Nepal has high snake biodiversity due to its varied elevations and ecosystems. The Terai region has the highest species density and sees the most snakebites, mainly from kraits and cobras, due to abundant agriculture which increases human-snake encounters. About 15,000 snakebites occur annually in Nepal, with 10% being poisonous and resulting in 10% mortality (85-120 deaths). The major fatal snakes are the king cobra, common cobra, Russell's viper, krait and saw-scaled viper. Snakebites predominantly affect males over 15 years of age at night while working in farms. Prevention efforts include guidelines, free antivenom distribution, and education on habitat modification and first

1. Presenter:Bimal khadka
Resource Faculty:Ram B. Sah
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2. Introduction
Nepal is a small yet beautiful Himalayan kingdom with a
population of 28 million, most of whom live in a rural
environment.
The climate and ecology of the country is mainly
determined by elevation which defines 3 ecological zones
extending from east to west through out the country
The ecological diversity is matched by species variety of
snake found in different regions of the country.
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3. Distribution of snakes
 Terai region: Pan-oriental (Indian) species.
 high diversity of snakes in terms of species density. (mostly
Karait and cobra)
 Mid-hill region: 1500 and 3500 metres above sea level.
 pan-oriental and Indo-chinese species.
 Himalayan region: northern most region above 3500
metres
 himalayan and and Tibetan species ( Pit vipers).
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4. Agriculture
 Agriculture is the main stay of Nepalese economy.
 The agriculturally prosperous terai region with hot
climate, high seasonal rainfall, lush natural vegetation,
high density of rodents, rich reptiles and amphibian flora
making ideal habitat for snake to live and increase
availability of marshy land to undergo hibernation.
 The abundance of snake and human activities, mainly
agriculture, increases the man – snake encounter leading
to snakebite.
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5. Agriculture
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6. Cultural and Religious View:
Hindu people worship the “king of
snakes” (Nag) in the snake festival
(Nagpanchami) celebrated in July in mid
monsoon.
 snakebite can be avoided
 rain will be assured for their crops.
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7. Herpetologists classified snakes:
1.Colubridae
i. Elapidae : -cobra, krait, mamba, coral
snakes, taipan,
-found in all parts of the world
except Europe.
ii. Crotalidae : -rattle snake, pigmy snake,
copper heads, bush master,
-Asia & America
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8. iii. Hydrophidae: -all sea snakes,
-myotoxic,
-they seldom bite.
2. Viperidae :
i. Viperinae: -Russell’s viper, Saw-scaled
viper, Gaboon viper,
-Found everywhere in the world
except America.
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9. Worldwide:
Worldwide the published statistics on the incidence,
morbidity and mortality are largely based on the hospital
data and is grossly inadequate except for a few countries
where snakebite is rare or is correctly reported.
• Snakebite is estimated to account for a tenth as much
mortality as malaria, but there is no equivalent global
snakebite strategy.
• An international initiative is required to refocus the
world’s attention on this neglected, but eminently
treatable, disorder.
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10. Asia
In Asia alone, it has been estimated that four million
snakebite cases occurs each year of which 50% are
envenomed resulting in 100,000 annual deaths.
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11. Nepal
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12. Snakes found in Nepal
79 species of snakes are found in Nepal •
Among them 21 species are poisonous
5 sp. Of Kraits,
3 of Cobras
1 sp.of Coral,
1 sp. Of Russel’s viper and and sp. of pit vipers)
•
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13. Majority of bites and consequent mortality
is attributable to 5 species:
They are the dangerously poisonous snakes in our country.
1.Ophiophagus hannah (king cobra),
2. Naja naja (common cobra),
3. Daboia rusellii (Russell's viper),
4. Bungarus caeruleus (krait) and
5. Echis carinatae (saw-scaled viper).
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14. 1.King Cobra (Ophiophagus hannah)
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15. 2.Common Cobra (Naja naja)
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16. 3. Common Krait (most common)
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17. 4. Russell’s Viper (Daboia rusellii)
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18. 5. Saw-scaled Viper (Echis carinatae)
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19. Other non-poisonous snakes in Nepal
• Blind snake –tropical snakes with scales over
eyes adapted for burrowing and
 eating small invertebrates
• tree snake-slender tree dweller native all over
 SE asia
• Sand snake
• Worm snake
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20. Public health problem
 Snake bite is a common event in many rural areas where
transportation and medical facilities are grossly
inadequate.
 Most of the trained health workers are urban based where
snakebite is rare.
 Therefore faith healers play a major role in the treatment
of snakebite.
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21. Epidemiology
 Zoonotic like snake bite is medical emergency and cause hospital
admission.
 79 species of snakes are found in Nepal •
 Around 15000 snakebite cases occur annually •
 Around 10% of these cases are poisonous bites •
 Mortality is 10% among poisonous bite •
 26 district of terai including inner terai are highly affected •
 Every year 85-120 people die due to poisonous snake bite in
Nepal •
 ASVS free distribution policy implemented since FY 2056/057
(1998/99 ) •
 Indian Quadri-valent ASVS is used
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22. Snake bite cases and deaths.
Snake bite cases and deaths
Fiscal
year
Total
case
Non
poisonou
s
Poisonou
s
Cure No. of
Deaths
% of
Death
2065/66 13017 11883 1134 1006 128 11.28
2066/67 17163 15844 1319 1188 131 9.93
2067/68 18204 17121 1083 965 118 10.89
2068/69 14768 13789 979 890 89 9.09
2069/70 14329 13462 867 788 79 9.11
Total 77481 72099 5382 4837 545
Source:
EDCD
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23. Snake bite case in Ward of Bpkihs
Fiscal year Total admitted
case
No of deaths % of deaths
2010/11 54 3 .06
2011/12 47 1 .020
2012/13 16 0 0
2013/14 29 0 0
2014/15 36 1 .03
Total 202 4
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Note : all death occurred in paediatrics ward
1 death occurred within 48 hours
3 deaths occurred after 48 hours after admission.
all death occurred in Rainy season

