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Pattern of snakebite cases evaluated at a tertiary care hospital

Article in Indian Journal of Forensic and Community Medicine · January 2019

DOI: 10.18231/2394-6776.2018.0049

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Original Research Article DOI: 10.18231/2394-6776.2018.0049

Pattern of snakebite cases evaluated at a tertiary care hospital

Kashif Ali1,*, Ishan Pathak2, Sheetal Sehrawat3
1Postgraduate, 2Assistant
Professor, 3Undergraduate, 1,3Dept. of Forensic Medicine & Toxicology, 2Dept. of Community Medicine, 1,3J.N.
Medical College, Belagavi, Karnataka, 2DM-Wayanad Institute of Medical Sciences, Meppadi, Kerala, India

*Corresponding Author: Kashif Ali

Email: alikashif568@[Link]

Abstract
Introduction: Snakebite is a serious public health issue worldwide especially in Indian subcontinent. The high mortality in India is due to
climatic factors, rural predominance of population and their agricultural dependence. It is a neglected disease that usually affects the rural
inhabitants indulging in agricultural activities. All snakes are tabooed for being deadly poisonous but truth is miles away as majority of
them belongs to non-poisonous category.
Objective: To study the pattern of Snakebite cases evaluated at KLE Hospital of J.N. Medical College, Belagavi, Karnataka.
Study Design: A retrospective hospital record based study.
Materials and Methods: The study was done by analyzing the case records at Medical Record Department of J.N. Medical College,
Belagavi, Karnataka for all patients admitted with Snakebite envenomation from January 2013 to December 2017. Relevant information
was entered in a pre-structured proforma which include age, sex, site of bite, place of residence, occupation, season and time of bite and
mortality. All the patients who came to hospital with the history of Snakebite were included in the study.
Results: There was total 143 Snake bite cases among which 89 (62.2%) were males and 54 (37.8%) were females. The highest incidence of
Snake bite was observed in age group of 20-29 years (29.4%). The majority of the victims belonged to rural areas 107 (74.8%) as compared
to urban areas 36 (25.2%). The most vulnerable occupation group was the people involved in the agricultural activities 85 (59.4%). The
maximum number of snake bite cases was reported during the rainy season (40.6%). 117 (81.8%) patients were bitten by venomous snakes
as compared to 26 patients (18.2%) which were bitten by non-venomous snakes.
Conclusion: Snakebite is a matter of great concern as it is one of the neglected health problems. It is a need of hour to educate the
community about the prevention of snakebite, early hospitalization and first aid measures by which there will be drastic fall in snakebite
cases.

Keywords: Snake bite, Pattern, Snake, Rural, Anti snake venom.

Introduction improper first aid measures, delay in transport and poor

Snakebite is a serious public health issue worldwide quality of healthcare services.
especially in Indian subcontinent. In India the mortality due The only specific antidote treatment available for
to venomous snake bite is 35000-50000 per annum snakebite envenomation is Anti Snake venom (ASV). The
according to WHO (World Health Organization).1 Snake antisnake venom is classified on the basis of species covered
bite cases are recently included in the list of neglected into monovalent and polyvalent. The monovalent antisnake
tropical diseases as per WHO (World Health Organization) venom can counteract against the bite of a single species
and it could be the most neglected of all the diseases in the while the polyvalent antisnake venom is effective against
21st century.2 Snake bite is one of the major life threatening multiple snake species. In India the available antisnake
problems all over the world which may cause local to venom covers only the “Big Four” species i.e. Common
systemic complications in the form of neurotoxicity, Cobra, Common Krait, Russel’s viper and Saw scaled viper.
haematotoxicity or myotoxicity. All snakes are tabooed for The best treatment for any snakebite case is the early
being deadly poisonous but truth is miles away as majority administration of antisnake venom which is beneficial in
of them belongs to non-poisonous category. People in preventing complications as well as morbidity. The current
countries like India still prefer the traditional healers rather study was conducted to assess and analyze the
than trained doctors mainly because of their great belief in epidemiological profile and outcome of snakebite victims
voodoos and due to illiteracy, ignorance and lack of admitted to a tertiary care hospital.
knowledge.
Usually poisonous snakes are nocturnal with small head Materials and Methods
scales while their belly scales are large covering the entire The study was done by analyzing the case records at
breadth with compressed tail and 2 long fangs. On contrary, Medical Record Department of J.N. Medical College,
the non-poisonous snakes have large head scales with small Belagavi, Karnataka for all the patients admitted with
belly scales partially covering the breadth with snakebite envenomation from January 2013 to December
comparatively less compressed tail and several small teeth. 2017. Relevant information was entered in a pre-structured
Snake venom is a toxic saliva secreted by the modified proforma which include age, sex, site of bite, place of
parotid salivary gland. The increased mortality and residence, occupation, season and time of bite and mortality.
morbidity is due to the inadequate training of the primary All the patients who came to hospital with the history of
level health workers, scarcity of anti-snake venoms, snakebite were included in the study.

