Computer Science editorial
Open AccessOA2025
Bites of Burden: Snake Bite Envenoming in India, Regional Venom Differences, Treatment Efficacy and Health System Challenges: A Systematic Review Addressing Evidence Gaps
This systematic review of 100 studies on snakebite envenomation in India finds that mortality is largely driven by modifiable health system and community factors, including delayed antivenom access, non-species-specific dosing, and frequent misidentification of biting species. Regional venom variation and economic burden are substantial, with annual losses estimated at ₹45–120 billion.
Avinash Z. Jaybhaye; Abhinov Thamminaina; S. Verma; Hirani Yash Bharatbhai; Mario Antony; Rahul S. S.; Harikrishnan C.· Indian Journal of Forensic Medicine and Pathology· 2025· DOI 10.21088/ijfmp.0974.3383.19126.11
The core problem
Snakebite envenomation is a neglected tropical disease that causes an estimated 58,000 deaths annually in India, accounting for roughly half of global snakebite deaths. Despite this burden, significant uncertainties persist regarding regional venom variation, species-specific antivenom requirements, health system performance, economic impact, and effective community-level interventions. This systematic review aims to evaluate the epidemiology and geographic distribution of snakebite envenomation in India and globally; clinical features, complications, and mortality associated with major venomous species; antivenom therapy practices, efficacy, dosing, and adverse reactions; emerging innovations in snakebite management; and gaps in policy, public health response, and research priorities.
Innovation
The review protocol was registered with PROSPERO (CRD420251168454). A comprehensive search of PubMed, Embase, Scopus, Web of Science, Google Scholar, and IndMed was conducted from January 1990 to October 2025, supplemented by screening reference lists of included articles and relevant reviews. Eligible studies were peer-reviewed human research from India or neighbouring South Asian countries, including randomized and non-randomized trials, cohort studies, cross-sectional studies, and case series with at least 20 patients, reporting data on epidemiology, venom composition, clinical features, treatment, outcomes, costs, or community knowledge related to snakebite envenomation. Single case reports, non-peer-reviewed opinions, and studies with unclear methods or incomplete outcome data were excluded. Two reviewers independently screened titles/abstracts and full texts and extracted data using a standardised form; disagreements were resolved by discussion or a third reviewer. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools appropriate to study design, with studies scoring at least 7/10 considered acceptable for quantitative synthesis. Random-effects meta-analysis was used to pool treatment outcomes and mortality, heterogeneity was quantified with I², and subgroup analyses explored the effects of snake species, geographic region, and time from bite to antivenom administration; funnel plots and Egger regression were used to assess publication bias.
Introduction
Snakebite envenomation is a neglected tropical disease that causes an estimated 58,000 deaths annually in India, accounting for roughly half of global snakebite deaths. Despite this burden, significant uncertainties persist regarding regional venom variation, species-specific antivenom requirements, health system performance, economic impact, and effective community-level interventions. This systematic review aims to evaluate the epidemiology and geographic distribution of snakebite envenomation in India and globally; clinical features, complications, and mortality associated with major venomous species; antivenom therapy practices, efficacy, dosing, and adverse reactions; emerging innovations in snakebite management; and gaps in policy, public health response, and research priorities.
Why it matters
The findings indicate that snakebite mortality in India is driven less by venom potency than by modifiable health-system and community factors, including delayed access to antivenom, non-species-specific dosing, and frequent misidentification of biting species. The substantial regional variation in venom potency and clinical outcomes underscores the need for region- and species-specific treatment protocols. The low treatment success for krait bites (41%) compared to cobras (94%) highlights the importance of accurate species identification and appropriate antivenom dosing. The economic burden, estimated at ₹45–120 billion annually, further emphasizes the need for effective interventions. Immediate priorities include ensuring reliable antivenom supply at first-contact facilities and scalable training for village health workers and clinicians. Future research should refine regional venom characterization, update economic estimates, and evaluate digital and community-based interventions. Limitations of the review include the predominance of retrospective hospital-based studies from a limited number of high-burden states, sparse data from Northeast and Central India, limited long-term disability outcomes, and heterogeneity in outcome definitions and economic methods.
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