Abstract

Background

Snake bites are a significant public health issue in tropical countries like Bangladesh, where a warm and humid climate fosters the habitat of venomous snakes. Despite its inclusion as a neglected tropical disease by the World Health Organization (WHO), snakebite envenomation remains an under-recognized and under-resourced problem. Agricultural workers, students, and rural populations face the greatest risk due to occupational and environmental exposure. Effective management strategies are critical to reducing the morbidity and mortality associated with this condition, as treatment gaps, delays, and reliance on traditional healers frequently exacerbate outcomes. This study provides insights into the clinical presentation, management, and outcomes of snakebite envenomation in Bangladesh, highlighting key risk factors for mortality and potential interventions.

Study Methodology: This retrospective observational study reviewed data from 14 patients admitted to the intensive care unit (ICU) at Dhaka Medical College Hospital between January 2023 and July 2024. Key variables, including demographic details, snakebite characteristics, baseline clinical parameters, and patient outcomes, were assessed. Categorical variables were analysed using the Chi-square test, while continuous variables were evaluated with Mann-Whitney U tests. Multiple logistic regression was applied to estimate the risk factors for mortality. Data analysis was performed using SPSS version 26, with a significance level set at p<0.05.

Results: The study revealed that snakebite envenomation predominantly affected males (92.8%), with the majority aged between 18 and 45 years (64.3%). Urban residents comprised 78.5% of cases, while farmers and students were equally impacted (28.57%). Most patients belonged to the middle socioeconomic class (57.15%). Snakebites occurred primarily in the morning (92.8%) and affected the lower extremities (78.57%), with Russell’s viper identified as the most common snake involved (57.15%), followed by cobras and kraits (21.42% each). Despite 64.28% seeking medical attention within 6–24 hours, 42.85% first consulted traditional healers. Universal use of local bandages and tourniquets was noted, with tetanus prophylaxis provided to 78.57% of patients. Clinically, all patients experienced pain and bleeding, with cellulitis in 57.14% and gangrene in 7.14%. Neurotoxic effects were present in 50%, including ptosis and respiratory paralysis, while systemic complications included acute kidney injury (57.14%), tachycardia (92.8%), and shock (42.85%). Ventilator-associated pneumonia developed in 42.85% of cases. All patients received polyvalent antivenom, with additional treatments such as blood transfusions (78.5%), mechanical ventilation (64.29%), and hemodialysis (50%). Despite these interventions, in-hospital mortality reached 35.71%, with an average ICU stay of 4.72 days. Mortality risk was significantly increased by bites from kraits (OR = 8.17) and Russell’s vipers (OR = 5.47), as well as complications like acute kidney injury (OR = 3.49, p = 0.02) and ventilator-associated pneumonia (OR = 4.35, p = 0.01). Hemodialysis significantly reduces the odds of mortality (OR = 0.17, p = 0.03), reinforcing its effectiveness in improving patient survival, particularly for severe envenomation cases presenting with AKI.

Conclusions: Despite the widespread use of initial interventions like bandages and tourniquets, delays in seeking formal medical care and reliance on traditional healers remain significant barriers to effective management. Acute kidney injury and ventilator-associated pneumonia are critical complications driving mortality risk, while timely hemodialysis is a vital life-saving intervention. These findings underscore the need for enhanced public awareness, rapid referral systems, and accessible critical care facilities to reduce snakebite-associated mortality in Bangladesh.