Snakebite Mortality in India: A Nationally Representative Mortality Survey
Snakebite Mortality in India: A Nationally Representative Mortality Survey
复制标题
DOI：
10.1371/journal.pntd.0001018
复制
发表时间：
2011-04-01
影响因子：
3.8
通讯作者：
Jha, Prabhat
中科院分区：
文献类型：
--
作者：
Mohapatra, Bijayeeni;Warrell, David A.;Jha, Prabhat
背景：长期以来，印度被认为是蛇咬伤最多的国家。然而，基于医院的报告不足，导致估计每年总蛇咬伤死亡率从1,300到50000不等。我们计算直接估计蛇咬伤死亡率从national mortality survey.Methods and Findings：我们进行了一项具有全国代表性的研究，在2001年至2003年从6,671个随机选择的地区的123,000例死亡。全职的非医疗现场工作人员就所有死亡事件采访了活着的受访者。潜在原因由130名训练有素的医生中的两名独立编码。分歧通过匿名调解解决，如果无法解决，则通过裁决解决。共有562例死亡（占总死亡人数的0.47%）被指定为蛇咬伤。蛇咬伤死亡主要发生在农村地区（97%），男性（59%）比女性（41%）更常见，在15-29岁（25%）和6月至9月的季风月份达到高峰。这一比例代表了全国每年约45，900例蛇咬伤死亡（99% CI 40，900 - 50，900）或年年龄标准化发生率为4.1/100，000（99%可信区间3.6-4.5），农村地区发病率较高（5.4/100，000; 99%可信区间4.8-6.0），安得拉邦的邦发病率最高（6.2）。每年蛇咬伤死亡人数最多的是北方邦（8,700人）、安得拉邦（5,200人）和比哈尔邦（4,500人）。由于全球蛇咬伤总数的很大一部分来自印度，全球蛇咬伤总数也可能被低估。社区教育、对医务人员的适当培训以及更好地分发抗蛇毒血清，特别是分发到流行率最高的13个邦，可以减少印度的蛇咬伤死亡人数。
Background: India has long been thought to have more snakebites than any other country. However, inadequate hospital-based reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey.Methods and Findings: We conducted a nationally representative study of 123,000 deaths from 6,671 randomly selected areas in 2001-03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication. A total of 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15-29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6-4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8-6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500).Conclusions: Snakebite remains an underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India.