Snakebite still remains a silent yet deadly public health crisis thus affecting rural populations
Representational Image. Pic/Pixabay
Despite the infrastructure advancements rural hospitals are still struggling with a critical gap that includes a lack of trained medical personnel and medical infrastructure to manage snakebite emergencies. Snakebite still remains a silent yet deadly public health crisis thus affecting rural populations. The recently launched National Action Plan for Snakebite Envenoming (NAP-SE) aims to change this by prioritizing medical training, referral systems, and infrastructure improvements to ensure timely, life-saving treatment.
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A paper titled Primary Health System Strengthening and System-level Interventions for tackling snakebite envenoming in India by Priyanka Kadam, Stuart Ainsworth, and Bhupeshwari Patel was published by Transactions Journal of the Royal Society of Tropical Medicine and Hygiene before World NTD (neglected tropical diseases) day on 31st January.
Priyanka Kadam, PhD (Hon), President and Founder- of Snakebite Healing and Education Society Member of WHO's roster of experts on Snakebite Envenoming said, "India reports the highest number of snakebite deaths annually, with 58,000 lives lost each year, surpassing other countries with high snakebite burdens. As a result, snakebite has been designated a notifiable disease and included in the National Health Program. Timely treatment at Primary Health Centres (PHCs) can significantly reduce this burden. However, PHCs face numerous challenges, including high staff vacancies, inadequate infrastructure, and a lack of skilled personnel to handle medical emergencies such as snakebites. To address this, it is crucial to allocate at least 2.5% of the country's GDP to enhance the medical facilities at government-run health centres across India.
"According to the research paper, Snakebite envenoming is classified by the WHO as a priority neglected tropical disease and it presents a significant global health challenge, inflicting substantial morbidity and mortality. India bears the highest snakebite burden, with approximately 58,000 deaths reported annually.
For the past 13 years, the Snakebite Healing and Education Society of India, operating within the civil society sector, has been dedicated to mitigate the impact of snakebites through both grassroots interaction, extending to the remotest regions across 12 snake bite endemic states in India, and through national and international advocacy.
As snakebite envenoming is a medical emergency, prompt treatment, which includes antivenom administration, is crucial in obtaining positive outcomes. In other global snakebite endemic regions that experience a high snakebite burden, lack of antivenom is often cited as a primary cause of high mortality. India has five major antivenom manufacturers, ensuring ample availability of antivenom, which is provided free of charge in government hospitals. Although the efficacy and availability of antivenoms available in India may vary, it is their experience that these issues are not primary factors in contributing to high snakebite mortality in India. Instead, the high number of snakebite deaths is primarily attributable to delays and barriers in snakebite victims accessing healthcare.
The research paper also states that the rudimentary facilities and lack of knowledge in appropriate snakebite management in many PHCs make handling medical emergencies such as snakebite a daunting task. This results in frequent referral of snakebite victims, commonly without primary treatment or stabilisation, to higher district hospitals which are often located some distance away in major population centres further delaying critical treatment and intervention, and so increasing the likelihood of poor outcomes.
"Often these patients are transported privately by the family, with little to no medical support, often resulting in patients dying en route. In discussions with SHE-INDIA during district-level Doctors and Nurses capacity-building workshops, clinicians who are familiar with the treatment of snakebite in India listed 10 common reasons why snakebite patients are referred from PHCs to other hospitals: A lack of trained medical personnel capable of managing snakebites, An absence of antivenom and necessary supportive drugs, Inadequate respiratory support equipment, Apprehension about anaphylaxis following antivenom administration, Cases where the snake responsible and the physical signs and symptoms of envenomation are unusual or atypical, Insufficient beds available for patient admission at PHCs,Patient families being uncertain about the treatment provided at PHCs, Concerns regarding potential violence from the patient’s family if the condition worsens, Absence of a pathological laboratory for diagnostic purposes, especially for viper envenomation and Lack of a blood bank, investigation facility and dialysis machine or qualified technician in PHCs.The list above demonstrates areas in which interventions could be put in place to mitigate the referral of snakebite patients from PHCs to higher level hospitals." states the paper
In conclusion, the paper clearly states that over the past two decades, there has been significant proactive investment in infrastructure development across India, with a primary focus on building roads, bridges, railways and hospitals. However, hospitals in many areas still face challenges related to the availability of medical personnel with appropriate knowledge of snakebite care and the associated medical infrastructure in which to manage it. We hope that the recent publication of the NAP-SE with a focus on education and training for proper emergency snakebite care and referral practices, alongside improving infrastructure, will lead to a wholesale change over the next decade towards more frequent positive outcomes for rural populations exposed to snakebite in India.
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