Snake bite in india pdf

Next SlideShares. You are reading a preview. Create your free account to continue reading. Sign Up. Upcoming SlideShare. Embed Size px. Start on. Show related SlideShares at end. WordPress Shortcode. Share Email. Top clipped slide. Download Now Download Download to read offline. Snake Bite. Vikas Kesarwani Follow. Dog Bite. Foreign body nose. First aid on snake bite. Treatment protocol of snake bite. Snake bite handout - ANMC. The proportion of all deaths from snakebites was highest at ages 5—14 years.

The age-standardised death rate per , population per year was 4. Figure 1 shows the odds ratios for snakebite deaths versus other deaths, adjusted for age, gender, and for high prevalence states 13 states with age-standardised snakebite death rates greater than 3 per , versus other states.

In contrast, gender and education were not significantly associated with risk of snakebite death. About 5,—7, snakebite deaths per month occurred during the monsoon period, compared to less than 2, deaths in the winter months. Odds ratio after adjusting for age, gender and states with a high prevalence of snakebite deaths see definition in Table 2.

Rainfall amount mm is cumulative daily rainfall for the past 24 hours measured by the India Meteorological Department [22] , [23]. Maximum and minimum temperatures are also measured daily and presented as monthly averages across the 13 snakebite high prevalence states.

Pearson correlation coefficients between snakebite mortality and weather were: i rainfall; 0. Annual age-standardised mortality rates per , from snakebite varied between states, from 3. The age and gender of snakebite deaths also varied by region, although these differences were not significant due to the small numbers of snakebite deaths in each state.

Deaths at ages 5—14 years were prominent in the states of Jharkhand and Orissa, whereas deaths at older ages were prominent in Andhra Pradesh, Bihar, Madhya Pradesh, and Uttar Pradesh data not shown. Death rates are standardised to UN population estimates for India [24]. The vertical bars represent the state wise estimated deaths in thousands.

Snakebite remains an important cause of accidental death in modern India, and its public health importance has been systematically underestimated.

It is more than fold higher than the number declared from official hospital returns [7]. The underreporting of snake bite deaths has a number of possible causes. Most importantly, it is well known that many patients are treated and die outside health facilities — especially in rural areas.

Thus rural diseases, be they acute fever deaths from malaria and other infections [19] or bites from snakes or mammals rabies; [28] , are underestimated by routine hospital data. Moreover, even hospital deaths may be missed or not reported as official government returns vary in their reliability, as shown from a study of snakebites in Sri Lanka [29].

The true burden of mortality from snakebite revealed by our study is similar in magnitude to that of some higher profile infectious diseases; for example, there is one snakebite death for every two AIDS deaths in India [18]. Consequently, snakebite control programmes should be prioritised to a level commensurate with this burden. Our data suggest underestimation in recent global estimates of mortality from snakebite deaths [10] : the upper bounds of recent annual estimates were 94, deaths globally and 15, deaths in India.

This total for India is only about one-third of the snake bite deaths detected in our study. The incidence of snakebite deaths per , population per year in a recent community-based study in Bangladesh was similar to ours [30] , suggesting that much of South Asia might have thousands more snakebite deaths than is currently assumed. Considering the widely accepted gross underestimation of snakebite deaths in Africa [11] , it seems highly probable that well over , people die of snakebite in the world each year.

A minimal number of non-fatal snakebites in India may be estimated with far less certainty. Indian data from routine public sector hospitals [7] are clearly under-reports of deaths recording only 1 in 5 of the deaths we estimated to have occurred in hospital.

The actual number of non-fatal bites in India may well be far higher, as the community-based study in Bangladesh found about non-fatal bites for each death [30]. Our study has limitations; notably the misclassification of snakebite deaths. However, snakebites are dramatic, distinctive and memorable events for the victim's family and neighbours, making them more easily recognizable by verbal autopsy.

We observed a reasonably high sensitivity and specificity when compared to re-sampled deaths. Confusion with arthropod bites and stings is unlikely because of the different circumstances, size and behaviour of the causative animal and the course of envenoming. For example, most deaths from hymenoptera stings result from rapidly evolving anaphylaxis.

