The Epidemiology of Snakebite in Bhutan: A Retrospective Study

Bhutan is a tropical country where snakebite is supposedly common, but official data are scanty and unmethodical. Deaths from snakebites were reported from areas where snakebites are common. Four-year (2018-2021) data of snakebite from 45 Bhutanese hospitals were collected and analysed to describe the burden and map by districts. A total of 371 snakebites were recorded from 45 hospitals during the 4 years. Most cases were seen in the southern and central parts of the country. There was a definite rise in the number of cases in the warmer months, starting from March and peaking between June and August. About 240 (65%) of the bites occurred in males, and the highest number of snakebites occurred during farming (<i>n</i> = 100, 27%), bush walking (<i>n</i> = 42, 11.3%), herding (<i>n</i> = 15, 4%) and trekking (<i>n</i> = 1, 0.2%). The most common anatomical bite site was the leg (<i>n</i> = 167, 45.01%), followed by the hand (<i>n</i> = 81, 21.8%), finger (<i>n</i> = 56, 15.09%), toes (<i>n</i> = 11, 2.96%), thigh region (<i>n</i> = 6, 1.6%), head and face (<i>n</i> = 3, 0.8%), chest and shoulder (<i>n</i> = 3, 0.8%) and abdomen (<i>n</i> = 1, 0.3%). Most snakes were unidentified (<i>n</i> = 266, 71.7%). Those identified were vipers (<i>n</i> = 74, 19.9%), rat snakes (<i>n</i> = 12, 3.2%), kraits (<i>n</i> = 7, 1.88%), cobras (<i>n</i> = 6, 1.61%), river snakes (<i>n</i> = 5, 1.34%) and wolf snakes (<i>n</i> = 1, 0.26%). Forty-three (11.6%) of the bite victims had resorted to non-medical home treatment. Even with an obvious underreporting, snakebite is a significant public health problem, and Bhutan should embrace more public health and clinical activities to prevent morbidities and mortalities from snakebite.