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Volume 10, Issue 1 (Spring 2023)                   J Prevent Med 2023, 10(1): 36-47 | Back to browse issues page

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Jaberhashemi S A, Amiri Z, Norouzi M, Shahi M. Epidemiological Factors and Indicators Related to Venomous Bites and Stings in High-risk Areas of Southern Iran. J Prevent Med 2023; 10 (1) :36-47
URL: http://jpm.hums.ac.ir/article-1-639-en.html
Epidemiological Factors and Indicators Related to Venomous Bites and Stings in High-risk Areas of Southern Iran
Seyed Aghil Jaberhashemi1 , Zahra Amiri2 , Mojtaba Norouzi3 , Mehran Shahi *4
1- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
2- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
3- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
4- Department of Medical Entomology and Vector Control, Infectious & Tropical Diseases Research Center, School of Public Health, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Keywords: Epidemiology, Sting, Bite, Snake, Scorpion, Iran
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Introduction
In tropical regions of the world, bites and stings of poisonous animals are considered a medical emergency. These injuries not only directly cause physical harm to the victim, but also indirectly cause severe allergic reactions and sometimes dangerous secondary infections. It also causes psychological disorders and increases economic costs. In the southern regions of Iran, scorpion stings and snake bites are among the most important medical problems. About 250,000 cases of bites and stings by animals occur in Iran every year, of which 50,000 cases are related to scorpions. In Iran, about 50 people die due to scorpion stings each year, most of which are related to the southern provinces. Despite the existence of this problem, comprehensive studies on the epidemiology of venomous bites and stings have not been conducted in high-risk areas of the country, including Hormozgan province. The purpose of this study is to investigate the factors and epidemiological indicators effective in causing poisoning caused by the bites of poisonous animals in the high-risk areas of Bashagard city in the south of Iran.

Methods
This is a descriptive-analytical study. The studied population consists of all patients bitten by poisonous animals, including snakes, centipedes, and scorpions, who visited Baqiyatullah Azam Hospital in Bashagard city in 2018-2019. They all included in the study based on the census sampling method. By reviewing the literature, a checklist was prepared to find the epidemiological factors and indicators related to venomous bites/stings. The checklist surveyed variables such as age, sex, occupation, level of education, type of bite/sting, history of previous bites/stings, number of bites/stings on the body, time between bites/stings and referral to the emergency department, bite/sting area, initial symptoms at the time of bite/sting, symptoms at the time of visit, traditional treatment measures and serum therapy performed, results of treatment measures, and duration of hospitalization. The information was extracted from the hospital information system. The data was entered into the EXCEL software, 2013. The data were statistically analyzed in SPSS software, version 19 software. For descriptive analysis, absolute and relative frequency, Mean±SD were calculated. Chi-square test was used to check the difference in variables. The significance level was set at 0.05.

Results
Of 201 patients with bites and stings by venomous animals, 37% were male and 63% were female. Their mean age was 27 years. The highest frequency was related to the age group <10 years and the lowest was related to the age group >60 years. The results of chi-square test showed no significant difference in duration of hospitalization between males and females (P=0.55). In terms of the type of bite/sting, the most cases were related to scorpion stings, which were caused by the Mesobuthus mirshamsii. Most of the bites/stings were during daytime. The chi-square test results showed a significant difference in duration of hospitalization among the participants in terms of the type of bite/sting (P<0.001). Most of the bites/stings were on the hands of the injured and 96% of them occurred inside residential houses in rural areas. The chi-square test results showed a significant difference in duration of hospitalization among the participants in terms of the number of bites/stings on the body and the bite/sting area (P<0.001). The average time between bite/sting and hospital admission was two hours. The average serum received for each patient was one vial. During this study, one case of death due to scorpion sting was reported.

Discussion
The results obtained in this study showed that the prevalence of bites/stings in women was higher than in men. It seems that women and children are more at risk due to their presence in residential houses. The mean age of the injured was 27 years, which is consistent with the results of other studies. Among the reasons for the high number of injuries at this age, we can point to the fact that most people at this age are highly active and have curious and risky behaviors such as lifting stones and objects without wearing gloves, not inspecting clothes, walking barefoot or not wearing proper shoes. The most observed injuries were caused by the sting of scorpion M. mirshamsii. This scorpion is most abundant in rural areas of Iran. The most bites/stings were on the hands of the patients. In other studies, most cases of bites and stings have been reported in the hands and feet of patients. Most of the bite/sting cases were in rural areas in summer. Among the influential factors in this regard, we can indicate the oldness of houses, lack of building improvement, and sleeping on the floor. Personal protection training using social media, especially in rural areas, can be effective in reducing cases of poisonous bites and stings.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by Hormozgan University of Medical Sciences (Code: IR.HUMS.REC.1399.568).

