Lack of awareness, inadequate health provisions & the dominance of forest areas and traditional healers are Odisha’s major challenges
Globally, 7,400 people are bitten by snakes daily, resulting in about 2.7 million cases of envenoming and 81,000-138,000 deaths. Low-and middle-income countries witness at least 3,500-5,350 deaths annually, equivalent to 1.2 deaths per 100,000 population, according to the World Health Organization (WHO).
Snakebite is a well-known occupational hazard among farmers, plantation workers and other outdoor workers, resulting in the loss of thousands of innocent lives each year and many cases of chronic physical handicap, enormous suffering, disability and premature deaths.
India accounts for half of the global burden of snakebite deaths due to its huge coastline and large dependence on agriculture.
In the last 20 years, India has recorded 1.2 million snakebite deaths, with an average of 58,000 deaths per year. Around 70 per cent of these deaths occurred in low-altitude rural areas of eight states — Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh (including Telangana), Rajasthan and Gujarat, according to a 2020 study.
The economic cost of snakebite envenoming is unmanageable, as it affects not only the victims but often their entire families, particularly in poor communities where they do not have social security cover.
Considering all these facts, snakebite, or snakebite envenoming, was included as a neglected tropical disease in humans by WHO way back in 2009.
In view of the growing cases of snakebite envenoming, WHO launched a strategy in 2019 for preventing and controlling snakebites. It aims to halve the number of deaths and cases of severe disabilities due to snakebites by 2030.
Odisha, located on the eastern coast of India with a 480-kilometre-long coastline, has nearly 70 per cent of its population living in rural areas. The majority of them are engaged in the agriculture sector.
Around 34 per cent of the state’s total area is covered by forest. Lack of information, awareness, an efficient mode of transportation, inadequate health provisions, the dominance of forest areas and the predominance of quacks and traditional healers in rural and tribal-dominated populations result in a high burden of disabilities and deaths due to snakebites in Odisha.
Most snakebite victims are either unable to reach the health facility in time or prefer to visit the traditional practitioners for immediate relief, resulting in the loss of the golden hour of the treatment and making it costly in their lives.
A dearth of authentic snakebite morbidity and mortality data and under-reporting or unclear diagnosis of the poisonous and non-poisonous snake categories result in a high burden of snakebite cases.
Realising the extent of the issue, Odisha was the first state in the country to declare snakebite a “disaster” in 2015, and specially designated wards were identified in every hospital to treat snakebite cases.
However, the number of snakebite death cases in Odisha has more than doubled to 1,159 in 2021 from 522 in 2015. It has been steadily increasing over a period of time.
A graph showing year-wise snakebite deaths in Odisha from 2015-2021. Source: Office of Special Relief Commissioner, Revenue and Disaster Management Department, Government of Odisha.
Due to the dearth of reliable snakebite envenoming information, we explored the ex-gratia claim service statistics for different disaster categories in Odisha to comprehend snakebite envenoming.
It has been observed that in Odisha, 6,351 people died due to snakebite envenoming from 2015-2021. Among the districts, Ganjam (307) had the highest number of snakebite deaths, followed by Keonjhar (297) and Balasore (293). The least number of snakebite deaths was observed in Gajapati (18), followed by Boudh (24) and Kandhamal (27).
A map showing district-wise snakebite death in Odisha from 2015-2021. Source: Odisha State Disaster Management Authority.
On estimating the snakebite death rate per million people, it was found that 26 people in Odisha died due to snakebite envenoming per million in the year 2021.
Among the districts, Malkanagiri (98), the tribal and dense forest-dominated district, reported the highest number of snakebite deaths and Gajapati (3.3), the lowest.
Although the district of Gajapati is a tribal and dense forest-dominated district, a lack of awareness and information among the people might have resulted in poor reporting of the snakebite death. Non-reporting of snakebite causality is common across all populations. The number of snakebite deaths per million people is presented below the graph.
A graph showing snakebite death per million population. Source: Author’s estimation using data from the Office of Special Relief Commissioner and Census of India.
Among the disaster casualties in Odisha, snakebite deaths alone accounted for more than 40 per cent of the total disaster deaths.
Further, to explore more, we estimated the snakebite death rate per 1,000 deaths using 2021 snakebite death information. For every 1,000 deaths in Odisha, three people died due to snakebite envenoming in the year 2021, which accounted for 0.3 per cent of total deaths. While analysing district-wise data, the figure stands at nine for Malkanagiri, followed by Deogarh (seven), Boudh and Anugul (six), and Dhenkanal and Jharsuguda (five).
Among the districts, Gajapati (0.4) recorded the lowest snakebite death rate, followed by Rayagada (0.6) and Koraput (0.8).
Snakebite envenoming has many consequences for victims and their families. It often makes poor people poorer because of the high treatment costs and loss of income.
Some snakebite victims have suffered financial losses equivalent to 3.6 years of their income, and others have sold land worth up to 14 years of income, according to a study.
Some families have to discontinue their children's education because of lost income following snakebite envenoming or so that the children can work to contribute to the family income or care for a disabled snakebite victim, according to another study.
Plenty of literature has documented a strong association between low socio-economic status or poverty and a high burden of snakebite envenoming and death.
People who belong to rural hunter-gatherers, agricultural workers, working children (10-14 years of age), families living in poorly constructed houses and people with limited access to education and health care are all particularly vulnerable to snakebite, noted a 2019 study.
Lack of awareness and information, coupled with weak health systems for immediate response to snakebite victims and a lack of regulatory frameworks, make the situation more unsafe.
The dearth of exact epidemiological or clinical data with limited frequency made it difficult for health practitioners to determine the envenoming cases.
Limited investment in snakebite envenoming research to identify and improve the current gap and treatment process and in the development of a next generation of anti-venoms at a lower cost with greater safety and efficacy is another area of concern.
Appropriate action may be taken to strengthen the health system to deliver services on snakebite envenoming treatment across all facilities, particularly in tertiary care health facilities.
Devising operational snakebite treatment protocols and developing and conserving natural snake habitats, launching mass awareness programmes on the utilisation of health facilities for snakebite envenoming treatment and to avoid social taboos and cultural treatment practices, focusing on rural, agricultural workers, tribal and forest dwellers are the key.
A concerted effort using technological interventions is also required to strengthen Odisha’s health system supply chains for snakebite treatment.
Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth
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