Introduction:
Mammals, reptiles and arthropods that live closely and interact with man can inflict injury or death in human beings through bites.[1] Most of the bites from dogs, cats, scorpion and centipede cause minor lesions for which no medical help is sorted.[2] In India, the number of annual deaths reported due to rabies and snake bites is 20000 and 50000 respectively and there is no reliable mortality and morbidity data available due to lack of proper reporting system and large number of people opting for non traditional methods.[3,4] Most of the deaths following bites can be prevented by simple wound washing, proper treatment, vaccination, anti-rabies immunoglobulin’s and anti-snake venom. Unfortunately, at risk populations are not well informed about the risk and what to do in case of any bites.[4] The people most affected by these bites live in poor rural communities, although the impact of these health issues are dramatic and economically significant it does not appear to be a priority health issue in the design of national health programs and therefore regarded as most neglected among the neglected global health problems.[5] Most of the studies available are either hospital based retrospective studies or on a particular condition which is not indicating the true incidence of the animal bites and envenoming in the community.[6-9] Hence, the present community based cross sectional study was conducted with the objectives of finding the period prevalence of different bites, its epidemiological risk factors and its treatment seeking behaviour. This study will help us in establishing the anti-rabies clinic in the Rural Health Training Centre and to develop health education messages for the community.
Materials and Methods
Study area:
The present cross sectional study was undertaken in Tiruvenainallur of Villupuram district in Tamil Nadu which is located about 200 kilometres from Chennai. The district is having a literacy status of 71.8% and agriculture is the main occupation.[10] The Rural Health Training Centre (RHTC) located in Thiruvenainallur is the peripheral centre of the Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital which undertook the present study. The field practising areas of RHTC is 34 villages covering a population of 63921. This RHTC used for training and sensitization of Medical undergraduates, interns, post graduates and nursing students on health problems in rural areas and for community outreach programs and school health programs. In this present study all the 34 villages covering population 63921 were included.
Sample size and sampling:
Considering the prevalence of animal bites as 7.4% with 95% confidence limits and a 5% of relative error in the prevalence, design effect of 1, the minimum sample size required was 18865, calculated using Open EPI version (2.3) software package.[11] Taking an average of 5 members in a household, the total number of households required for the study was 3773. With a non response of 10 %, the number of households required for the study was 4150. All the members of all age groups and both the sexes were included in the study. Population proportional to size (PPS) method was used to select number of households in each village. To begin with, trained social workers prepared mapping of the all the 34 villages where study was conducted. They listed number of households in each village and prepared maps in conjunction with the villagers.
Data collection tool:
A questionnaire was prepared consisting of basic socio-demographic features, history of any bites in the preceding 12 months, risk factors and local practices and treatment seeking. The prepared questionnaire was pilot tested in a village where study was not conducted to check the validity of its content and necessary corrections were made.
Data collection:
Data was collected for a period of one year. Every month medical interns were posted in RHTC. Training for medical interns and social workers was done every month. House to house visit was made in all the villages. Households were selected by systematic random sampling. All the members in the household were included in the study. Trained interns and social workers after obtaining written consent administered the questionnaire to the respondents. Housewife of the house or any other responsible adult was enquired about the bites caused to all family members during last one year. To ensure quality of data, filled up questionnaires were randomly rechecked in the field for accuracy and completeness of the data by post graduates and faculty of Community Medicine department.
Data Analysis:
Data was entered and analysed in Epi_info (3.4.3) software. The prevalence of bites was estimated as proportion and odds ratio with its 95% confidence interval were calculated for assessment of risk factors for animal bites.
Results
In this study, information of 12947 adults was included and the overall period prevalence of bites was 81.8/1000 population. The most common bite was dog bite (289) followed by scorpion (287) and centipede (231). The other common bites were rat (115), snake (85), cat (30) and monkey (16) (Table-1).
