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Current available data on snake bites in Nepal are based solely on hospital statistics. This community-based study aimed at evaluating the impact of snake bites and determining the risk factors associated with a fatal outcome in southeastern Nepal. A total of 1,817 households, selected by a random proportionate sampling method, were visited by trained fieldworkers in five villages. Extensive data from snake bite victims during the 14 previous months were recorded and analyzed. One hundred forty-three snake bites including 75 bites with signs of envenoming were reported (annual incidence = 1,162/100,000 and 604/100,000, respectively), resulting in 20 deaths (annual mortality rate = 162/100,000). Characteristics of krait bites such as bites occurring inside the house, while resting, and between midnight and 6:00 AM were all factors associated with an increased risk of death, as were an initial consultation with a traditional healer, a long delay before transport, and a lack of available transport. An initial transfer to a specialized treatment center and transport by motorcycle were strong protective factors. Among the 123 survivors, wounds required dressing and surgery in 30 (24%) and 10 (8%) victims, respectively, the mean working incapacity period was 15 days, and the mean out-of-pocket expense was 69 U.S. dollars. Snake bite is a major but neglected public health problem in southeastern Nepal. Public health interventions should focus on improving victims’ rapid access to anti-snake venom serum by promoting immediate and fast transport to adequate treatment centers, particularly for bites occurring at night.
Received December 28, 2003. Accepted for publication February 14, 2004.
Acknowledgment: We thank Chandra Shah (health assistant in charge of the Damak Health Centre) for his precious contribution to the fieldwork.
Financial support: The study was funded by the Sonisca Foundation.
Authors’ addresses: Sanjib K. Sharma, Department of Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, Telephone: 977-25-525-555, Fax: 977-25-520-251. François Chappuis and Louis Loutan, Travel and Migration Medicine Unit, Geneva University Hospital, 24 Rue Micheli-du-Crest, Geneva, Switzerland, Telephone: 41-22-372-9610, Fax: 41-22-372-9626. Nilhambar Jha, Department of Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, Telephone: 977-25-525-555, Fax: 977-25-520-251. Patrick A. Bovier, Department of Community Medicine, Geneva University Hospital, Geneva, Switzerland, Telephone: 41-22-372-3311, Fax: 41-22-372-9626. Shekhar Koirala, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, Telephone: 977-25-525-555, Fax: 977-25-520-251.
Reprint requests: François Chappuis, Travel and Migration Medicine Unit, Geneva University Hospital, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland, Telephone: 41-22-372-9610, Fax: 41-22-3729626, E-mail: francois.chappuis{at}hcuge.ch.
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