ICMR-National Task Force Project: Incidence, mortality and socioeconomic burden of snakebite in India, an interim report

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Despite which comprehensive epidemiological data remains scarce. This study aimed to estimate the incidence, mortality, clinical outcomes, treatment-seeking behavior, and socio-economic burden of SBE across India. Methods: Cross-sectional survey involving residents from 31 districts across 13 states in India, representing an approximate population of 83.9 million. Data collection was managed by trained frontline health workers using a standardized questionnaire. Statistical analyses included incidence and mortality rates, with additional analysis based on treatment costs and socio-economic status. Findings: The survey reported 7,094 snakebite cases, with a mortality rate of 2.6%, of which 43.1% occurred outside a hospital setting. Incidence was highest among males (64.1%), in the age group 30–39 years (20.9%), and during the monsoon season (62.1%). 86.4% of victims required hospitalization, with 60.2% receiving anti-snake venom (ASV); however, 17.2% experienced adverse reactions. Socio-economic analysis revealed that 87.7% of victims lacked insurance highlighting the substantial economic burden imposed on affected families. Average out-of-pocket (OOP) expenditure for a victim was INR 6500. The mean cost towards treatment of SBE was INR 7500 (range 50-376600). Mean cost of treatment in the private sector was INR 27400, 3900 in the public sector and 3600 for alternate forms of treatment. Interpretation: Snakebites pose a significant public health challenge in India, with high out-of-pocket expenditure and a significant proportion of deaths occurring outside hospital settings, indicating delays in seeking medical care. Reliance on faith healers, inadequate access to quality healthcare and anti-snake venom (ASV), and financial hardship further exacerbate the burden. These findings highlight the urgent need for improved healthcare infrastructure, enhanced ASV availability, standardized treatment protocols, and financial protection measures to improve patient outcomes and reduce the economic impact on affected families. Health sciences/Medical research/Epidemiology Earth and environmental sciences/Environmental social sciences/Socioeconomic scenarios Snakebite Envenomation Venomous Non-venomous Epidemiology Mortality Economic burden Introduction Snakebite envenomation (SBE) a neglected global health issue, predominantly affecting rural populations in tropical and subtropical countries. ( 1 ) 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 limited. ( 1 ) 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 regions. ( 1 ) India bears the largest burden of snakebite envenomation globally, accounting for nearly half of the world's snakebite deaths. ( 3 ) 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 activities. ( 5 ) Snakebite mortality is significantly higher in rural areas, with the highest number of fatalities recorded in Uttar Pradesh, Andhra Pradesh, and Bihar. ( 5 ) 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 activity. ( 3 ) 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 campaigns. ( 6 ) 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 complications. ( 7 ) Social and cultural factors play a significant role in the delayed presentation to medical facilities, as many victims rely on traditional healers, contributing to complications. ( 7 ) Vaiyapuri et al. (2013) reported the substantial economic burden from SBE on affected families from the state of Tamil Nadu, while Roshnath et al. (2018) studied the incidence of snakebites and the associated compensation payments in Kannur district, of Kerala, further emphasizing the financial strain on rural communities. ( 8 , 9 ) Dandona et al. (2018) expanded on these findings by examining the high mortality rates due to snakebites in Bihar, underscoring the need for more comprehensive public health interventions. ( 10 ) 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 Africa. ( 11 ) 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 snakebite. ( 12 ) 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-life. ( 13 , 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 2030. ( 15 , 16 ) Objective Addressing these gaps, 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 across 13 states in five different geographical zones. Specifically, the study findings in 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. Methods Study Design The study was a cross-sectional, population-based survey designed to estimate snakebites' epidemiological and socio-economic burden across 13 states in five geographical zones of India. Over a one-year period, it captured data on snakebite incidence, mortality, injury patterns, therapeutic aspects, treatment-seeking behaviours, and the cost of illness among snakebite victims. Study Population The study population included all residents in the selected districts across the 13 states. The study covered 336 blocks in 31 districts, representing approximately 83.9 million people. Inclusion and Exclusion Criteria Inclusion Criteria : All snakebite victims identified by ASHAs and their family members who consented to participate. Exclusion Criteria : Cases related to poisoning or non-ophidian bites, and individuals who refused consent. Ethical Considerations Ethical approvalwas obtained from the Institutional Ethics Committee of Amrita Institute of Medical Sciences and other participating institutes. Informed consent was obtained from all participants, and data confidentiality was strictly maintained. Outcome Measures Primary Outcomes : Incidence, mortality rates, and treatment seeking behaviour of victims of snakebite, and socio-economic burden including treatment costs Secondary Outcomes : Clinical course of snakebite victims, including symptoms, hospital stay duration, and use of anti-snake venom (ASV) vials. Data Collection Data was collected by trained frontline health workers (ASHAs) at the ward level, who are typically aware of health events in their communities. These workers reported new snakebite cases within two weeks of the incident, discharge from hospital or death, regardless of whether the victim sought treatment in a hospital or through alternative methods. Using a standardised questionnaire, field officers gathered detailed data on each case, including victim characteristics, clinical outcomes, and treatment costs. Data were entered in real-time using tablets and synchronized to a central server. To minimize the risk of missing snakebite cases, several measures were implemented. Training sessions were held for ASHAs at district, sub-district and Block levels on the data entry process for reporting snakebite. Training sessions also included modules on the sentinel signs and symptoms of envenoming, first-aid measures, the Do’s and Don’ts, and identification of the common venomous snakes of the region. Additionally, the grant included provisions for incentivizing ASHAs to report each snakebite case to the District Coordinator. Statistical Analysis Data quality was monitored through random verification by district coordinators and Principal Investigators. The data were analysed using statistical software R (version 4.4.2, Foundation for Statistical Computing, Vienna,Austria). Incidence rates were calculated with 95% confidence. Continuous variables were presented as means and standard deviations, while categorical variables were presented as frequencies and percentages. Detailed methodology used in this study can be assessed in the study protocol paper published in the PLOS ONE journal, https://doi.org/10.1371/journal. pone.0270735. (17) The study has been reported using the STROBE checklist for cross-sectional studies. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Results Table 1 Descriptive Statistics of Victim Characteristics. Number Percentage Gender Male 4546 64.08 Female 2545 35.88 Trans 3 0.04 Age 0–9 259 3.65 10–19 849 11.97 20–29 1372 19.34 30–39 1485 20.93 40–49 1320 18.61 50–59 944 13.31 > 60 865 12.19 Occupation Agriculture/Farming 1741 24.54 Animal Husbandry 18 0.25 Government Service 346 4.88 Unskilled Labor 1805 25.44 Skilled Labor/Artisans 211 2.97 Unemployed/No Occupation 303 4.27 Business 212 2.99 Housewife 1227 17.30 Student 1148 16.18 Not Available 83 1.17 BPL (below-poverty-line) Yes 3726 52.52 No 3368 47.48 Co-morbidities present Yes 708 9.98 No 6386 90.02 Co Morbidities Hypertension 508 71.75 Diabetes 95 13.42 Dyslipidaemia 15 2.12 COPD 11 1.55 CVD 10 1.41 Other 69 9.75 Previous bite history Yes 235 3.3 No 6859 96.7 *COPD- Chronic Obstructive Pulmonary Disorder, CVD- Cardio Vascular Diseases The total number of snakebites reported in all project districts during the study period is 7,094. The gender distribution in the study predominantly comprises of males (64.1%), with females constituting 35.9%. The age groups are widely represented, with the highest proportions in the 30–39 age group (20.9%), followed by the 40–49 (18.6%) and 20–29 (19.3%) age groups. Unskilled labour is the most common occupation among participants (25.4%), followed by agriculture/farming (24.5%) and housewives (17.3%). Over half of the participants (52.5%) live below the poverty line (BPL). Among those with comorbidities, hypertension is the most common (71.6%). A minority of the population (3.3%) reported a previous snake bite history. (Table 1 ) Table 2 Types and Species of Snakes Number Percentage Snake Type Non-venomous 2956 41.67 Hematotoxic 2371 33.42 Neurotoxic 1767 24.91 Species Non-Venomous 2956 41.67 Russell’s viper 1204 16.97 Krait 812 11.45 Saw-Scaled viper 564 7.95 Cobra 511 7.20 Other Venomous Species 1047 14.76 Snake capture Not captured 5105 71.96 captured 405 5.71 Killed 1584 22.33 The distribution of snakebite types reported includes non-venomous bites at 41.7%, hematotoxic bites at 33.4%, and neurotoxic bites at 24.9%. Breaking down the bites by specific species, Russel's viper accounts for 17%, krait for 11.5%, saw-scaled viper for 7.9%, cobra for 7.2%, and other venomous species for 14.8%. 