Funding
This study was carried out with the financial support of the Vice-Chancellor of Research and Technology of Hormozgan University of Medical Sciences.

Authors' contributions
Conceptualization, methodology, investigation, writing–review & editing, and resources: Mehran Shahi, Seyed Aghil Jaberhashemi; Writing–original draft: Mehran Shahi, Seyed Aghil Jaberhashemi, Zahra Amiri and Mojtaba Noroozi; Supervision: Mehran Shahi.

Conflicts of interest
The authors declaed no conflict of interest.

Acknowledgements
We would like to thank and appreciate the Research and Technology Vice-Chancellor of Hormozgan University of Medical Sciences and also for the cooperation of Ali Zarei from the medical records unit of Baqiyatallah-al-Azam Hospital (A.J.).

References
 
  1. World Health Organization (WHO). Animal bites [Internet]. 2018 [Updated 2018 February 5]. Available from: [Link]
  2. Dehghani R, Fathi B, Aboo-Saaidi Z, Jalalati A, Ramezani M, Nohi M. Epidemiology of poisonings in Shahid Beheshti Hospital in Kashan, Iran. Int J Med Toxicol Forensic Med. 2015; 5(3):144-50. [DOI:10.22037/ijmtfm.v5i3(Summer).7578]
  3. Kashef S, Harati H. [Annual survey of acute poisoning in children admitted to the emergency ward of Shiraz Namazi Hospital (Persian)]. J Yazd Univf Med Sci. 2002; 10(2):42-6. [Link]
  4. Beck RJ, Rahm SJ, Pollak AN. Intermediate emergency care and transportation of the sick and injured. Burlington: Jones & Bartlett Learning; 2004. [Link]
  5. Moradi M, Ghaemi K, Mehrpour O. A hospital base epidemiology and pattern of acute adult poisoning across Iran: A systematic review. Electron Physician. 2016; 8(9):2860-70. [DOI:10.19082/2860] [PMID] [PMCID]
  6. Alavi SM, Alavi L. Epidemiology of animal bites and stings in Khuzestan, Iran, 1997-2006. J Infect Public Health. 2008; 1(1):51-5. [DOI:10.1016/j.jiph.2008.08.004] [PMID]
  7. Hon KL, Fu CC, Chor CM, Tang PS, Leung TF, Man CY, et al. Issues associated with dog bite injuries in children and adolescents assessed at the emergency department. Pediatr Emerg Care. 2007; 23(7):445-9. [DOI:10.1097/01.pec.0000280509.67795.a9] [PMID]
  8. Gheshlaghi F, Yaraghi A, Hashemi ES. [An epidemiological study on scorpionism in Isfahan province (Persian)]. J Isfahan Med Sch. 2011; 28(114):885-91. [Link]
  9. Besharat M, Abbasi F. [Snakebite in Iran: Diagnosis, treatment and prevention (Persian)]. J Med Counc Iran. 2009; 27(1):63-76. [Link]
  10. Khan A, Al-Kathiri WH, Balkhi B, Samrkandi O, Al-Khalifa MS, Asiri Y. The burden of bites and stings management: Experience of an academic hospital in the Kingdom of Saudi Arabia. Saudi Pharm J. 2020; 28(8):1049-54. [DOI:10.1016/j.jsps.2020.07.004] [PMID] [PMCID]
  11. Ozkan O, Adigüzel S, Yakiştiran S, Cesaretli Y, Orman M, Karaer KZ. Androctonus crassicauda (Olivier 1807) scorpionism in the Sanliurfa provinces of Turkey. Turkiye Parazitol Derg. 2006; 30(3):239-45. [PMID]
  12. Forrester MB, Stanley SK. Epidemiology of scorpion envenomations in Texas. Vet Hum Toxicol. 2004; 46(4):219-21. [PMID]
  13. Ozkan O, Uzun R, Adiguzel S, Cesaretli Y, Ertek M. Evaluation of scorpion sting incidence in Turkey. J Venom Anim Toxins Incl Trop Dis. 2008; 14(1):128-40. [DOI:10.1590/S1678-91992008000100010]
  14. Shahi M, Habibi-Masour R, Salehi M, Ghasemi-Nang M, Rafizad E, Abbasi M, et al. Scorpions and scorpionism in Roudan county, southern Iran. J Arthropod Borne Dis. 2019; 13(4):353. [DOI:10.18502/jad.v13i4.2231]