Indian Journal of Forensic and Community Medicine, October-December, 2018;5(4):215-217 215

Kashif Ali et al. Pattern of snakebite cases evaluated at a tertiary care hospital

Results
A total of 143 snake bite cases among which 89 Table 2: Distribution of cases according to occupation
(62.2%) were males and 54 (37.8%) were females. The Occupation Number of cases Percentage
highest incidence of snake bite was observed in age group Farmer 85 59.4
of 20-29 years (29.4%) followed by 40-49 years (21.7%) Housewife 26 18.2
and least in 0-10 years (4.9%) as shown in Table 1. The Student 21 14.7
majority of victims belonged to rural areas 107 (74.8%) as Others 11 7.7
compared to urban areas 36 (25.2%). The most vulnerable Total 143 100
occupation group was the people involved in agricultural
activities 85 (59.4%) followed by housewives 26 (18.2%) Table 3: Distribution of cases according to time of bite
and students 21 (14.7%) as shown in Table 2. Time Number of cases Percentage
96 (67.1%) victims were bitten during the night as Day time 47 32.9
compared to 47 (32.9%) during the day time (as shown in Night time 96 67.1
Table 3). The maximum numbers of cases were reported
Total 143 100
during the rainy season (40.6%) as compared to other
seasons which is depicted in Table 4. According to Table 5,
Table 4: Distribution of cases according to season
103 (72%) cases were bitten on lower extremity followed by
Season Number of cases Percentage
35 (24.5%) on upper extremity, 3 (2.1%) on the trunk and 2
Summer 33 23.1
(1.4%) on head and neck. 117 (81.8%) patients were bitten
by venomous snakes as compared to 26 patients (18.2%) Rainy 58 40.6
which were bitten by non-venomous snakes as depicted in Winter 52 36.3
Table 6. Among 117 venomous snake bites, 17 patients Total 143 100
expired during the hospital stay.
Table 5: Distribution of cases according to site of
Table 1: Distribution of cases according to age and sex snakebite
Age Male Female Total number Percentage Place of bite Number of cases Percentage
Group of cases Lower limb 103 72
<10 04 03 07 4.9 Upper limb 35 24.5
11-19 17 12 29 20.2 Trunk 03 2.1
20-29 24 18 42 29.4 Head and Neck 02 1.4
30-39 16 06 22 15.4 Total 143 100
40-49 20 11 31 21.7
>50 08 04 12 8.4
Total 89 54 143 100

Table 6: Distribution of cases according to venomosity and mortality

Type of Snake Number of cases Percentage Mortality Percentage
Venomous 117 81.8 17 100
Non-venomous 26 18.2 0 0
Total 143 100 17 100

Discussion across snakes in their life very often due to their living
In the present study, 89 (62.2%) patients were male conditions, habits, working and walking bare footed. The
victims whereas the female victims were 54 (37.7%) in most vulnerable occupation group was the people involved
number. The male victims outnumbered the female victims in agricultural activities (59.4%) followed by housewives
because the males are more indulged in outdoor activities, (18.2%) and students (14.7%) which is similar to studies
agricultural and field work. This is consistent to the studies done by Logaraj et al6 and Anjum et al.7 This is because still
done by Jarwani et al3 and Brunda et al.4 The higher the farmers and laborers are not using good protective
incidence of snakebites were observed in the age group of shoes, etc., for their safety. The most common site of the
20-29 years (29.4%) followed by 40-49 years (21.7%) and bite was lower extremities (72%) followed by upper
11-19 years (20.2%) which is similar to the study done by extremities (24.5%). This finding suggests that the site of
Lal et al.5 Snakebite is more common in younger age group snakebite is predominantly determined by accidental or
as they are involved in agricultural activities and are risk inadvertent contact of the reptile during the activity. This is
takers. comparable to the studies done by Thapar et al,8 Shetty et
The majority of victims belonged to rural areas (74.8%) al9 and Monteiro et al.10
as compared to urban areas (25.2%) as the snakes are in The maximum number of snakebite cases was reported
abundance in rural areas and the people living there come during the rainy season (40.6%) because of the flooding of

