Snakebite patterns in rural Sri Lanka and their implications for preventive measures.

Area of Science:

• Epidemiology
• Public Health
• Tropical Medicine

Background:

• Snake envenoming is a significant health issue in rural tropical regions, yet prevention strategies are often overlooked.
• This study focuses on the epidemiology of snakebites in rural Sri Lanka to inform targeted prevention efforts.

Purpose of the Study:

• To describe the epidemiology of snakebites in rural Sri Lanka.
• To identify specific snakebite patterns to guide the development of focused preventative strategies.

Main Methods:

• Prospective recruitment of snakebite cases at the Teaching Hospital, Anuradhapura, Sri Lanka.
• Extraction of epidemiological data from August 2013 to October 2014 and May 2017 to January 2023.
• Species identification via specimen or serum analysis using enzyme-linked immunosorbent assay for authenticated cases.

Main Results:

• A total of 4708 snakebites were recorded, with *H. hypnale* (44.6%), *D. russelii* (33.3%), *B. caeruleus* (4.6%), and *N. naja* (2.8%) being the most common identified species.
• Most bites occurred on the lower limb (78.8%), primarily the foot (70.9%), with a significant number happening between 6-9 pm (30.7%).
• Specific patterns emerged: *H. hypnale* bites often occurred outdoors (82.1%) on the foot (51.8%) or hand (26.2%) during domestic activities, *D. russelii* bites predominantly on the foot (89.2%) outdoors on farmland (43.0%), *B. caeruleus* bites at night (74.3%) while sleeping (60.6%), and *N. naja* bites during the day (85.5%) outdoors.

Conclusions:

• Epidemiological findings highlight key opportunities for snakebite prevention.
• Protective footwear could prevent a majority of *D. russelii* (83%) and *H. hypnale* (52%) lower limb bites.
• Using long-handled tools for household chores and ensuring safer sleeping environments could mitigate hand bites from *H. hypnale* and nocturnal bites from *B. caeruleus*, respectively.