Burden Of Snakebite Research Articles

Core outcome set for intervention research on snakebite envenomation in South Asia

BackgroundThe 2019 WHO strategy to reduce snakebite burden emphasises the need for fostering research on snakebite treatments. A core outcome set (COS) is a consensus minimal list of outcomes that...

National task force study on ‘the incidence, mortality, morbidity and economic burden of snakebite in India’

National task force study on ‘the incidence, mortality, morbidity and economic burden of snakebite in India’

Reported snakebite mortality and state compensation payments in Madhya Pradesh, India, from 2020 to 2022.

India experiences the highest snakebite burden globally, with 58 000 predicted deaths annually. The central Indian state of Madhya Pradesh is thought to have a substantial snakebite burden and provides compensation to families who can demonstrate by postmortem and hospital treatment reports that their relatives have died due to snakebite. This study represents the first report on the frequency of distribution of compensation for snakebite deaths in Madhya Pradesh. Statewide snakebite death compensation data from 2020-2021 and 2021-2022, provided by the Madhya Pradesh health authorities, were analysed alongside interviews with 15 families that described the events that ultimately led to their compensation claims. Compensation was paid to a total of 5728 families, with a total value equating to 22 912 Lakhs (approximately US${\$}$27.94 million). Families described commonly recognised snakebite risk factors and behaviours in the events that resulted in their relatives' deaths. The snakebite burden in Madhya Pradesh is significant, both in terms of mortality and economic expenditure of the state. Sustained investment in preventative interventions, as well as monitoring of the rate of compensation payouts due to snakebite death as a measure of intervention effectiveness, should be considered to substantially reduce snakebite incidence and mortality.

From fangs to antidotes: A scoping review on snakebite burden, species, and antivenoms in the Eastern Mediterranean Region.

Snake bites cause considerable morbidity and mortality worldwide, yet evidence from low- and middle-income countries remains fragmented. This is particularly the case in Eastern Mediterranean Region where available data on snake bites is relatively weak. Without reliable data, it is difficult to make the case for greater visibility and investment to address the snakebite burden in this Region. A scoping review was therefore conducted to summarize evidence on snake bites in countries of the Eastern Mediterranean. The review employed manual and electronic searching methods of four databases plus Google Scholar, ultimately including 196 records from 20 countries published between 2000 and 2023. More than half originated from Iran, Morocco, and Pakistan. Many records lacked information on permanent sequalae, disability, snake species, and types and sources of antivenoms. When identified, offending snakes belonged to 30 species. Use of more than 12 types of antivenoms were described across the Region, and some were not specific to indigenous species. Despite the relatively large number of publications identified, the data were concentrated in just a few countries in the Region, and there was little or no information available for the remainder. As is the case worldwide, disability associated with snake bites was poorly characterized and quantified across the Region. There is an urgent need for concrete action at national and regional levels to enhance epidemiological surveillance, research, and the collection of clinical, disability and outcomes data to inform policy and public health investment. Greater regional cooperation and collaboration is also crucial for addressing this neglected disease throughout the Region.

In-silico screening of bioactive compounds from nut grass (Cyperus rotundus) to inhibit the α-bungarotoxin from Kraits (Bungarus spp.) venom

ABSTRACT Kraits (Bungarus spp.) are the snakes that commonly cause fatal bites in Tropical Asia due to their neurotoxic venom. The complex process of antivenom production contributes to the lack of available antivenom and amplifies the burden of snakebite in that region. Thus, the victims seek traditional medicine such as root extract from nut grass (Cyperus rotundus). In the present study, we utilized bioinformatics methods to analyze the potential inhibitory activity of bioactive compounds from nut grass (Cyperus rotundus) against kraits’ α-bungarotoxin. Twenty-one bioactive compounds were screened using ADMET, membrane permeability prediction, molecular docking and molecular dynamics simulations. Among these bioactive compounds, we found that alpha-cyperone, cyperol, cyperusol, rotundine A, rotundine B and 4,6,3’,4’-Tetramethoxyaurone had inhibitory activity by presenting a good ability to pass phospholipid bilayer and could bind stably into active sites of α-bungarotoxin with minimum energy required. Importantly, the neutralization property of these bioactive compounds resides in their combinational function, underscoring the crucial significance of their combined action rather than individual contributions. In conclusion, this study identifies a combination of six bioactive compounds from C. rotundus with a potential as an alternative antivenom based on in-silico screening and provides essential data for the development of a plant-based antivenom.

