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Protection against Snake Bites by Sleeping under a Bed Net in Southeastern Nepal

Snake bites in persons while they are asleep indoors are associated with a high risk of fatal outcome in southeastern Nepal. The preventive impact of sleeping under a bed net was assessed in four villages in a case-control study. A case was defined as a person with a history of snake bite that occurred indoors while asleep. Cases were matched with controls by village, type of household, sex, and age category. Of the 11,176 households visited, 56 cases, including 13 (23%) with a fatal outcome and 56 controls were included in the analysis. Sleeping under a bed net was a strong protective factor (odds ratio = 0.02, 95% confidence interval = 0.007–0.07, P < 0.0001), whereas the place of sleeping in the household and the use of a cot were not associated with the risk of snake bite. These findings provide further support for use of bed nets in this region.

Received December 14, 2006. Accepted for publication April 4, 2007.

Acknowledgments: We thank Chandra Shah, health assistant in charge of the Damak Red Cross Snake Bite Treatment Centre, for his precious contribution to the fieldwork. We are also grateful to Gabrielle Landry for kindly editing the manuscript.

Financial support: The study was funded through grants allocated by the Geneva University Hospitals and by the Sonisca Foundation.

^* Address correspondence to François Chappuis, Travel and Migration Medicine Unit, Geneva University Hospitals, 1211 Geneva 14, Switzerland. E-mail: francois.chappuis{at}hcuge.ch

Authors’ addresses: François Chappuis and Louis Loutan, Travel and Migration Medicine Unit, Geneva University Hospitals, 24 Rue Michelidu-Crest, 1211 Geneva 14, Switzerland, Telephone: 41-22-372-9620, Fax: 41-22-372-9626, E-mails: francois.chappuis{at}hcuge.ch and louis.loutan{at}hcuge.ch. Sanjib K. Sharma, Department of Medicine, B. P. Koirala Institute of Medical Sciences, Dharan, Nepal, Telephone: 977-25-525335, Fax: 977-25-520251, E-mail: drsanjib{at}yahoo.com. Nilhambar Jha, Department of Community Medicine, B. P. Koirala Institute of Medical Sciences, Dharan, Nepal, Telephone: 977-25-525335, Fax: 977-25-520251, E-mail: niljha{at}yahoo.com. Patrick A. Bovier, Department of Community Medicine, Geneva University Hospitals, 24 rue Michelidu-Crest, 1211 Geneva 14, Switzerland, Telephone: 41-22-372-9636, Fax: 41-22-372-9600, E-mail: patrick.bovier{at}hcuge.ch.