5.7% of victims brought a captured live specimen of the snake while 22.3% of victims brought the killed specimen along.(Table 2 ) Table 3 Bite Details and Clinical Presentation Number Percentage Season June-September (monsoon) 4406 62.1 October- January (winter) 1435 20.2 February-May(summer) 1253 17.7 Time of Bite 6:00 AM − 1:59 PM 2780 39.19 2:00 PM − 9:59 PM 2991 42.16 10:00 PM − 5:59 AM 1323 18.65 Bite Site Genital Area 3 0.04 Head, Face, and Neck 75 1.06 Lower Limbs (Legs, Feet, Toes) 4461 62.9 Torso (Chest, Abdomen, Back) 47 0.7 Upper Limbs (Arms, Hands, Fingers) 2408 33.9 Unknown 100 1.4 Activity at time of bite Farming 1637 23.08 Walking 1275 17.97 While at work (non-farming) 1182 16.66 Sleeping 749 10.56 Inside the house 728 10.26 Tending to live-stock 117 1.65 Others 1406 19.82 Localized Reaction Yes 3125 44.05 No 3969 55.95 Neurological symptoms present Yes 1236 17.42 No 5858 82.58 Symptoms details Numbness and tingling 306 4.52 ptosis 252 3.72 Respiratory paralysis 210 3.10 Muscular paralysis 121 1.79 Peripheral neuropathy 39 0.58 Others 308 4.55 Bleeding manifestation Present Yes 1775 25.02 No 5319 74.98 Bleeding site Bite site 1567 90.06 Mouth and oral cavity 108 6.21 Haematuria 9 0.52 Uterine or vaginal 8 0.46 Gastrointestinal 6 0.34 Intra-cranial 5 0.29 Ears 5 0.29 Airways and Lungs 2 0.11 Intra-muscular 2 0.11 Others 23 1.32 Not known 5 0.29 The seasonal distribution of snakebites highlights a peak during June to September, comprising 62.1% of incidents, with the next highest incidence occurring from October to January (20.2%). Time of bite analysis reveals that bites most frequently happen in the afternoon and evening (2:00 PM − 9:59 PM), accounting for 42.2%, followed by morning (6:00 AM − 1:59 PM) with 39.2%, and the least during nighttime hours (10:00 PM − 5:59 AM) at 18.6%. (Table 3 ) The lower limbs (legs, feet, toes) are predominantly site of bite, constituting 62.9% of cases, followed by the upper limbs (arms, hands, fingers) at 33.9%. There are minimal instances involving the head, face, and neck, torso, and genital area. Analysis of victim activity at the time of the bite indicates that farming (23.1%) is the most common context, followed by walking (18%) and other work-related activities (16.7%). (Table 3 ) Table 4 Hospitalization and Bite Management Details Number Percentage Immediate first aid Torniquet/pressure bandage Yes 4380 61.74 No 2714 38.26 Hospitalised Yes 6128 86.38 No 966 13.62 Hospital Facility Type Primary Health Centre 530 8.65 Taluk Hospital 1655 27.01 District Hospital 2138 34.89 Medical College 886 14.46 Private Hospital 883 14.41 Alternate Treatment 36 0.59 Use of blood products Yes 204 2.88 No 6890 97.12 Requirement of Dialysis Yes 81 1.14 No 7013 98.86 Requirement of Ventilator Yes 452 6.37 No 6642 93.63 Requirement of wound debridement Percentage Yes 408 5.75 No 6686 94.25 ASV Used Yes 4267 60.15 No 2732 38.51 Don’t know 95 1.34 Adverse reaction to ASV Yes 733 17.18 If ASV discontinued due to adverse reactions Yes 270 6.33 Long Term Sequel None 6675 94.09 Neurological sequel 164 2.31 Skin lesions (eczema etc) at bite site 78 1.10 Other 68 0.96 Psychological 35 0.49 Local reactions at bite site 32 0.45 Renal complications 16 0.23 Cardiac sequel 12 0.17 Amputations/ Disabilities 11 0.16 Endocrinal abnormalities 3 0.04 Patient Died Yes 195 2.75 No 6899 97.25 Location of Death Hospital 111 56.92 Outside hospital settings 84 43.08 61.7% of snakebite victims received initial first aid in the form of a tourniquet or pressure bandage. A substantial majority, 86.4%, were subsequently hospitalized, utilizing a range of facilities from Primary Health Centres (PHCs) at 8.7% to District Hospitals at 34.9%, with other cases handled in private hospitals (14.4%) and a fraction of the victims also sought treatment solely through alternative medicine. (Table 4 ) The average duration of hospital stays was recorded at 2.24 days. Regarding intensive care needs, 6.4% of patients required ventilator support and 5.7% underwent wound debridement. Antivenom serum (ASV) was administered to 60.2% of cases; however, 17.2% of these patients experienced adverse reactions, leading to the discontinuation of ASV in 6.3% of those affected. Long-term effects varied, with neurological sequelae being the most frequent (2.3%), followed by skin lesions at the bite site (1.1%). Other complications included psychological effects, local reactions, renal and cardiac complications, and in rare cases, amputations or disabilities. The percentage of victim who died due to SBE is 2.6%, with deaths almost evenly distributed between outside hospital (43.1%) and hospital settings (56.9%). (Table 4 ) Table 5 Economic Profile of Victims Number Percentage Insurance Yes 875 12.33 No 6219 87.67 Scheme None 6219 87.67 Self - Public (Jan Arogya) 598 8.43 State Insurance 157 2.21 Other 88 1.24 Self-employer provided (Employee State I) 14 0.20 Covered by family plan of children 9 0.13 Self - Private 9 0.13 Disability Insurance Yes 31 0.44 No 7063 99.56 Any other financial support Yes 293 4.13 No 6801 95.87 Life Insurance Yes 124 1.75 No 6970 98.25 A significant majority, 87.7%, do not have any form of insurance, while only 12.3% are insured. with a smaller percentage using public schemes like Jan Arogya (8.4%), state insurance (2.2%), and other miscellaneous options including employer-provided insurance (ESI), private insurance, or being covered by a family plan of children, each representing less than 1.5% of the total. Life insurance coverage is also minimal, with 98.3% of the population not having any life insurance and only 1.7% covered. (Table 5 ) Table 6 Out-of-pocket expenditure for patients treated for snake bites Mean Median (IQR) Range (Min-Max) Amount paid out pocket for patients 6453.5 2000 (500–5000) 50–376668 Amount paid out pocket for patients – venomous bite 7527 2000 (500–5000) 50–376668 Amount paid out pocket for patients – Non venomous bite 3954 1400 (500–4000) 30–150000 Amount paid out pocket for patients Private 27402 14000 (5000–30000) 50–376668 Government 3898 1500 (500–4000) 30–100000 Alternate treatment 3580 2500(750–4150) 100 -10000 On average, patients pay ₹6,453.50, with a median of ₹2,000 (IQR: ₹500-₹5,000) and a broad range from ₹50 to ₹376,668. Patients bitten by venomous snakes incur slightly higher costs, averaging ₹7,527. Conversely, non-venomous bites are less costly, averaging ₹3,954, with a median cost of ₹1,400 (IQR: ₹500-₹4,000) and a narrower range. Private hospitals charge the highest, with an average cost of ₹27,402 and a median of ₹14,000 (IQR: ₹5,000-₹30,000). In contrast, government facilities offer more affordable care, averaging ₹3,898 with a median of ₹1,500 (IQR: ₹500-₹4,000), and alternate treatment centres average ₹3,580, with a median of ₹2,500 (IQR: ₹750-₹4,150) with a maximum cost cap of ₹10,000. (Table 6 ) Table 7 District-wise Distribution of Events, Deaths, Incidence Risk, Mortality Risk, and Case Fatality Rate District State Number of Incidents Number of Deaths Projected Population 2024 (Annual Growth rate 1.64%, India 2001–2011) Incidence Risk (in 100000 Population) Mortality Risk (in 100000 Population) Case Fatality Rate Aizawl Mizoram 85 --- 494579 17.19 --- --- Amritsar Punjab 196 11 3077190 6.37 0.36 5.61 Bikaner Rajasthan 150 3 2920629 5.14 0.1 2 Champhai Mizoram 38 --- 155357 24.46 ---- ---- Chamba Himachal Pradseh 158 4 641320 24.64 0.62 2.53 Chittoor Andhra Pradesh 531 3 5157030 10.3 0.06 0.56 Cuttack Odisha 869 9 3242516 26.8 0.28 1.04 Dhalai Tripura 88 2 467301 18.83 0.43 2.27 Ernakulam Kerala 113 2 4055370 2.79 0.05 1.77 Hoshiarpur Punjab 197 11 1960265 10.05 0.56 5.58 Jaisalmer Rajasthan 537 1 827681 64.88 0.12 0.19 Kangra Himachal Pradseh 381 22 1865688 20.42 1.18 5.77 Kannur Kerala 155 4 3117154 4.97 0.13 2.58 Ludhiana Punjab 183 19 4322670 4.23 0.44 10.38 Lunglei Mizoram 26 1 199443 13.04 0.5 3.85 Nainital Uttarakhand 229 10 1179408 19.42 0.85 4.37 Nanded Maharashtra 856 29 4152855 20.61 0.7 3.39 Pakke Kessang Arunachal Pradesh 8 --- 18975 42.16 ---- ---- Papum Pare Arunachal Pradesh 20 1 218155 9.17 0.46 5 Pune Maharashtra 236 13 11649974 2.03 0.11 5.51 Raigad Maharashtra 1012 16 3254537 31.1 0.49 1.58 Sambalpur Odisha 563 11 1286271 43.77 0.86 1.95 South Tripura Tripura 195 2 1082294 18.02 0.18 1.03 Udaipur Rajasthan 156 13 3791014 4.11 0.34 8.33 Una Himachal Pradseh 112 8 643906 17.39 1.24 7.14 Total 7094 195 59781583 11.87 0.33 2.75 There are a total of 7,094 snakebite incidents across various districts in India. Among these, Jaisalmer in Rajasthan reports the highest incidence risk at 64.9 per 100,000 population (95% CI: 59.39–70.37). Other districts with notable incidence risks include Sambalpur in Odisha (43.8, 95% CI: 40.15–47.39), Raigad in Maharashtra (31.1, 95% CI: 29.18–33.01), and Champhai in Mizoram (24.5, 95% CI: 16.68–32.24). (Table 8) In terms of fatalities, the data records a total of 195 deaths. The district of Nanded in Maharashtra reported 29 deaths at a mortality risk of 0.70 per 100,000 population (95% CI: 0.44–0.95). Kangra in Himachal Pradesh reports the highest risk of deaths at 22 cases, with a case fatality rate of 5.8% (mortality risk 1.18 per 100,000 population, 95% CI: 0.69–1.67). Ludhiana in Punjab also has a significant number of deaths (19), but with a higher case fatality rate of 10.4% (mortality risk 0.44 per 100,000 population, 95% CI: 0.24–0.64). (Table 7 ) Discussion Snakebite is an NTD traditionally under the health system’s radar globally. India bears the largest burden of incidence and mortality resulting from SBE. The only representative data is verbal autopsy-based mortality data from the One-Million death study (1MDS) 18 and subsequent follow-up. Available data on snakebite is predominantly from hospital case series (Maharashtra, West Bengal, Tamil Nadu, Karnataka and Kerala), with two community-level sampled studies from West Bengal from Burdwan district 19 and South 24 Parganas 20 , and a sampled study on mortality for the state of Bihar. 