Epidemiology of snakebite envenomation in Northwest Iran: insights from East Azerbaijan Province

The World Health Organization (WHO) recognizes snakebite as a neglected tropical disease, particularly impacting vulnerable rural populations. Asia has the highest burden worldwide, and Iran is a hotspot, harboring 30 venomous snake species. The northwest region, particularly East Azerbaijan Province, is identified as a high-risk area due to the diverse snake population and widespread agricultural activity. This study aims to fill the data gap in this province, providing insights for preventive measures and improved treatment protocols to mitigate the socioeconomic impacts of snakebite envenomation. The descriptive retrospective study was conducted over three years (2021–2023) in East Azerbaijan Province, northwestern Iran. Data collection involved retrieving records of patients who met the inclusion criteria based on recent snakebite history. Collected demographic and clinical data included age, sex, education level, geographical location of bite, time of bite and management, treatment received, and hospitalization duration. Statistical analyses were performed using IBM SPSS Statistics. A significance level of p < 0.05 was considered statistically significant. The study analyzed 533 snakebite cases in East Azerbaijan Province, where Sina Hospital in Tabriz recorded 32.1% of admissions. The average annual incidence was approximately 4.3 per 100,000, with Khoda-Afarin County having the highest incidence (25.3 per 100,000) and Heris the lowest (0.00). Most victims were male (77.5%) and the mean age was 39.4 years. Significant associations were found between age group and sex, with females being more represented in younger groups. Most bites occurred in rural areas and between hours 12:00 and 18:00. The majority of patients had a middle school education. Snakebites peaked in June, and 62.4% of patients were admitted within one hour of the bite. The median time to antivenom administration was 1.17 h, and 62.0% of inpatients were hospitalized for more than 24 h. Antivenom was administered in 82.6% of cases, and a case fatality rate of 0.2% was observed. This study characterizes the epidemiology of snakebites in East Azerbaijan Province, revealing a distinct risk profile with an average annual incidence of 4.3 per 100,000. The findings indicate significant geographic variation, particularly in northern counties, likely due to environmental factors and agricultural practices that increase human-snake interactions. The male predominance among victims and the age distribution highlight the occupational risks associated with outdoor activities. Despite improved access to care, rural delays in treatment remain a concern, underscoring the need for targeted prevention strategies and improved facilities and antivenom availability in high-risk areas. Overall, the study underscores the importance of integrating snakebite surveillance into public health initiatives to inform resource allocation and intervention strategies.