Abstract
<title>Abstract</title> <p> <bold>Background</bold> Snakebite envenoming, the dominant cause of venomous animal contact in sub-Saharan Africa, is a poverty-related neglected tropical disease controllable through antivenom access and health-system reach, and the focus of a World Health Organization commitment to halve death and disability by 2030. Whether progress has matched population growth, and whether the region will meet that target, has not been established using Global Burden of Disease (GBD) 2023. <bold>Methods</bold> We analysed GBD 2023 estimates of deaths, disability-adjusted life years (DALYs) and incidence from venomous animal contact across 46 sub-Saharan African countries, four regions, five Socio-demographic Index quintiles, 1990 to 2023. We quantified trends with the estimated annual percentage change (EAPC) and joinpoint regression, partitioned the change in deaths into population growth, ageing and epidemiological change by Das Gupta decomposition, measured cross-country inequality with the slope index of inequality (SII) and concentration index, and projected age-standardised mortality to 2030 against the WHO target. <bold>Results</bold> Age-standardised mortality fell 28.9%, from 3.75 to 2.67 per 100,000 (EAPC − 1.26, 95% CI -1.32 to -1.20), yet deaths rose 54.8%, from 15,170 to 23,478, and the region's share of global deaths climbed from 16.3% to 25.1%. Thirty-three of 46 countries recorded a falling rate alongside a rising death count. Decomposition attributed 17,966 additional deaths to population growth and 9,683 averted deaths to epidemiological change, while ageing contributed 25 (0.3%). Burden concentrated in the poorest countries (concentration index − 0.153, 95% CI -0.281 to -0.008). The decline has stalled, from − 1.41% annually between 1995 and 2018 to -0.06% between 2018 and 2023. On the post-2005 trajectory the projected 2030 rate is 2.37 per 100,000, 60.2% above the target of 1.48; meeting it would require an 8.05% annual decline. <bold>Conclusions</bold> Sub-Saharan Africa made real epidemiological progress until 2018 but has since been overtaken by population growth and its improvement has stalled, and it will miss the WHO 2030 target by a wide margin. Because ageing is not a driver, the shortfall reflects intervention that has not scaled rather than demographic inevitability: antivenom access and health-system reach must expand faster than the population, and progress should be tracked against both rates and counts. Clinical trial number: not applicable. </p>