10 The ICMR-funded National Task Force study is, hence, the only representative study assessing incidence, mortality, treatment-seeking behaviour, therapy and the economic burden across the country. SBE is hugely underreported as several rural victims do not seek modern medical care which in turn is responsible for the unacceptably high mortality and morbidity. The fact that SBE is a medicolegal case (MLC) again is a cause for the underreporting as it is only the definitive incident that gets listed in the national registry. SBE is in most circumstances accidental, occurring while engaged in outdoor occupations, affects the economically productive rural populations, and is eminently treatable. Recent estimates suggest an annual mortality of 58000 due to SBE which reflects inequity, impoverishment, agricultural practices, financial burden of treatment, lack of physical infrastructure and the state of the health system in the country. 18 SBE is a disease associated with poverty and impoverishment, majorly affecting marginalised and rural populations who typically are underserved by the health system. Most rural victims rely on alternate systems of medicine or faith healers for immediate care and treatment. A significant proportion of snakebites are from non-venomous species or dry bites on which faith healers build up a reputation, at the cost of losing precious initial hours in cases of envenoming. Rural victims depending on faith healers is partly related to their availability and the non-availability of medical services in the primary care setting beyond afternoon hours. The NTF study has been completed in 11 states and is underway in West Bengal and Meghalaya. The project was sanctioned in February 2020, was planned to get underway in September 2020, and was stalled across states due to the raging COVID-19 pandemic. The data was gathered for a continuous period of one year across all the states, starting at different time-points. The state of Rajasthan was the first to get started, followed by Kerala, while Uttarakhand was the last from among the 11 states from sites where the study has been completed. Extrapolation of the results from the selected sites to countrywide statistics would suggest a total incidence of snakebite for the country at 120,852 annually, considering that the population included in the study is 5.87% of the total Indian population of 1.42 billion. Of the total of 788 districts 25 have been surveyed (3.2%). The reasons for the low numbers could be underreporting as cases may have been missed by ASHA workers; low numbers secondary to the effect of the pandemic as agricultural activity had diminished considerably then; the study not being representative enough with large states like Uttar Pradesh, Madhya Pradesh and Bihar being excluded and the study being in progress in West Bengal which is again considered one of the hot-spots for SBE; the fact that of the eleven states represented three are in the North-East with low population densities; snakebite is considered a bad omen for the village in Arunachal Pradesh leading to the incident kept a secret and it not being reported; the study team not being to create the necessary ecosystem necessary to report snakebite incidents through the public health system in certain districts; the subject being foreign to ASHA workers whose primary role is in maternal and child health. The study underlines the fact that SBE is a disease of impoverishment with 53% of victims being below-the-poverty line. SBE was seen to be seasonal, mostly associated with outdoor professions, predominantly affecting males in the productive age-groups. Significantly only 12% of the victims had insurance cover in spite of the fact that each BPL card holder is eligible to the Ayushman Jan Aarogya health card which provides for free treatment in public sector and select empanelled hospitals in the corporate sector. A distressing statistic is that 43% of deaths occurred outside hospital settings or in transit, suggesting that individuals did not seek care following alternate or faith healing. Treatment for SBE was predominantly availed in the public sector hospitals in most states with a couple of exceptions like Kerala and the Punjab. The study is the first nationally representative, at-scale, community-based study on the incidence and mortality of snakebites in the country. One of the unmeasured outcomes of the study is the training of ASHA workers in the study districts on first-aid measures, identification of venomous species and recognising sentinel symptoms and signs of neuro- and hemotoxicity suggesting envenoming. A trained cadre of health workers at the community level would go a long way in ensuring timely referral to healthcare facilities with the capability to manage SBE. This would be critical to meeting the WHO SDG goals for 2030 for SBE. 16 Trained health workers would be the interphase between the victim and the health system especially in remote regions with inadequate health facilities, thereby helping overcoming the issue of victims depending on faith healers and alternate systems of medicine. Declarations Funding Indian Council of Medical Research (ICMR). Contributors: JCM and OB conceptualized the study and oversaw its design and implementation. All other authors contributed to various aspects of the study, including data collection, statistical analysis, clinical interpretation, epidemiological assessment, and manuscript review. They played key roles in ensuring data accuracy, providing subject matter expertise, and refining study conclusions. Dr. Jaideep C. Menon and Dr. Omesh Kumar Bharti had full access to all the data and take final responsibility for the decision to submit for publication. All authors reviewed and approved the final manuscript. Declaration of interests: We declare no competing interests . Acknowledgement: This study was funded by the Indian Council of Medical Research (ICMR) through its Task Force project (58/6/6/SB-Kerala2020-NCD-II dated 25.02.2020). We extend our sincere gratitude to Mr. Selman Siddique for his efficient liaison work during the field data collection phase, which was vital for the success of our research. We also wish to thank Dr. R M Kini, Harikrishnan T Menon, Dr. Amitava Banerjee, Dr. Oommen V Oommen, and P. R. Sudhakaran for their invaluable input as subject experts. Their insights and expertise were instrumental in shaping the scope and direction of this study. Conflicts of Interest: None. References World Health Organization (2024) Snakebite envenoming. Available from https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming . Assess Date September Kasturiratne A, Lalloo DG, de Janaka H (2021) Chronic health effects and cost of snakebite. Toxicon: X , 9–10 , 100074. https://doi.org/10.1016/j.toxcx.2021.100074 Suraweera W, Warrell D, Whitaker R, Menon G, Rodrigues R, Fu SH, Begum R, Sati P, Piyasena K, Bhatia M, Brown P, Jha P (2020) Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. eLife 9:e54076. https://doi.org/10.7554/eLife.54076 Gayathri G, Muralidar S, Prakash D, Kamalakkannan A, Thuthikkadu Indhuprakash S, Thirumalai D, Ambi SV (2023) The concept of Big Four: Road map from snakebite epidemiology to antivenom efficacy. Int J Biol Macromol 242(Part 1):124771. https://doi.org/10.1016/j.ijbiomac.2023.124771 Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM et al (2011) Snakebite Mortality in India: A Nationally Representative Mortality Survey. PLoS Negl Trop Dis 5(4). https://doi.org/10.1371/journal.pntd.0001018 White J (2013) Envenoming and antivenom use in Australia. 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Herpetol Bull. ;26–29 Dandona R, Kumar GA, Kharyal A, George S, Akbar M, Dandona L (2018) Mortality due to snakebite and other venomous animals in the Indian state of Bihar: Findings from a representative mortality study. PLoS ONE 13(6). https://doi.org/10.1371/journal.pone.0198900 Ediriweera DS, Kasturiratne A, Pathmeswaran A, Gunawardena NK, Wijayawickrama BA, Jayamanne SF et al (2016) Mapping the Risk of Snakebite in Sri Lanka—A National Survey with Geospatial Analysis. PLoS Negl Trop Dis 10(7). https://doi.org/10.1371/journal.pntd.0004813 Chakma JK, Menon JC, Dhaliwal RS, Indian Council of Medical Research# (2020) White paper on venomous snakebite in India. Indian J Med Res 152(6):568–574. https://doi.org/10.4103/ijmr.IJMR_3377_20 Gutiérrez J, Calvete J, Habib A et al (2017) Snakebite envenoming. 