Table 1: Distribution of animal bites and envenomings in last one year in adults |
| Biting animal/envenomings |
Number |
Period prevalence (per 1000) |
Dog |
289 |
22.3 |
Cat |
30 |
2.3 |
Wild animal |
2 |
0.15 |
Domestic animal |
5 |
0.38 |
Monkey |
16 |
1.23 |
Rat |
115 |
8.8 |
Snake |
85 |
6.5 |
Scorpion |
287 |
22.1 |
Centipede |
231 |
17.8 |
Total |
1060 |
81.8 |
The prevalence of dog bites among males (OR-1.4, 95% CI-1.1-1.88) was significantly higher than in females. With the reference population of age groups 18-30 years, the odds of having dog bites among people> 30 years was significantly higher. The odds of bitten by a dog was significantly increased for people below poverty line (OR: 1.4. 95% CI; 1-1.9), people in kachha house (OR: 1.3, 95% CI; 1-1.8) and semi-pucca houses (OR: 1.5, 95% CI; 1.1-1.9). Keeping housewife as reference population, farmers (OR: 2.4, 95% CI; 1.6-3.6), and daily wage labourers (OR: 1.7, 95% CI; 1.1-2.6), were having significant risk for getting dog bites. When compared with graduates, dog bites were significantly higher among illiterates (OR: 2.2, 95% CI; 1.4-3.5) and those who went to school only (OR: 1.6, 95% CI; 1-2.5). In our study cat bites does not have a significant association with any of the epidemiological factors. (Table-2)
Table 2: Sociodemographic characteristics of dog bite and cat bite victims |
| Variables |
Dog bites(N-289) |
Odds ratio(95% CI) |
Cat bite(N-30) |
Odds ratio (95% CI) |
Sex |
Female (N-6351) |
115 |
1 |
16 |
1.1(0.5-2.4) |
Male (N-6596) |
174 |
1.47 (1.15-1.88)* |
14 |
1 |
Age (years) |
18-30 (N-4844) |
66 |
1 |
12 |
1 |
31-40 (N-2927) |
60 |
1.5(1.07-2.17)* |
7 |
0.9 (0.3-2.4) |
41-50(N-2112) |
66 |
2.3 (1.6-3.3)* |
3 |
0.5 (0.1-2) |
>50(N-3064) |
97 |
2.3 (1.7-3.2)* |
8 |
1 (0.4-2.5) |
Socioeconomic status |
APL ( N-2416) |
213 |
1 |
8 |
1 |
BPL (N-10389) |
72 |
1.47(1.1-1.97)* |
22 |
0.6 (0.2-1.4) |
No ration card (N-142) |
4 |
1 (0.26-3.3) |
- |
- |
House type |
Pucca (N- 4930) |
87 |
1 |
13 |
1 |
Semi Pucca (N- 4267) |
111 |
1.49 (1.1-1.9)* |
7 |
0.6 (0.2-1.5) |
Kachha (N- 3750) |
91 |
1.37 (1- 1.86)* |
10 |
1 (0.4-2.3) |
Occupation |
Housewife (N- 2692) |
37 |
1 |
7 |
1.6 (0.5-4.8) |
Farmer (N- 2776) |
91 |
2.4 (1.6-3.6)* |
8 |
1.8 (0.6-5) |
Labourer (N-2961) |
70 |
1.7 (1.1- 2.6)* |
8 |
1.7 (0.6-4) |
Others (N- 4518) |
91 |
1.54 (1- 2.3)* |
7 |
1 |
Education |
Graduate (N-1633) |
22 |
1 |
2 |
1 |
Illiterate (N-4755) |
137 |
2.2(1.4-3.5)* |
13 |
2.2 (0.5-10) |
School (N-6559) |
140 |
1.6 (1-2.5)* |
15 |
1.8 (0.4-8.2) |
| *indicates p value <0.05 |
The factors significantly associated with higher risk for scorpion bites were female (OR: 1.5, 95% CI; 1.2-1.9), age groups 31-40 years (OR: 1.8, 95% CI; 1.4-2.5), age groups 41-50 years (OR: 1.5, 95% CI; 1.1-2.2), age group above 50 (OR: 1.4, 95% CI; 1.-1.9), people living in kaccha house (OR: 1.3, 95% CI; 1-1.8), semi-pucca house (OR: 1.3, 95% CI; 1-1.8), house wife (OR: 1.5, 95% CI; 1.1-2.1), daily wage labourers (OR: 1.5, 95% CI; 1.1-2.1), illiterate (OR: 2.4, 95% CI; 1.4-4) and people who studied up to school (OR: 2, 95% CI; 1.1-3.4). The prevalence of snake bites were significantly higher among males (OR: 1.6, 95% CI; 1-2.6) compared to females. Among different age groups, people between 41-50 years (OR: 4.6, 95% CI; 2.5-8.5) were having significantly higher risk for snake bites. The other significant risk factors were occupation such as farming (OR: 3.7, 95% CI; 2-7) and daily wage labourer (OR: 2.8, 95% CI; 1.5-5.4). Illiterates (OR: 4, 95% CI; 1.2-16.5) and people who studied up to school only (OR: 3.9, 95% CI; 1.2-15.9) were having increased risk for snake bites. Centipede bites were significantly higher among females ((OR: 2.1, 95% CI; 1.6-2.7), age group of 41-50 years (OR: 1.5, 95% CI; 1-2.2) and among housewife (OR: 1.8, 95% CI; 1.2-2.5). People living in semi-pucca houses (OR: 1.9, 95% CI; 1.2-3) and below poverty line (OR: 2.7, 95% CI; 1.3-5.4) were having significantly increased risk for rat bites (Table-3).
