Behavioural and environmental risk factors associated with snake-human conflict: A scoping systematic review

Snakebite envenoming remains a major yet neglected public health problem, disproportionately affecting rural and agrarian populations in low- and middle-income countries. While clinical management and antivenom availability have received increasing attention, far less emphasis has been placed on synthesising the upstream behavioural, environmental, occupational, and socioeconomic circumstances that shape snake-human conflict and lead to snakebite. Existing evidence on these circumstances is fragmented, heterogeneous, and context-specific, limiting its utility for informing prevention strategies. A comprehensive mapping of reported circumstances associated with snake-human conflict is therefore essential to support primary prevention, policy development, and future analytical research.

This scoping review aimed to map and synthesise the available evidence on behavioural and environmental circumstances associated with snake-human conflict among populations living in snake-endemic settings across diverse geographic and socioecological contexts. Specifically, the review sought to (i) describe the range of reported circumstances under which snake-human conflict occurs, (ii) characterise the populations and contexts in which these encounters take place, and (iii) identify gaps in the existing evidence base.

A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A comprehensive search of electronic databases (including PubMed, Embase, Scopus, Web of Science, CINAHL, and Global Index Medicus) and grey literature sources was under taken without date restrictions. Observational studies, descriptive epidemiological studies, community surveys, surveillance analyses, mixed-methods studies, and qualitative research reporting behavioural, environmental, occupational, or socioeconomic circumstances related to snakebite were eligible for inclusion. Two reviewers independently screened records, assessed full texts, and charted data using a standardised extraction framework. Extracted data were synthesised using descriptive numerical summaries and narrative thematic mapping across four domains: environmental, occupational, behavioural, and socioeconomic determinants. No critical appraisal or effect estimation was undertaken, consistent with scoping review methodology.

A total of 142 studies met the inclusion criteria, representing evidence from Asia, Africa, the Americas, Australia, and Europe, with the majority originating from South Asia. The synthesis included 47892 reported snakebite circumstances, 15931 time-of-bite records, 85593 anatomical site records, and 1,16,759 snake identification records. Agricultural or farm-related activities (59.1%), working (9.1%), and walking (8.4%) were the most frequently reported circumstances associated with snakebite. Day-time bites were slightly more common than night-time bites (54.6%), with a peak between 12 PM and 6 PM. The lower limb accounted for 79% of reported bite sites. Reported circumstances clustered into four interconnected domains: environmental factors (seasonality, climate, housing, land use), occupational exposures (agriculture, plantation work, forestry, manual labour), behavioural practices (barefoot walking, night-time activity, sleeping on the floor, snake handling), and socioeconomic vulnerability (poverty, limited education, rurality, constrained healthcare access).

This scoping review demonstrates that snake-human conflict and snakebite occur within predictable socioecological contexts shaped by interacting environmental, occupational, behavioural, and socioeconomic determinants. The findings highlight opportunities for prevention through integrated, context-specific strategies addressing environmental management, occupational safety, behaviour change, and structural vulnerability. While the review does not estimate risk or causality, it provides a consolidated evidence map to inform policy, programme design, and future analytical research aimed at reducing the global burden of snakebite envenoming.