Kraits important agents of snakebite death in South Asia may unobtrusively envenom sleeping victims, who may die after developing severe abdominal pain, descending paralysis, respiratory failure and convulsions [31]. Such deaths might not be associated with snakebite at all. These examples suggest possible underestimation of deaths in our data. Since the numbers of deaths observed in each state were small, the estimated totals for each state are uncertain.

However, the state distribution is broadly consistent with that reported by the RGI survey of deaths in selected rural areas in the s [32]. The marked geographic variation across states in our study is similar to that in a country-wide survey conducted during the period —45, which identified Bengal, Bihar, Tamil Nadu, Uttar Pradesh, Madhya Pradesh, Maharashtra and Orissa as having the highest death rates from snakebite [6].

Moreover, despite the obvious underestimates in hospitalised data [7] , their geographical distribution of bites and deaths were similar to what we observed from household reports of deaths. The marked differences in snakebite mortality between states of India may be attributable to variations in human, snake and prey populations, and in local attitudes [8] and health services.

The 13 states with the highest snakebite mortality are inhabited by the four most common deadly venomous snakes: Naja naja , Bungarus caeruleus , Echis carinatus and Daboia russelii.

With the exception of E. While some species can inhabit altitudes of up to 2, metres [2] , this is exceptional and higher mountainous regions have considerably lower death rates.

However, the relative risk of dying from snakebite versus another cause was greater at ages 5—14 years. The peak age range and gender associated with snakebite mortality varied between states, perhaps reflecting differences in the relative numbers of children and women involved in agricultural work [34] — [35].

The slight excess among Hindus may reflect more tolerance of snakes and greater use of traditional treatments [2]. Snakebites and snakebite fatalities peak during the monsoon season in India [33] , [36] and worldwide [10] , probably reflecting agricultural activity, flooding, increased snake activity, and abundance of their natural prey.

This emphasises three points: i hospital-based data reflect poorly the national burden of fatal snakebites; ii inadequacy of current treatment of snakebite in India; and iii vulnerability of snakebite victims outside hospital. Practicable solutions include strengthening surveillance to allow a more accurate perception of the magnitude of the problem, improving community education to reduce the incidence of snakebites and speed up the transfer of bitten patients to medical care, improving the training of medical staff at all levels of the health service including implementation of the new WHO guidelines [12] , and deployment of appropriate antivenoms and other interventional tools where they are needed in rural health facilities to decrease case fatality [36] — [38].

In addition, phylogenetic and venom studies are needed to ensure appropriate design of antivenoms to cover the species responsible for serious envenoming. The Registrar General of India has managed the SRS since they established the survey in , and is collaborating with several of the authors in the ongoing Million Death Study.

All study materials are available at www. The opinions expressed here are those of the authors and do not necessarily represent those of the Government of India. We thank Ansely Wong for comments and Brendon Pezzack for graphics. Department of Community Medicine S. Medical College, Cuttack, Orissa: Dr. B Mohapatra. John's Research Institute, St. The authors have declared that no competing interests exist. PJ is supported by the Canada Research Chair program.

The senior author had full access to all the data and had final responsibility for the decision to submit for publication on behalf of the authors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. National Center for Biotechnology Information , U. Published online Apr Bijayeeni Mohapatra , 1 David A. Jotkar , 4 , 7 Peter S. David A. Raju M. Peter S. John Owusu Gyapong, Editor.

Author information Article notes Copyright and License information Disclaimer. John's Research Institute, Bangalore, India,. Thus, most tribes in … Expand. View 2 excerpts, cites background.

Clinical profile and outcomes of snake bite poisoning in a tertiary care centre in South Tamilnadu. Use of anti-snake venom and clinical outcomes in snake envenomation: a prospective observational study.

An unusual case of snake bite in North east India. Indian Journal of Medical Specialities. Perspective on the Therapeutics of Anti-Snake Venom.

Snakebite envenomation, cognized as a neglected tropical disease, is a dread public health concern with the most susceptible groups being herdsmen, the elderly, active farmers, hunters, fishers, … Expand. Toxicology international. View 1 excerpt, references background. Anti-snake venom properties of medicinal plants. Epidemiology of snake bite in the district of Burdwan, West Bengal.

Journal of the Indian Medical Association. An epidemiological field survey on snake bite was conducted on 26 randomly selected villages with a population of 18, in the district of Burdwan, West Bengal to assess the magnitude of the problem … Expand. Hamirpur district is the most literate and smallest district of Himachal Pradesh.