Study Of Clinical Profile of Patients with Snake Bites in A Tertiary Care Hospital in Rural Konkan, Maharashtra.

Snakebite envenomation is a significant global health burden, officially classified as a Neglected Tropical Disease by the World Health Organization. It disproportionately affects rural populations in tropical and subtropical countries, with India bearing the highest burden, accounting for an estimated 58,000 deaths annually according to the Million Death Study [1]. The agrarian economy of rural India places a large population, particularly farmers and laborers, at high risk of encountering snakes during agricultural activities or within their dwellings [2].

 

The "Big Four" venomous snakes—Indian Cobra (Naja naja), Common Krait (Bungarus caeruleus), Russell's Viper (Daboia russelii), and Saw-scaled Viper (Echis carinatus)—are responsible for the majority of life-threatening envenomations in the Indian subcontinent [3]. Envenomation can lead to two primary syndromic presentations: neurotoxic paralysis, characterized by ptosis, ophthalmoplegia, and progressive respiratory failure, commonly associated with elapids (kraits and cobras); and hemotoxic/vascular effects, including local tissue damage, coagulopathy, systemic bleeding, and acute kidney injury, typically caused by viperidae [4].

 

Despite the availability of effective treatment with polyvalent anti-snake venom (ASV), pre-hospital factors remain major contributors to poor outcomes. These include the application of harmful first-aid measures (e.g., tourniquets, incision), initial consultation with traditional healers, and delays in reaching appropriate medical care [5]. This study aims to elucidate the clinical and epidemiological profile of snakebite victims presenting to a tertiary care hospital in the rural Konkan region of Maharashtra, which will help in improving local management protocols and public health interventions.

A hospital-based cross-sectional study was conducted between January 2025 to June 2025 in the Department of Pediatrics at BKL Walawalkar Rural Hospital, Dervan, Ratnagiri, a tertiary care center serving the rural population of the Konkan region. A total of 60 consecutive patients of age ≤12 years and both genders presenting with a history of snakebite, with or without evidence of envenomation (local swelling, pain, neurotoxic or hematotoxic signs), were included in the study.

Patients with wounds from other animals, those with psychiatric illness, or those who left against medical advice before initial assessment were excluded. After obtaining informed consent, detailed history and clinical examination findings were recorded on a pre-designed, semi-structured proforma. Parameters included demographic data, details of the bite (time, place, site), first-aid measures used, clinical manifestations, treatment received (including number of ASV vials), and outcome.

 

Statistical Analysis: Data was entered into Microsoft Excel and analyzed using appropriate statistical software. Descriptive statistics were presented as frequencies, percentages, means, and standard deviations.

Table 1: Socio-demographic profile of snakebite patients (n=60)

 

A total of 60 snakebite cases, the largest single group was 10 to 12 years old (35.0%) followed by 28.3% from age group 7 to 9 years. There was a notable male predominance, with males comprising 63.3% of the cases and females 36.7%. Males in this region are at a higher risk.

The vast majority of patients (86.7%) were residents of rural areas, underscoring that snakebite is primarily a rural health problem in this region.

 

Table 2: Profile of the snakebite incident (n=60)

 

Clinical manifestations among snakebite patients:

The clinical manifestations are detailed in Table 3. Local symptoms like pain and swelling were the most common. Neuroparalytic manifestations (e.g., ptosis) were observed in 17 patients (28.3%), while hematotoxic manifestations were seen in 7 patients (11.7%).

 

 

Table 3: First-aid practices

 

Outcome of the Patients

First-aid practices are shown in Table 4. The use of a tourniquet was reported by 6 patients (10.0%), and harmful practices like incision were reported by 5 patients (8.3%). The average number of ASV vials used was 7.2. Three patients (5.0%) succumbed to their envenomation.

 

This study provides a contemporary overview of the clinical and epidemiological profile of snakebite victims in the rural Konkan region of Maharashtra. Our findings align with and sometimes contrast the national and regional data, highlighting the importance of localized studies. The predominance of male victims (63.3%) is a consistent finding across numerous Indian studies, such as those by Patil et al. (2022) in Karnataka (68.5% males) and by Sharma et al. (2021) in North India (65.1% males) [6,7] and Haridas et al. (2023) [8].

 

A notable finding was that a majority of bites occurred indoors (56.7%), which contrasts with several studies reporting a higher incidence of outdoor bites [6,7]. However, this supports the findings of a study by Kulkarni et al. (2020) in Western Maharashtra, which reported 52% of bites occurring inside dwellings, particularly during the night, likely due to the nocturnal nature of common kraits entering homes in search of prey [9]. This also explains the high proportion of bites on the lower limbs (61.7%), as people are often bitten while sleeping on the floor, a finding consistent with the 59.8% reported by Patil et al. and 64.5% by Kulkarni et al. [6, 9].

 

The inability to identify the snake species remained strikingly high (81.7%), a common challenge in rural India that complicates initial management. This is comparable to the 78.9% reported by Sharma et al. and even higher than the 70.2% found in a study by Mehta et al. (2021) in Gujarat [7,10]. Despite this, the timely presentation to the hospital within 6 hours for 85% of our patients is a positive indicator and is significantly better than the 62% reported by Haridas et al. [8], potentially reflecting improved ambulance services or community awareness in our region.

 

Clinically, neuroparalytic manifestations (28.3%) were more than twice as common as hematotoxic ones (11.7%). This pattern differs from studies in regions with a higher prevalence of viperine species. For instance, a study by Saini et al. (2019) in Punjab reported hematotoxicity in 42% of cases versus neurotoxicity in 22% [11]. Our findings, however, are similar to those of Kulkarni et al., who reported neurotoxicity in 31.5% of cases, suggesting a potentially higher prevalence of elapids (kraits and cobras) in the Konkan region [9]. The case fatality rate of 5.0% falls within the range reported by other tertiary care studies in India, which varies from 3% to 8% depending on the time to presentation and the quality of intensive care facilities [6,8,10].

This study concludes that snakebite in rural Konkan predominantly affects male children, with a significant number of bites occurring indoors. Neurotoxic envenomation is the most frequent clinical syndrome, underscoring a high prevalence of elapid species in the region. While most patients present early, harmful first-aid practices persist. Therefore, community health programs must focus on promoting preventive measures like protective footwear and mosquito nets, alongside educating against tourniquets and incisions, to reduce mortality and morbidity.

 

Implement community education on preventive measures (e.g., protective footwear, mosquito nets) and the dangers of harmful first-aid practices like tourniquets and incision.

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