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Indian Journal of Community Medicine

Epidemiological Profile of Snakebite cases Admitted in JIPMER Hospital

Author(s): Panna Lal, Srihari Dutta*, S.B. Rotti*, M. Danabalan*, Akshay Kumar*

Vol. 26, No. 1 (2001-01 - 2001-03)

Deptt. of Preventive and Social Medicine, Maulana Azad Medical College, New Delhi *JIPMER, Pondicherry-6

Abstract:

Research question: What is the epidemiological profile of snakebite cases admitted in JIPMER Hospital from 1990-96.

Objectives: To find out the socio-demographic profile of snakebite cases admitted in JIPMER Hospital during 7 years period.

Study design: Retrospective descriptive study of all cases during the study period.

Setting: JIPMER Hospital, Pondicherry.

Subjects: 865 cases of snakebite.

Results: Proportional case rate of snakebite cases increased from 2.9/1000 admissions in 1990 to 5.2/1000 admissions in 1996. About 68% of the cases were males; majority of cases (93.8%) were agricultural workers and labourers. Adults (15-60 years) accounted for 81.8% of cases. About 28% of cases came from a distance of 50 kms and more. About 40% of cases were observed from the period of September to November which coincided with maximum rainfall. About 85% of cases either got relieved or cured and 13.5% experienced mortality.

Keywords: Snakebite, Epidemiological profile

Introduction:

Snakes are distributed all over the world except in Arctic, New Zealand and Ireland and are more prevalent in temperate and tropical countries1. On an average annually nearly 2,00,000 persons are bitten by snakes worldwide and 30,000-40,000 of them die because of complications following snakebite2. In India 20,000 people die every year due to the same reason3. The snakebite problem is generally considered as a rural problem since most of the snakebites are encountered in rural areas and this has been linked with environmental and occupational conditions4.

Snakebite is an important and serious medical problem in many parts of India. However, reliable data for the morbidity and mortality are not available since there is no proper reporting system. Moreover, the records of the large number of cases do not come to official statistics as people seek traditional methods of treatment. Most of the studies in India deal with clinical and management aspects. Epidemiological studies related to snake bites are very few. The present study was undertaken with the objectives of finding out the socio-demographic profile of snakebite cases admitted in JIPMER hospital during 1990-96; and assessing the economic impact of snake bite cases on medical services and families of the victims.

Material and Methods:

The computerised summary of 865 cases of snakebite admitted in JIPMER hospital from January 90 to December 96 were obtained from the Medical Records Department of the hospital and was analysed manually. The data for rainfall were collected from the Bureau of Economics and Statistics, Pondicherry to find out any link with snakebites.

Having discussion with the physicians looking after the snakebite cases in the ward, the outcomes of the snakebite treatment was defined as, Relieved, if there was relief of symptoms but patient didn't get cured fully; Cured, if the patient became free from symptoms and complications; Expired, if cases died in due course of treatment; LAMA, if cases left against medical advice and SNR, if status of the cases was not recorded.

Results:

Table I: Distribution of admission for all diseases and snake bite cases.

Year Total
in-patients
Snakebites
cases
Cases per
1000 admission
1990 29,954 86 2.9
1991 30,729 88 2.9
1992 31,464 119 3.8
1993 33,315 116 3.5
1994 32,743 124 3.8
1995 34,866 142 4.1
1996 36,945 190 5.2
Total 23,0,016 865 3.8

*2=33.4, df=6, p<0.01.

It was observed that the number of snakebite cases per 1000 hospital admissions steadily (p<0.01) increased from 2.9 in 1990 to 5.2 in 1996 and the average number was 3.8 per 1000 admission (Table I). Males (68.3%) were bitten more than the females (31.7%). Age-wise distribution of cases showed that the majority (81.8%) belonged to 15-60 years age group, next common age group was 6-14 years which comprised 11.7% of total cases. It was observed that 56.9% of cases came from a distance between 0-50 km and 28% came from a distance of 51-100 km or more.

Table II: Association of snakebite cases with average rainfall.

Quarter No. cases Percentage Average rainfall (mm)
Dec-Feb 103 11.9 90.4
Mar-may 218 25.2 49.3
Jun-Aug 198 22.8 82.8
Sep-Nov 346 40.0 209.2

About 40% of the snakebite cases were seen in the month of September to November during which time, this area and the surrounding area experienced highest rainfall of 209.2 mm (Table II).

Analysing the various outcomes, it was observed that majority (56.4%) were relieved, 28.4% were cured and 13.5% cases expired while receiving treatment.

Discussion:

Much of information available on snakebites is based on hospital studies. The actual incidence and thereby the extent of the burden would be known from the community-based studies. It was reported that average frequency of snakebites per year was 13.8 per 1,00,000 population in Kenya5, 215 per 1,00,000 population in central province and 526 per lakh in Kairuku sub-province in Papua New Guinea6 and 6.8 to 7.4 per lakh per year in Sao Paulo, Brazil7. The proportion of cases of 380 per one lakh hospital admission in the present study was comparable to 330 per lakh admitted cases in Ambajogai study1.

