Cross-sectional survey of the incidence, mortality and socioeconomic burden of snakebite envenoming in India
Cross-sectional survey of the incidence, mortality and socioeconomic burden of snakebite envenoming in India
Introduction
Snakebite envenomation (SBE) a neglected global health issue, predominantly affecting rural populations in tropical and subtropical countries1. SBE is acute and life-threatening, often leading to serious morbidity and mortality, without prompt treatment. The long-term consequences include physical disability and psychological distress in addition to the socio-economic burdens on the victim and family. Globally, snakebites cause between 81,000 to 138,000 deaths annually, with four times the number of physical disabilities. This burden is concentrated in impoverished rural areas of Asia, Africa, and Latin America, particularly where access to healthcare is limited1,2. In 2017, the World Health Organization (WHO) officially recognized SBE as a neglected tropical disease (NTD), focusing on its high impact on low-income populations and its chronic underrepresentation in global health agendas. WHO’s Snakebite Envenoming Strategy aims to halve the global burden of snakebites by 2030 by improving access to affordable antivenoms, training healthcare providers, and enhancing community awareness in snakebite-prone regions1.
India bears the largest burden of snakebite envenomation globally, accounting for nearly half of the world’s snakebite deaths3. This is primarily attributed to India’s large agrarian population, at risk for snake-human conflict. The “big four” venomous species responsible for most envenomation in India include the Indian cobra (Naja naja), common krait (Bungarus caeruleus), Russell’s viper (Daboia russelii), and saw-scaled viper (Echis carinatus)4. Despite the widespread occurrence of snakebites, India’s official statistics have long underreported the true number of cases and deaths. Recent estimates suggest that between 45,900 and 58,000 deaths occur annually due to snakebites in India, with most victims being young adults involved in outdoor activities5. Snakebite mortality is significantly higher in rural areas, with the highest number of fatalities recorded in Uttar Pradesh, Andhra Pradesh, and Bihar5. Snakebite incidents in India demonstrate significant geographic and seasonal variations. Geographically, the incidence of snakebites is highest in rural agricultural regions, where healthcare access is limited. Mortality rates spike during the rainy season when increased human activity in the fields coincides with higher snake activity3. In contrast to the high mortality rates in India, countries like Australia have successfully reduced fatalities from venomous animals through well-organized healthcare systems and public awareness campaigns6.
Several factors contribute to the high morbidity and mortality secondary to snakebite, such as delayed access to healthcare in rural areas, non-uniform treatment protocols, and lack of awareness of first-aid measures and the quality of the commercially available anti-snake venom (ASV). Healthcare providers are often inadequately trained to handle snakebite envenoming and its complications7. Social and cultural factors play a significant role in the delayed presentation to medical facilities, as many victims rely on traditional healers, contributing to complications7.
Vaiyapuri et al. reported the substantial economic burden from SBE on affected families from the state of Tamil Nadu, while Roshnath et al. studied the incidence of snakebites and the associated compensation payments in Kannur district, of Kerala, further emphasizing the financial strain on rural communities8,9. Dandona et al. expanded on these findings by examining the high mortality rates due to snakebites in Bihar, underscoring the need for more comprehensive public health interventions10. A notable gap identified across these studies is the lack of research in India quantifying the morbidity burden of snakebites using Disability Adjusted Life Years (DALYs), a metric that has been employed in studies from other countries like Nigeria, Sri Lanka, and regions in Sub-Saharan Africa11.
A significant gap in current research on SBE in India is the lack of comprehensive data, particularly in underserved and remote regions. Most available data are hospital-based and fail to capture the public health aspects related to snakebite12. Further research is required to explore the long-term consequences of snakebites, including chronic disabilities and psychological impact, and socio-economic consequences. More attention needs to be given to rehabilitation and follow-up care for snakebite survivors, as many are left with long-term health complications that hinder their quality-of-life13,14.
The need for a nationwide survey on snakebite incidence and mortality in India is critical in addressing these data gaps and improving public health responses. Such a survey would provide comprehensive epidemiological data, offering insights into the true scale of the snakebite problem, regional variations in presentation and complications, therapeutic aspects and the most at-risk demographic groups. It would also assess the treatment-seeking behaviour of victims. Accurate data collection would be essential for resource allocation, such as the distribution of antivenoms and the development of targeted interventions in the context of region-specific ASV. By addressing the knowledge gaps, the findings of a nationwide survey could guide public health policies and contribute to achieving the WHO’s goal of halving the global burden of snakebite envenomation by 203015,16.
The primary objective of this study is to comprehensively assess the epidemiological, health seeking behaviour and socio-economic burden of snakebites in India by conducting an annual incidence study. This paper provides interim analysis results and aims to determine the incidence and mortality rates associated with snakebites within the selected districts, document the clinical course of snakebite victims including predominant symptoms, duration of hospital stay, the number of anti-snake venom (ASV) vials used, and any complications experienced, understand the treatment-seeking behaviours of snakebite victims, and evaluate the overall cost of illness due to snakebites in these communities.
Menon, J. C., Bharti, O. K., M S, A., Bawaskar, H. S., Mohapatra, A., Punde, D., Gajbhiye, R. K., Mohapatra, B. N., Majhi, C., Dhikav, V., Bhaskar, M., Raina, S. K., Raut, S., Mahale, S. D., Munshi, H., Singh, P., Joshi, A., Awasthi, S., Bahuguna, S., . . . Pati, S. (2025). Cross-sectional survey of the incidence, mortality and socioeconomic burden of snakebite envenoming in India. Nature Communications, 16(1), 1-8. https://doi.org/10.1038/s41467-025-64849-2