Retrospective Study of Snakebites Based on Hospital and Community Survey in Western Development Region, Nepal

Abstract

Snakebite is one of the most serious neglected public health problems in rural areas of WDR of Nepal, especially in four districts of Terai region (Rupandehi, Nawalparasi, Kapilbastu and Palpa) and is an important medical emergency and reason for admission to hospital due to deadly venomous Cobra and Krait bite. The study basically focused to analyze the annual snakebite incidences, human mortality and morbidity, amount of anti snake venom serum used for the patients, first aid measures adopted by the patients and duration of snakebite time to hospital arrival time. The retrospective study of snakebites recorded in 2008-2010 in different health institutions from WDR of Nepal, where treatments of snakebites are available was carried out during June 2011 to February 2012. Questionnaire surveys were conducted with the local people in small part of the study area Devdaha VDC by random sampling method in April 2012. Out of 6,993 cases of snakebite, 9.15% patients were found to have features of envenoming including 84 deaths during three years. The death rate was found 1.2% and the CFR was found 13.12%. The significant difference was found in number of snakebite cases visiting the different hospitals (p value < 0.001, df = 9, χ XI

2 = 37.0323). Snakebite incidences occur most frequently (71.96%) during the month of June to September. The highest snakebite mortality and highest ASVS consumption were also recorded during the same months. As comparison to males (46.40%), females (53.60%) were more victimized. The 11-20 years age group was mostly victimized (26.34%). The mortality rate in case of children (0-10 years) was found to be higher than those of adults. The majority of the patients (52.15%) sustained bites in the lower extremities, while 30.67% were bitten in the upper extremities. This study recorded more or less equal proportion of day and night snakebite cases. The total consumption of polyvalent ASVS was 10,327 vials. An average of 16 ASVS vials was administered to each victim. It was found that a total of 1,313 vials were used by death cases only. The majority of the patients (45.11%) were reported within one hour after bite. Only 857 victims were reported having first aid treatment. In the questionnaire survey, many respondents applied tourniquets and very few applied PIB and LCPI as a first aid treatment method. Further research should be conducted to improve health facilities and management of snakebite and also for the production of ASVS in Nepal.