Community awareness, empowering healthcare workers can reduce snakebite deaths, says study

he model demonstrated in the qualitative study carried out in the Dahanu block of Palghar district is now set to be replicated in two other blocks in Gadchiroli and Thane

A multi-pronged intervention including community awareness, mapping vulnerable populations, empowering healthcare and paramedical staff could result in bringing down snakebite mortality and morbidity, a new study has shown. The model demonstrated in the qualitative study carried out in the Dahanu block of Palghar district is now set to be replicated in two other blocks in Gadchiroli and Thane.

Snakebite is a neglected public health issue, largely affecting the poor.

Snakebite is a neglected public health issue, largely affecting the poor. Experts say that there are no accurate estimates of snakebite incidents and deaths in Maharashtra. India has recorded an estimated 1.2 million deaths due to snake bites between 2000 to 2019.

In 2013, the researchers of the study had set out to understand the burden of snakebites in the Dahanu block and investigate the problems at the community level, as well as the healthcare level. They found that there was inadequate knowledge about venomous snakes in the community, healthcare workers lacked the confidence to administer the anti-snake venom (ASV) and most patients were referred to higher centres.

“The rate of deaths was higher as the patients lost the golden hour of treatment,” said Dr Himmatrao Bawakasar, an expert on snake and scorpion bites and a contributing author of the study published in the PLOS One journal on Thursday. The study was carried out by the National Institute for Research in Reproductive Health (NIRRH) in partnership with the government of Maharashtra. It was funded by the Indian Council of Medical Research’s Tribal Health Research Forum.

According to the study, nearly 50% of medical officers in the Dahanu block lacked accurate knowledge about Krait (a species of highly venomous snake) bite symptoms or the renal complications due to the bite of a Russell viper. Nurses and Accredited Social Health Activist (Asha) workers were found to have more knowledge about identifying venomous snake bites and ASV, while a majority of auxiliary nurse midwives (ANMs) and multi-purpose workers lacked most of this knowledge. In the community, most people preferred herbal medicines and traditional faith healers over a government health facility.

“A lot of doctors feared administering the ASV as they were not confident to deal with anaphylaxis (a severe allergic reaction) that may follow after the administering the ASV,” said Bawakasar.

The incidence of snakebites in the Dahanu block was 216 per lakh population in 2013. It went up to 264 in 2014 and 338 in 2015. The case fatality rate was around 4.4% (as recorded in 2014). Based on the initial findings, the team of researchers developed an exhaustive model which involved training doctors, Asha workers, anganwadi workers and creating awareness and busting myths among the locals about snake bites. The team conducted 18 focus group discussions for six months in 2017 to initiate discussions about snake bites, prevention and first aid.

“Our interventions began in 2016, and by 2017 we were able to bring down the case fatality rate of snakebite to 0.4%,” said Dr Rahul Gajbhiye, principal investigator and corresponding author of the study. “The number of snakebite incidents in 2017 was 304 per lakh population,” he said.