One of the things that are difficult to find related to snakebites is papers on how they affect the life of people. How this stressful situation is reflected, mostly at psychological and economical level. Some studies say that many patients suffer from Post Traumatic Stress disorder or depression after a snakebite.
I'm starting to see snakebites as divided into three parts:
- The first part is THE ACCIDENT ITSELF, and this must be approached with preventive measures basically, awareness campaigns like for car accidents or labor accidents. To be aware, do not drink alcohol, use some protection... There is no much done on job security and even car security is still very precarious. In some cases, appropriate laws and application of this legal measures eventually will be needed. Prevention is better than cure. Better safe than sorry.
- Second part is immediately AFTER THE ACCIDENT, and here is were all the diagnostic, therapeutic, research and others play a role.
- MEDIUM, LONG TERM CONSEQUENCES of the accident for the individual and the society.
There is plenty of literature on the second topic but very few on the first (awareness, prevention) and even less on the third (human impact of the bites).
Let's see what i there on the "cosmonet"!
This is a beautiful and rigorous study on the socio-economic impact of snakebites on the Rural population of Tamil Nadu, India. I will present a summary of the full article.
This is a PLOS article (open-access article). Please refer always to the original.
Snakebite and its Socio-Economic Impact on the Rural Population of Tamil Nadu, India.
Valyapuri S, Valyapuri R, Ashokan R, Ramasamy K, Nattamalsundar K et al.
University of Reading, United Kingdom / Karpagam University, Coimbatore, Tamil Nadu, India.
November 2013 / vol 8 / Issue 11 / e80090
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080090
Conclusions: Snakebite has a considerable and disproportionate impact on rural populations, particularly in South Asia. This
study provides an incentive for researchers and the public to work together to reduce the incidence and improve the
outcomes for snake bite victims and their families.
University of Reading, United Kingdom / Karpagam University, Coimbatore, Tamil Nadu, India.
November 2013 / vol 8 / Issue 11 / e80090
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080090
Abstract
Background: Snakebite represents a significant health issue worldwide, affecting several million people each year with as many as 95,000 deaths. India is considered to be the country most affected, but much remains unknown about snakebite incidence in this country, its socio-economic impact and how snakebite management could be improved.
Methods/Principal Findings:
We conducted a study within rural villages in Tamil Nadu, India, which combines a household survey (28,494 people) of snakebite incidence with a more detailed survey of victims in order to understand the health and socio-economic effects of the bite, the treatments obtained and their views about future improvements. Our survey suggests that snakebite incidence is higher than previously reported. 3.9% of those surveyed had suffered from snakebite and the number of deaths corresponds to 0.45% of the population. The socio-economic impact of this is very considerable in terms of the treatment costs and the long-term effects on the health and ability of survivors to work. To reduce this, the victims recommended improvements to the accessibility and affordability of antivenom treatment.
Background: Snakebite represents a significant health issue worldwide, affecting several million people each year with as many as 95,000 deaths. India is considered to be the country most affected, but much remains unknown about snakebite incidence in this country, its socio-economic impact and how snakebite management could be improved.
Methods/Principal Findings: We conducted a study within rural villages in Tamil Nadu, India, which combines a household survey (28,494 people) of snakebite incidence with a more detailed survey of victims in order to understand the health and socio-economic effects of the bite, the treatments obtained and their views about future improvements. Our survey suggests that snakebite incidence is higher than previously reported. 3.9% of those surveyed had suffered from snakebite and the number of deaths corresponds to 0.45% of the population. The socio-economic impact of this is very considerable in terms of the treatment costs and the long-term effects on the health and ability of survivors to work. To reduce this, the victims recommended improvements to the accessibility and affordability of antivenom treatment.
INTRODUCTION:
The objective of this study was to obtain a more complete understanding of the incidence and effects of snakebites among the rural population of India and in particular to obtain the snakebite incidence rate in three different sizes of rural villages, prevalence rate in male and female populations and socio-economic impact of snakebites on rural population.
METHODS:
HOUSEHOLD SURVEY:
Villages were divided into three categories based on the number of households (2001 census Tamil Nadu). Type I less than 100 houses, type II between 100 and 250 and type III more than 250 houses.
Ten villages from each of the three categories were randomly selected. The sample size is statistically meaningful and representative of the different geographical regions of Tamil Nadu.
