The socio-economic burden of snakebite in Sri Lanka

PLoS Negl Trop Dis. 2017 Jul 6;11(7):e0005647. doi: 10.1371/journal.pntd.0005647. eCollection 2017 Jul.

Abstract

Background: Snakebite is a major problem affecting the rural poor in many of the poorest countries in the tropics. However, the scale of the socio-economic burden has rarely been studied. We undertook a comprehensive assessment of the burden in Sri Lanka.

Methods: Data from a representative nation-wide community based household survey were used to estimate the number of bites and deaths nationally, and household and out of pocket costs were derived from household questionnaires. Health system costs were obtained from hospital cost accounting systems and estimates of antivenom usage. DALYs lost to snakebite were estimated using standard approaches using disability weights for poisoning.

Findings: 79% of victims suffered economic loss following a snakebite with a median out of pocket expenditure of $11.82 (IQR 2-28.57) and a median estimated loss of income of $28.57 and $33.21 for those in employment or self-employment, respectively. Family members also lost income to help care for patients. Estimated health system costs for Sri Lanka were $ 10,260,652 annually. The annual estimated total number of DALYS was 11,101 to 15,076 per year for envenoming following snakebite.

Interpretation: Snakebite places a considerable economic burden on the households of victims in Sri Lanka, despite a health system which is accessible and free at the point of care. The disability burden is also considerable, similar to that of meningitis or dengue, although the relatively low case fatality rate and limited physical sequelae following bites by Sri Lankan snakes means that this burden may be less than in countries on the African continent.

MeSH terms

  • Animals
  • Antivenins / economics
  • Antivenins / therapeutic use
  • Health Care Costs*
  • Humans
  • Income
  • Snake Bites / economics*
  • Snake Bites / epidemiology
  • Snake Bites / therapy*
  • Sri Lanka / epidemiology

Substances

  • Antivenins

Grant support

This study was supported by the National Health Medical Research Council, Australia [Grant Numbers NHMRC 631073, NHMRC 630650]. In addition, GKI and AD were supported by NHMRC Program Grant 1055176, AD by NHMRC Practitioner Fellowship 1059542, and GKI by NHMRC Senior Research Fellowship 1061041. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.