Indian Journal of Forensic and Community Medicine, October-December, 2018;5(4):215-217 216

Kashif Ali et al. Pattern of snakebite cases evaluated at a tertiary care hospital

the habitats of the snakes and other rodents and insects are 7. Anjum A, Husain M, Hanif SA. Epidemiological Profile of
more during this time. The majority of victims were bitten Snakebite at Tertiary care Hospital, North India. J Forensic
Res. 2012;3:146.
during night time (67.1%) as compared to day time (32.9%) 8. Thapar R, Darshan BB, Unnikrishnan B. Clinico-
which is similar to findings reported by Logaraj et al 6 and Epidemiological Profile of Snakebite cases admitted in a
Sharma et al.11 Snakebites are more common during night Tertiary care Centre in South India: A 5 Years Study. Toxicol
and in poor lighting conditions where people inadvertently Int. 2015;22(1):66-70.
step on the snakes. 117 (81.8%) patients were bitten by 9. Shetty AK, Jirli PS. Incidence of Snakebites in Belgaum. J
venomous snakes as compared to 26 patients (18.2%) which Indian Acad Forensic Med. 2010;8:139-141.
10. Monteiro FN, Kanchan T, Bhagavath P, Kumar GP. Krait bite
were bitten by non-venomous snakes and among these 117 poisoning in Manipal region of Southern India. J Indian Acad
venomous snake bites, 17 patients expired during the Forensic Med. 2011;33:43-45.
hospital stay which is similar to the study conducted by 11. Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake
Nagaraju et al.12 envenomation in a North Indian Hospital. Emerg Med J.
2005;22:118-120.
12. Nagaraju K, Kannappan N, Gopinath K. Survey on Pattern of
Conclusion snake bite cases admitted in South Indian tertiary care
It is a need of hour to impart knowledge regarding the Hospital. Int J Pharm Sci Res. 2015;6(10):4362-4367.
prevention of snake bite, early hospitalization and the first
aid measures to the young people, rural farmers and field How to cite this article: Ali K, Pathak I, Sehrawat S.
workers as they are more prone to snake bite. In poisonous Pattern of snakebite cases evaluated at a tertiary care
snake bite, early administration of ASV (Anti Snake venom) hospital. Indian J Forensic Community Med.
will result in less complications and mortalities. Most of the 2018;5(4):215-217.
reported snakebite cases are due to non-poisonous bites
which need only reassurance and first aid. It is necessary to
educate the people about the poisonous and non-poisonous
snake bites through community health programs. According
to this study, the snake bites were more common in rural
areas and among people who are engaged in agricultural
activities, so health education programs should be
conducted to enlighten the rural farmers towards the use of
boots to prevent snakebite. Along with this the Primary
Health Centres (PHC) and Rural Health Training Centres
(RHTC) should always be fully equipped with facilities to
give first aid measures and administer antisnake venom if
required.

Conflict of Interest: None

Source of Funding: Self-funded

Ethical Clearance: Taken from Institutional Ethics

Committee

References
1. Mohapatra B, Warrell DA, Suraweera W. Snakebite Mortality
in India: A Nationally Representative Mortality Survey. PLoS
Negl Trop Dis. 2011;5(4):e1018.
2. World Health Organization. Neglected Tropical Diseases 2017.
Available from:
[Link]
3. Jarwani B, Jadav P, Madaiya M. Demographic, epidemiologic
and clinical profile of Snakebite cases presented to Emergency
Medicine department, Ahmedabad, Gujarat. J Emerg Trauma
Shock. 2013;6:199-202.
4. Brunda G, Sashidhar RB. Epidemiological profile of snakebite
cases from Andhra Pradesh using immunoanalytical approach.
Indian J Med Res. 2007;125:661-668.
5. Lal P, Dutta S, Rotli SB, Danabalan M, Kumar A.
Epidemiology profile of snakebite cases admitted in JIPMER.
Indian J Community Med. 2001;26:36-38.
6. Logaraj M, Thirumavalavan R, Gopalakrishnan S.
Epidemiology of snakebite reported in a Medical College
Hospital in Tamil Nadu. Int J Health Allied Sci. 2013;2:53-55.
Indian Journal of Forensic and Community Medicine, October-December, 2018;5(4):215-217 217

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