“I sold my towel and shoes to pay the traditional healer”: Care-seeking costs and productivity losses among snakebite victims in Eastern Province, Rwanda

Snakebite envenomation (SBE) is endemic to sub-Saharan Africa and generally over-represented in rural, remote, and impoverished agricultural communities. While poverty is an established risk factor, little research has been done to investigate the economic consequences of SBE. This cross-sectional, quantitative study aimed to measure out-of-pocket spending and lost income when a household member was bitten by a snake. In 2020, 732 snakebite survivors from Eastern Province (Rwanda) agreed to complete a survey administered by telephone. The survey focused on participant demographics, income, direct medical and non-medical costs, care-seeking decisions, and lost work during convalescence. Our results suggested that patients incurred the highest mean expenses when they sought care from hospitals (11 307 RWF or 12 USD) or traditional healers (5 836 RWF or 6 USD) but that the highest maximum cost was incurred from traditional healers (300 000 RWF or 313 USD). Across all victims, the total amount paid to traditional healers (3.4 million RWF or 3 537 USD) was 4.7 times higher than all other care providers combined. On average, families lost 111 814 RWF (117 USD) per snakebite in direct treatment costs and indirect productivity losses. Many victims sought care from traditional healers despite being eligible for free medical care. Altogether, this study serves as a reminder of the serious physical and financial consequences associated with SBE and provides justification for new investments into SBE prevention and care.Author summary: Snakebite is a life-threatening situation in sub-Saharan Africa, especially for rural and poor populations. Despite being preventable and treatable, it receives little attention from policymakers. The goal of this study was to estimate the financial losses experienced by snakebite victims due to treatment costs and lost work. Interviews with 732 snakebite victims from Eastern Province, Rwanda, indicated that a typical adult lost 12.0% of their annual income due to a single bite. Moreover, caregivers lost time and income when caring for a sick family member. Patients preferentially sought care from traditional healers rather than Community Health Workers, nurses or physicians, even when they qualified for free hospital care. Consequently, victims in our study group paid five times more to traditional healers (3.4 million RWF or 3 537 USD) than to all other care providers combined. Altogether, our analysis suggests that Rwandese lose 7.4 million USD each year in treatment costs and lost work due to snakebite. These results serve as evidence to policymakers that investments to prevention and treatment programs will not only reduce pain and suffering, but also contribute to national goals targeting poverty reduction.