The Indian Council of Medical Research (ICMR) task force has started a study on the incidence, mortality, morbidity and socio-economic burden of snakebite in the country.
First of its kind in India, the study will look prospectively at the incidence of snakebite covering 13 states, including Himachal Pradesh, in five zones of India and a population of 84 million. The other states are Rajasthan, Maharashtra, Kerala, Tamilnadu, Andhra Pradesh, Odisha, West Bengal, Uttarakhand, Meghalaya, Arunachal Pradesh, Mizoram and Tripura.
An article on the study ‘ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: A study protocol’ has been published in the international research journal Plos One on 22 August, 2022.
The national Principal Investigator for the ICMR study is Dr Jaideep C.Menon from Preventive Cardiology & Population Health Sciences, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, while Dr Omesh Bharti, State Epidemiologist with Department of Health and Family Welfare, Himachal Pradesh government is the national Principal Co-Investigator.
“This study will generate real data on snakebite incidence, mortality, morbidity and socio-economic burden of snakebite for the first time in the country to help the decision makers in policy framing to prevent and control snakebite in India. The country still doesn’t know the real snakebite burden and is hence groping in the dark when it comes to policy,” said Dr Omesh Bharti, the national Principal Co-Investigator for the study.
He said the survey is in progress and it takes into consideration all the geographical areas like hilly, plains, marshy, desert and coastal. “It is the first such study designed for the survey of snakebite incidence in South East Asia. Sri Lanka has done it, but they covered a population of 1 per cent only, whereas our study would cover a population of 6.12 per cent,” said Dr Bharti.
He said the snakebite incidence study is being carried out in 31 districts in six geographical zones in the country, including West, Central, South, East, North and North-East in 13 states. Three districts of Himachal Pradesh, Kangra, Chamba and Una, are also included in it.
According to the article on ‘study protocol’ to know snakebite incidence, snakebite is possibly the most neglected of the NTDs (Neglected Tropical Diseases).
Half of the global deaths due to venomous snakebites, estimated at 100,000 per year, occur in India. The only representative data on snakebite available from India is the mortality data from the RGI-MDS study (Registrar General of India- 1 Million Death Study) and another study on mortality from the state of Bihar. The incidence data on snakebite is available for 2 districts of the state of West Bengal only.
It was only in 2017 that snakebite was added back onto the WHO (World Health Organization) list of neglected tropical diseases (NTDs), after being struck off the list in 2013.
Geographically, the greatest impact of snakebite is in the tropical and subtropical regions, with the highest occurrence in India. Global estimates of snakebite range from 4.5 million to 5.4 million bites annually with an estimated 2 million of them in India with significant physical, mental and socioeconomic consequences.
The ICMR’s study protocol for snakebite incidence and burden mentions that the hospital-based data on snakebite admissions and use of ASV (Anti-Snake Venom) are gross underestimates as most snakebite victims in rural India depend more on alternate treatment methods which do not get represented in National registries.
The ICMR study is a multi-centric study to determine the incidence, morbidity, mortality and economic burden of snakebites in India covering all 5 geographical zones of the country.
“The protocol involves a community level surveillance for snakebite covering 31 districts in 13 states of India in order to obtain annual incidence of snakebites from the community. The frontline health workers will be trained to gather information on new cases of snakebite over the study period of 1- year, from “wards “(smallest administrative subunit of a village or town) that they represent in the study districts. Dedicated field officers would collect data on snakebites, victim characteristics, outcomes, utilization of health facilities on a questionnaire sheet designed for this purpose. The study duration is for 18 months from April 2022 to October 2023,” said Dr Bharti.
As per the Registrar General of India- Million Death Study (RGI-MDS) the number of deaths due to venomous snakebite in India is 46,900 per year. This is considerably high, compared to only 10–12 deaths per year, due to venomous snakebite in the US and Australia, this despite the fact that less populous Australia has probably more venomous species.
Reports suggest that only 20–30% of victims of snakebite in rural India seek treatment in hospitals. Under-reporting and lack of data on incidence, mortality and socio-economic burden make it difficult to understand the true impact of a condition on the health of a population.