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Low-lying agricultural areas of rural India witnessed most cases of deaths due to snakebite envenoming in the last 2 decades

Poisonous snakebites have killed more than a million Indians in the last two decades, finds a recently published article entitled Trends in snakebite mortality in India from 2000 to 2019 in a nationally representative mortality study. Published in the open access journal elifesciences.org, the research-based study has found that the country accounts for nearly half the total number of annual deaths in the world caused by snakebite envenoming.

Who are the snakebite victims?

Following the analysis of 2,833 snakebite deaths from 611,483 verbal autopsies from an earlier study (i.e. Indian Million Death Study from 2001 to 2014, which estimated 46,000 annual deaths caused by snakebite in India) and performing a systematic review of literature from the period 2000-2019 covering 87,590 snake bites, the authors of the research article have estimated that 1.2 million snakebite deaths occurred in the country (representing an average of 58,000 per year) between 2000 and 2019.

Of the 1.2 million deaths, 6.02 lakh deaths occurred among males and 5.65 lakh deaths occurred among females.

Nearly half of the victims (i.e. 46.5 percent) of deadly snakebites were aged 30-69 years and over a quarter (i.e. 27.8 percent) were children below 15 years. Please see table-1 for details.

Table 1: Estimated snakebite deaths in thousands by age and sex from 2000 to 2019 in India

Source: Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study, published on July 7th, 2020, https://elifesciences.org/articles/54076

Note: Total deaths for 2001-2014 Indian Million Death Study period were 807,500. Deaths for 2000-2019 were calculated by extrapolating these annual deaths. The extrapolated annual deaths in thousands for outside the study period were 54.0 for 2000, 62.3 for 2015, 62.0 for 2016, 61.4 for 2017, 60.3 for 2018 and 59.8 for 2019. Lower limit (LL) and Upper limit (UL) are lower and upper uncertainty bounds for estimates. The major uncertainty in analyses, however, is not the demographic totals, but the cause of death classification. Hence, the lower bound was based on immediate agreement of both physicians on the ICD-10 code for snakebite and upper bound based on either of two physicians coding as snakebite death.
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Roughly 70 percent of victims who died due to snakebites during the period 2001-2014 were people residing in densely populated low-lying agricultural areas in the states of Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh (including Telangana), Rajasthan and Gujarat. Most deaths related to snakebite envenoming have occurred during the rainy season in rural areas when confrontations between snakes and humans are likely to be more frequent at home and outdoors. Please consult chart-1, which show results from the review of literature.

Chart 1: Characteristics of snakebites from analysis of 88,000 snakebite events in the published literature during 2000-2019


Source: Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study, published on July 7th, 2020, https://elifesciences.org/articles/54076
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The study adds that the overall lifetime risk of being killed by snakebite is approximately 1 in 250, but in some areas (such as the ones discussed above), the lifetime risk reaches 1 in 100.

The study has estimated 1.11–1.77 million snakebites in India during 2015, of which 70 percent indicated symptoms of envenomation. Although avoidable, snakebite deaths and disability is a major public health challenge for poor rural communities in several parts of Asia, Africa, Latin America and Oceania, including India, says the article.

Besides Russell’s viper (Daboia russelii), kraits (Bungarus species) and cobras (Naja species), other unidentified species also pose a threat to human lives in India. For example, Russell's viper bites happen during the day, when farmers work in their paddy fields or at night when someone walks without using a light and carelessly steps on the snake.

How to save human lives?

The article suggests that prevention and treatment strategies might substantially reduce snakebite mortality and morbidity in the country. Research shows that if low altitude, intensely agricultural areas are targeted with education about simple methods, such as ‘snake-safe’ harvest practices, wearing rubber boots and gloves and using rechargeable torches (or mobile phone flashlights), then the risk of snakebites could be reduced to a large extent. Distribution of effective anti-venom in rural areas and among populations in greatest need, can also reduce snakebite mortality and morbidity. Public-private partnerships for ambulance services in remote areas of states like Bihar, Jharkhand and Odisha can be started to prevent deaths and morbidity from snakebite envenoming.

The World Health Organization (WHO) has set the target of reducing by half the number of deaths and morbidity on account of snakebite envenoming by 2030. If India is able to prevent and control this phenomena, then much of the global target of halving snakebite death and morbidity rates by 2030 would be met.

Data on snakebite prevalence and envenomation

Although the Government of India has officially recorded only 15,500 snakebite deaths in public hospitals during the period 2003 to 2015, data from the Indian Million Death Study reveals that the country faced 1,54,200 snakebite related deaths, which is about ten times greater than the official figure.  

The Government of India should designate and enforce snakebite as a ‘Notifiable Disease’ within the Integrated Disease Surveillance Programme in order to prevent gross under-reporting of snakebite related mortality and morbidity, recommends the study. Since most deaths occur at home, death tracking by community through ongoing mortality surveillance will also be required.

References:

Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study -Wilson Suraweera, David Warrell, Romulus Whitaker, Geetha Menon, Rashmi Rodrigues, Sze Hang Fu, Rehana Begum, Prabha Sati, Kapila Piyasena, Mehak Bhatia, Patrick Brown and Prabhat Jha, published on July 7th, 2020, please click here to access

Study estimates more than one million Indians died from snakebite envenoming over past two decades, World Health Organisation Newsroom, 10 July, 2020, please click here to access

Snakebite Mortality in India: A Nationally Representative Mortality Survey -Bijayeeni Mohapatra, David A. Warrell, Wilson Suraweera, Prakash Bhatia, Neeraj Dhingra, Raju M Jotkar, Peter S Rodriguez, Kaushik Mishra, Romulus Whitaker and Prabhat Jha, published in PLoS on April 12th, 2011, please click here to access

1.2 million died from snake bite in India between 2000-2019: Report -Anirudh Bhattacharyya, Hindustan Times, 7 July, 2020, please click here to access
 

Image Courtesy: World Health Organisation/ Ben Owens