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Snakebite is an important and serious medical problem throughout the entire terai region
of Nepal. But comprehensive study of snakebite epidemiology in Western Development
Region of Nepal is scarce. We described the status of snakebite situation in the region
based on retrospective data retrieved from 10 snakebite treatment centers during June
2011...
Context in source publication
Context 1
... three years' (2008)(2009)(2010) retrospective snakebite patterns. We extracted information from medical registers of 10 health institutions (1 Zonal Hospital, 3 District Hospital, 1 Community Hospital, 1 Mission Hospital, 2 Primary Healthcare Centers (PHCs) and 2 snakebite treatment centers in Army Camps) in the Western Development Region (WDR) (Fig. 1, Table 1) during June 2011 to February 2012 using pretested data collection ...
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Citations
... [6, [8][9][10] However, despite having an extensive study on snakebite, the data on envenoming in hills and mountains of western Nepal is scarce [8][9][10][11]. A retrospective study in Nepal examined snakebite poisoning in children admitted to a hospital emergency department between 2004 and 2010 (246 cases, ages up to 14). All children experienced neurological symptoms where the fatality rate stayed high at 28.2%. ...
... All children experienced neurological symptoms where the fatality rate stayed high at 28.2%. [11]. Another study (April 2018 -April 2019) at Nepal's Far West Provincial Hospital examined snakebite cases which resulted that the case fatality rate significantly improved to 4.7% (17 deaths), likely due to following the WHO's 2016 snakebite guidelines [12]. ...
Introduction: Snakebite is a medical emergency resulting in significant morbidity and mortality globally. Snakebite, in Nepal presents a complicated medical situation, characterized by unique clinical features, treatment approaches, and outcomes. Therefore, there is an increasing demand for scholarly research into the effective care and management of snakebites in Nepal. This retrospective study aims to analyze the clinical characteristics, treatment approach and outcome of snakebites at a tertiary care facility in Pokhara, Nepal. Materials and Methods: Medical records of snakebite patients admitted to the tertiary care facility for a period of one year (August 30, 2018 to August 30, 2019) were retrospectively reviewed. Data on demographics, clinical features, and treatment approaches were collected and analyzed. Results: A total of 247 snakebite cases were included in the study. The results of clinical presentation revealed that the majority of cases (61.5%) had no fang marks. Similarly, majority of patients had cellulitis (68.4%), pain and swelling (29.1%), change in skin color (22.7%), and vesicles and bullae (2.0%). Neurological symptoms were not present in any cases (100.0%). 72.5% of patients experienced no bleeding, while 19.8% exhibited external bleeding and 7.7% had internal bleeding. Fresh frozen plasma was administered among 94 (38.1%) of snakebite patients admitted to the hospital. Hospital stays were brief, with 79.4% of patients staying less than 5 days with only 19.0% being referral cases. The findings of treatment approach indicated that anti-snake venom was not used in any reported cases. Finally, the outcome showed improving condition in all the cases with no use of anti -venom. Conclusions: This retrospective analysis provides insights into the clinical characteristics and treatment patterns of snakebites, highlighting patterns and areas for further investigation and improvement in treatment protocols particularly the use of anti-snake venom
... Similar impact can be expected in Nepal where about 20,000 to 37,661 people are bitten by snakes resulting in 1,000 to 3,225 deaths annually [6,7]. However, there is an epidemiological knowledge gap due to inconsistent and incomplete hospital-based records of admitted snakebite cases [8,9] and limitations of recently accomplished community-based snakebite studies [10]. While designing the cross-sectional survey in the 23 districts of terai region of Nepal [7], investigators excluded towns and cities from where snakebite envenomings and deaths are frequently reported [11][12][13][14]. ...
... This could occur due to the high priority of journalists to expose envenomed and dead cases known from healthcare institutions as well as communities to the public. The government's national database was based on hospitals where medical record systems were poor [9] or inadequate [25]. This epidemiological study is the most comprehensive because it illustrated incidences of Nepalese snakebite envenomings known for 13 years in the terai, hills, and mountains, representing all provinces, 50 districts and 27 STCs and highlighted deaths representing 43 districts and 19 STCs (Table 1, Figures 2 & 3). ...
