A prospective study of snakebite in a tertiary care hospital in south-western Nepal

Abstract

Background Snakebite is a neglected public health issue in Nepal. We aimed to characterize patients with snake envenoming admitted to hospital in south-western Nepal. Methods This was a prospective cohort study of 476 snakebite patients admitted to Bheri Hospital from May to December 2017. Data were collected on patient demographics, bite circumstances, snake type, treatment-seeking behavior, clinical effects, complications and treatment. Results There were 139/476 (29%) patients with clinical features of envenomation and 10 deaths (8%), of which six were prehospital deaths; 325/476 (68%) patients used non-recommended prehospital first aid, including 278 (58%) who applied a tourniquet and 43 (9%) consulting traditional healers. Median time to hospital arrival was 1.5 (IQR: 0.8–4) h. Also, 127 envenomated patients (91%) developed neurotoxicity and 12 (9%) hemotoxicity, while 124 patients (89%) received antivenom, with a median dose of 10 (4–30) vials. Three patients developed anaphylaxis following antivenom administration; 111 of 139 (80%) cases were admitted to the ICU and 48 (35%) were intubated. Median length of hospital stay for all cases was 0.5 (IQR: 0.5–1.2) d, but it was 2.2 (IQR: 1.5–3.8) d for envenomated cases. Conclusions The majority of snakebite patients used non-recommended first aid or attended traditional healers. Almost one-third of patients developed systemic envenomation and required antivenom. The case fatality rate was high, but many died prior to arriving in hospital.

Analysis of News Media-Reported Snakebite Envenoming in Nepal during 2010–2022

“…These envenomings mostly occurred while people sleep (Tables 2 and 3). Similar observations were reported in a hospital-based study of envenomated cases from 11 districts [11] representing far-and mid-western Nepal and a community survey in 23 districts [6] across the Terai region of Nepal. Although envenomings while victims' active and passive conditions were not significantly different (p-value: 0.823, Table 2), people should be wary at bed time in residential areas, particularly in the tropical regions of Nepal because we found the maximum envenoming while sleeping (p-value: <0.001, Table 3).…”

“…Although there were frequent reports of students and farmers being mostly envenomed in different parts of Nepal [A Ph.D. dissertation carried out in eastern, central, and some parts of western Nepal [10] and next study carried out in a referral hospital in the mid-western Nepal [11] reported envenomed students (27-35%) and farmers (24-43%)], we found all occupational people being equally vulnerable to venomous snakebites (Table 2). Our analyses showed that people engaged in non-agricultural occupations (Table 2) were also affected by snakebite envenoming.…”

“…We found both sexes being equally vulnerable to snakebite envenomings (Table 2). However, there are reports of female dominance in recently conducted studies in different parts of Nepal [a survey carried out in the Terai [6,42] and a study of snakebite envenomings admitted in Bheri Hospital having service areas in western Terai to lower-middle hills of Nepal [11]]. Other distant past studies (a study of snakebite envenomings admitted in Bharatpur Hospital having service areas in south-central Terai to lower-middle hills of Nepal [43] and the subsequent study of confirmed Common Kraits and Russell's Viper envenoming known from western, central, and eastern Nepal [10]) showed male dominance.…”

“…Interestingly, we found females being mostly affected by snakebite envenomings when these episodes occurred in residential areas (p-value: 0.019, Table 4). The prevalent patriarchal culture leading to an increase of female activities and trends of more out-migrating male laborers than female laborers [11,44] might reflect the slight female preponderance of snakebite envenomings in and immediate surroundings of houses of Nepal. This suggests that females engaged in residential areas are at risk of venomous snakebites reflecting influence of patriarchal communities in Nepal where most of works at residential areas are often allocated to females.…”

“…One recent community-based study in the Terai region of Nepal reported the fatality rate of snakebite envenoming to be 22.4 per 100,000 [6] which is over five times of the recent estimate of the fatality rate for India [4]. During the cross-sectional survey between 30th November 2018 and 7th May 2019 in the 23 districts of Terai region of Nepal [6], the authors excluded towns and cities where snakebite envenomings and associated mortalities are frequently reported [10][11][12], but proportion of envenomings and human population is less. The inclusion of rural areas having high snakebite incidence but less human population caused higher proportion of envenomings and associated consequences compared to the urban areas.…”