India has seen an estimated 1.2 million (12 lakh) snakebite deaths from 2000 to 2019, an average of 58,000 per year. Of concern is the inappropriate perception, inadequate awareness, and knowledge about snakes and snakebites that may predispose the tribal community to increased risks of venomous snakebites, according to a new study by the Indian Council of Medical Research – National Institute for Research in Reproductive Health and Public Health Department, Maharashtra. The study was published in PloS One on August 5.
Snakebite neglected public health issue in many tropical countries
The snakebite envenoming (poisoning from snake bites) was classified by the World Health Organisation (WHO) as a high-priority neglected tropical disease. About 5.4 million (54 lakh) snake bites occur globally each year, resulting in 1.8 to 2.7 million cases of envenoming. There are between 81,410 and 1,37,880 deaths and around three times as many amputations and other permanent disabilities each year, caused by snakebites.
Many snakebite victims, mostly in developing countries, suffer from long-term complications such as deformities, contractures, amputations, visual impairment, renal complications and psychological distress.
India accounts for nearly 50 per cent of global snakebite deaths
India has the highest number of snakebite cases and accounts for nearly 50% of the global snakebite deaths. Farmers, labourers, hunters, shepherds, snake rescuers, tribal and migrant populations, and those with limited access to education and healthcare are high-risk groups for snakebites.
Lack of awareness, inadequate knowledge of prevention of snakebite and lack of first aid amongst the community, as well as peripheral healthcare workers, delay in receiving lifesaving treatment, and non-availability of trained medical officers for management of snakebite contribute to a higher number of deaths, Dr Smita Mahale, former director of ICMR-NIRRH and coordinator of the snakebite research programmes at the institute, told The Indian Express.
WHO launched its roadmap with an aim to halve death and disability from snakebite by 2030. Much before the WHO roadmap was launched, researchers from ICMR-NIRRH and Public Health Department, Maharashtra, started community awareness and health system capacity building from the year 2013. They are continuing their work through a national study funded by the National Task Force on snakebite, ICMR.
After community intervention, CFR due to snakebite poisoning declined
A cross-sectional study was carried out from June 2016 to October 2018 in the Dahanu block, one of the tribal blocks with a higher tribal population in Palghar district of Maharashtra.
Dr Rahul Gajbhiye, principal investigator and corresponding author of the study, said that the aim was to understand awareness, knowledge of snakebites, prevention, first aid practices, and healthcare-seeking behaviour of the community members for snakebite treatment and to assess the knowledge, and management practices for snakebites among traditional faith healers, snake rescuers, and healthcare workers in the tribal block of Dahanu.
Initially, the study was started as a part of the research activity of Model Rural Health Research (MRHRU), Dahanu, Palghar district. Based on the pilot study on snakebite, Tribal Health Research Forum, ECD Division of Indian Council of Medical Research (ICMR), funded the study. The case fatality rate due to snakebite envenomation in 2014 was 4.4%. After community intervention, training of medical officers and frontline health workers, the case fatality rate was gradually reduced to 0.4 % in 2017.
Superstitions about snakebites abound
The study demonstrates inadequate knowledge, wrong perceptions, use of unproven methods for prevention and management of snakebites amongst the tribal community in Dahanu, Dr Himmatrao Bawaskar, co-author of the study and an international expert on snakebite management, told The Indian Express.
The community had wrong perceptions on the identification of venomous snakes and snakebites. Belief in a snake god, ability of tamarind seeds or magnets to reduce the venom effect were some of the superstitions reported in the study.
Fifty per cent of the medical officers in Dahanu block did not have correct knowledge about the Krait bite symptoms, and renal complications due to the Russell viper bite, the study’s lead authors Dr Itta Krishna Chaaithanya and Dr Dipak Abnave have said.
According to the study, one female respondent said, “We give green chilies or dry chili powder, salt, sugar to the snakebite victims to eat, if they can identify the taste then it is a non-venomous bite but if they are unable to identify taste then it is venomous snakebite’.
Another respondent said, “After the bite, if the victim can’t walk even five steps and death occurs immediately, it is considered as venomous snakes”.
Some participants stated, “If pregnant woman encounters a snake and if she looks at the snake then the snake will become blind”.
Need to include snakebite management in curriculum of training institutions
There was no ‘IEC’ (Information, Education, and Communication) material available on the identification of venomous and non-venomous snakes, prevention, first aid, and treatment of snakebites in any of the government healthcare facilities in the study area, according to the study team.
They have recommended the inclusion of snakebite management in the curriculum of training institutions of state public health departments in India, mandatory short-term training of medical graduates during their internship and also as a part of the induction training on joining state health services in India. The study has recommended a multi-sectoral approach of community awareness, capacity building of healthcare facilities for reducing the mortality and morbidity due to snakebite envenoming in India