Tag Archives: snakebite

Global mortality of snakebite envenoming between 1990 and 2019

Snakebite envenoming is an important cause of preventable death. The World Health Organization (WHO) set a goal to halve snakebite mortality by 2030. We used verbal autopsy and vital registration data to model the proportion of venomous animal deaths due to snakes by location, age, year, and sex, and applied these proportions to venomous animal contact mortality estimates from the Global Burden of Disease 2019 study. In 2019, 63,400 people (95% uncertainty interval 38,900–78,600) died globally from snakebites, which was equal to an age-standardized mortality rate (ASMR) of 0.8 deaths (0.5–1.0) per 100,000 and represents a 36% (2–49) decrease in ASMR since 1990. India had the greatest number of deaths in 2019, equal to an ASMR of 4.0 per 100,000 (2.3—5.0). We forecast mortality will continue to decline, but not sufficiently to meet WHO’s goals. Improved data collection should be prioritized to help target interventions, improve burden estimation, and monitor progress.

Read the full paper published in Nature Communications (Open Access ) here

The impact of climate change on the burden of snakebite: Evidence synthesis and implications for primary healthcare

Snakebite is a public health problem in rural areas of South Asia, Africa and South America presenting mostly in primary care. Climate change and associated extreme weather events are expected to modify the snake-human-environment interface leading to a change in the burden of snakebite. Understanding this change is essential to ensure the preparedness of primary care and public health systems.

An evidence synthesis to better understand this aspect was published in Journal of Family Medicine and Primary Care and is available (open acess) here.

COP26 Special Report on Climate Change and Health

The World Health Organization(WHO) has released a special Report on Climate Change and Health propose a set of priority actions from the global health community to governments and policy makers, calling on them to act with urgency on the current climate and health crises today (11th October 2021). The report lists 10 recommendations for priority action and is available here.

Prior to the publication a public consultation was conducted by the WHO in which I provided feedback in individual capacity (acknowledged in WHO report) . The feedback revolved around the following themes(full submission available for download):

  1. need for developing global, regional and national agendas for climate crisis preparedness, support for more interdisciplinary/transdisciplinary collaboration,
  2. recognition of rights and dignity of health workforce in our path to climate resilience,
  3. greater recognition of the impact of climate change on non-communicable diseases and injuries, particularly chronic kidney disease, snakebite, and cardiovascular diseases needs priority attention.
  4. higher taxation of app-based food delivery business which has higher carbon footprint;
  5. stop promotion of vegetarian diets which amounts to cultural imperialism by suppression of food practices of minorities, tribal, Adivasi and Indigenous populations who are being being attacked for their traditional meat-based food practices by removing words like “eating less meat” & “largely plant-based diet”;
  6. ensure food security of vulnerable people by providing guarantee against price fluctuations through development of appropriate investment and legal mechanisms.

It is pleasing to note that the WHO has involved stakeholders meaningfully and inculcated feedback in letter and spirit. The removal of terms “eating less meat” is welcome, but more work needs to be done to prevent climate action being used as an opportunity for cultural imperialism. Continuing to work with stakeholders to understand the several issues better, as evidence evolves will be key to climate action. We have to grapple the defining issue of our generation together.

Feedback given to COP26 Special Report Download

Mitigating the chronic burden of snakebite: turning the tide for survivors

The International Snakebite Awareness Day has taken place annually on Sept 19 since 2018. Snakebites kill an estimated 137 880 people each year and three times as many survivors live with life-changing disabilities. ,,Since 2018, there has been some increased funding for research and development of antivenoms and other therapies. But there is a pressing need to additionally focus on the chronic aspects of snakebite care. The WHO strategy for snakebite envenoming aims to decrease not only mortality but also morbidity by 50% by 2030.

In a comment piece in The Lancet , Soumyadeep Bhaumik & colleagues propose a system-oriented approach with multi-component interventions to address chronic aspects of snakebite care, together with social support and investments in multidisciplinary research to end the neglect of snakebite. It highlights that the NTD community’s goal to “end the neglect” can be truly achieved in the snakebite domain only if snakebite survivors are at the centre of the response here (free but needs registration by e-mail) .

Photo by Richard McAlister on Pexels.com

Need for transdisciplinary systems thinking to address snakebite

Snakebite, a major public health issue but a hugely neglected problem continues to affect millions of people with death and disability worldwide. In 2018, the first ever International Snakebite Awareness Day was celebrated on September 19, to emphasize on awareness and actions needed to tackle the burden of snakebite. The George Institute for Global Health (TGI), will be organizing a seminar on the topic ‘Need for transdisciplinary approach for addressing snakebite burden’ on this day. The deliberations of the seminar aim to expand the lens from the current clinically dominant approach to address snakebite to include learnings from other disciplines and enable systems thinking to solve the issue.