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Toxicon: official J Int Soc Toxinology 56(7):1223–1235. https://doi.org/10.1016/j.toxicon.2009.11.020 Dalhat MM, Potet J, Mohammed A, Chotun N, Tesfahunei HA, Habib AG (2023) Availability, accessibility and use of antivenom for snakebite envenomation in Africa with proposed strategies to overcome the limitations.Toxicon:X,18*. 100152. https://doi.org/10.1016/j.toxcx.2023.100152 World Health Organization (2021), September 19 Snakebite envenoming: An interactive data platform to support the 2030 targets . https://www.who.int/news/item/19-09-2021-snakebite-envenoming-an-interactive-data-platform-to-support-the-2030-targets Menon JC, Bharti OK, Dhaliwal RS, John D, Menon GR et al (2022) ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: A study protocol. PLoS ONE 17(8):e0270735. https://doi.org/10.1371/journal.pone.0270735 Jha P, Gajalakshmi V, Gupta PC, Kumar R, Mony P, Dhingra N, Peto R, RGI-CGHR Prospective Study Collaborators (2006) Prospective study of one million deaths in India: rationale, design, and validation results. PLoS Med 3(2):e18. https://doi.org/10.1371/journal.pmed.0030018 Hati AK, Mandal M, De MK, Mukherjee H, Hati RN (1992) Epidemiology of snake bite in the district of Burdwan, West Bengal. J Indian Med Assoc 90(6):145–147 Majumder D, Sinha A, Bhattacharya SK, Ram R, Dasgupta U, Ram A (2014) Epidemiological profile of snake bite in south 24 Parganas district of West Bengal with focus on underreporting of snake bite deaths. Indian J Public Health 58(1):17–21. https://doi.org/10.4103/0019-557X.128158 Table 8 Table 8 is not available with this version. Additional Declarations There is NO Competing Interest. Supplementary Files ReportingSummary.pdf Reporting Summary Cite Share Download PDF Status: Published Journal Publication published 10 Nov, 2025 Read the published version in Nature Communications → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSnakebite envenomation (SBE) a neglected global health issue, predominantly affecting rural populations in tropical and subtropical countries. \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e 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 limited. \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e 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\u0026rsquo;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 regions. \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIndia bears the largest burden of snakebite envenomation globally, accounting for nearly half of the world's snakebite deaths. \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e This is primarily attributed to India\u0026rsquo;s large agrarian population, at risk for snake-human conflict. The \u0026ldquo;big four\u0026rdquo; venomous species responsible for most envenomation in India include the Indian cobra (\u003cem\u003eNaja naja\u003c/em\u003e), common krait (\u003cem\u003eBungarus caeruleus\u003c/em\u003e), Russell\u0026rsquo;s viper (\u003cem\u003eDaboia russelii\u003c/em\u003e), and saw-scaled viper (\u003cem\u003eEchis carinatus\u003c/em\u003e).\u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e Despite the widespread occurrence of snakebites, India\u0026rsquo;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 activities. \u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e Snakebite mortality is significantly higher in rural areas, with the highest number of fatalities recorded in Uttar Pradesh, Andhra Pradesh, and Bihar.\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e 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 activity. \u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e 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 campaigns. \u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral 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 complications. \u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e Social and cultural factors play a significant role in the delayed presentation to medical facilities, as many victims rely on traditional healers, contributing to complications. \u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eVaiyapuri et al. (2013) reported the substantial economic burden from SBE on affected families from the state of Tamil Nadu, while Roshnath et al. (2018) studied the incidence of snakebites and the associated compensation payments in Kannur district, of Kerala, further emphasizing the financial strain on rural communities.\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e Dandona et al. (2018) expanded on these findings by examining the high mortality rates due to snakebites in Bihar, underscoring the need for more comprehensive public health interventions.\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e 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 Africa.\u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA 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 snakebite. \u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e 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-life.\u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe 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 2030. \u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e"},{"header":"Objective","content":"\u003cp\u003eAddressing these gaps, 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 across 13 states in five different geographical zones. Specifically, the study findings in 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.\u003c/p\u003e \n\n "},{"header":"Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e\n\u003cp\u003eThe study was a cross-sectional, population-based survey designed to estimate snakebites' epidemiological and socio-economic burden across 13 states in five geographical zones of India. Over a one-year period, it captured data on snakebite incidence, mortality, injury patterns, therapeutic aspects, treatment-seeking behaviours, and the cost of illness among snakebite victims.\u003c/p\u003e\n\u003cp\u003eStudy Population\u003c/p\u003e\n\u003cp\u003eThe study population included all residents in the selected districts across the 13 states. The study covered 336 blocks in 31 districts, representing approximately 83.9\u0026nbsp;million people.\u003c/p\u003e\n\u003cp\u003eInclusion and Exclusion Criteria\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e: All snakebite victims identified by ASHAs and their family members who consented to participate.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e: Cases related to poisoning or non-ophidian bites, and individuals who refused consent.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEthical Considerations\u003c/p\u003e\n\u003cp\u003eEthical approvalwas obtained from the Institutional Ethics Committee of Amrita Institute of Medical Sciences and other participating institutes. Informed consent was obtained from all participants, and data confidentiality was strictly maintained.\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary Outcomes\u003c/strong\u003e: Incidence, mortality rates, and treatment seeking behaviour of victims of snakebite, and socio-economic burden including treatment costs\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary Outcomes\u003c/strong\u003e: Clinical course of snakebite victims, including symptoms, hospital stay duration, and use of anti-snake venom (ASV) vials.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eData was collected by trained frontline health workers (ASHAs) at the ward level, who are typically aware of health events in their communities. These workers reported new snakebite cases within two weeks of the incident, discharge from hospital or death, regardless of whether the victim sought treatment in a hospital or through alternative methods. Using a standardised questionnaire, field officers gathered detailed data on each case, including victim characteristics, clinical outcomes, and treatment costs. Data were entered in real-time using tablets and synchronized to a central server.\u003c/p\u003e\n\u003cp\u003eTo minimize the risk of missing snakebite cases, several measures were implemented. Training sessions were held for ASHAs at district, sub-district and Block levels on the data entry process for reporting snakebite. Training sessions also included modules on the sentinel signs and symptoms of envenoming, first-aid measures, the Do\u0026rsquo;s and Don\u0026rsquo;ts, and identification of the common venomous snakes of the region. Additionally, the grant included provisions for incentivizing ASHAs to report each snakebite case to the District Coordinator.