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Clinical Trial
. 2018 Jun 7;13(6):e0198900.
doi: 10.1371/journal.pone.0198900. eCollection 2018.

Mortality due to snakebite and other venomous animals in the Indian state of Bihar: Findings from a representative mortality study

Rakhi Dandona  1   2 , G Anil Kumar  1 , Archana Kharyal  1 , Sibin George  1 , Md Akbar  1 , Lalit Dandona  1   2
Affiliations
Clinical Trial

Mortality due to snakebite and other venomous animals in the Indian state of Bihar: Findings from a representative mortality study

Rakhi Dandona et al. PLoS One. .

Abstract

Background: Animal bites and stings contribute significantly to mortality in certain parts of the world. India accounts for the highest number of snakebites and related mortality globally. We report on mortality due to bite or sting of a venomous animal from a population-based study in the Indian state of Bihar which estimated the causes of death using verbal autopsy.

Methodology/principal findings: Interviews were conducted for all deaths that occurred from January 2012 to March 2014 in 109,689 households (87.1% participation) covering 627,658 population in 1,017 clusters representative of the state using the Population Health Metrics Research Consortium shortened verbal autopsy questionnaire. Cause of death was assigned using the SmartVA automated algorithm. The annualized mortality rate per 100,000 population due to snakebite, scorpion sting and other animals adjusted for age, sex and urban-rural population distribution of the state; and detailed contextual information on snakebites are reported. Deaths due to bite/sting of a venomous animal accounted for 10.7% of all deaths due to unintentional injuries, with an adjusted mortality rate of 6.2 (95% CI 6.0-6.3) per 100,000 population. The adjusted snakebite mortality rate was 4.4 (95% CI 4.3-4.6) which was significantly higher in the rural areas (4.8, 95% CI 4.7-5.0) and in females (5.5, 95% CI 5.3-5.7). Snakebites accounted for 7.6% of all unintentional injury deaths across all ages but for 33.3% of the deaths in 10-14 years age group. A similar proportion of snakebite deaths occurred while sleeping (30.2%), playing (30.2%) and during field/outdoor activities (27.9%). In these cases, 8.2% people were already dead when found, 34.7% had died before treatment could be provided, and 28 (57.1%) had died post treatment among whom 46.4% had sought treatment at a health facility, 25% with a traditional healer, and the rest from both. Death before reaching a health provider, non-availability of medicines or doctor, referral patterns, and sex-differentials in the context of snakebite deaths are reported. None of the verbatim specifically mentioned anti-venom being used for treatment. The adjusted mortality rate for scorpion sting was 0.9 (95% CI 0.8-0.9).

Conclusions: The findings from this large representative sample documents the magnitude of snakebite mortality in Bihar and highlight the circumstances surrounding the snakebite events that could facilitate prevention and intervention opportunities.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The proportion of deaths due to bite/sting of a venomous animal among the unintentional injury deaths by age group in the Indian state of Bihar using verbal autopsy interviews.
Animals other than snake include scorpion, dogs and unknown animal.
Fig 2
Fig 2. The distribution of deaths due to venomous animal bite/sting by seasonality in the Indian state of Bihar using verbal autopsy interviews.
See this image and copyright information in PMC

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