Clinico-epidemiological profile of snakebite cases in Siraha District, Nepal: a 10-year retrospective study

Snakebite is a neglected tropical disease causing significant mortality in Nepal's Terai region. This 10-year retrospective study (April 2014 to March 2024) analyzed 3499 cases at Lahan Hospital, Siraha. Systemic envenomation occurred in 4.6% of patients (n = 160), 70% of whom exhibited neurotoxicity. The median age was 29 years, with a slight female predominance (51.8%). Most bites occurred during the monsoon (73.2%), and night-time bites during sleep were strongly associated with envenomation (OR 28.4). Only 3.5% of victims arrived within the 'golden hour,' with a median arrival time of 4.8 hours. Arrival after 6 hours significantly increased mortality risk (OR 4.2). Harmful first-aid practices, such as tourniquet use, were reported in 25.5% of cases and were associated with higher odds of death (OR 1.9). The overall hospital-based case fatality rate (CFR) was 1.66%, but this rose to 36.25% among systemically envenomed patients. Notably, 11.25% of envenomed patients died before antivenom could be administered, often presenting in cardiac arrest. While overall mortality remains low, the high fatality among envenomed victims highlights critical gaps in prehospital care. Reducing deaths requires community-based interventions to minimize transport delays and discourage unsafe first-aid practices.