\u003c/p\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eData quality was monitored through random verification by district coordinators and Principal Investigators. The data were analysed using statistical software R (version 4.4.2, Foundation for Statistical Computing, Vienna,Austria). Incidence rates were calculated with 95% confidence. Continuous variables were presented as means and standard deviations, while categorical variables were presented as frequencies and percentages. Detailed methodology used in this study can be assessed in the study protocol paper published in the \u003cem\u003ePLOS ONE\u003c/em\u003e journal, https://doi.org/10.1371/journal. pone.0270735. \u003csup\u003e(17)\u003c/sup\u003e The study has been reported using the STROBE checklist for cross-sectional studies.\u003c/p\u003e\n\u003cp\u003eThe funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescriptive Statistics of Victim Characteristics.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u0026ndash;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e865\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgriculture/Farming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnimal Husbandry\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment Service\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnskilled Labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSkilled Labor/Artisans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed/No Occupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot Available\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eBPL\u003c/p\u003e\n \u003cp\u003e(below-poverty-line)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eCo-morbidities present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eCo Morbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDyslipidaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCOPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrevious bite history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*COPD- Chronic Obstructive Pulmonary Disorder, CVD- Cardio Vascular Diseases\u003c/p\u003e\n\u003cp\u003eThe total number of snakebites reported in all project districts during the study period is 7,094. The gender distribution in the study predominantly comprises of males (64.1%), with females constituting 35.9%. The age groups are widely represented, with the highest proportions in the 30\u0026ndash;39 age group (20.9%), followed by the 40\u0026ndash;49 (18.6%) and 20\u0026ndash;29 (19.3%) age groups. Unskilled labour is the most common occupation among participants (25.4%), followed by agriculture/farming (24.5%) and housewives (17.3%). Over half of the participants (52.5%) live below the poverty line (BPL). Among those with comorbidities, hypertension is the most common (71.6%). A minority of the population (3.3%) reported a previous snake bite history. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTypes and Species of Snakes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSnake Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-venomous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHematotoxic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeurotoxic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpecies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-Venomous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRussell\u0026rsquo;s viper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKrait\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSaw-Scaled viper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCobra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther Venomous Species\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSnake capture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot captured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e71.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecaptured\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe distribution of snakebite types reported includes non-venomous bites at 41.7%, hematotoxic bites at 33.4%, and neurotoxic bites at 24.9%. Breaking down the bites by specific species, Russel\u0026apos;s viper accounts for 17%, krait for 11.5%, saw-scaled viper for 7.9%, cobra for 7.2%, and other venomous species for 14.8%. 5.7% of victims brought a captured live specimen of the snake while 22.3% of victims brought the killed specimen along.(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBite Details and Clinical Presentation\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eSeason\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJune-September (monsoon)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOctober- January (winter)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFebruary-May(summer)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eTime of Bite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6:00 AM \u0026minus;\u0026thinsp;1:59 PM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2:00 PM \u0026minus;\u0026thinsp;9:59 PM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10:00 PM \u0026minus;\u0026thinsp;5:59 AM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eBite Site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGenital Area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHead, Face, and Neck\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower Limbs (Legs, Feet, Toes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTorso (Chest, Abdomen, Back)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper Limbs (Arms, Hands, Fingers)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eActivity at time of bite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWalking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhile at work (non-farming)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSleeping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e749\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInside the house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTending to live-stock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eLocalized Reaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eNeurological symptoms present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5858\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eSymptoms details\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumbness and tingling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eptosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRespiratory paralysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuscular paralysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePeripheral neuropathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eBleeding manifestation Present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e74.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"11\" align=\"left\"\u003e\n \u003cp\u003eBleeding site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBite site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMouth and oral cavity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHaematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUterine or vaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGastrointestinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntra-cranial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAirways and Lungs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntra-muscular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot known\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe seasonal distribution of snakebites highlights a peak during June to September, comprising 62.1% of incidents, with the next highest incidence occurring from October to January (20.2%). Time of bite analysis reveals that bites most frequently happen in the afternoon and evening (2:00 PM \u0026minus;\u0026thinsp;9:59 PM), accounting for 42.2%, followed by morning (6:00 AM \u0026minus;\u0026thinsp;1:59 PM) with 39.2%, and the least during nighttime hours (10:00 PM \u0026minus;\u0026thinsp;5:59 AM) at 18.6%. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eThe lower limbs (legs, feet, toes) are predominantly site of bite, constituting 62.9% of cases, followed by the upper limbs (arms, hands, fingers) at 33.9%. There are minimal instances involving the head, face, and neck, torso, and genital area. Analysis of victim activity at the time of the bite indicates that farming (23.1%) is the most common context, followed by walking (18%) and other work-related activities (16.7%). (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eHospitalization and Bite Management Details\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eImmediate first aid Torniquet/pressure bandage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eHospitalised\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eHospital Facility Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary Health Centre\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTaluk Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDistrict Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical College\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlternate Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eUse of blood products\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eRequirement of Dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eRequirement of Ventilator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eRequirement of wound debridement Percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eASV Used\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdverse reaction to ASV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIf ASV discontinued due to adverse reactions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003eLong Term Sequel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e94.