STS PROJECT- 2018 References ID: 2018-05225 Title: A study on Awareness of first aid measures in snakebite among general population in a rural areaIntroduction :Venomous snakes can be found throughout the world with a wide distribution, excluding few islands and frozen environments.

1 Being a tropical country, snakebites are common in India, requiring immediate medical attention7 as snakebite envenomings causes organ and tissue damage specific to each species of snake.1 Snakebite has been included in the WHO’s ‘neglected tropical disease’ in 2009.5India is home to 270 species of snake, among which 60 species are venomous.3 The common venomous snakes in India, called ‘The Big Four’ includes the Indian cobra (Naja naja), common krait (Bungarus caeruleus), Russell’s viper (Daboia russelii) and Saw-scaled viper (Echis carinatus).3,5 Estimates indicate India has the highest snakebite mortality in the world. According to the World Health Organization, the number of bites is estimated to be around 83,000 per annum and 11,000 deaths per annum.

9 Studies indicate deaths due to snakebite occurs predominantly in rural areas(97%), commonly in males(59%) and generally around rainy monsoon months between June to September.4Snakebite is regarded as an occupational hazard and it is strongly associated with occupations like farming, plantation work, herding, etc,.5 For example, rural farmers with their non-mechanised, low-cost farming methods have high risks of snakebite, with their hands and feet being the most frequent sites of snakebites in Asia.6Some of the factors which are responsible for the high mortality rate include lack of proper transportation facilities to tertiary health care, lack of knowledge for providing first aid and practice of traditional first aid measures which may aggravate the action of venom.

7,8 The traditional methods of first aid in cases of snakebite like application of tourniquets, electric shock, incisions and suction have been found to be harmful by increasing spread of venom and causing local tissue damage at site of snakebite.3,9The first aid treatment involves immobilisation at the site of snakebite and quick transport to nearby tertiary care hospital for administration of anti-snake venom (ASV) which is the mainstay of treatment.7 ASV is a polyvalent antidote against snake venom, effective against all the ‘Big Four’ species of snake which is the specific treatment in India.9Clear understanding of first aid measures can retard or slow down morbidities caused due to snakebite, like tissue necrosis, gangrene formation, muscle paralysis, extensive bleeding and even permanent disability.2,5This study assesses the general population regarding their knowledge on first aid measures to be provided in case of snakebite and provides the appropriate first aid measures which need to be followed.

By creating an awareness of first aid measures in snakebite, it can help in bringing down the mortality and morbidity caused due to snakebite in India. Objectives:1)      To assess the knowledge of the general population regarding the management of snakebite.2)      To direct the general population towards appropriate practice of first aid measures in management of snakebite.

 2) Methodology :A.     Study design: Prospective, observational.B.     Study method: Questionnaire based study.

C.     Sample size: 200.D.

     Study place:  Kuthambakkam, Chennai.E.      Study duration : 2 months.F.

      Study population: General population.G.     Selection criteria: This study is a questionnaire?based study.H.     Data collection procedures: ·         Self made questionnaires prepared with relevant questions to the topic and will be distributed to the participants.

·         The questionnaire includes: 1) Name, 2) Age, 3) Sex, 4) Occupation, 5) Education·         Study participants will be asked to tick only one of the options in the column.·         After prior briefing about the study, sufficient time will be given to the participants to complete the questionnaire.·         After completion of the questionnaire, information regarding the topic will be shared in the form of verbal and printed instructions.I.         Quality control, confidentiality: The confidentiality of the study will be maintained by not revealing their names and the result will be used only for the research purpose for the future benefit of the society.

The questions in the questionnaire are answered without any external influence. The records of this study will be kept private.J.       Plan of analysis/ statistical tools: Statistical analysis will be done using SPSS statistical analysis software. Percentage wise distribution of various parameters employed in the study will be analysed.K.      Ethical considerations: Study will be conducted after obtaining prior approval from Institutional Ethical Committee. The participants will not be forced to participate in the study and there will not be any remuneration or extra benefit provided to them.

The confidentiality of the study will be maintained by not revealing their names and the result will be used only for the research purpose. Implications:1)      This study will help create awareness in the general population regarding the proper management of snakebites, enabling the provision of proficient first aid in the event of a snakebite and improving the efficacy of specific treatment in tertiary healthcare.2)      This study will help lower morbidity and mortality rates caused by snakebites, thereby preventing incidents of anaphylaxis, paralysis, ulceration, gangrene formation and acute renal failure.

 References :1)      David A. Warrell, J-M Gutierrez, Rabies and envenomings: A neglected public health issue: Report of a consultative meeting. Geneva: World Health Organisation, 20072)      Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al., The Global Burden of Snakebite: A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths, 2008. PLoS Med 5(11): e218.3)      AS Ray; Snake Bite its First Aid & Anti Snake Venom (ASV): Details Guidelines; PharmaTutor; 2014; 2(10); 85-884)      Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al., Snakebite Mortality in India: A Nationally Representative Mortality Survey, 2011.

PLoS Negl Trop Dis 5(4): e1018.5)      David A. Warrell, WHO Guidelines for the management of snake-bites, WHO Regional Office for South East Asia, 2010. 6)      Harrison RA, Hargreaves A, Wagstaff SC, Faragher B, Lalloo DG, Snake Envenoming: A Disease of Poverty, 2009. PLoS Negl Trop Dis 3(12): e569.7)      Halesha B, Harshavardhan L, Lokesh AJ, Channaveerappa P, Venkatesh K, A study on the clinico-epidemiological profile and the outcome of snake bite victims in a tertiary care centre in southern India, Journal of clinical and diagnostic research: JCDR, 2013; 7(1): 122-1268)      Simpson ID, A study of current knowledge base in treating snake bite among doctors in high risk countries of India and Pakistan: does snake bite treatment training reflect local requirements?, Trans R Soc Trop Med Hyg, 2008; 102:1108-14.9)      Snake Bite: Indian Guidelines and Protocol,Surjit Singh, Gagandip Singh,Chapter 94 page 424-427 


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