Predictors of In-Hospital Mortality Among Paediatric Snakebite Patients in Northeastern Nigeria: A Survival Analysis Study

Paediatric patients of snakebite envenoming are vulnerable to severe complications due smaller body size and dependence on adults for timely medical attention. However, there is limited literature on risk factors for mortality in pediatric populations, particularly within rural Nigerian settings, where snakebite envenoming is prevalent. 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 years who presented with a snakebite from January through December 2024. We estimated cumulative survival probability over time using Kaplan-Meier curves and identified predictors of mortality using multivariable Cox proportional hazards models. SBTRH managed 2,192 snakebite patients in 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 in hospital 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 (Echitab) were more likely to die in hospital than those who were given antivenom (HR = 10.07, 95% CI = 3.89-26.07). Aligning with other studies on poor outcomes following snakebite, 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 reiterate a need for strengthening antivenom supply chains and implementing targeted educational campaigns.