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeurological sequel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSkin lesions (eczema etc) at bite site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePsychological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLocal reactions at bite site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRenal complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCardiac sequel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmputations/ Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndocrinal abnormalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePatient Died\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eLocation of Death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutside hospital settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e61.7% of snakebite victims received initial first aid in the form of a tourniquet or pressure bandage. A substantial majority, 86.4%, were subsequently hospitalized, utilizing a range of facilities from Primary Health Centres (PHCs) at 8.7% to District Hospitals at 34.9%, with other cases handled in private hospitals (14.4%) and a fraction of the victims also sought treatment solely through alternative medicine. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003eThe average duration of hospital stays was recorded at 2.24 days. Regarding intensive care needs, 6.4% of patients required ventilator support and 5.7% underwent wound debridement. Antivenom serum (ASV) was administered to 60.2% of cases; however, 17.2% of these patients experienced adverse reactions, leading to the discontinuation of ASV in 6.3% of those affected.\u003c/p\u003e\n\u003cp\u003eLong-term effects varied, with neurological sequelae being the most frequent (2.3%), followed by skin lesions at the bite site (1.1%). Other complications included psychological effects, local reactions, renal and cardiac complications, and in rare cases, amputations or disabilities.\u003c/p\u003e\n\u003cp\u003eThe percentage of victim who died due to SBE is 2.6%, with deaths almost evenly distributed between outside hospital (43.1%) and hospital settings (56.9%). (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eEconomic Profile of Victims\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInsurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf - Public (Jan Arogya)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eState Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-employer provided (Employee State I)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCovered by family plan of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf - Private\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisability Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAny other financial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e95.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLife Insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eA significant majority, 87.7%, do not have any form of insurance, while only 12.3% are insured. with a smaller percentage using public schemes like Jan Arogya (8.4%), state insurance (2.2%), and other miscellaneous options including employer-provided insurance (ESI), private insurance, or being covered by a family plan of children, each representing less than 1.5% of the total. Life insurance coverage is also minimal, with 98.3% of the population not having any life insurance and only 1.7% covered. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eOut-of-pocket expenditure for patients treated for snake bites\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRange (Min-Max)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmount paid out pocket for patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6453.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2000 (500\u0026ndash;5000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;376668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmount paid out pocket for patients \u0026ndash; venomous bite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2000 (500\u0026ndash;5000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;376668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmount paid out pocket for patients \u0026ndash; Non venomous bite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1400 (500\u0026ndash;4000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;150000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmount paid out pocket for patients\u003c/p\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14000 (5000\u0026ndash;30000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;376668\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3898\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1500 (500\u0026ndash;4000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u0026ndash;100000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlternate treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2500(750\u0026ndash;4150)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 -10000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eOn average, patients pay ₹6,453.50, with a median of ₹2,000 (IQR: ₹500-₹5,000) and a broad range from ₹50 to ₹376,668. Patients bitten by venomous snakes incur slightly higher costs, averaging ₹7,527. Conversely, non-venomous bites are less costly, averaging ₹3,954, with a median cost of ₹1,400 (IQR: ₹500-₹4,000) and a narrower range. Private hospitals charge the highest, with an average cost of ₹27,402 and a median of ₹14,000 (IQR: ₹5,000-₹30,000). In contrast, government facilities offer more affordable care, averaging ₹3,898 with a median of ₹1,500 (IQR: ₹500-₹4,000), and alternate treatment centres average ₹3,580, with a median of ₹2,500 (IQR: ₹750-₹4,150) with a maximum cost cap of ₹10,000. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab7\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistrict-wise Distribution of Events, Deaths, Incidence Risk, Mortality Risk, and Case Fatality Rate\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDistrict\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eState\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of Incidents\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of Deaths\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProjected Population 2024 (Annual Growth rate 1.64%, India 2001\u0026ndash;2011)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIncidence Risk (in 100000 Population)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMortality Risk (in 100000 Population)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCase Fatality Rate\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAizawl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMizoram\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e494579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmritsar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePunjab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3077190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBikaner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRajasthan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2920629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChamphai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMizoram\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChamba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHimachal Pradseh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e641320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChittoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAndhra Pradesh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5157030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCuttack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOdisha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3242516\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDhalai\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTripura\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e467301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eErnakulam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKerala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4055370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHoshiarpur\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePunjab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1960265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJaisalmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRajasthan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e827681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKangra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHimachal