Menace of Snakebites in India

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    In News

    • A study published in  Nature Communications recently estimated that a vast majority of snakebite deaths globally — up to 64,100 of the 78,600 deaths — occur in India. 

    Key Points

    • Study: 
      • Researchers from 21 countries, published in  Nature Communications recently estimated that a vast majority of snakebite deaths globally.
      • The study used data from verbal autopsy and vital statistics (civil registration) to estimate snakebite deaths from the Global Burden of Disease 2019 study.
      • The study also suggests that the global target of halving the number of deaths and injuries from snakebite by 2030 is unlikely to be met.
    • About Snakebite: 
      • It is a neglected tropical disease (NTD).
      • It is a public health problem in India and many other low- and middle-income countries. 
    • Death: 
      • A global estimate of deaths due to snakebite was not known till recently.
      • The global estimate of deaths due to snakebite comes 14 years after the previous one in 2008 and provides a more robust estimate. 
      • Before the current study, it was known that India is responsible for up to half of the global deaths due to snakebite. But the current study shows snakebite deaths in India are much higher at almost 80% of the global deaths.
    • Within India:
      • Uttar Pradesh has the highest number of deaths, estimated to be up to 16,100, 
      • Followed by Madhya Pradesh (up to 5,790 deaths), and 
      • Rajasthan (up to 5,230 deaths).
    • Age-standardised death rate:
      • It accounts for different age-structures in different countries, thus allowing comparison between countries
      • In India, it is at 4.0 per 1,00,000, is also among the highest globally, and many times over than the global figure of 0.8 deaths per 1,00,000. 
        • Within India, Chhattisgarh, Uttar Pradesh, and Rajasthan have even higher age-standardised death rates, at 6.5, 6.0, and 5.8 per 1,00,000, respectively.
      • Only Somalia has a higher age-standardised death rate than India at 4.5 per 1,00,000. 
        • This indicates a failing health system in India and Somalia leading to high deaths in those who are bitten by venomous snakes. 

    Image Courtesy: Science 

    Issues

    • No proper strategy: 
      • Despite such a high number of deaths each year, there is no national strategy to address the burden of snakebite in India. 
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    • Prevention 
      • There is no programme by the government to either prevent snakebite or in preventing deaths or disability in those who are bitten by venomous snakebite.
    • Health system strengthening: 
      • With such a high number of deaths due to snakebites, there is a need for a strategy focusing on snakebite prevention and strengthening of health system. 
    • Awareness: 
      • Preventing snakebite needs more than simple awareness programmes. 
      • This is so because snakebite at its core is due to snake-human-environment conflict tied to many socio-cultural-religious aspects. 
    • Expensive: 
      • The costly drugs and diagnostics whose intellectual property is held outside India or leading to vertical programmes instead of integrated strengthening. 
      • Because snakebite affects the rural poor, a national strategy for snakebite brings in an equity focus which will bring cross benefits for other neglected tropical diseases, which happen in the same communities.

    Government Efforts

    • There is some recognition of snakebite as a public health problem with the Indian Council of Medical Research launching a national survey to estimate the burden.
    • As such, understanding the conflict and code signing community-based programmes for prevention of snakebites which are tested through community randomised cluster trials are required. To bring down deaths, strengthening of primary healthcare in India is also required.

    Way Ahead

    • There has been a lot of focus on snake antivenom availability
    • An analysis of system capacity for snakebite care revealed that there is a need for comprehensive strengthening of primary healthcare systems focusing on both access and quality of care across all health systems blocks, instead of a sole focus on snake antivenom availability.
    • Improving primary health care is important for snakebite because it is an acute medical emergency – the care needs to be closest to people bitten by snakes.
    • With the new global estimates available, it might be expected that global health funders and philanthropists would invest for research and programmes on snakebite in India, such that the global target can be made.

    Neglected Tropical Diseases

    • These are a diverse group of communicable diseases that are common in tropical and subtropical conditions in 149 countries.
      • These are most common among marginalised communities in the developing regions of Africa, Asia and the Americas.
      • NTDs threaten more than 1.7 billion people living in the poorest and most marginalized communities worldwide.
    • They are caused by a variety of pathogens such as viruses, bacteria, protozoa and parasitic worms.
    • Disease classified as NTD by WHO:
      • Buruli ulcer, Chagas disease, Dengue and Chikungunya, Guinea worm disease, Echinococcosis, Foodborne trematodiases. Human African trypanosomiasis, Leishmaniasis, Leprosy, Lymphatic filariasis, Mycetoma, chromoblastomycosis and other deep mycoses, Onchocerciasis, Rabies, Scabies and other ectoparasites, Schistosomiasis, Soil-transmitted helminthiases, Snakebite envenoming, Taeniasis/Cysticercosis, Trachoma and Yaws.

    Image Courtesy: Harvard 

    • These diseases generally receive less funding for research and treatment than diseases like tuberculosis, HIV-AIDS and malaria.
    • They are preventable and treatable.
    • Impacts:
      • Several NTDs disproportionately affect children, girls and women and the elderly.
      • Some diseases with cutaneous manifestations (the so-called “skin NTDs”, which include cutaneous leishmaniasis and leprosy) are disfiguring, particularly for women, because they delay health-seeking behaviour, diagnosis and treatment. 
      • These diseases often leave visible scars, which have psychological, social and economic impacts that are amplified for women because of gender-based cultural norms and expectations.
      • Children infected with soil-transmitted helminthiases are nutritionally and physically impaired.
      • These diseases take away their health along with the chances of staying in school, earning a living, or even being accepted by their family or community.
    • Challenges in Elimination:
      • For many NTDs, there are no vaccines or simple tests to ensure timely diagnosis and treatment, and treatments can be toxic, ineffective, and costly.
      • Lack of resources is the single most important roadblock that keeps countries from achieving the elimination of targeted diseases.
      • Where health systems are weak, as is often the case in remote and border areas, these diseases remain undiagnosed and untreated.
      • Preventing stigma and discrimination is a remaining challenge, which can lead families to discourage their relatives with disfiguring diseases from attending health services, along with the social displacement of people affected by NTDs.
    • Global Progress So Far:
      • The global NTD partnership includes hundreds of organizations that support programme implementation and contribute to working with health ministries and communities.
      • With the right investments and actions, progress to contain NTDs is within reach.
      • Since 2012 alone, 33 countries have eliminated at least one NTD and the number is increasing in the positive direction.
      • The WHO South-East Asia Region has made good progress towards eliminating the targeted diseases from individual countries and decreasing their burden at a regional and global scale.

    Source: TH