icmr-clears-13-cr-snakebite-awareness-project

The Indian Council of Medical Research (ICMR) has sanctioned a Rs 13-crore research project titled ‘Zero Snakebite Death Initiative: Community Empowerment and Engagement for Mitigation of Snakebite Envenoming. SARPA (Snakebite Awareness, Response, Prevention and Action)’ covering six states across the country, with Himachal Pradesh as one. The other states are Maharashtra, Odisha, West Bengal, Assam, and Kerala.

 

“The project, with a duration of four years, aims at developing and implementing a composite community-based model for the prevention and mitigation of snakebite from the learnings of successful models from across the country, along with strengthening the health system through training of doctors and paramedical staff across the care pathway from transport in ambulance to tertiary care,” said Principal Investigator of the project, Dr. Jaideep C. Menon, a noted cardiologist and Professor at Amrita Institute of Medical Science at Kochi in Kerala.

 

Dr. Menon, one of the members of the WHO panel of experts on snakebite envenoming, will carry out the research project in six states with his team of experts.

 

The research project envisages a composite model embedding models that have worked in limited geographies, across different settings in India, covering six states and five regions, in prevention and treatment of snakebite envenoming.

 

“These include community empowerment and capacity building of healthcare system, the use of gum-boots during agricultural activities, use of mosquito nets (which help prevent krait bite), use of torch at night, keeping homes pest/ rodent free, and community models of treatment (CHC-Demow), ASV ( anti-snake venom) infused in ambulances while in transit, digital technology enabled treatment and prevention, community awareness programs for students, general population, forest department, snake-handlers, community health workers etc,”  said Principal Investigator of the ICMR project, Dr Menon.

 

The project involves reaching out to existing networks of stakeholders working in the community for creating awareness on venomous species, first-aid measures, and effective treatment, using data for evidence creation and leveraging digital technology for IEC (Information, Education, and Communication) and facilitating therapy. 

 

“It includes developing an iterative dashboard of snake captures/sightings/killings and releases by species alongside incidents of snakebite envenoming (SBE) for the study areas,” he said.

 

“We aim at an empowered community aware of the threat of snake-human conflict and its prevention, better health-seeking behaviour and improved health outcomes in victims of snakebite envenoming through this implementation research,” he added.

 

Snakebite is predominantly a rural occurrence with significant socio-economic consequences, affecting impoverished communities with inadequate healthcare services. Ignorance on the subject and dependence on alternate therapies like traditional healers, ojhas, etc., causing delay in treatment, contribute to the high morbidity, mortality, and disability.

 

In the rural state of Himachal Pradesh, the snakebite incidence is high in the lower and mid-hills. The practice of reaching out to traditional healers is quite common, which often delays the treatment and hence leads to the death of the victim. The tradition of approaching the deities before a doctor is also prevalent in Himachal, which sometimes has adverse outcomes.

 

Snakebite envenoming is a neglected disease and kills more victims than all other NTDs (Neglected Tropical Diseases) put together. Snakebite envenoming is by far the largest cause of animal-human conflict and is also a major cause of loss of livestock.

 

Over 50 per cent of global mortality and morbidity related to snakebite envenoming occurs in India, as per WHO estimates, with a purported 58,000 deaths annually. This is in contrast to the US and Australia, with equally venomous species, where the mortality recorded annually is in the single digits.

 

Snakebite is predominantly a rural occurrence with significant socioeconomic consequences, affecting impoverished communities with inadequate healthcare services. Ignorance on the subject and dependence on alternate therapies like traditional healers, ojhas etc causing delay in treatment contribute to the high morbidity, mortality and disability. In the rural state of Himachal Pradesh, the snakebite incidence is high in the lower and mid hills, the practice of reaching out to the traditional healers in quite common, which often delays the treatment, and hence leads to the death of the victim. The tradition of approaching the deities before a doctor is also prevalent in Himachal, which sometimes has adverse outcomes.

 

Snakebite envenoming is a neglected disease and kills more victims than all other NTDs (Neglected Tropical Diseases) put together. Snakebite envenoming is by far the largest cause for animal-human conflict and is also a major cause for loss of livestock. Over 50 per cent of global mortality and morbidity related to snakebite envenoming occurs in India as per WHO estimates with a purported 58,000 deaths annually. This, as compared to the US and Australia with equally venomous species, where the mortality recorded annually is in the single digit. The snakebite envenoming is most often accidental and occurs with occupations and tasks that put individuals at risk of conflict with snakes (farming, harvesting, fruit-pickers, herders, plantation workers, saw-mill workers, grass cutters etc), predominantly in males (65-70 per cent) and in the productive age groups of 20-65 years (70 per cent).  Snakebite and the attributed mortality and morbidity are highest in impoverished rural communities, with poor social indices and poor access to quality health care. The economic consequences of snakebite envenoming on the household is hence enormous.

 

The most effective way to meet the WHO-SDG goal of halving deaths and disability from snakebite envenoming by 50 per cent by 2030 is through the implementation of the four pillars of the WHO strategy towards prevention and mitigation of snakebite.

 

Dr Menon said the country suffers due to poor infrastructure and development in rural hinterlands, poor access to quality healthcare, lack of awareness on the issue of snakebite envenoming and myths associated with it and poor health-seeking behaviour among victims. Ignorance on preventive aspects, available treatment and first-aid measures is a key driver for poor outcomes in snakebite envenoming. Educating and promoting an informed community is key to mitigation.

 

The data analysis in the research project would help in prioritising advocacy for policy integration of the intervention model at national and state levels and a sustainability plan can be developed to ensure continuity, including securing funding and embedding the model into local health systems. The documentation will support future research and refinement of snakebite prevention strategies.