Table 3: Sociodemographic characteristics of envenomings and rat bite victims |
| Variables |
Scorpion
(N-287) |
Odds ratio
(95% CI) |
Snake
(N-85) |
Odds ratio (95% CI) |
Centipede
(N-231) |
Odds ratio (95% CI) |
Rat bite
(N 115) |
Odds ratio (95% CI) |
Sex |
Female (N-6351) |
172 |
1.5 (1.2-1.9)* |
31 |
1 |
154 |
2.1 (1.6-2.7)* |
64 |
1.3 (0.9-1.9) |
Male (N-6596) |
115 |
1 |
54 |
1.68 (1-2.6)* |
77 |
1 |
51 |
1 |
Age (years) |
18-30 (N-4844) |
78 |
1 |
16 |
1 |
71 |
1 |
38 |
1 |
31-40 (N-2927) |
87 |
1.8 (1.4-2.5)* |
18 |
1.8 (0.9-3.6) |
52 |
1.2 (0.8-1.7) |
31 |
1.3 (0.8-2.2) |
41-50(N-2112) |
53 |
1.5 (1.1-2.2)* |
32 |
4.6 (2.5-8.5)* |
48 |
1.5 (1-2.2)* |
21 |
1.2 (0.7-2.1) |
>50(N-3064) |
69 |
1.4 (1-1.9)* |
19 |
1.9 (0.9-3.7) |
60 |
1.3 (0.9-1.9) |
25 |
1 (0.6-1.7) |
Socioeconomic status |
APL ( N-2416) |
44 |
1 |
18 |
1 |
45 |
1 |
9 |
1 |
BPL (N-10389) |
241 |
1.2 (0.9-1.7) |
66 |
0.8 (0.5-1.4) |
182 |
0.9 (0.6-1.3) |
105 |
2.7 (1.3-5.4)* |
No ration card (N-142) |
2 |
0.7 (0.1-2.7) |
1 |
0.9 (0.4-5.2) |
4 |
1.5 (0.5-4.3) |
1 |
1.8 (0.2-15) |
House type |
Pucca (N- 4930) |
89 |
1 |
32 |
1 |
97 |
1 |
30 |
1 |
Semi Pucca (N- 4267) |
104 |
1.3 (1-1.8)* |
27 |
1 (0.6-1.7) |
67 |
0.9 (0.6-1.2) |
50 |
1.9 (1.2-3)* |
Kachha (N- 3750) |
94 |
1.3 (1.02-1.8)* |
26 |
0.9 (0.5-1.6) |
67 |
0.7 (0.5-1) |
35 |
1.5 (0.9-2.5) |
Occupation |
Housewife (N- 2692) |
66 |
1.5 (1.1-2.1)* |
9 |
1 (0.4-2.3) |
69 |
1.8 (1.2-2.5)* |
27 |
1.4 (0.8-2.3) |
Farmer (N- 2776) |
61 |
1.2 (0.88-1.7) |
34 |
3.7( 2-7)* |
45 |
1.1 (0.7-1.6) |
26 |
1.3 (0.7-2.2) |
Labourer (N-2961) |
80 |
1.57 (1.1-2.1)* |
27 |
2.8 (1.5-5.4)* |
51 |
1.2 (0.8-1.7) |
30 |
1.4 (0.8-2.4) |
Others (N- 4518) |
80 |
1 |
15 |
1 |
66 |
1 |
32 |
1 |
Education |
Graduate (N-1633) |
18 |
1 |
3 |
1 |
25 |
1 |
13 |
1 |
Illiterate (N-4755) |
123 |
2.4 (1.4-4)* |
35 |
4 (1.3-16.5)* |
85 |
1.1 (0.7-1.8) |
60 |
1.1 (0.5-2) |
School (N-6559) |
146 |
2 (1.2-3.4)* |
47 |
3.9 (1.3-15.9)* |
121 |
1.2 (0.7-1.8) |
42 |
1.1 (0.6-2.1) |
*indicates p value < 0.05
The nature of the bites shows that unprovoked bites was more in dog bites (81.7%) followed by monkey (75%) and cat (70%). Outcome following bites shows that most were recovered and disability was present in monkey (6.3%) and dog bites (1.8%). There are no reported deaths following the bites. The most common site of the dog bite (80.6%) and cat bite (73.3%) victims are lower limbs. In monkey bites the most common site was upper limbs. In and around the home is the common place of bites for dog (55.7%) and cat (93.3%) bite victims. Most of the animals were healthy or health status unknown following the bites (Table-4).