Pradseh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1865688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKannur\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKerala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3117154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLudhiana\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePunjab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4322670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLunglei\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMizoram\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e199443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNainital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUttarakhand\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1179408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNanded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaharashtra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4152855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePakke Kessang\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArunachal Pradesh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e----\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePapum Pare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eArunachal Pradesh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e218155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePune\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaharashtra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11649974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRaigad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaharashtra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3254537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSambalpur\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOdisha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1286271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSouth Tripura\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTripura\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1082294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUdaipur\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRajasthan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3791014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUna\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHimachal Pradseh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e643906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e7094\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e195\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e59781583\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e11.87\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.33\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.75\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere are a total of 7,094 snakebite incidents across various districts in India. Among these, Jaisalmer in Rajasthan reports the highest incidence risk at 64.9 per 100,000 population (95% CI: 59.39\u0026ndash;70.37). Other districts with notable incidence risks include Sambalpur in Odisha (43.8, 95% CI: 40.15\u0026ndash;47.39), Raigad in Maharashtra (31.1, 95% CI: 29.18\u0026ndash;33.01), and Champhai in Mizoram (24.5, 95% CI: 16.68\u0026ndash;32.24). (Table\u0026nbsp;8)\u003c/p\u003e\n\u003cp\u003eIn terms of fatalities, the data records a total of 195 deaths. The district of Nanded in Maharashtra reported 29 deaths at a mortality risk of 0.70 per 100,000 population (95% CI: 0.44\u0026ndash;0.95). Kangra in Himachal Pradesh reports the highest risk of deaths at 22 cases, with a case fatality rate of 5.8% (mortality risk 1.18 per 100,000 population, 95% CI: 0.69\u0026ndash;1.67). Ludhiana in Punjab also has a significant number of deaths (19), but with a higher case fatality rate of 10.4% (mortality risk 0.44 per 100,000 population, 95% CI: 0.24\u0026ndash;0.64). (Table \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSnakebite is an NTD traditionally under the health system\u0026rsquo;s radar globally. India bears the largest burden of incidence and mortality resulting from SBE. The only representative data is verbal autopsy-based mortality data from the One-Million death study (1MDS)\u003csup\u003e18\u003c/sup\u003e and subsequent follow-up. Available data on snakebite is predominantly from hospital case series (Maharashtra, West Bengal, Tamil Nadu, Karnataka and Kerala), with two community-level sampled studies from West Bengal from Burdwan district\u003csup\u003e19\u003c/sup\u003e and South 24 Parganas\u003csup\u003e20\u003c/sup\u003e, and a sampled study on mortality for the state of Bihar.\u003csup\u003e10\u003c/sup\u003e The ICMR-funded National Task Force study is, hence, the only representative study assessing incidence, mortality, treatment-seeking behaviour, therapy and the economic burden across the country.\u003c/p\u003e \u003cp\u003eSBE is hugely underreported as several rural victims do not seek modern medical care which in turn is responsible for the unacceptably high mortality and morbidity. The fact that SBE is a medicolegal case (MLC) again is a cause for the underreporting as it is only the definitive incident that gets listed in the national registry.\u003c/p\u003e \u003cp\u003eSBE is in most circumstances accidental, occurring while engaged in outdoor occupations, affects the economically productive rural populations, and is eminently treatable. Recent estimates suggest an annual mortality of 58000 due to SBE which reflects inequity, impoverishment, agricultural practices, financial burden of treatment, lack of physical infrastructure and the state of the health system in the country.\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSBE is a disease associated with poverty and impoverishment, majorly affecting marginalised and rural populations who typically are underserved by the health system. Most rural victims rely on alternate systems of medicine or faith healers for immediate care and treatment. A significant proportion of snakebites are from non-venomous species or dry bites on which faith healers build up a reputation, at the cost of losing precious initial hours in cases of envenoming. Rural victims depending on faith healers is partly related to their availability and the non-availability of medical services in the primary care setting beyond afternoon hours.\u003c/p\u003e \u003cp\u003eThe NTF study has been completed in 11 states and is underway in West Bengal and Meghalaya. The project was sanctioned in February 2020, was planned to get underway in September 2020, and was stalled across states due to the raging COVID-19 pandemic. The data was gathered for a continuous period of one year across all the states, starting at different time-points. The state of Rajasthan was the first to get started, followed by Kerala, while Uttarakhand was the last from among the 11 states from sites where the study has been completed.\u003c/p\u003e \u003cp\u003eExtrapolation of the results from the selected sites to countrywide statistics would suggest a total incidence of snakebite for the country at 120,852 annually, considering that the population included in the study is 5.87% of the total Indian population of 1.42\u0026nbsp;billion. Of the total of 788 districts 25 have been surveyed (3.2%). The reasons for the low numbers could be underreporting as cases may have been missed by ASHA workers; low numbers secondary to the effect of the pandemic as agricultural activity had diminished considerably then; the study not being representative enough with large states like Uttar Pradesh, Madhya Pradesh and Bihar being excluded and the study being in progress in West Bengal which is again considered one of the hot-spots for SBE; the fact that of the eleven states represented three are in the North-East with low population densities; snakebite is considered a bad omen for the village in Arunachal Pradesh leading to the incident kept a secret and it not being reported; the study team not being to create the necessary ecosystem necessary to report snakebite incidents through the public health system in certain districts; the subject being foreign to ASHA workers whose primary role is in maternal and child health.\u003c/p\u003e \u003cp\u003eThe study underlines the fact that SBE is a disease of impoverishment with 53% of victims being below-the-poverty line. SBE was seen to be seasonal, mostly associated with outdoor professions, predominantly affecting males in the productive age-groups. Significantly only 12% of the victims had insurance cover in spite of the fact that each BPL card holder is eligible to the Ayushman Jan Aarogya health card which provides for free treatment in public sector and select empanelled hospitals in the corporate sector. A distressing statistic is that 43% of deaths occurred outside hospital settings or in transit, suggesting that individuals did not seek care following alternate or faith healing. Treatment for SBE was predominantly availed in the public sector hospitals in most states with a couple of exceptions like Kerala and the Punjab.\u003c/p\u003e \u003cp\u003eThe study is the first nationally representative, at-scale, community-based study on the incidence and mortality of snakebites in the country. One of the unmeasured outcomes of the study is the training of ASHA workers in the study districts on first-aid measures, identification of venomous species and recognising sentinel symptoms and signs of neuro- and hemotoxicity suggesting envenoming. A trained cadre of health workers at the community level would go a long way in ensuring timely referral to healthcare facilities with the capability to manage SBE. This would be critical to meeting the WHO SDG goals for 2030 for SBE.