Strategic priorities for accelerating action to reduce the burden of snakebite.

Strategic priorities for accelerating action to reduce the burden of snakebite.

Snakebite prevalence and risk factors in a nomadic population in Samburu County, Kenya: A community-based survey.

Snakebite is an important public health concern, especially in tropical areas, but the true burden remains unclear due to sub-optimal reporting and over-reliance on health facility-based data. A community-based cross-sectional survey was conducted in Samburu County, Kenya from December 2019 to March 2020. Geospatial techniques were used to create a sampling frame of all households in Samburu County and a multistage cluster sampling strategy to select households and recruit study participants. Five year prevalence and mortality rates were estimated, the characteristics and circumstances of snakebite were described, and multilevel logistic regression models were built to identify independent risk factors for snakebite. We recruited 3,610 individuals living in 875 households from 30 clusters. The 5-year prevalence of snakebite was 2.2% (95% CI 1.4%-3.4%), and the 5-year mortality rate was 138 (95% CI 44-322) deaths per 100,000 inhabitants, resulting in an estimated 1,406 snakebites and 88 deaths from snakebites per year in Samburu County. Snakebite incidents often occurred at night between 9pm and 6 am (44%, n = 36), and the participants were mostly walking/playing outdoors (51%, n = 41) or sleeping (32%, n = 27) when they were bitten. Lower household socioeconomic status and smaller numbers of people per house were significant independent risk factors. Samburu County has a high snakebite burden and the most victims are bitten while sleeping or walking outdoors at night. Snakebite prevention and health promotion programs in Samburu County, and other endemic regions, need to be contextualised and consider the geographic, seasonal, and temporal specificities found in our study. Our findings also have implications for health care delivery, especially identification of the need for night-time staffing with expertise in snakebite management and antivenom availability to better manage patients and thereby improve outcomes.

Stakeholder perspectives from 15 countries in Africa on barriers in snakebite envenoming research and the potential role of research hubs.

Snakebite envenoming is a debilitating neglected tropical disease disproportionately affecting the rural poor in low and middle-income countries in the tropics and sub-tropics. Critical questions and gaps in public health and policy need to be addressed if major progress is to be made towards reducing the negative impact of snakebite, particularly in the World Health Organisation (WHO) Africa region. We engaged key stakeholders to identify barriers to evidence-based snakebite decision making and to explore how development of research and policy hubs could help to overcome these barriers. We conducted an electronic survey among 73 stakeholders from ministries of health, health facilities, academia and non-governmental organizations from 15 countries in the WHO Africa region. The primary barriers to snakebite research and subsequent policy translation were limited funds, lack of relevant data, and lack of interest from policy makers. Adequate funding commitment, strong political will, building expert networks and a demand for scientific evidence were all considered potential factors that could facilitate snakebite research. Participants rated availability of antivenoms, research skills training and disease surveillance as key research priorities. All participants indicated interest in the development of research and policy hubs and 78% indicated their organization would be willing to actively participate. In conclusion, our survey affirms that relevant stakeholders in the field of snakebite perceive research and policy hubs as a promising development, which could help overcome the barriers to pursuing the WHO goals and targets for reducing the burden of snakebite.

Empowering Health care Systems and Communities for Snakebite Envenoming Control in India.

