Dr. V.V.Pillay MD, DCL
Chief, Poison Control Centre
Head, Dept of Analytical Toxicology
Professor, Forensic Medicine & Medical Toxicology
Amrita Institute of Medical Sciences & Research
Cochin, Kerala 682041
India
The Registrar General of India’s ‘Million Death Study’ has, for the first time, provided a direct estimate of mortality due to snake bite, nationally and in each state. Verbal autopsy was used to identify the causes of all deaths in 6671 randomly chosen sample areas, each covering about 1000 people. In 2005, 46000 people died of snake bite, approximately 1 for every 2 HIV/AIDS deaths. It must be noted that the total number of deaths due to snake bite may be even higher since some victims of nocturnal krait envenoming do not realize that they have been bitten and present with mysterious ‘early morning paralysis’ or seizures. Snake bite accounts for 3% of all deaths in children of the age of 5–14 years. Uttar Pradesh had the highest number of deaths (8700/year) and Andhra Pradesh the highest incidence of mortality due to snake bite (6.2/100 000 population/year).( Natl Med J India 2011; 24(6): 321-324. )
Ninety seven per cent of the victims of snake bite die in rural areas, 77% of them outside health facilities, presumably because they choose traditional healers. The reason is probably because most bitten people hail from uneducated strata and have more faith in traditional systems of medicine than allopathy. The problem can be addressed by increasing awareness about the dangers of such alternative therapies and the uitility of allopathic remedies, especially anti-snake venom. There are a few Govt-aided programs to tackle this issue, as well as some initiatives by a few NGOs. But they are not enough.
It is important to get snakebite included as a “notifiable disease”, which will make it mandatory for all snakebites to be reported to the public health authorities by doctors and hospitals across India involved in admitting snakebite cases. This will help us get exact figures of incidence of bites and mortality.
Use of snake anti-venom (SAV) in the healthcare system
The Indian Society of Toxicology had come out with a National Snakebite Management Protocol in 2006, based on the proceedings of a national conference in Cochin, Kerala. But the protocol has not received wide publicity or acceptance. As there are no nationally accepted guidelines for the management of snakebite in India, individual doctors and hospitals follow their own regimens. Some doctors claim that they have achieved very good results without employing SAVs, but these claims have not been subjected to peer scrutiny. SAVs are available erratically in the primary healthcare scenario. Sometimes there is adequate supply, and at other times there are no stocks.
SAVs are generally effective in the management of many snakebite cases, but contain antivenoms effective against only the 4 major venomous snakes: Common cobra, Common krait, Russells viper and Saw-scaled viper. Dialysis is often needed in viper envenomations where the patient was taken late to a hospital, or SAV therapy was inadequate or ineffective.
The focus of research in India is on diseases such as hypertension, diabetes, AIDS, etc. As a result, research in the field of snakebite has suffered. A lot needs to be done.
Dr. Soumyadeep Bhaumik 