTRH managed 2,192 snakebite patients between 1 January and 31 December 2024, out of which 723 paediatric patients were included in analyses; 702 of these patients were discharged alive, while 21 died in hospital. Those who took four hours or more to arrive at the hospital after being bitten were more likely to die at hospital discharge compared to those who arrived in less than four hours (hazard ratio (HR) = 5.87, 95% CI = 1.15-29.95). Further, those who were not given antivenom were more likely to die at hospital discharge than those who were given antivenom (HR = 10.07, 95% CI = 3.89-26.07). Conclusion This study identifies delayed hospital presentation and lack of antivenom administration among key predictors of in-hospital mortality among paediatric snakebite patients in Northeastern Nigeria. These findings underscore the need for urgent public health interventions, including the strengthening of antivenom supply chains, eliminating financial barriers to treatment, and the implementation of targeted educational campaigns aimed at early care-seeking behaviour.