Table 4: Characteristics of dog, cat and monkey bites |
| Variable |
Dog bite (%) (N-289) |
Cat bite (%) (N-30) |
Monkey (%) (N-16) |
Nature |
Provoked |
53 (18.3) |
9 (30) |
4 (25) |
Unprovoked |
236 (81.7) |
21 (70) |
12 (75) |
Outcome |
Recovered |
284 (98.2) |
30 (100) |
15 (93.7) |
Disability |
5 (1.8) |
- |
1 (6.3) |
Death |
- |
- |
- |
Site of bite |
Lower limb |
233 (80.6) |
22 (73.3) |
2 (12.5) |
Upper limb |
43 (14.8) |
4 (13.3) |
12 (75) |
Head and neck |
3 (1) |
2 (6.6) |
2 (12.5) |
Trunk |
1 (0.3) |
1 (3.3) |
- |
Others |
9 (3.1) |
1 (3.3) |
- |
Place of bite |
Home |
161 (55.7) |
28 (93.3) |
7(43.7) |
School |
3 (1) |
- |
- |
Work |
67 (23.1) |
2 (6.7) |
2 (12.5) |
Others |
58 (20) |
- |
7 (43.8) |
Fate of animal |
Healthy |
160 (55.3) |
20 (66.7) |
6 (37.5) |
Sick |
1 (0.3) |
- |
- |
Dead |
18 (6.2) |
- |
1 (6.3) |
Killed |
10 (3.4) |
1 (3.3) |
- |
Unknown |
100 (34.6) |
9 (30) |
9 (56.2) |
Table 5 shows that there was one death among the snake bite victims. Lower limbs followed by upper limbs are the most common site of bite in snake (82.3%, 14.1%), centipede (36.7%, 28.5%) and rat bite (52.1%, 42.6%). In scorpion bite the most common site of bite was upper limbs (48.4%). Home was the common place of bite in scorpion (76.6%), centipede (83.9%) and rat (93%). Workplace such as fields was the common place bite in snake (60%).
Table 5: Characteristics of envenomings and rat bite victims |
| Variable |
Dog bite (%) (N-289) |
Cat bite (%) (N-30) |
Monkey (%) (N-16) |
Nature |
Provoked |
53 (18.3) |
9 (30) |
4 (25) |
Unprovoked |
236 (81.7) |
21 (70) |
12 (75) |
Outcome |
Recovered |
284 (98.2) |
30 (100) |
15 (93.7) |
Disability |
5 (1.8) |
- |
1 (6.3) |
Death |
- |
- |
- |
Site of bite |
Lower limb |
233 (80.6) |
22 (73.3) |
2 (12.5) |
Upper limb |
43 (14.8) |
4 (13.3) |
12 (75) |
Head and neck |
3 (1) |
2 (6.6) |
2 (12.5) |
Trunk |
1 (0.3) |
1 (3.3) |
- |
Others |
9 (3.1) |
1 (3.3) |
- |
Place of bite |
Home |
161 (55.7) |
28 (93.3) |
7(43.7) |
School |
3 (1) |
- |
- |
Work |
67 (23.1) |
2 (6.7) |
2 (12.5) |
Others |
58 (20) |
- |
7 (43.8) |
Fate of animal |
Healthy |
160 (55.3) |
20 (66.7) |
6 (37.5) |
Sick |
1 (0.3) |
- |
- |
Dead |
18 (6.2) |
- |
1 (6.3) |
Killed |
10 (3.4) |
1 (3.3) |
- |
Unknown |
100 (34.6) |
9 (30) |
9 (56.2) |
Bleeding was present following bites from dog (80.6%), cat (63.3%) and monkey (75%) which indicates most of the bites are category 3 bites. Wound washing was done in 183 (63.3%) dog bite victims and 16 (53.3%) cat bite victims. Among the wound washed 101 (55.2%) dog bite cases washed with soap and water. In 82 (28.3%) dog bite cases applied irritants and the common irritant applied are ash, calotropis milk, lime, ink, etc. Primary health centre was the most preferred site for treatment following dog (145, 50.1%) and monkey bite (9, 56. 2%). Household remedies were the preferred mode of treatment for cat bite. Antirabies vaccine was given in 174 (60.2%) of dog bite cases, 12 (40%) cat bite, 13 (81.3%) of monkey bite cases. Out of 80.3% of category 3 dog bites, the important life saving measure of rabies Immunoglobulins (RIGS) was administered in only 18 (6.2%) cases (Table-6).