  15. Anil A, Singh S, Bhalla A, Sharma N, Agarwal R, Simpson ID. Role of neostigmine and polyvalent antivenom in Indian common krait (Bungarus caeruleus) bite. J Infect Public Health. 2010; 3(2):83-7. [DOI:10.1016/j.jiph.2010.01.002] [PMID]
  16. Bagheri M, Alipour H, Keshawarz A. Epidemiological study of scorpion-sting in patients referred to medical centers of Shiraz, south-west of Iran. J Health Sci Surveill Syst. 2021; 9(2):105-10. [DOI:10.30476/jhsss.2020.87847.1125]
  1. Rahimi M, Shadnia S, Mirzaei Nasab R, Soltaninejad K. Scorpion Stings in Tehran province, Iran: A seven-year hospital-based study. Int J Med Toxicol Forensic Med. 2020; 10(4):30274. [DOI:10.32598/ijmtfm.v10i4.30274]
  2. Ozköse Z, Ayoglu F. Etiological and demographical characteristics of acute adult poisoning in Ankara, Turkey. Hum Exp Toxicol. 1999; 18(10):614-8. [DOI:10.1191/096032799678839446] [PMID]
  3. Al-Asmari AK, Al-Saif AA. Scorpion sting syndrome in a general hospital in Saudi Arabia. Saudi Med J. 2004; 25(1):64-70. [PMID]
  4. Jarrar BM, Al-Rowaily MA. Epidemiological aspects of scorpion stings in Al-Jouf province, Saudi Arabia. Ann Saudi Med. 2008; 28(3):183-7. [DOI:10.5144/0256-4947.2008.183] [PMID] [PMCID]
  5. Khadem-Rezaiyan M, Moallem SR, Afshari R. Epidemiology of snake, spider and scorpion envenomation in Mashhad, Khorasan Razavi, Iran (2004-2011). Iran J Toxicol. 2018; 12(1):27-31. [DOI:10.29252/arakmu.12.1.27]
  6. Pipelzadeh MH, Jalali A, Taraz M, Pourabbas R, Zaremirakabadi A. An epidemiological and a clinical study on scorpionism by the Iranian scorpion Hemiscorpius lepturus. Toxicon. 2007; 50(7):984-92.[DOI:10.1016/j.toxicon.2007.07.018] [PMID]
  7. Bouaziz M, Bahloul M, Kallel H, Samet M, Ksibi H, Dammak H, et al. Epidemiological, clinical characteristics and outcome of severe scorpion envenomation in South Tunisia: Multivariate analysis of 951 cases. Toxicon. 2008; 52(8):918-26. [DOI:10.1016/j.toxicon.2008.09.004] [PMID]
  8. Jahan S, Mohammed Al Saigul A, Abdul Rahim Hamed S. Scorpion stings in Qassim, Saudi Arabia--a 5-year surveillance report. Toxicon. 2007; 50(2):302-5. [DOI:10.1016/j.toxicon.2007.03.013] [PMID]
  9. Jalali A, Savari M, Dehdardargahi S, Azarpanah A. The pattern of poisoning in southwestern region of iran: Envenoming as the major cause. Jundishapur J Nat Pharm Prod. 2012; 7(3):100-5. [DOI:10.17795/jjnpp-3504] [PMID] [PMCID]
  10. Al-Sadoon MK, Jarrar BM. Epidemiological study of scorpion stings in Saudi Arabia between 1993 and 1997. J Venom Anim Toxins Incl Trop Dis. 2003; 9(1):54-64. [DOI:10.1590/S1678-91992003000100003]
  11. Firooziyan S, Sadaghianifar A, Rafinejad J, Vatandoost H, Bavani MM. Epidemiological characteristics of scorpionism in West Azerbaijan province, northwest of Iran. J Arthropod Borne Dis. 2020; 14(2):193-201. [DOI:10.18502/jad.v14i2.3738] [PMID] [PMCID]
  12. Kamali K. Identification of important scorpion in Khuzestan. Scientific Journal in Agriculture, Chamran University Ahvaz. 1984; 1:34-5. [Link]
  13. Nazari M, Hajizadeh M. Faunistic study on scorpions and the epidemiology of scorpionism in bam, southeast of Iran. Glob J Health Sci. 2016; 9(2):177. [DOI:10.5539/gjhs.v9n2p177]
  14. Adiguzel S, Ozkan O, Inceoglu B. Epidemiological and clinical characteristics of scorpionism in children in Sanliurfa, Turkey. Toxicon. 2007; 49(6):875-80. [DOI:10.1016/j.toxicon.2006.12.012] [PMID]

 
Type of Study: Orginal | Subject: Medical Entomology
Received: 2022/06/10 | Accepted: 2023/04/9 | Published: 2023/07/1
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