A STUDY OF EPIDEMOLOGY AND OUTCOME OF SNAKE ENVENOMATION ADMITTED AT A TERTIARY CARE CENTRE, NORTH KERALA

Aims and Objectives:Snake envenomation is a medical emergency of significant public health concernfaced by rural populations mainly in tropical and subtropical countries with heavy rainfall and humid climate.Although India ia s single large contributor of snake bites,reporting is very poor. Very few studies describe epidemiology and outcome of snake bite from Kerala. Hence, this study was planned to collect information on various aspects of snake bite in a tertiary care hospital.. This tertiary care centre caters to all six districts of Kerala including Kozhikode,Kannur,Malappuram ,Kasargod,Palakkad and Wayanad . Study Setting and Design:This is a descriptive ,observational and crossectional study carried out at Govt Medical College ,Kozhikode Materials and Methods: Sampling Procedure:This was a descriptive cross-sectional study of all patients admitted with snake envenomation at Snake Bite unit, Govt Medical College,Kozhikode.Study period was from July 2017 –June 2018.Patients are included if they had a definite history of poisonous snake bite and developed features of envenomation and are evaluated based on a proforma with detailed history and clinical examination. Data are collected regarding age, sex, occupation, time of bite, symptoms, investigations, mode of treatment given and complications.Sample size is 110. Study Analysis: Data are analysed using computer software, Statitical Package for Social Sciences(SPSS) version 18.Data are expressed in its frequency and percentage .To elucidate the associations and comparisons between different parameters ,qualitative variables are analysed using Chi –square test and quantitative variables by t –test.The Institutional Ethics Committee of Govt. Medical College ,Kozhikode approved the research project. Written informed consent is obtained from all patients who had participated in this study in their vernacular language . Results:Detailed history with special reference to the type of snake, circumstances leading to the bite and clinical consequences are studied and final outcome is noted. Males (n=71) are bitten more often than females (n=31) .46 cases are in the age range of 40-60 years. 57(55%) cases are during the monsoon. Most (n=67) are encountered in the lower limbs. Viper is the most common poisonous snake encountered (73%)(n=75). 49 (48%) cases are from rural area. Among the viper bite Russells viper constitutes 26(25.4%) and Pit viper of 50(49%).Coagulation time is prolonged in 36 cases(35.3%). Hemotoxic symptoms present in 40(39.2%) victims ,neurotoxic features present in 32(31.3%) victims ,both hemotoxic and neurotoxic features are present in 12(11.7%) victims.Polyvalent anti snake venoum (ASV) is given to 66 cases. Hypersensitivity to ASV is noted in 13 cases out of 66 cases.Bite to needle time is >6hrs in all the victims who expired.The mortality rate among snake bite victims is 6.8%.The morbidity and mortality can be reduced substantially by early medical care and providing health education. Conclusion: On the basis of study findings ,Pit viper bites were predominant in our area which was less fatal.Eventhough the antisnake venom doesnot cover Pitviper,it was given empirically if coagulation failure occurs. Death was more in neurotoxic bites .Duration of hospital stay was more in Viper bites .Victims with bite to needle time <4 hrs were recovered earlier without complications. Morbidity and mortality due to this can be reduced by early administration of antisnake venom and management of complications.So prompt referral of victims with poisonous snake bite to centres where facilities in managing snake bite is crucial in preventing mortality.