Snakebite Mortality in India: A Nationally Representative Mortality Survey

Earlier hospital based reports estimate about 1,300 to 50,000 annual deaths from snakebites per year in India. Here, we present the first ever direct estimates from a national mortality survey of 1.1 million homes in 2001–03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. The study found 562 deaths (0.47% of total deaths) were assigned to snakebites, mostly in rural areas, and more commonly among males than females and peaking at ages 15–29. Snakebites also occurred more often during the rainy monsoon season. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4) and with the highest rate in the state of Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500). Thus, snakebite remains an underestimated cause of accidental death in modern India, causing about one death for every two HIV-related deaths. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Effective interventions involving education and antivenom provision would reduce snakebite deaths in India

Status of iodized salt coverage in urban slums of Cuttack City, Orissa

<b>Background: </b> For sustainable elimination of iodine deficiency disorders (IDD), it is necessary to consume adequately iodized salt on a regular basis and optimal iodine nutrition can be achieved through universal salt iodization. <b> Objective:</b> To assess the extent of use of adequately iodized salt in the urban slums of Cuttack.<b> Materials and Methods:</b> Using a stratified random multi-stage cluster sampling design, a cross-sectional study involving 336 households and 33 retail shops selected randomly from 11 slums of Cuttack was conducted in 2005. A predesigned pretested schedule was used to obtain relevant information and salt iodine was estimated qualitatively by using a spot testing kit and quantitatively using the iodometric titration method. <b> Statistical Analysis:</b> Proportion, Chi-square test. <b> Results:</b> Only 60.1&#x0025; of the households in urban slums of Cuttack were using adequately iodized salt i.e., the iodine level in the salt was &#8805;15 ppm. Iodine deficiency was significantly marked in sample salts collected from katcha houses as compared with salts collected from pucca houses. Households with low financial status were using noniodized/inadequately-iodized salt. Both crystalline and refined salts were sold at all retail shops. Crystalline salts collected from all retailers had an iodine content &#60; 15 ppm and refined salts collected from one retailer had iodine content &#60; 15 ppm. About 48.5&#x0025; of salt samples collected from retail shops were adequately iodized. <b> Conclusion:</b> In the urban slums of Cuttack, retailers were selling crystalline salts, which were inadequately iodized- this would be a setback in the progress towards eliminating IDD

Awareness, perception and practice of stakeholders in India regarding Village Health and Nutrition Day

Background: Village Health and Nutrition Day (VHND) is a community-based health service package delivered on a fixed day approach. Services like early registration of pregnancy, regular antenatal care and postnatal care, growth monitoring and referral of sick children, discussion of health topics to generate awareness, and convergence between health and ICDS, are delivered every month at VHND at the Anganwadi Center. This study explores the awareness, perception and practice of service providers, and beneficiaries, regarding VHND. Materials and Methods: It was a cross-sectional study conducted in Odisha during December 2009-November 2010. Personal interviews were conducted at the VHND sessions with 111 beneficiaries and 45 service providers using a semi-structured schedule to know their awareness, perception and practice regarding VHND sessions. Data analysis was done and reported as simple percentages. Results: Most of the health worker females and anganwadi workers considered health awareness as a key component of VHND. 52% of HWFs and 41% of AWWs had misconception about additional roles and responsibilities. 34% of beneficiaries had knowledge regarding fixed day approach of VHND, while 24% did not have knowledge regarding any of its purpose. Only 8% of referral cases had complete knowledge on the reason of referral. There was significant difference in between awareness and practice among the blocks. Conclusion: Service providers′ orientation should be improved. Behavior change communication activities should also be increased by the state. Referral cases should be properly counseled. The community believed that such a program should continue with better package and quality of services

Snakebite mortality in India: a nationally representative mortality survey. PLoS Neglected Trop. Dis

Abstract Background: India has long been thought to have more snakebites than any other country. However, inadequate hospitalbased reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey

Snakebite mortality in India: a nationally representative mortality survey. PLoS Neglected Trop. Dis

Abstract Background: India has long been thought to have more snakebites than any other country. However, inadequate hospitalbased reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey

Estimated snakebite deaths in the Indian states with a high prevalence of snakebite deaths, 2005.

<p>States are listed in descending order of death rates. Death rates are standardised to 2005 UN national estimates for India.</p><p>*States with a high-prevalence of snakebite deaths are defined as those with more than 10 million people where the annual snakebite death rate exceeds 3 per 100,000 population.</p

Snakebite deaths in the present study, 2001–03 and estimated national totals, by age.

<p>The overall study death total of 122,848 includes 8.7% senility, unspecified or ill defined deaths, which were not assigned to any specific disease categories.</p><p>*Proportional snakebite mortality per 1,000 after applying sample weights to adjust urban-rural probability of selection.</p>†<p>United Nations 2005 estimates for India.</p

Estimated deaths and standardized death rates in states with high prevalence of snakebite deaths, 2005.

<p>Death rates are standardised to 2005 UN population estimates for India <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001018#pntd.0001018-United1" target="_blank">[24]</a>. The vertical bars represent the state wise estimated deaths (in thousands). Total snakebite deaths for the 13 states with high-prevalence of snakebite death are 42,800 or 93% of the national total (these states have about 85% of the total estimated population of India). States where the snakebite death rate was below 3/100,000 or where populations are less than 10 million are not shown. The states with high-prevalence of snakebite deaths are: AP-Andhra Pradesh, BR-Bihar, CG-Chhattisgarh, GJ-Gujarat, JH-Jharkhand, KA-Karnataka, MP Madhya Pradesh, MH-Maharashtra, OR-Orissa, RJ- Rajasthan, TN-Tamil Nadu, UP-Uttar Pradesh, WB-West Bengal.</p

Selected risk factors for snakebite mortality in India (study deaths 2001–03).

<p>Odds ratio after adjusting for age, gender and states with a high prevalence of snakebite deaths (see definition in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001018#pntd-0001018-t002" target="_blank">Table 2</a>). Occupation ‘Other’ includes students and house wives.</p