Karnataka's decision to categorise snake bite cases as notifiable is hailed as a pivotal first stride in tackling this issue.
Published Feb 21, 2024 | 8:00 AM ⚊ Updated Feb 21, 2024 | 9:26 AM
Representative image. (Creative Commons)
Karnataka has etched its name in history as the first state in India to designate snakebite incidents as notifiable diseases, a groundbreaking move set to revolutionise the management of these potentially fatal encounters.
A notifiable disease is one that, when diagnosed, requires health providers (usually by law) to report to state or local public health officials.
Karnataka’s decision to categorise snakebite cases as notifiable is hailed as a pivotal first stride in tackling this issue.
Sumanth Bindumadhav, Director of Wildlife Protection at the Humane Society International/India, an organisation that works towards snakebite prevention and treatment, emphasised to South First, “At the very least, all healthcare facilities are now mandated to report snakebite cases, which they weren’t previously.”
Dr Jaideep C Menon, a renowned cardiologist who has been part of multiple studies and published research papers, including a white paper on snakebites and also part of the ICMR’s task force from Kerala, expresses strong support for Karnataka’s decision to make snakebite cases notifiable.
He highlights the collective effort of various groups in pushing this initiative forward, marking a significant departure from the norm where the notifiability of diseases is typically determined at the national level rather than by individual states.
“Karnataka’s action is a pivotal first step, setting a precedent for other states to follow. This is a very welcome first step,” Dr Menon tells South First, emphasising the potential ripple effect across the country.
The goal, according to Dr Menon, is to reach a tipping point where enough states adopt similar measures, prompting the ICMR, Union government, and the Ministry of Health and Family Welfare to officially recognise snakebites as notifiable diseases nationwide.
In December, the World Health Organization (WHO) unveiled its Regional Action Plan for preventing snakebite envenoming in Southeast Asia. According to this plan, WHO aims to halve snakebite-related deaths and disabilities by 2030.
The common krait is considered the most dangerous snake in India. (Wikimedia Commons)
Despite an annual average of 58,000 reported snakebite deaths, India continues to hold the dubious title of “Capital of Snakebite Cases”.
A 2020 study identified eight states — Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, united Andhra Pradesh, Gujarat, and Rajasthan — as bearing the highest burden of snakebite fatalities.
“These numbers merely scratch the surface. While official records note around 2,000 snakebites per year, a comprehensive study examining 2,833 snakebite deaths from the Indian Million Death Study (spanning 2001-2014) and reviewing 87,590 snakebite incidents (2000-2019) estimates 1.2 million snakebite deaths in the past two decades, averaging 58,000 annually,” explains Bindumadhav.
The study reveals that the most affected demographic includes individuals aged 30 to 69 years, constituting nearly half of the fatalities, and children under 15 years, representing over a quarter of the tragic losses. Moreover, the risk of snakebites in India is not to be underestimated, with 1 in 250 Indians facing the prospect of succumbing to a snakebite before the age of 70, a risk that intensifies in specific regions.
Prof Denny John, a professor of public health at the MS Ramaiah University of Applied Science in Bengaluru, also who is part of the ICMR-constituted task force on snakebites and a member of the WHO review committee on the regional action plan, appreciates Karnataka for taking the decision and calls for other states to notify snakebite cases.
Order notifying snakebite in Karnataka. (Supplied)
Snakebites, a prevalent yet neglected tropical disease, claim tens of thousands of lives annually in India, disproportionately impacting rural and agrarian communities. The notification of snakebite cases is expected to streamline a structured and efficient response mechanism, enabling health authorities to address incidents with the urgency they demand, explains Prof John to South First.
Bindumadhav emphasises that the morbidity in snakebite cases is alarmingly high, leading to the loss of livelihood for several family breadwinners. The economic burden is substantial due to the lasting impact of snakebites, often resulting in amputations and long-term health issues.
One compelling argument for notifying snakebite cases is the improvement in data collection and surveillance. Bindumadhav stresses that accurate data is crucial for understanding the scale and specifics of the snakebite problem, facilitating targeted interventions, and allocating resources effectively.
