An estimated 1.2 million snakebite deaths have happened in the country between 2000 and 2019. A new study by the National Institute for Research in Reproductive Health, an ICMR laboratory in Mumbai, and the Maharashtra state public health department has highlighted the lack of awareness and knowledge about snakes and snakebites that could be increasing the risks, especially amongst the tribal populations.
Snakebite neglected public health issue in many tropical countries
Snakebite envenoming is classified by WHO as a high-priority neglected tropical disease. About 5.4 million snake bites occur each year across the world, resulting in 1.8 to 2.7 million cases of envenomings (poisoning from snake bites). Between 80,000 and 1.4 lakh deaths, and around three times as many amputations and other permanent disabilities, are recorded each year. Many snakebite victims, mostly in developing countries, suffer from long-term complications such as deformities, contractures, amputations, visual impairment, renal complications, psychological distress.
India accounts for nearly 50 per cent of global snakebite deaths
India has the highest number of snakebite cases in the world, accounting for nearly 50 per cent 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.
According to Dr. Smita Mahale, former Director, ICMR-NIRRH and coordinator of the snakebite research programs at ICMR-NIRRH, - Lack of awareness, inadequate knowledge of prevention of snakebite and first-aid amongst the community as well as peripheral healthcare workers, delay in receiving lifesaving treatment [anti-snake venom (ASV)], and non-availability of trained medical officers for management of snakebite contribute to a higher number of deaths.
WHO launched its roadmap with the aim to halve deaths and disabilities from snakebite by 2030. Much before the WHO roadmap was launched, the researchers from ICMR-NIRRH and Public Health Department, Maharashtra started community awareness and health system capacity building from the year 2013 and continuing their work through a national study funded by National Task Force on snakebite, ICMR.
After community intervention CFR due to snakebite poisoning declined from 4.4 % in Dahanu block to 0.4% in 2017
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 (~70%) in the Palghar district of Maharashtra. Dr. Rahul Gajbhiye, principal investigator and corresponding author of the study, said the aim was to understand awareness, knowledge of snakebites, prevention, first-aid practices, and healthcare-seeking behavior of the community members for snakebite treatment and to assess the knowledge, and management practices for snakebites among the traditional faith healers, snake rescuers, and healthcare workers in Dahanu.
Initially, the study was started as a part of the research activity of Model Rural Health Research (MRHRU), Dahanu. Based on the pilot study on snakebite, Tribal Health Research Forum, ECD Division of Indian Council of Medical Research (ICMR) funded the study. The incidence of snakebite in the Dahanu block was 216 per one lakh population in 2013, 264 in 2014, and 338 in 2015. Total snakebite cases in the Dahanu block were 870 in 2013, 1060 in 2014, and 1360 in 2015. The case fatality rate due to snakebite envenomation in 2014 was 4.4 per cent. After the intervention of community awareness, training of medical officers and frontline health workers, the case fatality rate was gradually reduced to 0.4 per cent in 2017.
Belief in snake god, ability of tamarind seeds to reduce venom effect among superstitions in tribal community
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.
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 percent 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 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,” one female respondent was quoted as saying in the study.
Another respondent said, “After the bite if the victim cannot walk even five steps and death occurs immediately, it is considered as venomous snakes”.
Some other participants said if pregnant women look directly at snakes, it makes the snake 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, says co-researcher of the study team. They have recommended the inclusion of snakebite management in the curriculum of training institutions of the state public health departments in India.
It also called for mandatory short-term training of medical graduates during their internship and also as a part of the induction training on joining the state health services in India. The study has recommended a multi-sectoral approach of community awareness, capacity building of health care facilities for reducing the mortality and morbidity due to snakebite envenoming in India
Anuradha Mascarenhas, TIE
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