Snakebite envenoming (SBE) is a global health challenge, predominantly affecting economically disadvantaged regions. India contributes significantly to global snakebite mortality. Since 2013, the Indian Council of Medical Research (ICMR) has spearheaded efforts to combat SBE. A multi-sectoral engagement in the snakebite research projects and inputs from communities, traditional healers, and the health system have led to the creation of an Information Education and Communication (IEC) material suite, including management flowchart, information booklets, posters, and brochures, all available in local languages. These resources were broadly disseminated in high-burden regions in Maharashtra and Odisha, resulting in an approximately 10% increase in case reporting within a year. This holistic approach, engaging diverse stakeholders and addressing multiple facets of SBE, offers promise for alleviating the snakebite burden, not only in India but also in other low- and middle-income countries across South Asia, Africa, and South America, holding potential for broader positive global impact.

The Royal Armoury: Venomics and antivenomics of king cobra (Ophiophagus hannah) from the Indian Western Ghats

Despite being famous as ‘the king’ of the snake world, the king cobra (Ophiophagus hannah) has remained a mysterious species, particularly with respect to its venom ecology. In contrast, venom research has largely focussed on the ‘big four’ snakes that are greatly responsible for the burden of snakebite in the Indian subcontinent. This study aims to bridge the current void in our understanding of the O. hannah venom by investigating its proteomic, biochemical, pharmacological, and toxinological profiles via interdisciplinary approaches. Considering their physical resemblance, the king cobra is often compared to the spectacled cobra (Naja naja). Comparative venomics of O. hannah and N. naja in this study provided interesting insights into their venom compositions, activities, and potencies. Our findings suggest that the O. hannah venom, despite being relatively less complex than the N. naja venom, is equally potent. Finally, our in vitro and in vivo assays revealed that both Indian polyvalent and Thai Red Cross monovalent antivenoms completely fail to neutralise the O. hannah venom. Our findings provide guidelines for the management of bites from this clinically important yet neglected snake species in India.

Structural capacity and continuum of snakebite care in the primary health care system in India: a cross-sectional assessment

BackgroundIn 2019, the World Health Organization, set a target to halve the burden of snakebite, by 2030, and identified ‘health systems strengthening’ as a key pillar of action. In India, the country with most snakebite deaths, the Union Government identified (in September 2022) training of health workers as a priority action area. In this policy context, we provide empirical evidence by analysing the most recent nationwide survey data (District Level Household and Facility Survey − 4), to assess structural capacity and continuum of snakebite care in primary health care system in India.MethodologyWe evaluated structural capacity for snakebite care under six domains: medicines, equipment, infrastructure, human resources, governance and finance, and health management information systems (HMIS). We categorised states (aspirant, performer, front-runner, achiever) based on the proportion of primary health centres (PHC) and community health centres (CHC), attaining highest possible domain score. We assessed continuum of snakebite care, district-wise, under five domains (connectivity to PHC, structural capacity of PHC, referral from PHC to higher facility, structural capacity of CHC, referral from CHC to higher facility) as adequate or not.ResultsNo state excelled ( front-runner or achiever) in all six domains of structural capacity in PHCs or CHCs. The broader domains (physical infrastructure, human resources for health, HMIS) were weaker compared to snakebite care medicines in most states/UTs, at both PHC and CHC levels. CHCs faced greater concerns regarding human resources and equipment availability than PHCs in many states. Among PHCs, physical infrastructure and HMIS were aspirational in all 29 assessed states, while medicines, equipment, human resources, and governance and finance were aspirational in 8 (27.6%), 2 (6.9%), 17 (58.6%), and 12 (41.4%) states respectively. For CHCs, physical infrastructure was aspirational in all 30 assessed states/UTs, whereas HMIS, medicines, equipment, human resources, and governance and finance were aspirational in 29 (96.7%), 11 (36.7%), 27 (90%), 26 (86.7%), and 3 (10%) states respectively. No district had adequate continuum of snakebite care in all domains. Except for transport availability from CHC to higher facilities (48% of districts adequate) and transport availability from PHC to higher facilities (11% of districts adequate), fewer than 2% of districts were adequate in all other domains.ConclusionComprehensive strengthening of primary health care, across all domains, and throughout the continuum of care, instead of a piece-meal approach towards health systems strengthening, is necessitated to reduce snakebite burden in India, and possibly other high-burden nations with weak health systems. Health facility surveys are necessitated for this purpose.

