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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 10  |  Issue : 4  |  Page : 63-64

Snakebite mortality in India: Needs more attention in medical and health-care services


Ex-Principal, North Bengal Medical College, Siliguri, West Bengal; Ex-Professor and Head, Department of Community Medicine, MGM Medical College, Kishanganj, Bihar, India

Date of Submission12-Mar-2022
Date of Decision07-Jul-2022
Date of Acceptance17-Aug-2022
Date of Web Publication8-Nov-2022

Correspondence Address:
Jyoti Bikash Saha
Lake Town, Siliguri, West Bengal-734007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_10_22

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How to cite this article:
Saha JB. Snakebite mortality in India: Needs more attention in medical and health-care services. MRIMS J Health Sci 2022;10:63-4

How to cite this URL:
Saha JB. Snakebite mortality in India: Needs more attention in medical and health-care services. MRIMS J Health Sci [serial online] 2022 [cited 2023 Jan 30];10:63-4. Available from: http://www.mrimsjournal.com/text.asp?2022/10/4/63/360576



Snakebite is an unfortunate accidental interaction between a snake and a human being. Human being is vulnerable to snakebite from the dawn of human civilization because the snake is found on all continents except Antarctica and came into the world before human evolution.[1] Most snakes avoid human contact and keep distance unless they are started or injured. Nonpoisonous snakes are not a threat to human beings but poisonous ones are dangerous to humans. There are about 750 species of poisonous snakes in the world of which 250 can cause death in human beings by a single bite.[2]

The presence of snakes is not usually recognized like other wild animals due to their nocturnal behavior and shyness toward human beings. It is also difficult to see a snake in nature even after the bite. Well-adopted camouflage mechanism, swift movement, and fear of impending death after bites made snakes mysterious. The paucity of knowledge about snakes among common people enhances mysticism and gives rise to innumerable superstitions.[3] Management of snakebite cases by traditional snake charmers or faith healers (Ojhas) is common in rural areas. People often remain complacent with their traditional methods of application of a tight tourniquet, multiple incisions of the bite site, application of herbal products, and other different rituals.[4]

In most cases, the biting snake is not seen and even if it is seen, the effort to catch a snake may invite a repeat bite on the victim or another person.[5] Most of the familiar methods of first aid treatment of snakebite (“traditional/herbal”) have been found to result in more harm (risk) than good (benefit). Their use should never be allowed to delay the shifting of the patient to health facilities with modern medical care.[6] recommended first aid methods emphasize reassurance and mobilization of the patient, particularly the bitten limb. Antivenom serum (AVS) is the mainstay of treatment today for a poisonous snakebite with other supportive measures such as hemodialysis and plasmapheresis.[7]

The burden of medical and socioeconomic consequences after snakebite is more on the rural population. It is the single most important, neglected toxin-related injury. Often the victims of snake bites are young and active individuals. Its significant impact on human health and monetary resources is due to treatment expenditure and loss of productivity and life.[8] In rural areas of the country like India, snake-bitten people often die due to unavailability of AVS, poor treatment by quacks, and remote places of occurrence. Information on different epidemiological aspects such as incidence, morbidity, and mortality of snakebites is not comprehensive till today, as a result, information on the total number of envenomed individuals cannot be obtained and tracking of people admitted to health institutions for snakebite management becomes impossible.[9]

Most snakebites in the world are nonvenomous. However, the World Health Organization (WHO) estimates that around the world about 2,500,000 venomous snakebites occur per year resulting in 125,000 deaths of which 100,000 are in Asia. In India, the number of deaths provided by some authors as 25,000 to 30,000 annually thus seems to be understated. The Million Death study by the Government of India supports the estimation made by the WHO about the incidence of snakebite mortality, which states it to be approximately 50,000 per year and the highest in the world.[10]

Most of the snakebite fatalities are due to not seeking modern medical treatment, delay in reaching the hospitals, erratic pressure and inadequate training of attending doctors, and insufficient storage of medicine.[11] Studies have shown that doctors at the primary health care level hesitate to treat snakebites mainly due to a lack of confidence.[12] At the secondary and tertiary care level, management protocol based on textbooks published from Western countries, not appropriate for Indian settings is being forward ignoring the national therapeutic guidelines. Moreover, in different health-care institutions, AVS is often not administered judiciously.[13]

Finally, to overcome this unpleasant situation of snakebite mortality some attempts to be made in the health sectors in our country like early initiation of modern medical treatment, health-care providers at all levels including local faith healers need training in the management of snakebite cases as per existing government guideline according to their capacity with requisite logistics.

A system of network, including an emergency helpline number (toll-free) working round the clock can be developed for early transportation of victims to the places of modern medical management involving local social organizations. In this mechanism, the existing “Nischay Jan” scheme provided under National Rural Health Mission (NRHM) can be utilized judiciously.



 
  References Top

1.
Bhaumik S. Snakebite: A forgotten problem. BMJ 2013;346:f628.  Back to cited text no. 1
    
2.
Simpson ID, Jacobsen IM. Understanding and treatment of neurotoxic snake bite in the developing world. Indian J Emerg Paediatr 2009;1:15-24.  Back to cited text no. 2
    
3.
Pandey DP. Epidemiology of snakebites based on field survey in Chitwan and Nawalparasi districts, Nepal. J Med Toxicol 2007;3:164-8.  Back to cited text no. 3
    
4.
Chippaux JP. Snake Venoms and Envenomation. Florida: Krieger Publishing Company; 2006.  Back to cited text no. 4
    
5.
Ghosh S. Management of Snakebite, Medicine Update. 2008;90.  Back to cited text no. 5
    
6.
Sutherland SK. The pressure immobilisation technique. Med J Aust 1994;161:700-1.  Back to cited text no. 6
    
7.
Bawaskar HS, Bawaskar PH, Punde DP, Inamdar MK, Dongare RB, Bhoite RR. Profile of snakebite envenoming in rural Maharashtra, India. J Assoc Physicians India 2008;56:88-95.  Back to cited text no. 7
    
8.
Sharma SK, Chappuis F, Jha N, Bovier PA, Loutan L, Koirala S. Impact of snake bites and determinants of fatal outcomes in Southeastern Nepal. Am J Trop Med Hyg 2004;71:234-8.  Back to cited text no. 8
    
9.
Warrell DA. Snake bite. Lancet 2010;375:77-88.  Back to cited text no. 9
    
10.
Report on Causes of Death in India 2015-2016 Government of India. New Delhi: Office of the Register General. Ministry of Home Affairs 2018.  Back to cited text no. 10
    
11.
World Health Organization. Guidelines for the Production, Control and Regulations of Snake Antivenom Immunoglobulin. Geneva: World Health Organization; 2010.  Back to cited text no. 11
    
12.
Indian National Snakebite Protocols: Towards an Indian Snakebite Management Solution. New Delhi: NIHFW; 2007.  Back to cited text no. 12
    
13.
Mandal MM. MD (Community Medicine) Thesis 2011-14. Kolkata: West Bengal University of Health Sciences.  Back to cited text no. 13
    




 

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