Development, Validation, and Implementation of a Geography-Specific Syndromic Coding and Reporting System for Snakebite Envenoming (D-SERPENT): Protocol for an Implementation-Effectiveness Hybrid Study

Snakebite envenoming (SBE) is a neglected tropical disease with substantial morbidity and mortality. India accounts for nearly 50% of global snakebite deaths, yet the disease remains underreported due to a lack of standardized documentation and phenotypic classification. Current diagnosis is syndromic and lacks uniform data capture protocols.

This study aims to develop, validate, and implement a geography-specific syndromic coding and reporting system for SBE to improve standardized documentation, clinical management, surveillance, and epidemiological data quality in selected districts of India.

This implementation-effectiveness hybrid study will be conducted across 4 study districts in India, representing 4 geographical zones. Retrospective and prospective data will be encoded using a standardized, geography-specific coding system modeled on the International Classification of Diseases and SNOMED Clinical Terms (SNOMED CT). Stakeholders, including clinicians, researchers, and public health specialists, will contribute to the development of the coding system using the Delphi methodology. Training will be provided to project assistants for real-time data entry. A snakebite surveillance dashboard will be developed and hosted by the Indian Council of Medical Research.

The study is expected to establish a standardized, geography-specific syndromic coding and reporting system for SBE across selected districts in India. Its implementation is anticipated to improve classification accuracy, reporting completeness, and epidemiological data quality, thereby strengthening surveillance and supporting evidence-based clinical management and policy planning. The project's funding was approved in January 2025, and participating institutions provided ethics approval between March 2025 and May 2025. The geography-specific syndromic coding framework development, including stakeholder consultations and Delphi rounds, was conducted between June 2025 and August 2025, with prospective implementation of the coding and reporting system planned from September 2025 to September 2026. Data cleaning, validation, and statistical analyses are expected to be completed by March 2027, with the dissemination of findings anticipated in June 2027.

The study proposes a first-of-its-kind phenotypic data-driven approach to snakebite surveillance and treatment in India. The resulting coding system and dashboard will strengthen national reporting and guide future health policy and intervention programs.