Mark your calendars for 19th September 2021, Sunday, 14:00 -15:00 hours IST

Key Focus & Our Speakers 

  • Introduction to event: Snakebite – an issue like no other
  • Talk 1: Why ‘Neglected Tropical Disease’? The politics of ‘Otherization’ of snakebite in India
    • Dr Rahul Bhaumik, Department of History, Women’s College, University of Calcutta, West Bengal, India,
  • Talk 2: Snakebite & climate change: preparedness for the imminent crisis  
    • Dr Soumyadeep Bhaumik, Injury Division, The George Institute for Global Health, India; Meta-research and Evidence Synthesis Unit, The George Institute for Global Health
  • Talk 3: Using snake rescue data to develop snakebite mitigation strategies
    • Mr. Vishal Santra, Society for Nature Conservation, Research and Community Engagement, West Bengal, India; Captive and Field Herpetology, Wales, United Kingdom
  • Fireside Chat with audience interaction: Transdisciplinary systems approach for snakebite – challenges and way forward 

The session concludes with a Q&A session where the audience can engage with the panelists.

More information here . Register here .

Mental health conditions after snakebite

Snakebite is a neglected tropical disease. Snakebite causes at least 120 000 death each year and it is estimated that there are three times as many amputations. Snakebite survivors are known to suffer from long-term physical and psychological sequelae, but not much is known on the mental health manifestations post-snakebite.

Bhaumik S et al conducted a scoping review and searched five major electronic databases contacted experts and conducted reference screening to identify primary studies on mental health manifestations after snakebite envenomation to conduct a scoping review. They retrieved 334 studies and finally included 11 studies on the topic. Of the 11 studies , post-traumatic stress disorder (PTSD) was the most commonly studied mental health condition after snakebite, with five studies reporting it. Estimates of the proportion of snakebite survivors having PTSD varied from 8% to 43% across different studies reported in this review. The other mental health conditions reported were focused around depression, psychosocial impairment of survivors after a snakebite envenomation, hysteria, delusional disorders and acute stress disorders. The prevalence of depression in those affected by snakebite ranged from 25% to 54% in different studies. There is only one intervention study to address psychiatric morbidity after snakebite envenomation.

There is a need for more research on understanding the neglected aspect of psychological morbidity of snakebite envenomation, particularly in countries with high burden. From the limited evidence available, depression and PTSD are major mental health manifestations in snakebite survivors.

Read the full research in BMJ Global Health

Photo by RODNAE Productions on Pexels.com

Interventions for the management of snakebite envenoming: An overview of systematic reviews

Snakebite is a neglected tropical disease which has received priority attention in the global health space with WHO setting a target to decrease death and disability due to snakebite to 50% by 2030. High quality systematic reviews can inform policy and practice. We searched 13 electronic databases and PROSPERO, screened reference lists, and contacted experts. We identified 13 completed systematic reviews which has reviewed effectiveness and safety for first-aid, snake anti-venoms, drugs to prevent adverse reactions and fasciotomy. Evidence for interventions often came from few studies. We judged confidence on the results of the systematic reviews using AMSTAR-2 and all except one review was judged to have critically low confidence. Evidence with respect to specific geographic settings and for many specific anti-venoms is unavailable at the synthesis level and at the primary study level. Evidence related to late adverse reactions, wound-related outcomes, quality of life, duration of hospitalisation, cost, and disability is scarcely reported. Funding evidence gap maps, systematic reviews and development of core-outcome sets based on the results of this overview and subsequent conduct of randomised controlled trials for snakebite envenomation is essential.

Study Published in PloS Neglected Tropical Diseases (Open Access)

Quality of WHO guidelines on snakebite: the neglect continues

Snakebite remains a major public health challenge in many parts of rural Africa, Asia and South America. Available estimates suggest that there are about 94 000 deaths across the world annually due to snakebites; a conservative estimate as many deaths in low and middle-income countries are not reported.The burden on health systems due to snakebite is much higher than what is indicated by the mortality, because even non-venomous snakebite victims visit healthcare facilities for assessment and the morbidity due to snakebite has been scarcely documented. The social and economic consequences of snakebite are known to be high in communities with high prevalence.

snake

Despite its consequences, snakebite has largely been neglected in global health. The WHO readded snakebite to the list of neglected tropical diseases in 2017—potentially implying more attention and funding for disease control programmes and treatment access initiatives. Such initiatives and programme planning are informed by recommendations in practice guidelines. WHO guidelines are highly influential in South Asia, South-East Asia and sub-Saharan Africa (countries with high burden of snakebite) where the lack of in-country capacity for guideline development means WHO guidelines are used as it is or are being adapted .