Background: Despite snakebite being a medical emergency, it is still a neglected health issue in Nepal. Further, there exists gap of knowledge on snakebite epidemiology. Therefore, an analysis of incidence of snakebites reported in news is essential to understand snakebite epidemiology in Nepal and fill up existing knowledge gap in some extent. Objectives: We aimed analysing incidence of snakebites reported in the news media to know whether news-based incidence of snakebite is comparable to the similar incidence reported most comprehensively by Nepal Government, know the snakebite distribution patterns across its geo-climatic regions, provinces, and districts, understand supra-annual variations of snakebite incidence, and measure association between incidences of snakebites with the respective districts' human population density. Methods: We retrospectively searched and analyzed incidence of snakebites reported in news articles published between 2010 and 2022. Using line graphs and plotted maps, we compared the annual patterns of snakebites with the national data of snakebites reported by Department of Health Services of Nepal Government. Further, we used non-parametric inferential statistics to know representativeness of our dataset and association of snakebite incidence with population density of snakebite prone districts. Results: Snakebites were reported from 53 out of 77 districts of Nepal. People inhabiting 50 out of 53 districts were affected by snakebite envenoming (with 11% of collective envenoming rate) that resulted in deaths of people inhabiting 43 districts (with 15% of collective case fatality rate). The most of envenomings and deaths occurred in the lowlands of Nepal along the northern border of India. We deemed at least 10,339 snakebites, 2,113 envenomings, and 101 deaths annually in Nepal. Conclusions: The incidences of snakebites were high in flood affected areas, terai regions as well as some districts in the hills and mountains. Therefore, improvement of the snakebite risk map released by Nepal Government is essential to ensure prevention and control of snakebite envenoming in these high affected areas. Inclusion of urban areas in terai regions of this country is essential while designing the next more representative community-based study.
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Empowerment of Journalists is needed to understand various social and health issues costeffectively (take-home message from our recently published article).
Summary of this article:
Snakebites occurred in 53 out of 77 districts of Nepal. Snakebite envenomings occurred in 50 out of 53 districts. Among those envenomings, people died of snakebite envenomings in 43 districts. Among 100 snakebite envenomings, 15 cases died (i.e., case fatality rate was 15%). Most of these envenomings and deaths occurred in the lowlands of this country. A minimum of 10,339 snakebites occur annually resulting in 2,113 envenomings and 101 deaths in Nepal.
Compared to the past records, case fatality rate has been decreased in Nepal. However, incidences of envenomings and fatalities in the hills and mountains are challenges for snakebite management in Nepal.
Empowerment of journalists is essential to improve prospective snakebite reporting in news. Subsequently, the improved case reports in news supports to carry out more sophisticated research cost-effectively in Nepal and elsewhere having similar impact of snakebites.
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... In Nepal, 20,000 to 37,661 people are bitten by snakes resulting in 1,000 to 3,225 deaths annually [5,6]. However, there is an epidemiological knowledge gap due to inconsistent and incomplete hospital medical records of admitted snakebite cases [7,8], and limitations exist in community-based snakebite studies [9]. One recent community-based study in the Terai region of Nepal reported the fatality rate of snakebite envenoming to be 22.4 per 100,000 [6] which is over five times of the recent estimate of the fatality rate for India [4]. ...
Background
Snakebite envenoming is a well-known medical emergency in the Terai of Nepal in particular. However, there is an epidemiological knowledge gap. The news media data available online provide substantial information on envenomings. Assessing this information can be a pristine approach for understanding snakebite epidemiology and conducting knowledge-based interventions. We firstly analyzed news media-reported quantitative information on conditions under which bites occur, treatment-seeking behavior of victims, and outcomes of snakebite envenomings in Nepal.
Methodology/Principal findings
We analyzed 308 Nepalese snakebite envenomed cases reported in 199 news media articles published between 2010 and 2022 using descriptive statistics, Wilcoxon, and Chi-square tests to know why and how victims were bitten, their treatment-seeking behavior, and the outcomes. These envenomated cases known with substantial information represented 48 districts (mostly located in the Terai region) of Nepal. These envenomings mostly occurred in residential areas affecting children. Generally, envenomings among males and females were not significantly different. But, in residential areas, females were more envenomed than males. Further, victims’ extremities were often exposed to venomous snakebites while their active status and these episodes often occurred at night while victims were passive during snakebites indoors and immediate surroundings of houses. Snakebite deaths were less among referred than non-referred cases, males than females, and while active than passive conditions of victims.
