Cross-sectional survey of the incidence, mortality and socioeconomic burden of snakebite envenoming in India.

Snakebite, a neglected tropical disease is a major cause of mortality and morbidity in India, despite which reliable nationwide data are limited. To address this, we carried out a survey in 25 districts across 11 states, covering a 60 million population. The community-based study was led by frontline health workers who tracked cases and deaths, while field teams collected details on the bite, the type of snake, treatment received, and costs. Data were gathered continuously for a one-year period. Here we show that 7,094 snakebite cases were recorded, with a mortality rate of 0.33 per 100,000 population. Nearly half of the reported deaths occurred outside hospital settings. Bites were most common in males (64.1%), adults aged 30-39 years (20.9%), and during the monsoon season (62.1%). Most victims (86.4%) sought hospital care, 60.2% received anti-snake venom, and 17.2% experienced side effects to the anti-venom. Treatment placed a heavy financial burden on families; average out-of-pocket expenditure was INR 6,500, with higher costs in private hospitals (INR 27,400) compared to public facilities (INR 3,900). And 47.5% of the victims belonged to households below the poverty line. These findings show that faster access to hospitals, improved anti-venoms, and health insurance are urgently needed to prevent avoidable deaths.