Read the full article by Dr. Soumyadeep B and colleagues which presents the evaluation of WHO guidelines on snakebite at BMJ Global Health.  (open access)

 

 

 

Identifying Research Priorities and Setting Research Agenda in Clinical Toxinology with a Focus on Snake Envenomation

“Identifying Research Priorities and Setting Research Agenda in Clinical Toxinology with a Focus on Snake Envenomation” was the theme of the round table discussion at the Toxinological Society of India Conference 2014 held at Calcutta School of Tropical Medicine on November 22 2014.

Theme lecture on Identifying Research Priorities and Setting Research Agenda was delivered by Dr. Soumyadeep Bhaumik, Cochrane Agenda and Priority Setting Methods Group, & BioMedical Genomics Centre, Kolkata, India

Health Research priority setting processes enable policy-makers, researchers, clinicians and public health professionals to effectively use available resources to collectively decide on what problems or uncertainties are worth trying to resolve/understand for maximal benefit. A transparent and evidence based priority setting process not only helps prioritization but also puts in perspective of patients and the need to improve health outcomes and reverse inequity. Snakebites, a neglected tropical condition, affects millions and kills thousands and yet there is miniscule research in this arena. The presentation focused on the basic concepts of research priority setting exercise, its utility and methods and processes for identifying research gaps and setting research agendas including question formulation, evidence assessment and prioritization process.

The presentation is available here Identifying Research Priorities & Setting Research Agenda. (Click)

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The Round Table discussion that followed had the following discussants

1. Professor Y K Gupta (Chair), Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), New Delhi,India
2. Professor Yuri N. Utkin, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russia
3. Professor Chittaranjan Maity, Head of the Department, Department of Biochemistry,KPC Medical College,Kolkata,India
4. Professor Antony Gomes, Laboratory of Toxinology and Experimental Pharmacodynamics, University of Calcutta, Kolkata,India
5. Professor Juan J Calvete, Laboratorio de Venomica , Estrtuctural y Funcional Instituoto de Biomedicina de Valencia, Spain
6. Dr Soumyadeep Bhaumik, Cochrane Agenda and Priority Setting Methods Group, & BioMedical Genomics Centre, Kolkata, India
7. Professor Santanu K Tripathi (Rapporteur for Toxinological Society of India). Head of the Department , Clinical & Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata,India

The discussion focused to understand how priority setting processes can be inculcated in the field of snake envenomation and what broad domains can be considered priorities, as well as the ways to deal with challenges to development and implementation of research agenda in snake envenomation .

Please visit :  http://capsmg.cochrane.org/ for more details and resources on setting research agendas and identifying research priorities.

Perspective of different stakeholders in research priority setting for a public health problem in low and middle income nation

The 22nd Cochrane Colloquium in Hyderabad saw a special session on “Setting research agendas: balancing public health and patient level priorities” on 25th September 2014,  . The session organised by the Cochrane Agenda and Priority Setting Methods Group (CAPSMG)  had the following format :

Session Co-Chairs  Roberto D’Amico & Damian Francis

Rebecca Armstrong: Priority setting: the CPHG experience

Robert Dellavalle & Chante Karimkhani :On the Global Burden of Disease project and how it can help set priorities vis-a-vis public health and patient level priorities

Soumyadeep Bhaumik : Perspective of different stakeholders in a  research priority setting of a public health problem in LMIC

Kevin Pottie: Priority Setting for Guidelines and Interventions

Vivian Welch: Cochrane Agenda and Priority Setting Methods Group (CAPSMG)

Discussion Session : ROLE PLAY where participants took roles as policy makers, clinicians and members of the public for deciding priority for Ebola and Sin taxes for Sugar Sweetened Beverages. 

Dr. Soumyadeep B presentation at the session is attached and free to use under CC-BB-NY-SA (Click)

Perspective of different stakeholders in a research priority setting of a public health problem in LMIC 

Visit https://capsmg.cochrane.org/ For more details

Participants in Role Play at the Session
Participants in Role Play at the Session

Participants in Role Play at the Session
Participants in Role Play at the Session

Participants in Role Play at the Session
Participants in Role Play at the Session