Conclusion/Significance
The most of reported envenomed patients were children, and most envenomings were due to cobra bites. Consultation with traditional healers complicated snakebite management. In most cases, deaths that occur without medical interventions are a severe snakebite consequence in Nepal. Further, several deaths in urban areas and mountains and higher hills of Nepal suggest immediate need of snakebite management interventions in the most affected districts. Therefore, there is an urgent need to immediately admit Nepalese snakebite victims to nearby snakebite treatment centers without adopting non-recommended prehospital interventions. The strategies for preventing snakebite and controlling venom effects should also include hilly and mountain districts where snakebite-associated deaths are reported.
... 24 This study focused on this region considering that rural and poorer sectors of the population are the most affected by lethal snakebite, 6,25 and that incidence is much lower in the other two regions of Nepal (hills and Himalayas). 10,26 For a detailed description of the population selection, see Alcoba and colleagues. 27 For this analysis, we also excluded the largest metropolitan areas (>20 000 inhabitants), where snakebites are infrequent, and the population is in closer proximity to various health services. ...
... To illustrate the possibilities of scaling-up the access to healthcare in the Terai, we combined a 3-class map of population vulnerability, the geographical distribution of the rural population, and the location of health facilities treating haemotoxic SBE (no respirators) or no SBE at all, but that are willing to treat it. For the vulnerability map, we combined the average snakebite risk, the average speed of motorcycles (the most common vehicle), 11,32 the wet season (when snakebite is more frequent), 10,26,31 and the neurotoxic syndrome (the most widespread). 9, 10 We selected an area where facilities treating only haemotoxic syndrome were located in or near high-vulnerability populations, in regions of high rural population density, and whose catchments did not overlap with the catchment areas of current facilities treating neurotoxic syndrome. ...
Background
Snakebite envenoming is a neglected tropical disease that mainly affects poor populations in rural areas. In hyperendemic regions, prevention could partially reduce the constant risk, but the population still needs timely access to adequate treatment. In line with WHO's snakebite roadmap, we aim to understand snakebite vulnerability through modelling of risk and access to treatment, and propose plausible solutions to optimise resource allocation.
Methods
We combined snakebite-risk distribution rasters with travel-time accessibility analyses for the Terai region of Nepal, considering three vehicle types, two seasons, two snakebite syndromes, and uncertainty intervals. We proposed localised and generalised optimisation scenarios to improve snakebite treatment coverage for the population, focusing on the neurotoxic syndrome.
Findings
In the Terai, the neurotoxic syndrome is the main factor leading to high snakebite vulnerability. For the most common scenario of season, syndrome, and transport, an estimated 2.07 (15.3%) million rural people fall into the high vulnerability class. This ranges between 0.3 (2.29%) and 6.8 (50.43%) million people when considering the most optimistic and most pessimistic scenarios, respectively. If all health facilities treating snakebite envenoming could optimally treat both syndromes, treatment coverage of the rural population could increase from 65.93% to 93.74%, representing a difference of >3.8 million people.
Interpretation
This study is the first high-resolution analysis of snakebite vulnerability, accounting for uncertainties in both risk and travel speed. The results can help identify populations highly vulnerable to snakebite envenoming, optimise resource allocation, and support WHO's snakebite roadmap efforts.
Funding
Swiss National Science Foundation.
... Snakebite envenomation and its consequences are significant public health problem in the tropical regions throughout the world. 1 The majority of snake bites occur in rural areas in tropical and subtropical countries of Asia, Africa and America with a high fatality rate. 2 About 5.4 million snake bites occur each year, resulting in 1.8 to 2.7 million cases of envenoming (poisoning from snake bites). There are between 81,410 and 137,880 deaths and around three times as many amputations and other permanent disabilities each year. ...
BACKGROUND
Snake bite is a public health problem in terai and inner terai of Nepal. It is a medical emergency leading to significant
morbidity and mortality every year. This study aims to find the clinical profile and outcome of snake bite envenomation
patients in Bheri Hospital Nepalgunj.
