That snakebite (a neglected tropical disease) is a public health problem in India and many other low- and middle-income countries has been long known. But a global estimate of deaths due to snakebite was not known till recently.
A study that our group, along with researchers from 21 other countries, published in Nature Communications recently estimated that a vast majority of snakebite deaths globally — up to 64,100 of the 78,600 deaths — occur in India. The study also suggests that the global target of halving the number of deaths and injuries from snakebite by 2030 is unlikely to be met.
80% of global deaths
The study used data from verbal autopsy and vital statistics (civil registration) to estimate snakebite deaths from the Global Burden of Disease 2019 study. The global estimate of deaths due to snakebite comes 14 years after the previous one in 2008 and provides a more robust estimate. Before the current study, it was known that India is responsible for up to half of the global deaths due to snakebite. But the current study shows snakebite deaths in India are much higher at almost 80% of the global deaths.
Within India, Uttar Pradesh has the highest number of deaths, estimated to be up to 16,100, followed by Madhya Pradesh (up to 5,790 deaths), and Rajasthan (up to 5,230 deaths).
The study estimated that the age-standardised death rate (which accounts for different age-structures in different countries, thus allowing comparison between countries) in India, at 4.0 per 1,00,000, is also among the highest globally, and many times over than the global figure of 0.8 deaths per 1,00,000.
Only Somalia has a higher age-standardised death rate than India at 4.5 per 1,00,000. This indicates a failing health system in India and Somalia leading to high deaths in those who are bitten by venomous snakes. Within India, Chhattisgarh, Uttar Pradesh, and Rajasthan have even higher age-standardised death rates, at 6.5, 6.0, and 5.8 per 1,00,000, respectively.
Despite such high number of deaths each year, there is no national strategy to address the burden of snakebite in India. Recently, there is some recognition of snakebite as a public health problem with the Indian Council of Medical Research launching a national survey to estimate the burden. While this will help know the burden better, the absence of a specific national strategy to address snakebite implies there is no programme by the government to either prevent snakebite or in preventing deaths or disability in those who are bitten by venomous snakebite.
With such a high number of deaths due to snakebites, there is a need for a strategy focusing on snakebite prevention and strengthening of health system. Preventing snakebite needs more than simple awareness programmes. This is so because snakebite at its core is due to snake-human-environment conflict tied to many socio-cultural-religious aspects. As such, understanding the conflict and code signing community-based programmes for prevention of snakebites which are tested through community randomised cluster trials are required. To bring down deaths, strengthening of primary healthcare in India is also required.
Focus on healthcare
Traditionally, there has been a lot of focus on snake antivenom availability. An analysis of system capacity for snakebite care revealed that there is a need for comprehensive strengthening of primary healthcare systems focusing on both access and quality of care across all health systems blocks, instead of a sole focus on snake antivenom availability; we presented the results this month in the 21st World Congress of the International Society on Toxinology. Improving primary health care is important for snakebite because it is an acute medical emergency – the care needs to be closest to people bitten by snakes.
With snakebite deaths globally being predominantly in India, the global target to halve snakebite deaths by 2030, cannot be attained without action in India. With the new global estimates available, it might be expected that global health funders and philanthropists would invest for research and programmes on snakebite in India, such that the global target can be made.
Having a national strategy to address snakebite would mean that investments are towards the need of the country in health system strengthening and community-based programmes, instead of costly drugs and diagnostics whose intellectual property is held outside India or leading to vertical programmes instead of integrated strengthening. Because snakebite affects the rural poor, a national strategy for snakebite brings in an equity focus which will bring cross benefits for other neglected tropical diseases, which happen in the same communities.
- The study used data from verbal autopsy and vital statistics (civil registration) to estimate snakebite deaths from the Global Burden of Disease 2019 study.
- Within India, Uttar Pradesh has the highest number of deaths, estimated to be up to 16,100, followed by Madhya Pradesh (up to 5,790 deaths), and Rajasthan (up to 5,230 deaths).
- With such a high number of deaths due to snakebites, there is a need for a strategy focusing on snakebite prevention and strengthening of health system.
(Soumyadeep Bhaumik is an international public health specialist working in The George Institute for Global Health, India)