24. Snake bite case in emergency
department of BPKIHS
Admitted in emergency
Fiscal year
Cases in emergency
2010/11 185
2011/12 99
2012/13 43
2013/14 51
2014/15 51
Total 429
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Note : 2 deaths occurred in June and July of 2011/12.

25. Species of biting poisonous snake
 Only poisonous snake bite cases viz. pit viper’s bite which do
not need administration of anti-snake venom serum is reported
from hills and mountains. So, those cases are not entertained
for the purpose of analysis.
 Among poisonous case, 2/3rd cases due to krait bite, 1/3rd
due to cobra bite and very few cases due to Russell's viper
bite, health institutions used to report dhaman bites as
poisonous snake bite.
 Dhaman and cobra bite frequently confused amongst
healthcare providers.
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26. Age and sex:
• Among the genders, male are
 victimized slightly higher than females
• Among the age group, 2/3rd of the total cases belong to
adult age group, aged > 15 years and the rest belong to the
age group < 15 years. Among the dead, half belong to adult
age group aged > 15 years and half belong to age group < 15
years of age.
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27. Time of bite
 2/3rd of snake bite cases occur during night, rest in the
morning & evening time.
 Dusk to dawn covers 3/4th of the total poisonous
snakebite cases.
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28. Site of bite
 As 2/3rd of cases are due to krait bite and happened
during night time, site of bite and mark of bite could not
be conformed .
 So among the site of bites mention cases, half of the
people bitten on hand and rest were bitten on foot, head
& neck region and other parts of body.
 Other parts includes buttocks ,hip, back and chest.
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29. Monthly distribution of snake bite:
 No Reports of poisonous snakebite cases during
December, January, march. Few on February and
November.
 Incidence rise from month of April and remain at peak
level in month of June, July, august and September
(during and after monsoon).
 Decline from month of October to nearly level off during
December.
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30. Activities
 Development and distribution of snake bite management
guideline and treatment protocol for medical professionals
of the country.
 Free distribution of ASVS for the victims of poisonous
snake bite.
 Annually around 19000-21000 vials of ASVS is supplied for
1500-2000 people who are in high risk zones of the
country, through regional medical stores and hospitals.
 Training: SMO/MO and Paramedics on judicious use of
ASVS
 Develop and distribution of IEC materials to stakeholders
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31. Prevention is better than cure.
 In Nepal most snakebite cases occur due to
carelessness, specific occupation, lack of knowledge on
the snakes and poverty.
 Number of accidents can be reduced if following
instruction is followed
 Leave snake alone, avoid it as far as possible.
 Avoid having rubble, rubbish, unnecessary grass and
bush close to resident and play ground.
 Never handle, threatened, attack and trap a snake in
an enclose space.
 Never put hand, feet into the holes in land, trees,
hollow logs and thick grass without prior inspection.
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32. Prevention is better than cure.
 Always use light while walking at night.
 Do not gather firewood after dark.
 Keep the residence free of rodents, amphibians and lizard.
 Try to avoid indoor and outdoor sleeping on ground,sleep in
net.
 Take caution while waking on swamp area.
 Do not swim in water infested with snake.
 Do not believe that snakebite incidents, which takes place
inside water are harmless.
 People who live in the huts must check shoes before
putting them.
 If you are bitten, get away from the snakes as quickly as
possible in zigzag way and move to high altitude.
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33. References
 Sanjib Sarma MD, drsanjib@yahoo.com, snake and
snakebite cases in Nepal , CIN’ 2003,
 Nepal government, Ministry of health, Department of
health services, Epidemiology & disease control division,
Snakebite management guideline,2003.
 Annual health report, Nepal 2012/13.
 BPKIHS
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