The socio-economic burden of snakebite in Sri Lanka

José María Gutiérrez,Anuradhani Kasturiratne,A Rajitha Wickremasinghe,Hithanadura Janaka De Silva,Shaluka F Jayamanne,David G Lalloo,Geoff K Isbister,Andrew Dawson,Arunasalam Pathmeswaran

doi:10.1371/journal.pntd.0005647

Abstract

BackgroundSnakebite is a major problem affecting the rural poor in many of the poorest countries in the tropics. However, the scale of the socio-economic burden has rarely been studied. We undertook a comprehensive assessment of the burden in Sri Lanka.MethodsData from a representative nation-wide community based household survey were used to estimate the number of bites and deaths nationally, and household and out of pocket costs were derived from household questionnaires. Health system costs were obtained from hospital cost accounting systems and estimates of antivenom usage. DALYs lost to snakebite were estimated using standard approaches using disability weights for poisoning.Findings79% of victims suffered economic loss following a snakebite with a median out of pocket expenditure of $11.82 (IQR 2–28.57) and a median estimated loss of income of $28.57 and $33.21 for those in employment or self-employment, respectively. Family members also lost income to help care for patients. Estimated health system costs for Sri Lanka were $ 10,260,652 annually. The annual estimated total number of DALYS was 11,101 to 15,076 per year for envenoming following snakebite.InterpretationSnakebite places a considerable economic burden on the households of victims in Sri Lanka, despite a health system which is accessible and free at the point of care. The disability burden is also considerable, similar to that of meningitis or dengue, although the relatively low case fatality rate and limited physical sequelae following bites by Sri Lankan snakes means that this burden may be less than in countries on the African continent.

Highlights

Snakebite is a major public health problem in rural communities in Asia, Africa and Latin America [1]
We used data from a national household survey of snakebite in Sri Lanka to estimate the burden of death and disability and to calculate the financial cost of a snakebite episode for the Sri Lankan health system and for Sri Lankan households
We found that the burden of snakebite was considerable, similar to that of common diseases like meningitis or dengue and that treating snakebite cost the Sri Lankan government over $10 million each year

Summary

Introduction

Snakebite is a major public health problem in rural communities in Asia, Africa and Latin America [1]. Snakebite is a problem of tropical low and middle income countries that are already facing the considerable dual burden of communicable and non-communicable diseases; snakebite mortality is strongly associated with low per capita Gross Domestic Product and a low Human Development Index [2]. The victims are usually economically productive, young individuals in these communities whose future productive lifespan can be negatively affected by snakebite Most of those affected are rural daily wage earners employed in the informal sector that include farming and other labour intensive occupations, for whom snakebite results in a considerable opportunity cost for being away from work. We undertook a comprehensive assessment of the burden in Sri Lanka

Results

Discussion

Conclusion