METHODS
This was a cross sectional, observational study from april 2021 to november 2021. Patients with history of snake bite and
clinical features suggesting envenomation were enrolled in this study, their clinical data and outcome were recorded in Excel
sheet and analyzed by SPSS 20.
RESULTS
A total of 58 cases of snake envenomation was admitted and managed, out of which 3 cases expired with case fatality of
5.17%. Krait and cobra were the common snake bites in this region. 84.48% of the snake bites occur inside houses and more
than half 53.44% of the patients were bitten between 12am to 6am. The most common features of envenomation were
ptosis, blurring of vision, swallowing difficulty, dysphonia, neck muscle weakness, epigastric pain and salivation. Majority of
cases 96.55% was given 10 vials of Anti snake venom (ASV). Only 4 patients 6.89% needed ventilator assistance.
CONCLUSION
Mortality with snake bites can be minimized by strengthening the treatment centers and readily availability of ASV at such
centers. Public awareness about snake bite, first aid, rapid transport to out snake bite, first aid, rapid transport to health facilities would be the key to success in
reducing morbidity and mortality.
KEYWORDS: snake bite; envenomation; clinical profile; outcome
... The high YLL associated with snakebite in younger people needs to also be interpreted within the population structure of Nepal, which has a young average median age of the population. Still, our results converge with previous studies from Nepal [26][27][28][29][30][31] and India, 32 which have reported a substantial number of cases in children and young adults, possibly because older children are more likely to participate in outdoor activities than infants. ...
Background
Snakebite envenoming has a substantial health and socioeconomic effect in rural communities. However, there are insufficient epidemiological and animal data, which prevents accurate assessment on the effects of snakebite. We aimed to assess the health and socioeconomic effect of snakebite using a One Health perspective.
Methods
In this cross-sectional survey-based study, we assessed the health and socioeconomic effects of snakebite data using a multicluster survey that was previously done as part of the SNAKE-BYTE project in the Terai region, Nepal. Health effect was measured in terms of disability-adjusted life years (DALYs). Livelihood losses encompassed out-of-pocket health-care expenditures, losses of productivity due to days off work, and the losses due to mortality and treatment costs in domestic animals. Mortality losses in domestic animals were also estimated as animal loss equivalents, and overall human and animal health effect expressed using modified DALYs for zoonotic disease (zDALYs).
Findings
We estimate an annual snakebite burden of 200 799 DALYs (95% CI 103 137–357 805), mostly due to mortality in children and women. Snakebite is estimated to lead to US$2·8 million in yearly livelihood losses associated with human and animal cases. Overall, we estimate a yearly human and animal health burden of 202 595 zDALYs (104 300–360 284).
Interpretation
These findings present robust evidence on the extent of snakebite's health and socioeconomic effect and emphasise the need for a One Health perspective. The results also stress how improved data collection at the community level is crucial for improved assessments of its effect.
Funding
Swiss National Science Foundation.
... 9 Findings from community or hospital-based studies have shown a high snakebite envenoming incidence in Eastern, 10 Central, 11 and Western Terai. 12 These studies, although limited in scale and representativeness, showed high incidence, mortality, and disability due to snakebite envenoming, and the need for access to antivenoms, mechanical ventilation (in case of neurotoxic paralysis), and surgery (eg, fasciotomy and amputations). The Terai is the low altitude zone (<1000 m) of Nepal in the Ganges plain, with a typical monsoon warm tropical climate and predominant rice field agriculture. ...
Background
Each year, 2 million people worldwide are bitten by snakes, resulting in an estimated 81 000–138 000 deaths. WHO has added snakebite envenoming to the list of neglected tropical diseases, highlighting the need for stronger epidemiological evidence in endemic countries, such as Nepal.
Methods
We conducted a cross-sectional survey in villages randomly geospatially selected from aerial images from across the Nepal's Terai lowlands region (excluding towns and cities). We collected data between Nov 30, 2018 and May 7, 2019, and analysed snakebite incidence rates and outcomes in humans and domestic animals.
