Snake Bite as a Public Health Problem: Bangladesh Perspective

Abstract

Snake bite is an important but often under-recognized public health problem in Bangladesh, with an incidence density one of the highest in the world, which may be 623.4/100,000 person years. The proportion of poisonous snake bites is 10 to 45%, with the reported mortality 0.5 to 22%. Among the 82 species of snakes, 28 are venomous; bites by green pit vipers, cobras and kraits are the most commonly identified ones. High population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs favour the high burden of snake bites. Poorer rural populations are the main victims, imposing considerable socioeconomic impact. Treatment of snake bite is largely dominated by traditional snake charmers (Ozha) or 'Kaviraj' offering unscientific practices and healers, causing undue delay and precluding standard medical management. Delayed presentation to the hospital, lack of availability of antivenom and modern management facility are the main causes of death. Antivenoms are entirely dependent on import, are expensive, and are not 'customized' to local needs. Auxiliary intensive care facilities are not widely available; health care personnel often lack necessary expertise. However, the trend is changing. Public awareness is growing, health care personnel are being trained, and a national guideline for snake bite management has been formulated. Further research, introduction of modern diagnostic facilities, local manufacture of antivenom, and above all, integrated approach on the part of Government, policy-makers and international community can change the outlook of snake bite as a neglected tropical condition in Bangladesh.

A Review on the Potential of Antivenom Industry in Bangladesh

“…For this consequence, illegal antivenoms are smuggled resulting in a high cost of approximately $73 for a single dose [35]. A study on snake bite burden in Bangladesh has calculated the total treatment cost of snake bite envenoming which was $231 where per capita income is $2,227 and the poverty rate is 24% [9], [36]. Another study expressed that the total medical expenditure for venomous snake bites is seven times higher than for non-venomous snake bites where a minimum of $34 is needed for non-venomous snake bite management [37].…”

“…Epidemiological studies among the Indian sub-continent reveal that around 50,000 deaths annually in India, and 2,000 fatalities in Pakistan and Bangladesh due to snake bite intoxication [5]- [8]. There are 82 indigenous snake species with 28 venomous in Bangladesh [9], [10].…”