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India accounts for more than 80% of deaths caused by snakebites globally, study finds

Over 63,000 people died of snakebite in 2019, according to global study published in Nature Communications. Death rate substantially reduced since 2008, but far short of WHO goal.

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Bengaluru: A new global study has found that over 63,000 people died across the world due to snakebites in 2019, and out of this, the number of deaths was the highest in India at more than 51,000 — over 80 per cent of the total. Pakistan comes next with 2,070 deaths. The scale of the numbers makes “snakebite envenoming” the deadliest neglected tropical disease (NTD).

The study is currently the most up-to-date, with a previous survey having been carried out back in 2008. Authored by global research collaborator network Global Burden of Disease (GBD), it analysed data from 204 countries from 1990 to 2019. The findings were published last week in the journal Nature Communications.

All numbers recorded in the study indicate a substantial decrease in the rate of death, especially since 2008, compared to which the global age-standardised death rate has fallen by 36 per cent since 1990. However, the numbers are still far short of the World Health Organization’s (WHO) goal of halving snakebite deaths by 2030.

According to the report, South Asia is the region the highest mortality with 54,600 such deaths, making up 86 per cent of the global mortality numbers, owing to its ecology, socioeconomic vulnerability, and low healthcare capacity.

Sub-Saharan Africa has a mortality of 7,331 and the Americas together have recorded 370 deaths.

On the situation in India, Soumyadeep Bhaumik, a researcher at The George Institute for Global Health, New Delhi, and a co-author of the paper, said: “Community-based intervention strategies (which go beyond raising awareness) and strengthening health systems in an integrated fashion with adequate resources being made available to high-burden states can halve the deaths. Because there has not been much research on snakebites, these actions should be research-embedded — so that we can figure out what works and what does not as we go.”

Also read: Snakebites aren’t just lethal. In rural India, it means debts of lakhs to victims, families

Snakebite data

Historically, only a few studies have been undertaken on the global disease burden of “snakebite envenoming”, especially due to lack of data. A 1998 report noted that more than 1,00,000 deaths were attributed to snakebites, while in 2008, the number was estimated at 94,000.

In the latest report, the modelled estimates used data from existing sources such as official surveys, hospitals, verbal autopsies, civil registration, and others. However, not all data has been captured and not all of it is accurate, especially in places with high snakebite vulnerability like India, Sri Lanka, and the Terai region of Nepal.

Indian death and envenoming rates are extremely high because of lack of access to antivenom. In the country, antivenom for the Big Four snakes (Russell’s Viper, Common Krait, Indian Saw-scaled Viper and Indian cobra) is available readily, but is not distributed efficiently in rural areas.

“Snakebite is a public health problem in rural and Adivasi (tribal) areas of the country,” explained Bhaumik.

“We know that hospital-based data for snakebites is not adequate because most people with snakebites visit traditional practitioners. What we need are community-based surveys in districts where facilities report a high number of snakebites. This is so because snakebites, at the end of the day, are a localised (problem) with some areas having a high burden,” he said.

Furthermore, snakebite envenoming is also a large problem among cattle, and the burden for both animals and humans needs to be understood, he added.

Reducing envenoming 

Snakebite envenoming was considered a neglected tropical disease until 2013, when it was taken off the list. However, it was added to the list again in 2017, becoming the deadliest NTD.

In 2019, WHO announced a strategy to drastically reduce snakebite envenoming, which “affects 1.8-2.7 million people each year, claiming 81,000–138,000 lives and causing 400,000 cases of permanent disability”.

The programme targets deeply-affected communities and their healthcare systems, and aims to reduce envenoming in four steps: empowering and engaging people, ensuring safe and effective treatment, strengthening health systems, and increasing partnerships and resources.

However, the reduction in snakebite numbers, as seen in the latest report, is not enough to achieve the WHO’s 2030 goal, noted the paper.

While the Indian government has already started acting by training medical officers for better snakebite treatments, strategies that focus on community-based intervention are what is needed, said Bhaumik. “What we need are not separate activities but a comprehensive national strategy for addressing snakebites,” he asserted.

(Edited by Nida Fatima Siddiqui)

Also read: Snake antivenom in India ineffective in treating bites from most species, study finds

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