Professor John underscores that better data and awareness will enhance access to essential treatments, particularly life-saving antivenoms. Notification aids in identifying areas with frequent incidents, ensuring adequate stock and accessibility of antivenoms and medical facilities, especially during peak snakebite seasons.
Shedding light on the resistance often encountered in classifying non-infectious diseases as notifiable, despite the significant health burden they pose, Dr Menon says that like HIV was notified, there is a need to notify snakebite incidents and fatalities, considering the number of bites and deaths being encountered due to snakes.
Notifying snakebite cases also plays a crucial role in shaping public health policies and raising awareness. It can drive the development of education campaigns, reducing reliance on traditional and often ineffective remedies.
Experts argue that a comprehensive database of snakebite incidents can spur research into new and more effective antivenoms and treatments. Understanding the diversity of snake species involved and their geographical distribution can aid in developing region-specific antivenoms, potentially increasing treatment efficacy.
Reported snakebite cases and deaths in Karnataka. (South First)
The consolidated disease summary for reported snakebite cases and deaths in Karnataka between 2022 and 2023 stands at 8,728 cases with 30 deaths. In 2022, there were 3,412 reported cases with 17 deaths, and in 2023, the figures rose to 5,316 cases with 13 reported deaths.
Chikkaballapur tops the charts in Karnataka with 870 reported snakebite cases, followed by Uttara Kannada with 830 cases, Chitradurga with 680, and Udupi with 471 cases.
“We know from our work that in 80 percent of snakebite cases, people do not go to healthcare centres. They instead go to healers, temples, etc. The reality on the ground is much worse,” says Bindumadhav.
Snakebite cases across India bear the burden of being classified as medico-legal cases, a practice dating back to the British era. This legal status, rooted in colonial-era laws, complicates the already challenging task of providing timely and effective treatment to snake bite victims.
Annually, India witnesses numerous snakebite incidents, with victims navigating a bureaucratic maze due to the medico-legal process. Every snakebite, potentially fatal or not, requires a formal police report, transforming a health emergency into a bureaucratic ordeal.
Healthcare professionals often find themselves in a quandary, as treating a snakebite victim involves not only medical expertise but also the ability to navigate the legalities associated with such cases.
Baby cobras coming out of their nest in the Eastern Ghats. (Supplied)
“Once a snakebite case is brought in, our responsibilities double. We’re not just fighting to save a life but also ensuring that all legal protocols are followed,” a doctor from a district hospital in Karnataka tells South First, highlighting the added pressure on medical staff.
Bindumadhav points out that this legal complexity often prompts government doctors to refer patients to other hospitals, evading involvement in medico-legal procedures and further complicating timely care.
The medico-legal status also deters victims from seeking immediate medical help, fearing the complexities and stigma associated with legal proceedings. Many turn to traditional healers or home remedies, squandering precious time that could be devoted to administering life-saving antivenoms.
Citing the example of Karnataka, Bindumadhav says that the government gives a compensation of ₹2 lakh for loss of life from a snakebite. However, Professor Denny John, tells South First, “Many of them, nearly 50 percent of them have not got their compensation due to not having a policy to notify snakebite cases.”
Compounding the issue, victims’ families face hurdles in claiming compensation, with hospitals often refusing to attribute deaths to snakebites, recording them as cardiac or renal failures, a source at the Health Department tells South First. The entire process, involving the police and revenue departments, obtaining “No Objection” certificates, and ruling out foul play, proves to be a protracted ordeal, explains Bindumadhav.
He adds, “The ex-gratia amount is dispensed by the Revenue Department — and not the Forest Department or the Agriculture Department — under the Disaster Management Act. For loss of life from any human-wildlife conflict, the state Forest Department pays an ex-gratia amount of ₹15 lakh in Karnataka. However, despite snakes being classified as wild animals, it is considered as a natural calamity rather than a case of human-wildlife conflict.”
Experts and activists advocate for a re-evaluation of the medico-legal status of snakebites in India, emphasising the need for a system prioritising victim health without the fear of legal complications.
While the decision to notify snakebite cases is commendable for better public health management, challenges remain.
Ensuring compliance across all healthcare facilities, including rural and remote areas, is crucial. Training healthcare professionals in accurate reporting and snakebite management is also necessary, requiring collaborative efforts from the government, healthcare sector, and communities.