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| Village life in Tamil Nadu |
Households surveys were conducted from every house in each sampled village, a total of 7,578 households representing 28,494 people.
Every snakebite incidence that occurred in the last 10 years was registered and verified.
Answers were collected from 93 victims and 12 relatives of victims who had died following the snakebite. Between these 105 people this accounted for 129 bites.
Exhaustive statistical analysis was done.
RESULTS:
Household survey: A total of 7578 households representing 28,494 people were survey (621 from type I villages, 1871 from type II and 5086 from type III).
- 88.9% were involved in agriculture
- Total number of snakebites 1409. 1115 people (3.9% of the sample) had been bitten by a snake and 20% of these more than once. People living in small (type I) villages were more likely to suffer from snakebites.
- Rate higher in men than women
- 9% (127 people) of the total bites resulted in death (0.45% of the total population surveyed).
- The year-to-year variation correlated with the annual rainfall. More bites and deaths were recorded in years with higher rainfall.
- More precise data on the year the study was conducted show highest number of incidents between September and November, high incidents between April and June and low between December and March, correlating with the rainfall pattern as well as the agricultural activities. During wet months, more snakes may also enter into living areas to capture prey resulting in greater number of bites.
- Economically active age groups (between 11 and 50) had higher number of bites with higher risk between 40 and 50).
- In 77% of cases the snake was identified by the victim or the family. Of these, 79.4% were due to venomous snakes, all of which from the Big Four group, with Russell's viper and cobra being the most frequent cause of bites. Identification was not possible during night time.
DETAILED SURVEY OF SNAKEBITE VICTIMS
129 snakebite victims or their relatives answered a more detailed questionnaire which investigated the circumstances of the snakebite incidents, the treatments obtained, and their views about future improvement in treatment provision. In 12 of the cases the victim had died following the bite.
- 79% occurred when the victims were in the fields
- 15% of the bites occurred indoors
- 72% during working time
- 19% walking along main roads to villages or agricultural land
- More frequent one peak in the morning and one late afternoon.
- 82% on parts of the legs
- 16% on parts of the arm.
- 20% the snake was killed and 14% of victims took the snake to hospital for identification.
- Most frequent symptoms after snakebite were pain at the bite site, bleeding, giddiness, vomiting, sweating or unconsciousness and paralysis.
- 64,3% of the victims did not received first aid immediately after the bite. Where first aid was provided (98% by untrained individuals) the most common treatment was a tourniquet, applied with or without incision of the wound. Other measures were application of plants (Calotropis gigantea) , blood sucking, application of calcium carbonate. Some victims were advised to carry heavy weights or forced to vomit.
- 67% of victims went to hospital, 17% obtained traditional treatments and 10% had both. In hospital, 70% received snake antivenom (ASV)
HOW TREATMENT FOLLOWING SNAKEBITE COULD BE IMPROVED:
When the victims were asked for their views on how treatment following snakebite could be improved, most of the victims or their relatives considered that
- Health care facilities equipped with ASV should be available in each village or, failing that, a vehicle available in each village to take snakebite victims to hospital. The primary health centers available in some of the villages did not hold any ASV.
- Most of the victims or relative would be willing to go to hospital instead of traditional healers if hospital treatments were easily available.
- ASV is available free of charge in government hospitals, but the majority of victims suggested that snakebite should be treated free of charge even in private hospitals.
- Victims also suggested that increased knowledge among the general public about the correct first aid for snakebites and how to handle bites from non-venoumous snakes would be a priority.
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| www.indiansnakes.org |
SOCIO-ECONOMIC IMPACTS CAUSED BY SNAKEBITES
The major impact caused by snakebites was the financial burden to the family.
The direct cost (transport and medical expenses) to the victims of treating the snakebite varied considerably, from as little as zero (16.3% of victims) to a maximum of Rs 350,000.
The cost of treatment was increased dramatically in private hospitals due to the severity of the bites and the need for emergency medical equipment such as ventilator.
75% of the victims that obtained hospital treatment attended only private hospitals and paid the treatment cost themselves.
Delay in treatment may be due to having first sought treatments by traditional healers, or their village primary health centre prior to referral to the nearest town hospital, and the further referred to district government hospital. In some cases they had travelled further to private hospital.
None of the 108 victims who paid for their treatment were covered by medical insurance.
- Over 40% of victims required to take a loan to pay for the treatment. The financial implications of snakebites were exacerbated by a lack of availability of loans for medical and associated expenses by the nationalized banks.