Development, standardization, and contextualization of qualitative tools for possible use in the assessment and valuation of snakebite envenomation.

Snakebite envenoming, a neglected tropical disease (NTD), is an important public health problem that is responsible for more than 1 lakh deaths annually across the world. However, the majority of the data in this regard is from health institutions and data from community settings are scarce. The aim of the current study was to develop valid and reliable qualitative tools for assessing the burden of snakebites and the health-seeking behavior of the community. The tools developed thus will serve in creating a community connection and thereby strengthen primary care teams engaged in managing snakebites at the primary care level. A four-step design was used; (a) review of the available literature on the burden of disease, tools used to assess the burden, and the guidelines on snakebite (b) development, laying out, and contextualization of questions/items for the tools (c) pilot testing and establishment of validity. A focus group discussion guide, key informant interview schedule for health professionals, community leaders, and traditional faith healers were matured for the implementation. A reliable and valid qualitative tool was developed to discern the speculations related to snakebites and its management in rural field settings.

Availability, accessibility and use of antivenom for snakebite envenomation in Africa with proposed strategies to overcome the limitations.

Africa remains one of the regions with the highest incident and burden of snakebite. The goal of the World Health Organization to halve the global burden of snakebite by 2030 can only be achieved if sub-optimal access to antivenoms in the most affected regions is addressed. We identified upstream, midstream, and downstream factors along the antivenom value chain that prevent access to antivenoms in the African region. We identified windows of opportunities that could be utilized to ensure availability, accessibility, and affordability for snakebite endemic populations in Africa. These include implementation of multicomponent strategies such as intensified advocacy, community engagement, healthcare worker trainings, and leveraging the institutional and governance structure provided by African governments to address the challenges identified.

Snakebite care through the first two waves of COVID-19 in West Bengal, India: a qualitative study.

Snakebite is a public health problem in many countries, with India having the highest number of deaths. Not much is known about the effect of the COVID-19 pandemic on snakebite care. We conducted 20 in-depth interviews with those bitten by venomous snakes through the two waves of COVID-19 (March-May 2020; May-November 2021), their caregivers, health care workers and social workers in two areas (Sundarbans and Hooghly) of West Bengal, India. We used a constructivist approach and conducted a thematic analysis. We identified the following themes: 1. Snakebite continued to be recognised as an acute emergency during successive waves of COVID-19; 2. COVID-19 magnified the financial woes of communities with high snakebite burden; 3. The choice of health care provider was driven by multiple factors and consideration of trade-offs, many of which leaned toward use of traditional providers during COVID-19; 4. Rurality, financial and social disadvantage and cultural safety, in and beyond the health system, affected snakebite care; 5. There is strong and shared felt need for multi-faceted community programs on snakebite. We mapped factors affecting snakebite care in the three-delay model (decision to seek care, reaching appropriate health facility, receiving appropriate care), originally developed for maternal mortality. The result of our study contextualises and brings forth evidence on impact of COVID-19 on snakebite care in West Bengal, India. Multi-faceted community programs, are needed for addressing factors affecting snakebite care, including during disease outbreaks - thus improving health systems resilience. Community programs for increasing formal health service usage, should be accompanied by health systems strengthening, instead of an exclusive focus on awareness against traditional providers.

Children and Snakebite: Snake Venom Effects on Adult and Paediatric Plasma.

