In the Brazilian Amazon, long distances, low healthcare coverage, common use of ineffective or deleterious self-care practices, and resistance to seeking medical assistance have an impact on access to antivenom treatment. This study aimed to estimate snakebite underreporting, and analyze barriers that prevent victims from obtaining healthcare in communities located in 15 municipalities on the banks of the Solimões, Juruá and Purus Rivers, in the remote Western Brazilian Amazon. Information on the participants' demographics, previous snakebites, access to healthcare, time taken to reach medical assistance, use of self-care practices, and the reason for not accessing healthcare were collected through semi-structured interviews. In the case of deaths, information was collected by interviewing parents, relatives or acquaintances. A total of 172 participants who reported having suffered snakebites during their lifetime were interviewed. A total of 73 different treatment procedures was reported by 65.1% of the participants. Participants living in different river basins share few self-care procedures that use traditional medicine, and 91 (52.9%) participants reported that they had access to healthcare. Living in communities along the Juruá River [OR = 12.6 (95% CI = 3.2-49.7; p<0.001)] and the use of traditional medicine [OR = 11.6 (95% CI = 3.4-39.8; p<0.001)] were variables that were independently associated to the lack of access to healthcare. The main reasons for not accessing healthcare were the pprioritization of traditional treatments (70.4%), and the failure to recognize the situation as being potentially severe (50.6%). Four deaths from complications arising from the snakebite were reported, and three of these were from communities on the banks of the Juruá River. Only one of these received medical assistance. We found an unexpectedly high underreporting of snakebite cases and associated deaths. Snakebite victims utilized three main different healing systems: 1) self-care using miscellaneous techniques; 2) official medical healthcare generally combined with traditional practices; and 3) self-care using traditional practices combined with Western medicines. To mitigate snakebite burden in the Brazilian Amazon, an innovative intervention that would optimize timely delivery of care, including antivenom distribution among existing community healthcare centers, is needed.

中文翻译：

---

“看不见的种群”中的蛇咬伤：对巴西亚马逊西部偏远地区河流种群的横断面调查。

在巴西亚马逊地区，距离遥远、医疗保健覆盖率低、普遍采用无效或有害的自我保健做法以及拒绝寻求医疗援助等因素影响了获得抗蛇毒血清治疗的机会。本研究旨在估计巴西西部偏远亚马逊地区索利莫斯河、朱鲁阿河和普鲁斯河沿岸 15 个城市社区中蛇咬伤报告不足的情况，并分析阻碍受害者获得医疗保健的障碍。通过半结构化访谈收集了有关参与者的人口统计数据、以前被蛇咬伤、获得医疗保健的情况、获得医疗援助所需的时间、自我护理实践的使用以及不获得医疗保健的原因的信息。对于死亡，信息是通过采访父母、亲戚或熟人来收集的。共有 172 名自称生前曾被蛇咬伤的参与者接受了采访。65.1% 的参与者报告了总共 73 种不同的治疗程序。生活在不同流域的参与者很少有使用传统医学的自我保健程序，91 名（52.9%）参与者报告说他们能够获得医疗保健。居住在茹阿河沿岸社区 [OR = 12.6 (95% CI = 3.2-49.7; p<0.001)] 和传统医学的使用 [OR = 11.6 (95% CI = 3.4-39.8; p<0.001)]与缺乏医疗保健机会独立相关的变量。无法获得医疗保健的主要原因是优先考虑传统治疗（70.4%），以及未能认识到情况可能很严重（50.6%）。据报道，有四人死于蛇咬伤并发症，其中三人来自胡鲁阿河沿岸的社区。其中只有一人获得了医疗救助。我们发现蛇咬伤病例和相关死亡的漏报率出人意料地高。蛇咬伤受害者主要使用三种不同的治疗系统：1）使用各种技术进行自我护理；2）官方医疗保健普遍与传统做法相结合；3）传统疗法与西药相结合的自我护理。为了减轻巴西亚马逊地区的蛇咬伤负担，需要采取创新干预措施来优化及时提供的护理，包括在现有社区医疗中心之间分配抗蛇毒血清。