Findings
Among 63 454 human participants living in 13 879 households (249 villages), 166 were bitten by a snake over the previous 12 months; 48·8% were envenomed and 7·8% died. This corresponded to an annual crude incidence rate of 262 snakebites (adjusted incidence of 251·1 [95% CI 201·7–312·6]) and 20 deaths (22·4 [11·9–42·1]) per 100 000 people, extrapolating to 26 749–37 661 yearly bitten people and 2386–3225 deaths. Bitten people had a median age of 30 years (IQR 20–45) and with available data, 64% were female. Children younger than 15 years (n=6; 46%) and females (n=10; 77%) were disproportionately affected among the 13 people who died. The incidence was higher in the Eastern region, and mortality was higher in the Central region. Of 183 949 animals, owners reported 144 snakebites, with an annual incidence rate of 42–202 per 100 000 and mortality of 79–100%, varying by animal type. Spatial and seasonal incidence were similar in humans and in animals.
Interpretation
This study provides the first epidemiological estimates of snakebite envenoming in humans and domestic animals across Nepal's Terai lowlands. It was also the first to use a community-based, transdisciplinary, and One Health design. These findings call for a strengthening of preventive measures and better access to life-saving treatments.
Funding
Swiss National Science Foundation project 315130_176271 (SNAKE-BYTE).
... Similar methods from a One Health perspective, incorporating the risks and consequences of snakebite for domestic animals, are almost non-existent 6 . Until recently, previous studies in Nepal analysed the incidence of snakebite at district and sub-district level, either as community survey 22 or based on medical records 23,24 , but none have addressed the incidence or risk of snakebite at a national or subnational scale. Recently, human and animal snakebite incidences were analysed nationally for the Terai 11,12 , and here we analyse geospatially the risk of snakebite and the factors influencing it in humans and animals. ...
Most efforts to understand snakebite burden in Nepal have been localized to relatively small areas and focused on humans through epidemiological studies. We present the outcomes of a geospatial analysis of the factors influencing snakebite risk in humans and animals, based on both a national-scale multi-cluster random survey and, environmental, climatic, and socio-economic gridded data for the Terai region of Nepal. The resulting Integrated Nested Laplace Approximation models highlight the importance of poverty as a fundamental risk-increasing factor, augmenting the snakebite odds in humans by 63.9 times. For animals, the minimum temperature of the coldest month was the most influential covariate, increasing the snakebite odds 23.4 times. Several risk hotspots were identified along the Terai, helping to visualize at multiple administrative levels the estimated population numbers exposed to different probability risk thresholds in 1 year. These analyses and findings could be replicable in other countries and for other diseases.
... Similar methods from a One Health perspective, incorporating the risks and consequences of snakebite for domestic animals, are almost non-existent. 6 Until lately, previous studies in Nepal analysed the incidence of snakebite at district and sub-district level, either as community survey 22 or based on medical records, 23,24 but none addressed the incidence or risk of snakebite at a national or subnational scale. Recently, human and animal snakebite incidences were analysed nationally for the Terai, 11,12 and here we analyse geospatially the risk of snakebite and the factors in uencing it in humans and animals. ...
Most efforts to understand snakebite burden in Nepal have been localized to relatively small areas and focused on humans through epidemiological studies. We present the outcomes of a geospatial analysis of the factors influencing snakebite risk in humans and animals, based on both a national-scale multi-cluster random survey and, environmental, climatic, and socio-economic gridded data for the Terai region of Nepal. The resulting Integrated Nested Laplace Approximation models highlight the importance of poverty as a fundamental risk-increasing factor, augmenting the snakebite odds in humans by 63.9 times. For animals, the minimum temperature of the coldest month was the most influential covariate, increasing the snakebite odds 23.4 times. Several risk hotspots were identified along the Terai, helping to visualize at multiple administrative levels the estimated population numbers exposed to different probability risk thresholds in one year. These analyses and findings could be replicable in other countries and for other diseases.
... 10 The Nepal injury literature has previously shown that road traffic injuries are common in school aged children, 23 and that falls were the most common cause of non-fatal injury in children. 24 In contrast to the published literature which reported the importance of snakebites in children, 25 we found that dog bites were a more significant issue. Our data support a focus on these three mechanisms for childhood injury prevention. ...
Background
Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5–24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited.
Methods
A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations.
Results
The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%.
Conclusion
Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.