Snakebite is a globally neglected tropical disease, with coagulation disturbances being the primary pathology of many deadly snake venoms. Age-related differences in human plasma have been abundantly reported, yet the effect that these differences pose regarding snakebite is largely unknown. We tested for differences in coagulotoxic effects (via clotting time) of multiple snake venoms upon healthy human adult (18+) and paediatric (median 3.3 years old) plasma in vivo and compared these effects to the time it takes the plasmas to clot without the addition of venom (the spontaneous clotting time). We tested venoms from 15 medically significant snake species (from 13 genera) from around the world with various mechanisms of coagulotoxic actions, across the three broad categories of procoagulant, pseudo-procoagulant, and anticoagulant, to identify any differences between the two plasmas in their relative pathophysiological vulnerability to snakebite. One procoagulant venom (Daboia russelii, Russell's Viper) produced significantly greater potency on paediatric plasma compared with adult plasma. In contrast, the two anticoagulant venoms (Pseudechis australis, Mulga Snake; and Bitis cornuta, Many-horned Adder) were significantly more potent on adult plasma. All other procoagulant venoms and all pseudo-procoagulant venoms displayed similar potency across both plasmas. Our preliminary results may inform future studies on the effect of snake venoms upon plasmas from different age demographics and hope to reduce the burden of snakebite upon society.

Vasculotoxic Snake Bite: Infusion Antisnake Venom Therapy versus Bolus Antisnake Venom Therapy at Tertiary Care Centre

The problem of snake bites is widespread throughout the world and particularly in tropical regions. In India, snake bites are found to be one of the leading causes of mortalities and morbidities. According to statistics, approximately 35 000 to 50 000 fatal bites occur every year in India. However, snake bites are usually prevalent in rainy season. Burden of snake-bite has been documented by many investigators recently, with the consequences of snake bite being explored. Identifying chronic impairments and associated socioeconomic costs is an important part of assessing snakebite burden, however, providing significant data on these respect is difficult. Aim: To study infusion antisnake venom therapy versus bolus antisnake venom therapy in vasculotoxic snake bite at tertiary healthcare care. Material and methods: The current study was an observational study. During the study, four different anti-snake venom regimens were used to treat patients with vasculotoxic snake bites by comparing clinical manifestations, laboratory investigations, the amount of anti-snake venom required, the incidence of complications, and the outcomes. Results: In the present study, demographic data showed significant preponderance of snakebite amongst farmers (n=44). However, the drill was followed by housewives (n=29), students (n=17), teachers (n=4) and shopkeepers (n=3) amongst the reported cases respectively. Conclusion: study concludes that not only proper regimens but also the modality of treatment for the patients of viperine vasculotoxic snake bite is equally important. In order to decrease the morbidity and mortality of snake bite patients, it is imperative to make ASV available universally in areas with high snake bite incidences and to adequately train health care providers about snake bite treatment.

The economic burden of snakebites to households in Ghana: a case of two districts in the Oti Region of Ghana

The economic burden of snakebites to households in Ghana: a case of two districts in the Oti Region of Ghana

Snakebite Incidence, General Awareness and Belief of Snakebite Management at a Rural Municipality of Eastern Nepal

Background: Understanding people’s awareness on snakebite management would be highly beneficial to develop strategic program at local levels of Nepal. We aimed to identity snakebite incidence, general awareness and beliefs of people regarding snakebite management in rural communities.
 Materials and Methods: A community-based cross-sectional study was conducted at Budhiganga Rural Municipality from September to November 2022 among 245 households. Ethical clearance was taken from institutional review committee of Birat Medical College. Microsoft Excel 2019 and SPSS software ver. 2025 were used for data analysis.
 Results: Annual snakebite incidence rate was 2332 per 100000 populations. Majority (71%) could not identify biting snake and attended traditional healers (70%). Among study participants, 25% had false belief that banded krait is not poisonous. Various false beliefs on snakebite first aid management were reported such as use of tourniquet (81%), washing bite sites (53.47%), cutting bite site (52%) and so on. Further, prevalent false beliefs on food-related practices were snake drinks milk (85.31%), giving victim water following the snakebite was beneficial (47%), giving chilly to those bitten was beneficial (41.63%) and so on.
 Conclusion: Despite the existing burden of snakebites, people are not aware about the correct ways to manage them and were still attending traditional healers as a means of treatment. The mis beliefs about snakebite first aid management are very much prevalent.

