Snakebite prevalence, burden, healthcare-seeking behavior, and climate change awareness: a cross-sectional household survey in rural Gulu District, northern Uganda

Background Snakebite envenoming (SBE) is a WHO-listed neglected tropical disease affecting mainly rural communities in sub-Saharan Africa. Northern Uganda is a recognized high-burden area, but surveillance depends on health facility records, which cannot count victims who never reach care. Community-level data are therefore scarce, and awareness of climate change as a potential driver is unknown. We determined the household prevalence, health outcomes, socioeconomic burden, knowledge, attitudes, and climate change awareness of SBE in rural Gulu District. Methodology/Principal findings We conducted a cross-sectional household survey in Palaro Subcounty, Gulu District, using multi-stage cluster sampling. A structured questionnaire was administered to 244 consenting household heads or knowledgeable adults; estimates were design-weighted. Lifetime household prevalence was 36.9% (95% CI 20.0-57.7). Most bites occurred while walking or farming, on roads or in fields, and at night, peaking in May. Among the most recent events, 7/90 (7.8%) ended in death and 4 (4.4%) in permanent disability. Five of the seven deaths occurred before the victim reached a health facility. A traditional healer was the first source of care for 50.6% of victims, whereas only 2.2% presented first to a hospital. The median estimated cost per event (78,333 UGX) was about seven-tenths of mean monthly household income, yet the median direct cost was zero: the loss was almost entirely forgone labor (median 14 days lost). Awareness of climate change was high (91.5%), and 59.7% believed it affects snakebite. Conclusions/Significance More than a third of households have been affected by snakebite. Still, most of this burden is invisible to facility-based surveillance: deaths occur before arrival, first care is sought outside the formal system, and economic loss runs through forgone labor rather than medical fees. Antivenom access alone will be insufficient unless victims reach care sooner. High community awareness of climate change offers an entry point for integrated prevention.