New Delhi: The Union government last month announced snakebikes as a notifiable condition, making it mandatory for all hospitals in India including private establishments to notify the Centre on every case of snakebite and related deaths.
But experts working in the said area say that this mere step—taken as part of the National Action Plan for Prevention and Control of Snakebite Envenoming from India by 2030 (NAPSE)—may not be adequate because the biggest challenge the country faces is lack of adequate snakebite management, which requires emergency medical care in nearly all districts.
Snakebite envenoming is a neglected and potentially life-threatening tropical disease caused by the toxins in the bite of a venomous snake and which primarily affects rural communities in South Asia and Africa. It is estimated that globally, up to 78,600 people died due to snakebites in 2019.
According to government estimates, the condition kills nearly 58,000 people annually in India, the highest for any country globally.
In addition to deaths, snakebites can cause considerable long-term physical disabilities, may lead to mental health manifestations, and potentially add to the socio-economic problems of already deprived communities.
“One of the key objectives under NAPSE is to strengthen the surveillance of snakebite cases and deaths in India,” Union health secretary Punya Salila Srivastava wrote in a letter addressed to state health secretaries last week.
A robust surveillance system, the letter said, is essential for accurately tracking snakebite incidents and deaths as it will provide valuable data to inform and evaluate the effectiveness of interventions.
“Therefore, a mandatory notification of all snakebite cases and deaths is required to strengthen snakebite surveillance. It will help the stakeholders gauge accurate burden, high risk areas, factors responsible for deaths of snakebite victims etc resulting in improved clinical management of snakebite victims,” the letter read.
It also said that the fact that snakebites are now a notifiable condition will increase the number of cases and deaths reported from private health facilities.
In 2019, the World Health Organization (WHO) released a strategy to reduce snakebite related deaths and disabilities by 50 percent by 2030. One of the four objectives of the WHO’s strategy is strengthening health systems with a focus on ensuring time-critical service delivery in primary health care.
But researchers working in the area underlined that according to available evidence, most people bitten by snakes do not go to hospitals.
“If they do, they go to government hospitals as most people bitten by snakes are economically poor.The latest notification policy, therefore, only implies additional capture of data from private hospitals,” Dr Soumyadeep Bhaumik, a public health researcher associated with the George Institute for Global Health in India and Australia, told ThePrint.
The government says that there are about 300 species found in India of which 52 are venomous. The venomous snakes found in the country belong to three families Elapidae, Viperidae and Hydrophidae (sea snakes).
The most common Indian elapids are Naja naja (Indian cobra) and Bungarus caeruleus (common krait); and common viperids Daboia russelii (Russell’s viper) and Echis carinatus (saw-scaled viper).
While kraits are mostly active at night, often biting a person sleeping on the floor, the highest number of viper and cobra bites have been reported during the day or early darkness, when watering plants or walking barefoot in grown grass and soybean crops.
It is estimated that of a total of five to six lakhs snakebites in India every year, only 30 percent are venomous bites.
The government also concedes that the high fatality rate from krait bites—the most common fatal snakebite—is due to the negligible availability of snake antivenom, delayed and inappropriate administration of antivenoms, lack of standard protocol for management, inexperienced doctors and non-availability of ventilators.
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Systemic gap a major issue
A 2020 study published in the journal eLife showed that Rajasthan and Gujarat recorded the highest number of snakebites from 2001 to 2014. In 2016, a Union health ministry estimate identified that Uttar Pradesh—the most populous state—faced the highest brunt, with 8,700 deaths reported due to snakebites every year.
The government acknowledged that only about 22 percent of snakebite victims visited hospitals after being bitten, and nearly 65.7 percent of snakebite deaths were due to common krait bites, most of them occurring in the months of June to September.
This is mainly because even today, most victims initially approach traditional healers for treatment, and many are not even registered in the hospital, according to the health ministry’s standard treatment guideline on management of snakebites.
But when it comes to states responding to the crises, they perform poorly.
A 2022 study titled Structural capacity and continuum of snakebite care in the primary health care system in India: a cross-sectional assessment underlined that snakebite is a medical emergency and hence, care provisioning at the primary healthcare level—which is closer to the geographical site of bite incidents—is essential for reducing mortality and morbidity due to snakebite.
The study, helmed by Bhaumik, found that broader domains such as physical infrastructure, human resources for health and health information management systems were weaker compared to snakebite care medicines in most states at both primary and community health centre levels.
“What, in fact, is needed is the Union government providing all high burden states unconditional but ring-fenced funds for health system strengthening with a focus on infrastructure and permanent jobs for doctors, nurses and accredited social health activists (ASHAs) under the National Health Mission, apart from a free 24×7 referral service and antivenom supply,” Bhaumik said.
“All of this with monthly monetary support to snakebite survivors and prevention focus are essential. This will be a game changer policy, helping decrease death and disability due to snakebites by 2030 and to top it all, health systems’ work will benefit all forms of healthcare delivery, and not just that of snakebites,” he added.
A senior member of the Indian Council of Medical Research-National Task Force Expert Group for ‘Research on Snakebite in India’, who did not wish to be named, told ThePrint that while as a notifiable disease, the healthcare system gains the ability to collect accurate and real-time data on snakebite envenoming—which is crucial for understanding the scale and regional distribution of the problem—it may not be sufficient in itself to tackle the crisis.
“This will enhance the allocation of resources, improve access to lifesaving antivenom, and facilitate timely interventions but the crucial task now is to identify the gaps and fill them,” he said.
(Edited by Radifah Kabir)
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