A narrative systematic review of snakebite risk factors in Kenya, incorporating grey and academic literature.

Snakebite is a neglected tropical disease, the drivers of which remain poorly understood and controlled in many countries. Incorporating grey literature has been recommended by previous academic publications on snakebite, due to the limited studies available globally, to provide a more accurate understanding of burden. In this review we aimed to identify and better understand risk factors that are associated with increased risk of snakebite, specifically across Kenya, using both grey and academic literature sources. We appraised academic studies using the Mixed Methods Appraisal Tool, while grey literature was assessed using the Authority, Accuracy, Coverage, Date and Significance guidelines. This systematic review synthesised evidence from 16 eligible peer-reviewed studies and 4 grey literature sources (1994-2025) examining determinants of snakebite risk and outcomes across Kenya. Given the limited number of eligible studies and heterogeneity of study types we conducted a thematic narrative synthesis. A total of 25 variables clustered into four domains were assessed, spanning human demographic factors, and environmental exposures. This study concurred with established literature on factors such as rurality, poverty and farming increasing snakebite risk, but also highlights discrepancies with global data. Several studies reported no seasonal variation or more bites in the dry season; bites were reported to occur equally in the day and the night in some studies; and no significant gender difference was observed in several reports. Overall findings converged on a consistent picture, snakebite envenoming in Kenya is concentrated among poorer, rural populations, and is more consistently linked to livelihoods and housing conditions, than seasonality or temporality. Actual burden and species responsible for bites remain poorly understood.