Table 6: Characteristics of the wound and the treatment in animal bites |
| Characteristics |
Dog bite (%)(N-289) |
Cat bite (%)(N-30) |
Monkey (%) (N-16) |
Number of wounds |
1 |
233 (80.6) |
24 (80) |
12 (75) |
2 |
38 (13.1) |
6 (20) |
2 (12.5) |
>3 |
18 (6.3) |
- |
2 (12.5) |
Bleeding |
Yes |
233 (80.6) |
19 (63.3) |
12 (75) |
No |
59 (19.4) |
11 (36.7) |
4 (25) |
Wound wash |
Yes |
183 (63.3) |
16 (53.3) |
12 (75) |
No |
106 (36.7) |
14 (46.7) |
4 (25) |
Wound wash |
Water only |
82 (44.8) |
10 (62.5) |
7 (58.3) |
Soap and water |
101 (55.2) |
6 (37.5) |
5 (42.7) |
Application irritants |
Yes |
82 (28.3) |
5 (16.6) |
5 (31.3) |
No |
207 (71.7) |
25 (83.4) |
11 (68.7) |
Source of treatment |
Government |
145 (50.1) |
10 (33.3) |
9 (56.2) |
Private |
15 (5) |
2 (6.6) |
5 (31.3) |
Traditional healers |
76 (26.2) |
3 (9.9) |
- |
RHTC |
2 (0.6) |
3 (9.9) |
- |
Others |
51 (17.6) |
12 (40) |
2 (12.5) |
Vaccine given |
Yes |
174 (60.2) |
12 (40) |
13 (81.3) |
No |
115 (39.8) |
18 (60) |
3 (19.7) |
Number of doses of vaccine |
< 3 |
102 (58.6) |
12 (100) |
8 (50) |
>3 |
72 (41.4) |
- |
8 (50) |
RIGS |
Given |
18 (6.2) |
- |
2 (12.5) |
Not given |
271 (93.8) |
- |
14 (87.5) |
Table 7 shows that Irritants were applied in the wounds in 78 (27%) scorpion bites, 29 (25.3%) of rat bites and 50 (21.6%) centipede bites. The most common irritants applied were onion, ash, lime, etc. Government hospitals such as Primary health center were the preferred mode of treatment following snake bite and only 8 (9.4%) of them were given anti-snake venom.
Table 7: Characteristics of the wound and the treatment in Envenomings and Rat bites |
| Characteristics |
Scorpion (%) (N-287) |
Snake (%) (N-85) |
Centipede (%) (N-231) |
Rat (%) (N-115) |
Wound wash |
Yes |
71 (24.7) |
37 (43.5) |
64 (27.7) |
58 (50.4) |
No |
216 (75.3) |
48 (56.5) |
167 (72.3) |
57 (49.6) |
Wound wash |
Water only |
55 (19.1) |
30 (35.2) |
40 (17.3) |
30 (26) |
Soap and water |
16 (5.5) |
7 (8.2) |
24 (10.7) |
28 (24.3) |
Application of irritants |
Yes |
78 (27.1) |
13 (15.2) |
50 (21.6) |
29 (25.3) |
No |
207 (72.9) |
72 (84.8) |
181 (78.4) |
86 (74.7) |
Source of treatment |
Government |
74 (25.7) |
53 (62.3) |
76 (32.9) |
52 (45.2) |
Private |
78 (27.1) |
9 (10.5) |
60 (25.9) |
30 (26) |
Traditional healers |
63 (21.9) |
16 (18.8) |
59 (25.5) |
21 (18.2) |
RHTC |
4 (1.3) |
- |
4 (1.7) |
4 (3.4) |
Others |
68 (23.6) |
8 (9.4) |
32 (13.8) |
8 (6.9) |
TT vaccine given |
Yes |
125 (43.5) |
60 (70.5) |
47 (20.3) |
35 (30.4) |
No |
162 (56.5) |
25 (29.5) |
184 (79.7) |
80 (69.6) |
Anti- snake venom |
Given |
- |
8 (9.4) |
- |
- |
Not given |
- |
77 (90.6) |
- |
- |
Discussion
Overall, the period prevalence of all bites was 84/1000 adult population during the study period. Dog bite was the most common bite followed by scorpion and centipede bite. Dog bites were significantly higher among males, people below poverty and among farmers and labourers. Scorpion bites were significantly higher among housewives, illiterates and people living in cache and semi Pucca houses. Males, farmers and daily wage labourers were having increased risk of snake bites. Almost 82% of dog bites were unprovoked and lower limb was the most common site of bite. In Snake and rat bite, lower limb was the most common site and 60% of the snake bite occurred in the work place. Eighty percent of the dog bites were category 3 wounds and only 35% of wounds were washed with soap and water. Application of irritants such as calotropis milk, onion, ash, etc. was common among the cases. Half of the victims preferred public facilities for treatment and two third of cases took anti rabies vaccine. Among 81% of category 3 bite victims only 6.2% were given the life saving measure of rabies immunoglobulins.
