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 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):
need for developing global, regional and national agendas for climate crisis preparedness, support for more interdisciplinary/transdisciplinary collaboration,
recognition of rights and dignity of health workforce in our path to climate resilience,
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.
higher taxation of app-based food delivery business which has higher carbon footprint;
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”;
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.
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) .
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
Ms Deepti Beri, The George Institute for Global Health, India
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
Professor Anthony Zwi, Global Health and Development, School of Social Sciences, UNSW, Australia
Dr. Jagnoor Jagnoor, Injury Division, The George Institute for Global Health, India
The session concludes with a Q&A session where the audience can engage with the panelists.
Convalescent plasma has a long history in treatment of infectious diseases – being used when other therapies are available .The use of plasma from patients who have recovered from COVID-19 was used similarly as it can neutralize viral particles and hence help patient care. But many randomized controlled trials have now been completed and it is time now for using evidence to inform not only clinical care but also future research.
The talk will have presentation’s from Dr Aparna Mukherjee (ICMR) and Professor Peter Horby ( Oxford University) and Dr Soumyadeep Bhaumik (The George Institute for Global Health, India). The seminar is moderated by Bharath Kumar Tirupakuzhi Vijayaraghavan (Apollo Hospitals, India)
Dr Soumyadeep Bhaumik will talk about ” From trials to the bedside: convalescent plasma during the COVID-19 pandemic”
Abstract of talk
The use of convalescent plasma in hospitalized COVID-19 patients has started from the beginning of the pandemic. However, during the second wave of the COVID-19 pandemic – with a failing health system , with exhausted doctors and desperate patients – this meant widespread irrational use . Patient and care-givers had to run pillar-to-post to secure plasma from COVID-survivors. The national guidelines remained unchanged and many doctors were confident about its utility . I will discuss the sum-total of evidence (from a systematic review), discuss about how confident we are about the results (through GRADE), and put it in the evidence-to-decision framework in the Indian context. I will also touch on problems in our current guidelines which exist in form of mere flowcharts.
Event is free to attend but requires pre-registration: Click
India is breaking records of COVID-19 positive cases across the world. Daily cases in the country have hit a new high of over three lakhs. In West Bengal too, one in every three people in West Bengal is testing positive. For the past few days, there have been calls on social media pleading for beds in Kolkata. The election climate though seems apathetic to the pandemic.
In a podcast with Suno India, India’s leading podcast platform, Dr Soumyadeep Bhaumik discusses with Ms Suryatapa Mukherjee talks about :
how lack of national #lockdown is killing the poor – no equity
need to focus on prevention & think beyond biomedical lens- not just vaccines
On 22nd April 2021 in the midst of a crumbling health system the AIIMS/ ICMR-COVID-19 National Task Force/Joint Monitoring Group , Ministry of Health & Family Welfare has finally issued a revised “Clinical Guidance for Management of Adult COVID-19 patients” (* see post-publication note in end). In essence, it is not much of a guideline but a flowchart (much like the previous one). It does not adhering to any standards of a guideline, does not present any evidence (not even citations!), nor does it communicate anything around risk-benefits for any of the drugs. As such, it is impossible to understand how the guideline was developed and why some drugs were chosen and why it was not.
The article however focusses only on one aspect of the guidelines- the recommendation for hydroxychloroquine being recommended as a “may do” . However, this recommendation for hydroxychloroquine is contrary to data from randomized controlled trial. Between July 2020 (when the last guideline was issued) and now, there is a lot of trials that has been completed and we now have reasonable evidence to inform decision making. Evidence from randomized controlled trial shows that hydroxychloroquine does do not have any effect on mortality (based on data from 10859 patients ; 29 studies) in COVID=19 patients . In fact patients given hydroxychloroquine may have significantly more diarrhea , nausea and vomiting compared to those not given so. Diarrhoea and vomiting are known to increase the risk of hypovolaemia, hypotension and acute kidney injury, additional health systems burdens which one should avoided at all costs in this phase of the pandemic.
Even if we look at health systems relevant outcomes (which are of course equally important to patients) which are of significance in the currently crumbling health system recommending the use of hydroxychloroquine does not make any sense – it increases the number of people who need mechanical ventilation(based on data from 6379 patients ;5 studies).
*As of 10th May 2021 – another version of the AIIMS/ICMR guideline is being circulated in social media without hydroxychloroquine . I could not verify the veracity of this version of guideline being genuine considering the ICMR website https://www.icmr.gov.in/ still hosts the 22nd April 2021 version
Coronavirus disease (Covid-19), which originated in China, is now a full-blown pandemic which has thrown governments and societies off-track in an unprecedented manner. War metaphors have been used widely to describe the scenario, but many critics decry them as harmful narratives. In this piece, we discuss the utility of the war metaphor to build solidarity and fraternity, which will be essential to get through the crisis. We also explain how concerns regarding increased authoritarianism and state excesses due to the use of these narratives are misplaced. We then tease out the colonial era concept of war that guides the arguments against the use of war metaphors in pandemics. We argue that in the post-modern world and in South Asian and African philosophies, wars are seen through the prism of the larger cause of dharma or ubuntu and that individual losses or gains in these contexts are part of a larger cause. The use of war metaphors reflects the need to get together for a societal cause. These metaphors are largely understood across societies while other alternatives are exclusionary, poetic and tangential in nature.
Read the full article in Indian Journal of Medical Ethics here (open access)
Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com
The COVID-19 outbreak that originated in Wuhan City, China, in December 2019 now affects 213 countries or territories across the globe. Better health workforce utilisation and support are key pillars to enhance health systems capacity. Community health workers (CHWs) constitute a significant proportion of frontline health workforce in many countries and play an important role in control and prevention of pandemics like COVID-19.
A rapid evidence synthesis was conducted to understand what role CHWs can play in pandemics. The study found that in previous pandemics, CHWs have played several roles including for generating community awareness countering stigma and contact tracing. CHW engagement in contact tracing might hamper routine primary service delivery. Policies, guidance and training for these had to be developed. Disruption in supply chain, logistics and supportive supervision for CHWs have been common in pandemic scenarios. CHWs have been at increased risk for contracting disease. In the course of pandemics, CHWs have experienced stigmatisation, isolation and socially ostracisation. Improved remuneration, additional incentives, public recognition countering societal stigma, provision of psychosocial support and personal protective equipment were reported to be enablers. There is not much evidence about initialisation of new CHW programmes during pandemics. Considering the complexity of barriers faced even in contexts with well-integrated programmes, ambitious programmes need to be considered with caution.
Read the full study in BMJ Global Health here (open access)
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.
Dr. Soumyadeep Bhaumik 