Roopak Goswami
Guwahati, Nov 17: India’s first community-based national survey on snakebite envenoming has delivered the most detailed picture yet of how snakebites are affecting millions, exposing deep inequalities in healthcare access, financial protection and emergency response.
Covering 60 million people across 25 districts in 11 states, the survey recorded 7,094 snakebite cases and 195 deaths, with a mortality rate of 0.33 per 100,000 population. One of the most alarming findings: 43% of deaths occurred outside hospitals, reflecting delays caused by poor transport, lack of nearby facilities and continued reliance on faith healers.
The Indian Council of Medical Research (ICMR)-funded study was conducted over a continuous one-year period between 2020 and 2024, depending on when each state could begin fieldwork amid the COVID-19 pandemic. Nature Communications published the study last week.
Snakebite envenomation (SBE) is a neglected global health issue, predominantly affecting rural populations in tropical and subtropical countries. India bears the largest burden of snakebite envenomation globally, accounting for nearly half of the world’s snakebite deaths. This is primarily attributed to India’s large agrarian population, at risk for snake-human conflict.
The study shows a clear demographic and seasonal pattern. Men made up 64% of victims, and the highest incidence occurred among those aged 30-39 years, mirroring the vulnerability of India’s agrarian workforce. More than 62% of bites happened during the monsoon, when snakes are more active and farm activity increases. Lower limbs were the most common site of bites, and farming, walking and other outdoor labour were the leading circumstances.
The clinical findings underline systemic gaps. Although 86% of victims reached hospitals, only 60% received anti-snake venom (ASV). Among those who did, 17% suffered adverse reactions and treatment had to be discontinued in 6% of these cases. Hematotoxic bites were the most common (33.4%), followed by neurotoxic bites (24.9%), with Russell’s viper (17%), kraits (11.5%), saw-scaled vipers (7.9%) and cobras (7.2%) accounting for most venomous cases.
The economic impact is equally severe. Victims paid an average of ₹6,453, with costs soaring to ₹27,402 in private hospitals. Despite government health schemes, only 12% of victims were insured, while over 52% belonged to below-poverty-line households, deepening financial stress.
District-level variations were striking: Jaisalmer (Rajasthan) reported the highest incidence, Kangra (Himachal Pradesh) recorded the highest mortality rate, and Nanded (Maharashtra) had the most deaths. The study also documented long-term impacts ranging from neurological complications to psychological trauma.
Conducted through India’s frontline ASHA workforce, this first-of-its-kind dataset reveals that snakebite remains a disease of poverty, demanding urgent reforms in emergency care, ASV supply, rural health infrastructure and insurance coverage. The final phase of the survey, underway in West Bengal and Meghalaya, will include state-specific estimates and the long-term disability burden.