The present community based study describes the prevalence of various bites, its risk factors and its treatment seeking behaviour. This study covered a large representative sample of 12947 adults and used systematic random sampling method. There are studies available either for rabies related bites or other bites separately and most of which are hospital based. This present study highlights the treatment seeking behaviour and traditional beliefs which indicate there is a need for health education program for bites. Recall bias may be an important limitation in the study.
In the present study, the main biting animal was dog and most of the dog bites were in adult males and people of below poverty line. Sudarshan et al and Ichhpujani RL et al reported similar findings in their study.[12,13] Farmers and labourers had increased risk for the bite, which may be due to outdoor activities and increased chance for man animal contact. Lower limb was the most common site of bite, a hospital based study in Mumbai also showed similar findings.[14] Only 35% of victims washed their wounds with soap and water and application of irritants such as calotropis milk, native leaf treatment etc., seem to be common practice. Agarwal N and Kalaiselvan G in a community based study in India reported application of irritants in the wounds of bite victims.[11,14] Among the dog bite cases, only 60% were vaccinated with anti-rabies vaccine. Government facilities were the mainstay of treatment and Sudharshan et al reported similar findings.[12] Bleeding was present in 80% of bites which indicates these were class III bites but only 6.2% were given rabies immunoglobulins (RIGS). The main reasons for not using RIGS were non availability in primary health centres and to travel to medical college to avail it which located far from the study area and lack of awareness to use it among people. There was no reported case of rabies in the present study and in a recent study by Kakkar M shows that rabies deaths in Tamil Nadu was reduced from 0.75 to 0.43 per lakh population.[15] Tamil Nadu was the state in India to start rabies control initiative and it emphasises in rural areas on availability of vaccine in primary health centre and community awareness program regarding bites.[16] However there is a need to strengthen this program regarding wound washing, vaccination, RIGS, Do’s and Dont’s following animal bites.
Snake bites were more common among males, farmers and labourers. This may be due to people working in natural habitats of snakes such as sugar cane fields, rice fields without any protective wearing. In a country like India with a vast rural population the accessibility to protective devices such as shoes, gloves etc., and their usage is limited and this increases their vulnerability to snake bites. Most of the bites occurred in the work place and lower limb is the most common site of bite. Halessa BR, Sujeet Raina, Logaraj M and Albuquerque PLMM in their record based hospital study reported similar findings.[7,8,17,18] Most of the people preferred government facilities for treatment and case fatality rate of snake bites was 1.2% (1/85) in the study population.
The Scorpion and centipede bites were common in females and people living in kaccha houses. Kaccha houses having cracks and crevices, ill lighted with dark corners makes an ideal place for these insects to hide and increases the vulnerability of the women who is doing household activities. Almost half of the bitten victims prefer traditional medicine or household remedies such as applying ash, onion over the wound. There are studies available in India, Brazil, Venezuela and Hong Kong, which cannot be compared with the present study because of variation of place of study, sample size and type of respondents.[19,20]
Conclusions: Considering the high prevalence of different bites and treatment seeking behaviour indicates there is a lack of awareness regarding all forms of bites in the rural community. The existing program of rabies control has reduced the number of rabies deaths, but community awareness about different bites, its personal protective measures and treatment seeking has to be strengthened.
Competing interests: None declared
Ethical consideration: All the ethical principles were adhered in the present study. The study was approved by Research committee and Institute Ethics committee of Sri Manakula Vinayagar Medical College Hospital, Puducherry.
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