Estimating economic and disease burden of snakebite in ASEAN countries using a decision analytic model.

Understanding the burden of snakebite is crucial for developing evidence-informed strategies to pursue the goal set by the World Health Organization to halve morbidity and mortality of snakebite by 2030. However, there was no such information in the Association of Southeast Asian Nations (ASEAN) countries. A decision analytic model was developed to estimate annual burden of snakebite in seven countries, including Malaysia, Thailand, Indonesia, Philippines, Vietnam, Lao PDR, and Myanmar. Country-specific input parameters were sought from published literature, country's Ministry of Health, local data, and expert opinion. Economic burden was estimated from the societal perspective. Costs were expressed in 2019 US Dollars (USD). Disease burden was estimated as disability-adjusted life years (DALYs). Probabilistic sensitivity analysis was performed to estimate a 95% credible interval (CrI). We estimated that annually there were 242,648 snakebite victims (95%CrI 209,810-291,023) of which 15,909 (95%CrI 7,592-33,949) were dead and 954 (95%CrI 383-1,797) were amputated. We estimated that 161,835 snakebite victims (69% of victims who were indicated for antivenom treatment) were not treated with antivenom. Annual disease burden of snakebite was estimated at 391,979 DALYs (95%CrI 187,261-836,559 DALYs) with total costs of 2.5 billion USD (95%CrI 1.2-5.4 billion USD) that were equivalent to 0.09% (95%CrI 0.04-0.20%) of the region's gross domestic product. >95% of the estimated burdens were attributed to premature deaths. The estimated high burden of snakebite in ASEAN was demonstrated despite the availability of domestically produced antivenoms. Most burdens were attributed to premature deaths from snakebite envenoming which suggested that the remarkably high burden of snakebite could be averted. We emphasized the importance of funding research to perform a comprehensive data collection on epidemiological and economic burden of snakebite to eventually reveal the true burden of snakebite in ASEAN and inform development of strategies to tackle the problem of snakebite.

ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: A study protocol

Snakebite is possibly the most neglected of the NTDs (Neglected Tropical Diseases). Half of the global deaths due to venomous snakebites, estimated at 100,000 per year, occur in India. The only representative data on snakebite available from India is the mortality data from the RGI-MDS study (Registrar General of India- 1 Million Death Study) and another study on mortality from the state of Bihar. Incidence data on snakebite is available for 2 districts of the state of West Bengal only. Hospital-based data on snakebite admissions and use of ASV are gross underestimates as most snakebite victims in rural India depend more on alternate treatment methods which do not get represented in National registries. The proposed study is a multi-centric study to determine the incidence, morbidity, mortality and economic burden of snakebites in India covering all 5 geographical zones of the country. A community level surveillance for snakebite covering 31 districts in 13 states of India in order to obtain annual incidence of snakebites from the community. Frontline health workers will be trained to gather information on new cases of snakebite over the study period of 1-year, from "wards "(smallest administrative subunit of a village or town) that they represent in the study districts. Dedicated field officers would collect data on snakebites, victim characteristics, outcomes, utilization of health facilities on a questionnaire sheet designed for this purpose. The study duration is for 18 months from April 2022 to October 2023. The study would be the first of its kind in India looking prospectively at the incidence of snakebite covering 13 states in 5 zones of India and a population of 84 million. Our study covers 6.12% of the total population of the country as compared to the incidence study conducted in Sri Lanka which covered 1% of the total population.