Abstract/Summary

Snakebite envenoming (SBE) is a neglected tropical disease affecting the rural impoverished communities in many tropical and subtropical countries. Around 5.4 million people are affected by snakebites each year resulting in around 1.8-2.7 million cases of envenoming, 140,000 deaths and triple the number of amputations and permanent disabilities. India is considered the 'snakebite capital' of the world and it is estimated to account for up to 50% of these snakebite statistics. Unfortunately, accurate epidemiological field data on SBE like most other neglected tropical diseases is lacking, and often remains incomplete; this can be attributed to multiple reasons such as a lack of policy, inadequate funding to conduct the research, limited medical and health infrastructure for data collection and monitoring and difficulties in ascertaining reporting data in rural areas to measure the true impact of SBE. Delays in seeking prompt hospital treatment are one of the primary causes of SBE-induced deaths and disabilities. The root causes for patients to defer and postpone hospital treatment are many and complex, from strong confidence in traditional healers for treating SBE to fear of high treatment costs in hospitals. The clinical presentation following SBE of many snake species across India can be quite different, but there are no defined diagnostic tests or biomarkers available to aid prompt diagnosis of SBE specifically in rural healthcare settings. Notably, healthcare professionals in rural settings often lack confidence and training in managing SBE. Hence, in the first theme of this study, we sought to develop the use of novel biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) in Russell’s viper bites, determine the most effective yet affordable antibiotics for SBE, evaluate the treatment costs for SBE in private tertiary care hospitals and establish knowledge gaps and training needs for healthcare professionals to pinpoint areas of focus to improve the clinical management of SBE in India. In the second theme of this study, we aimed to determine the level of snake phobia in Indian communities, understand the challenges faced by snake rescuers who play a vital role in mitigating SBE burden while saving lives, and the necessity to improve public awareness about SBE. Overall, this study has underpinned various aspects of SBE, and these findings will form a strong base to develop several health policies to mitigate the SBE burden in rural India.