- In order to repay the loan, the families often had to sell their valuables.
- The victims who paid for their treatment found it necessary to:
- 17.8% sold stored crops (Rs 1000-20000)
- 14% sold Valuable items (Rs10000-100,000)
- 9.3% sold cattle (Rs 5000-30000)
- 5.4% sold vehicles such as bicycles (1000-2000) and motorcycles (5000-20000)
- A small number of people found it necessary to remove their children from education and send them to work.
- Some had to sell family land or property (Rs 50000-400,000).
According to the Indian labour bureau, the average daily wage in India for agricultural occupations in 2007-2008 was Rs 76 for a man and Rs 54 for a woman.
35% of the victims were admitted in hospital for more than a week for their treatment. In addition, around 50% had home rest after their treatment of between 1 month and 2 years, reducing family income.
LONG TERM ECONOMIC AND PHYSICAL EFFECTS are associated with envenomation.
In two cases encountered in this study, the bite killed the only son within a family, leaving elderly parents with no financial support.
Even where victims survived there were medium and long term consequences in 90% of cases.
In the long term 68% of victims experienced tiredness, which affected their ability to work. In six of these cases the victim was no longer able to work in agriculture and had to find alternative employment.
35% of victims experienced pain at the bite site or elsewhere ini the body. Other symptoms as numbness, swelling of face, hands and legs, liquid oozing from the bite site, blurred vision, eye watering, giddiness, shivering and nausea.
DISCUSSION
This is the first large household survey of snakebite incidence. Snakebite is a significant problem within the rural population, particularly in the smallest villages.
The distribution of bites with respect to age and gender are consistent with snakebite being an occupational health hazard affecting mostly agricultural workers.
Bites are more common during periods of high rainfall and at harvest times.
In most cases the species of snake could be identifies and was either one of the Big Four or a non-venomous snake.
Accepting the limitation in extrapolating these data to the whole population, if we assumed the data obtained from the 30 sampled villages as representative on entire rural Tamil Nadu, we would estimate on average that around 113,000 snakebites and 10,000 associated deaths occur annually within the rural population of Tamil Nadu.
Mohapatra et al. estimated the annual death rate within Tamil Nadu to be 3,100. Interestingly, our data suggest that the number of bites is only 11 times the number of deaths, which is considerably lower than the ratio of 64 bites/death suggested by Mohapatra et al. based on hospital data.
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| A sign hangs outside of a clinic in rural Tamil Nadu. The sign makes clear that the clinic stocks antivenin against snake |
Immediate first aid often takes the form of traditions treatments.
The delays in arrival at hospital, possibly linked to patients first seeking locally available traditional treatments or to the distance from health centre, caused complications.
The socio-economic impacts that snakebites cause to victims are substantial. Beginning from the one-off direct cost to long term cost, endanger the livelihood of the family. The type of venomous snake responsible for envenomation is also a factor. For example, when Russell's or saw scaled viper bites occurred, they caused severe bleeding disorders and necrosis at the bite site, and these resulted in blood or plasma transfusion and/or skin grafts and major surgery. Elapid bites frequently cause severe respiratory distress / failure resulting in a requirement for ventilator use and multi-speciality hospitals.
The clinicians that we interviewed in this study (data not shown) emphasized:
- The need for reduction in the incidence of snakebite by
- raising community awareness of the risks
- prevention by wearing appropriate footwear
- Improvements in the training of medical personnel in rural areas and in the education of medical students.
- Standard protocols and tools for diagnosis and treatment
- Improvements to the currently available antivenoms either in terms of reduced side effects or improved efficacy. The available polyvalent ASV may not be effective against bites from some snakes (e.g. hump nose pit viper and Levantine viper) more recently recognized to be of medical significance.
The victims also suggested
- educating the community to enable them to administer first aid and making the availability of first aid kits in the rural community centres for easy and immediate access.
The authors hope that this study will provide the incentive for researchers, the general public and clinicians to work together to achieve the key initiatives of the global snakebite initiative:
- Improved community education
- Improved education of medical personnel
- Improved research on efficacy and safety on antivenom
The Study material S1 can be downloaded from the publication.
ॐ लोकाः समस्ताः सुखिनो भवन्तु ॥
Om Lokah Samasthah Sukhino Bhavantu
May all beings everywhere be happy and peaceful.
May all beings everywhere be happy and peaceful.
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