02741nas a2200313   4500000000100000008004100001653001000042653001400052653002100066653003900087653001400126100001600140700001400156700001600170700001300186700001400199700001300213700001600226700001300242700001500255700001000270700003900280245008000319856009800399300001000497490000600507520190000513022001402413       2011                            d10aIndia10aMortality10aMortality survey10aNeglected tropical diseases (NTDs)10asnakebite1 aMohapatra B1 aWarrell D1 aSuraweera W1 aBhatia P1 aDhingra N1 aJotkar R1 aRodriguez P1 aMishra K1 aWhitaker R1 aJha P1 aMillion Death Study Collaborators 00aSnakebite mortality in India: a nationally representative mortality survey.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0001018&type=printable  ae10180 v53 a<p><strong>BACKGROUND: </strong>India has long been thought to have more snakebites than any other country. However, inadequate hospital-based reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey.</p>

<p><strong>METHODS AND FINDINGS: </strong>We conducted a nationally representative study of 123,000 deaths from 6,671 randomly selected areas in 2001-03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication. A total of 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15-29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6-4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8-6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500).</p>

<p><strong>CONCLUSIONS: </strong>Snakebite remains an underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India.</p>
  a1935-2735