\u003csup\u003e16\u003c/sup\u003e Trained health workers would be the interphase between the victim and the health system especially in remote regions with inadequate health facilities, thereby helping overcoming the issue of victims depending on faith healers and alternate systems of medicine.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndian Council of Medical Research (ICMR).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eContributors:\u0026nbsp;\u003c/strong\u003eJCM and OB conceptualized the study and oversaw its design and implementation. All other authors contributed to various aspects of the study, including data collection, statistical analysis, clinical interpretation, epidemiological assessment, and manuscript review. They played key roles in ensuring data accuracy, providing subject matter expertise, and refining study conclusions. Dr. Jaideep C. Menon and Dr. Omesh Kumar Bharti had full access to all the data and take final responsibility for the decision to submit for publication. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interests:\u0026nbsp;\u003c/strong\u003eWe declare no competing interests\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eThis study was funded by the Indian Council of Medical Research (ICMR) through its Task Force project (58/6/6/SB-Kerala2020-NCD-II dated 25.02.2020). We extend our sincere gratitude to Mr. Selman Siddique for his efficient liaison work during the field data collection phase, which was vital for the success of our research. We also wish to thank Dr. R M Kini, Harikrishnan T Menon, Dr. Amitava Banerjee, Dr.\u0026nbsp;Oommen V Oommen, and P. R. Sudhakaran for their invaluable input as subject experts. Their insights and expertise were instrumental in shaping the scope and direction of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2024) Snakebite envenoming. Available from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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Nat Rev Dis Primers 3:17063. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/nrdp.2017.63\u003c/span\u003e\u003cspan address=\"10.1038/nrdp.2017.63\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuti\u0026eacute;rrez JM, Williams D, Fan HW, Warrell DA (2010) Snakebite envenoming from a global perspective: Towards an integrated approach. Toxicon: official J Int Soc Toxinology 56(7):1223\u0026ndash;1235. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.toxicon.2009.11.020\u003c/span\u003e\u003cspan address=\"10.1016/j.toxicon.2009.11.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDalhat MM, Potet J, Mohammed A, Chotun N, Tesfahunei HA, Habib AG (2023) Availability, accessibility and use of antivenom for snakebite envenomation in Africa with proposed strategies to overcome the limitations.Toxicon:X,18*. 100152. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.toxcx.2023.100152\u003c/span\u003e\u003cspan address=\"10.1016/j.toxcx.2023.100152\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2021), September 19 \u003cem\u003eSnakebite envenoming: An interactive data platform to support the 2030 targets\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news/item/19-09-2021-snakebite-envenoming-an-interactive-data-platform-to-support-the-2030-targets\u003c/span\u003e\u003cspan address=\"https://www.who.int/news/item/19-09-2021-snakebite-envenoming-an-interactive-data-platform-to-support-the-2030-targets\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenon JC, Bharti OK, Dhaliwal RS, John D, Menon GR et al (2022) ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: A study protocol. PLoS ONE 17(8):e0270735. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0270735\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0270735\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJha P, Gajalakshmi V, Gupta PC, Kumar R, Mony P, Dhingra N, Peto R, RGI-CGHR Prospective Study Collaborators (2006) Prospective study of one million deaths in India: rationale, design, and validation results. PLoS Med 3(2):e18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pmed.0030018\u003c/span\u003e\u003cspan address=\"10.1371/journal.pmed.0030018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHati AK, Mandal M, De MK, Mukherjee H, Hati RN (1992) Epidemiology of snake bite in the district of Burdwan, West Bengal. J Indian Med Assoc 90(6):145\u0026ndash;147\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajumder D, Sinha A, Bhattacharya SK, Ram R, Dasgupta U, Ram A (2014) Epidemiological profile of snake bite in south 24 Parganas district of West Bengal with focus on underreporting of snake bite deaths. Indian J Public Health 58(1):17\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/0019-557X.128158\u003c/span\u003e\u003cspan address=\"10.4103/0019-557X.128158\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 8","content":"\u003cp\u003eTable 8 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"nature-portfolio","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"","title":"Nature Portfolio","twitterHandle":"","acdcEnabled":false,"dfaEnabled":false,"editorialSystem":"ejp","reportingPortfolio":"","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Snakebite Envenomation, Venomous, Non-venomous, Epidemiology, Mortality, Economic burden","lastPublishedDoi":"10.21203/rs.3.rs-5917450/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5917450/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eSnakebite envenomation (SBE), a neglected tropical disease is a significant cause of mortality and disability in India. Despite which comprehensive epidemiological data remains scarce. This study aimed to estimate the incidence, mortality, clinical outcomes, treatment-seeking behavior, and socio-economic burden of SBE across India.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eCross-sectional survey involving residents from 31 districts across 13 states in India, representing an approximate population of 83.9\u0026nbsp;million. Data collection was managed by trained frontline health workers using a standardized questionnaire. Statistical analyses included incidence and mortality rates, with additional analysis based on treatment costs and socio-economic status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings: \u003c/strong\u003eThe survey reported 7,094 snakebite cases, with a mortality rate of 2.6%, of which 43.1% occurred outside a hospital setting. Incidence was highest among males (64.1%), in the age group 30–39 years (20.9%), and during the monsoon season (62.1%). 86.4% of victims required hospitalization, with 60.2% receiving anti-snake venom (ASV); however, 17.2% experienced adverse reactions. Socio-economic analysis revealed that 87.7% of victims lacked insurance highlighting the substantial economic burden imposed on affected families. Average out-of-pocket (OOP) expenditure for a victim was INR 6500. The mean cost towards treatment of SBE was INR 7500 (range 50-376600). Mean cost of treatment in the private sector was INR 27400, 3900 in the public sector and 3600 for alternate forms of treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterpretation: \u003c/strong\u003eSnakebites pose a significant public health challenge in India, with high out-of-pocket expenditure and a significant proportion of deaths occurring outside hospital settings, indicating delays in seeking medical care. Reliance on faith healers, inadequate access to quality healthcare and anti-snake venom (ASV), and financial hardship further exacerbate the burden. These findings highlight the urgent need for improved healthcare infrastructure, enhanced ASV availability, standardized treatment protocols, and financial protection measures to improve patient outcomes and reduce the economic impact on affected families.\u003c/p\u003e","manuscriptTitle":"ICMR-National Task Force Project: Incidence, mortality and socioeconomic burden of snakebite in India, an interim report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-15 16:00:51","doi":"10.21203/rs.3.rs-5917450/v1","editorialEvents":[],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"nature-communications","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"NCOMMS","sideBox":"Learn more about [Nature Communications](http://www.nature.com/ncomms/)","snPcode":"","submissionUrl":"https://mts-ncomms.nature.com/","title":"Nature Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature Communications","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"6d211367-d7c9-440e-b950-19ec8b611e42","owner":[],"postedDate":"February 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":44038141,"name":"Health sciences/Medical research/Epidemiology"},{"id":44038142,"name":"Earth and environmental sciences/Environmental social sciences/Socioeconomic scenarios"}],"tags":[],"updatedAt":"2025-11-11T08:08:59+00:00","versionOfRecord":{"articleIdentity":"rs-5917450","link":"https://doi.org/10.1038/s41467-025-64849-2","journal":{"identity":"nature-communications","isVorOnly":false,"title":"Nature Communications"},"publishedOn":"2025-11-10 05:00:00","publishedOnDateReadable":"November 10th, 2025"},"versionCreatedAt":"2025-02-15 16:00:51","video":"","vorDoi":"10.1038/s41467-025-64849-2","vorDoiUrl":"https://doi.org/10.1038/s41467-025-64849-2","workflowStages":[]},"version":"v1","identity":"rs-5917450","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5917450","identity":"rs-5917450","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}