The number of cases admitted per year due to snakebites has been observed to be increasing between the year 1990 and 1996. The increasing trend of snake bite cases over the study period might be due to an overall increase in number of hospital admissions and also to selection of the hospital by the victims because of better facilities.

Age-Sex:

In the present study majority were in the age group of 15-60 years followed by the age group of 6-14 years. The male: female ratio was 2.1:1. In a similar study from Ambajogai (Maharashtra) 88% cases were in age group of 11-50 years1 and male female ratio was 3.2:1. Male preponderance has been observed in other studies also. Male: Female ratio was 1.9:1 in Thailand8, 1.3:1 in Pakistan10 and 2:1 in Karnataka (India)9. The age groups commonly affected were 11-50 years in Maharashtra1, 10-40 years in Nepal8, 15-44 years in Pakistan10 and 6-40 years in Zimbawe11.

Occupation:

Snakebites were commonly seen among labourers and agricultural workers in the present study. Similar findings have been reported in Brazil, Thailand and Pakistan7,8,10.

In the present study, 27.9% cases came from the distance of 51-100 km. Quite a good number of cases (15.1%) came from a distance even beyond 100 km.

Seasonal variation:

In the present study, highest number of bites were seen in the period from September to November during which time highest rainfall was experienced. Similar association with higher rainfall has also been reported from Brazil and Zimbawe7,11.

The mean duration of hospital stay in our study was found to be two days. Similar results were also observed from Thailand8. The mortality rate observed among the admitted cases of snakebite in the present study was 13.5%. This is quite high compared to other studies like 0.4% from Brazil7, 0.07% from New Guinea6 and 3.5% from Thailand8.

JIPMER hospital being a teaching hospital has got all the facilities for management of snakebite cases. But still high mortality may be due to the delay in arriving at JIPMER hospital after snakebite which may be because of the long distance, as majority of the cases came from around 50 km and secondly initial treatment seeking behaviour from traditional healers and local practitioners. As the chance of getting complications following snakebite increases with passage of time, this might be responsible for the observed mortality among our study subjects despite best treatment available.

Conclusion:

Snakebite was seen more among adults, male agricultural labourers and farmers with a peak occurrence during rainy seasons. About 85% of the victims either got relieved or cured with a mortality of 13.5%.

Acknowledgments:

We thank Mr. V. Balsubramanian, Medical Record Officer cum Tutor for his kind help in providing computerised data sheets as required by the authors.

References:

  1. Mulay DV, Kulkarni VA, Kulkarni SG, Kulkarni ND, Jaju RB. Clinical profile of snakebites at SRTR Medical College Hospital, Ambajogai (Maharashtra). Indian Medical Gazette 1986; 131: 363-6.
  2. Wallace JF. Disorders caused by venoms, bites and stings. In: Isselbacher KJ, Martin JB, Braunwald E, editors. Harrison's Principle of Internal Medicine. New York: McGraw Hill Inc; 1994. p.2467-73.
  3. David A Warrel. Animals hazardous to humans, snake. In: Strickland GT, editor. Hunter's Tropical Medicine. Philadelphia: W.B. Saunders Company; 1991. p.877-9.
  4. Hati AK, Mandal M, Mukerjee H. Epidemiology of snakebite in the district of Burdwan. Journal of Indian Medical Association 1992; 90: 145-7.
  5. Cooms MD, Dunachie SJ, Brooker S, Haynee J, Church J, Warrel DA. Snakebite in Kenya: a preliminary survey of four areas. Transactions of the Royal Society of Tropical Medicine and Hygiene 1997; 91: 319-21.
  6. Lalloo DG, Trevett AJ, Sewari A, Naraqui S, Theakston RD, Warrell DA. The epidemiology of snakebite in central province and national capital distict, Papua New Guinea. Transaction of the Royal Society of Tropical Medicine and Hygiene 1995; 89: 178-82.
  7. Ribeiro LA, Jorge MT, Iversson LB. Epidemiology of accidents due to bites of poisonous snakes: a study of cases attended in 1988. Revista de Saude Publica 1995; 29: 380-8.
  8. Buranasin P. Snakebites at Maharat Nakhon Ratchasima Regional Hospital. South East Asian Journal of Tropical Medicine and Public Health 1993; 24: 186-92.
  9. Kulkarni ML, Anees S. Snake venom poisoning: experience with 633 cases. Indian Pediatrics 1994; 31: 1239-43.
  10. Rano Mal. A study of snakebite cases. Journal of Pakistan Medical Association 1994; 44: 289.
  11. Nhachi CF, Kasilo OM. Snake poisoning in rural Zimbawe: A prospective study. Journal of Applied Toxicology 1994; 14: 192-3.
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