The National Institute for Research in Reproductive and Child Health (NIRRH) has begun a study in Maharashtra and Odisha aiming for community empowerment and capacity building of the public healthcare system to prevent and manage snakebite envenomation.
A recent national mortality survey estimated that India had 1.2 million snakebite deaths (average 58,000/year) from 2000 to 2019, an increase of about 8,000 deaths/year compared to the earlier estimated survey (2001–2003). Snakebites lead to around 81,410-137,880 deaths from 1.8 million-2.7 million cases globally.
The World Health Organization (WHO) on May 23, 2019, launched its roadmap to reduce the death and disability from snakebites by 50 per cent by 2030.
A NITI Aayog meeting was held in May last year in which Dr Rahul Gajbhiye, senior scientist at the NIRRH, under Indian Council of Medical Research (ICMR), outlined the need for a national snakebite prevention and management programme.
The ICMR National Snakebite Project (INSP) uses a multi-sectoral approach to reduce the burden of snake bite envenomation.
Recently, ICMR-NIRRH researchers published a report ‘National snakebite project on capacity building of health system on prevention and management of snakebite envenoming including its complications in selected districts of Maharashtra and Odisha in India: a study protocol’ in PLOS One open-access journal.
Himmatrao Bawaskar, a Padma Shri awardee known for his significant research on scorpion stings treatment, was the paper’s co-author.
“Culturally appropriate educational and awareness materials in regional languages through the ICMR National Snakebite Project (INSP) have been developed, and these educational and awareness materials will be useful for the states having a high burden of snakebites in India,” Dr Gajbhiye, principal investigator, ICMR national task force study and a co-author of the study, told The Indian Express.
For instance, researchers have explained how simple, cost-effective interventions such as using a bed net while sleeping, using a torch and stick while walking in the dark, banning open defecation practices, and using knee-length footwear in farms can aid in the prevention of snakebites.
“The study is currently being carried out in the Shahapur block of Thane district in Maharashtra, Aheri block of Gadchiroli district in Maharashtra, Khordha block of the Khordha district in Odisha and Kashipur block of the Rayagada district in Odisha,” said Dr Hrishikesh Munshi, another co-author of the study.
The two-year implementation research involves the collection of retrospective data, community focus group discussions, facility assessment for snakebite management preparedness, training of medical officers, interviews of healthcare workers, development of comprehensive culturally appropriate IEC material in local languages, post-training prospective data collection and evaluation of the interventions to assess their impact.
The genesis of the snakebite project was Dr Rahul Gajbhiye’s experience and learnings from Dahanu, Maharashtra. Dr Gajbhiye, with his research team, chalked out an implementation research project that utilised a multi-sectoral approach to improve community awareness for the prevention and early referral of snakebite victims to health facilities and empower medical officers to manage the snakebite envenomation and its complications.
Their efforts led to a significant reduction in the case fatality rate, from 4.5 per cent to 0.4 per cent in the Dahanu block, Maharashtra. The ICMR National Task Force (NTF) Expert Group on Snakebite Research in India, set up in 2019, recommended an upscaling of the Dahanu model employing a similar methodology to a national-level project involving the west and east zones of India.
Dr Gajbhiye developed the project and collaborated with Public Health Department, Maharashtra, and ICMR-Regional Medical Research Center (RMRC), Bhubaneswar, for implementation in Maharashtra and Odisha states, respectively, said Dr Smita Mahale, former director of NIRRCH and co-author.
An earlier study conducted by ICMR-NIRRH revealed the unnecessary practice of anti-snake venom ASV intradermal tests being carried out by medical officers and that the ASV manufacturers recommended this practice in their ASV vial inserts. The Maharashtra public health department brought this issue to light, and formal letters were issued to manufacturers to remove the ASV test dose recommendation, said Dr Geetanjali Sachdeva, director of NIRRH, Mumbai.
The INSP protocol will help establish Model clinical snakebite management centres all over the country.
