Underestimation of snakebite mortality by hospital statistics in the Monaragala District of Sri Lanka

Fox, Sean M.; Rathuwithana, A.C.; Kasturiratne, A.; Lalloo, David G.; Silva, H. J. de

doi:10.1016/j.trstmh.2005.09.003

Cited by 64 publications

(57 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, existing epidemiological data remain fragmented and the true impact of snake bites is very likely to be underestimated. Surveys in rural Sri Lanka showed that hospital data record less then half of the deaths due to snakebite [9]–[11]. In Nepal, a review of district hospital records showed that national figures underestimated the incidence of snake bite by one order of magnitude [12].…”

Section: Epidemiologymentioning

confidence: 99%

Snake Bite in South Asia: A Review

Alirol

Sharma

Bawaskar³

et al. 2010

PLoS Negl Trop Dis

389

380

View full text Add to dashboard Cite

Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world's most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms' composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data generated by well-designed research studies. Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle. The deficiency of snake bite management in South Asia is multi-causal and requires joint collaborative efforts from researchers, antivenom manufacturers, policy makers, public health authorities and international funders.

show abstract

Section: Epidemiologymentioning

confidence: 99%

Snake Bite in South Asia: A Review

Alirol

Sharma

Bawaskar³

et al. 2010

PLoS Negl Trop Dis

389

380

View full text Add to dashboard Cite

show abstract

“…However, these data, based on hospital records, underestimate the true extent of the problem. 2,3 More than 100 terrestrial snake species inhabit Sri Lanka, but only six are medically important: Indian cobra ( Naja naja ), common and Sri Lankan kraits ( Bungarus caeruleus and B. ceylonicus ), Russell's viper ( Daboia russelii ), saw-scaled viper ( Echis carinatus ), and hump-nosed pit viper ( Hypnale hypnale ). 4,5 Three other vipers, H. nepa , H. walli , and Trimeresurus trigonocephalus , bite rarely and with negligible consequences as do some mildly venomous colubrids.…”

Section: Introductionmentioning

confidence: 99%

Syndromic Approach to Treatment of Snake Bite in Sri Lanka Based on Results of a Prospective National Hospital-Based Survey of Patients Envenomed by Identified Snakes

Ariaratnam¹,

Sheriff²,

Arambepola³

et al. 2009

Am J Trop Med Hyg

106

View full text Add to dashboard Cite

Abstract. Of 860 snakes brought to 10 hospitals in Sri Lanka with the patients they had bitten, 762 (89%) were venomous. Russell's vipers ( Daboia russelii ) and hump-nosed pit vipers ( Hypnale hypnale ) were the most numerous and H. hypnale was the most widely distributed. Fifty-one (6%) were misidentified by hospital staff, causing inappropriate antivenom treatment of 13 patients. Distinctive clinical syndromes were identified to aid species diagnosis in most cases of snake bite in Sri Lanka where the biting species is unknown. Diagnostic sensitivities and specificities of these syndromes for envenoming were 78% and 96% by Naja naja , 66% and 100% by Bungarus caeruleus , 14% and 100% by Daboia russelii , and 10% and 97% by Hypnale hypnale , respectively. Although only polyspecific antivenoms are used in Sri Lanka, species diagnosis remains important to anticipate life-threatening complications such as local necrosis, hemorrhage and renal and respiratory failure and to identify likely victims of envenoming by H. hypnale who will not benefit from existing antivenoms. The technique of hospital-based collection, labeling and preservation of dead snakes brought by bitten patients is recommended for rapid assessment of a country's medically-important herpetofauna.

show abstract

“…The actual figures are likely to be much higher than these estimates. A study in a rural Sri Lankan community found that nearly two-thirds of snakebite related deaths are not reported in hospital-based data [3]. A nationally representative survey in Bangladesh suggested that incidence of snakebite is much higher than previously estimated [4].…”

Section: Introductionmentioning

confidence: 94%

Neurotoxicity in Snakebite—The Limits of Our Knowledge

2013

View full text Add to dashboard Cite

Snakebite is classified by the WHO as a neglected tropical disease. Envenoming is a significant public health problem in tropical and subtropical regions. Neurotoxicity is a key feature of some envenomings, and there are many unanswered questions regarding this manifestation. Acute neuromuscular weakness with respiratory involvement is the most clinically important neurotoxic effect. Data is limited on the many other acute neurotoxic manifestations, and especially delayed neurotoxicity. Symptom evolution and recovery, patterns of weakness, respiratory involvement, and response to antivenom and acetyl cholinesterase inhibitors are variable, and seem to depend on the snake species, type of neurotoxicity, and geographical variations. Recent data have challenged the traditional concepts of neurotoxicity in snake envenoming, and highlight the rich diversity of snake neurotoxins. A uniform system of classification of the pattern of neuromuscular weakness and models for predicting type of toxicity and development of respiratory weakness are still lacking, and would greatly aid clinical decision making and future research. This review attempts to update the reader on the current state of knowledge regarding this important issue.

show abstract

Underestimation of snakebite mortality by hospital statistics in the Monaragala District of Sri Lanka

Cited by 64 publications

References 3 publications

Snake Bite in South Asia: A Review

Snake Bite in South Asia: A Review

Syndromic Approach to Treatment of Snake Bite in Sri Lanka Based on Results of a Prospective National Hospital-Based Survey of Patients Envenomed by Identified Snakes

Neurotoxicity in Snakebite—The Limits of Our Knowledge

Contact Info

Product

Resources

About