STUDY CHARACTERISTICS OF INCLUDED RECORDS.

Background
Snake bites cause considerable morbidity and mortality worldwide, yet evidence from low- and middle-income countries remains fragmented. This is particularly the case in Eastern Mediterranean Region where available data on snake bites is relatively weak. Without reliable data, it is difficult to make the case for greater visibility and investment to address the snakebite burden in this Region. A scoping review was therefore conducted to summarize evidence on snake bites in countries of the Eastern Mediterranean.
Methodology/principal findings
The review employed manual and electronic searching methods of four databases plus Google Scholar, ultimately including 196 records from 20 countries published between 2000 and 2023. More than half originated from Iran, Morocco, and Pakistan. Many records lacked information on permanent sequalae, disability, snake species, and types and sources of antivenoms. When identified, offending snakes belonged to 30 species. Use of more than 12 types of antivenoms were described across the Region, and some were not specific to indigenous species.
Conclusion/significance
Despite the relatively large number of publications identified, the data were concentrated in just a few countries in the Region, and there was little or no information available for the remainder. As is the case worldwide, disability associated with snake bites was poorly characterized and quantified across the Region. There is an urgent need for concrete action at national and regional levels to enhance epidemiological surveillance, research, and the collection of clinical, disability and outcomes data to inform policy and public health investment. Greater regional cooperation and collaboration is also crucial for addressing this neglected disease throughout the Region.

背景
蛇咬伤在全球范围内造成了沉重的发病与死亡负担，但低收入和中等收入国家的相关研究证据仍较为零散。东地中海区域（Eastern Mediterranean Region）的情况尤为突出，该区域现有的蛇咬伤相关数据相对薄弱。若缺乏可靠数据，便难以论证提升该区域蛇咬伤负担应对工作的关注度与投入力度的必要性。为此，本研究开展了一项范围综述（scoping review），旨在总结东地中海区域各国关于蛇咬伤的研究证据。

方法学/主要结果
本综述采用手动与电子检索相结合的方式，检索了4个数据库及谷歌学术（Google Scholar），最终纳入了2000年至2023年间发表的来自20个国家的196篇文献记录。其中超过半数的文献来自伊朗、摩洛哥与巴基斯坦。多数文献未提及永久性后遗症、伤残情况、致病蛇类种类以及抗蛇毒血清的类型与来源。经确认的致病蛇类共涉及30个物种。该区域已报道使用了12种以上的抗蛇毒血清，其中部分血清并非针对本土蛇种。

结论与意义
尽管本次综述纳入的文献数量相对较多，但相关数据仅集中于区域内少数国家，其余多数国家的相关信息极少甚至完全缺失。与全球现状一致，该区域内蛇咬伤相关伤残的特征描述与量化分析均较为匮乏。当前亟需在国家与区域层面采取切实行动，加强流行病学监测、相关研究以及临床、伤残与转归数据的收集工作，从而为政策制定与公共卫生投入提供依据。此外，加强区域间合作与协作，对于在全区域范围内应对这一被忽视的疾病也至关重要。