Journal of Toxicology and Environmental Health Sciences
Subscribe to JTEHS
Full Name*
Email Address*

Article Number - 32A29934520


Vol.5(3), pp. 43-51 , March 2013
DOI: 10.5897/JTEHS12.059
ISSN: 2006-9820



Full Length Research Paper

Inclusion of incorrect information on snakebite first aid in school and university teaching materials in Nepal



Deb P. Pandey
  • Deb P. Pandey
  • Biodiversity and Climate Research Centre (BiK-F), Frankfurt, Germany, Department of Zoology, Birendra Multiple Campus, Tribhuvan University (T.U.), Bharatpur, Chitwan, Nepal
  • Google Scholar
Bishnu P. Khanal
  • Bishnu P. Khanal
  • Department of Zoology, Birendra Multiple Campus, Tribhuvan University (T.U.), Bharatpur, Chitwan, Nepal,Kalika Medical and Technical Institute, Nawalparasi, Nepal,Nepal Polytechnic Institute, Chitwan, Nepal
  • Google Scholar







 Accepted: 18 January 2013  Published: 31 March 2013

Copyright © 2013 Author(s) retain the copyright of this article.
This article is published under the terms of the Creative Commons Attribution License 4.0


In previous studies in Nepal, snakebite victims were found to either not have Pressure Immobilization Bandaging (PIB) or Local Compression Pad Immobilization (LCPI) performed for first aid, or had it performed incorrectly. The goal of this study was to evaluate training texts regarding first aid measures for snakebite and the rates of performance of both methods currently recommended, as well as ineffective or harmful practices. The study was conducted from September, 2009 to November, 2010. It evaluated the venomous snakebite first aid measures recommended in the 31 most recently published and commonly used Nepalese reference works and textbooks aimed at paramedical personnel, primary health care workers, medical undergraduates, and students of class five to bachelor´s degree. It compared the suggestions of these with those of published guidelines for the management of snakebite envenomation. Up to 100% of first aid measures advocated in these materials differed significantly from published guidelines. This included the omission of appropriate activities, misstatements and prescription of inappropriate treatments. Among appropriate recommendations that were missing was the advice to apply PIB or LCPI, and the suggestion to go to a snakebite treatment center. Fifty-five percent of the references did recommend emergency transport. Inclusion of accurate evidence-based information regarding first aid measures for venomous snakebite in commonly used texts could help to reduce the application of ineffective or harmful pre-hospital practices, their associated morbidity and mortality, and increase the use of appropriate methods.

 

Key words: Envenomation, snakebite, pressure immobilization bandaging, local compression pad immobilization, curriculum, health education.

Alberts MB, Shalit M, LoGalbo F (2004). Suction for venomous snakebite: a study of "mock venom" extraction in a human model. Ann. Emerg. Med. 43(2):181-186.
http://dx.doi.org/10.1016/S0196-0644(03)00813-8
 
Amaral CFS, Campolina D, Dias MB, Bueno CM, Rezende NA (1998). Tourniquet ineffectiveness to reduce the severity of envenoming after Crotalus durissus snake bite in Belo Horizonte, Minas Gerais, Brazil. Toxicon 36(5):805-808.
http://dx.doi.org/10.1016/S0041-0101(97)00132-3
 
Ariaratnam CA, Sheriff MHR, Theakston RDG, Warrell DA (2008). Distinctive epidemiologic and clinical features of common krait (Bungarus caeruleus) bites in Sri Lanka. Am. J. Trop. Med. Hyg. 79(3):458-462.
PMid:18784244
 
Bhetwal BB, O’Shea M, Warrell DA (1998). Snake and snakebite in Nepal. Trop. Doct. 28(4):193-195.
PMid:9803834
 
Blaylock RSM (1994). Pressure immobilization for snakebite in southern Africa remains speculative. S. Afr. Med. J. 84(12):826-827.
PMid:7570229
 
Bush SP, Hegewald KG, Green SM, Cardwell MD, Hayes WK (2000). Effects of a negative pressure venom extraction device (extractor) on local tissue injury after artificial rattlesnake envenomation in a porcine model. Wilderness Environ. Med. 11(3):180-188.
http://dx.doi.org/10.1580/1080-6032(2000)011[0180:EOANPV]2.3.CO;2
 
Canale E, Isbister GK, Currie BJ (2009). Investigating pressure bandaging for snakebite in a simulated setting: bandage type, training and the effect of transport. Emerg. Med. Aust. 21(3):184-190.
http://dx.doi.org/10.1111/j.1742-6723.2009.01180.x
PMid:19527277
 
CBS (2011). Preliminary result of national population census 2011. Central Bureau of Statistics, Nepal Government, Kathmandu. Available at: http://census.gov.np/index.php?view=article&catid=6:home&id=31:preliminary-result-of-national-population-census-2011-released&format=pdf, Accessed on 21.6.2012.
 
Chandio AM, Sandelo P, Rahu AA, Ahmed ST, Dahri AH, Bhatti R (2000). Snake bite: treatment seeking behaviour among Sindh rural populaiton. J. Ayub Med. Coll. 12(3):3-5.
 
Chauhan S, Faruqi S, Bhalla A, Sharma N, Varma S, Bali J (2005). Pre-hospital treatment of snake envenomation in patients presented at a tertiary care hospital in northwestern India. J. Venomous Anim. Toxins Incl. Trop. Dis. 11(3):275-282.
http://dx.doi.org/10.1590/S1678-91992005000300006
 
Chippaux JP, Ramos-Cerrillo B, Stock RP (2007). Study of the efficacy of the black stone on envenomation by snake bite in the murine model. Toxicon 49(5):717-720.
http://dx.doi.org/10.1016/j.toxicon.2006.11.002
PMid:17174999
 
Christensen PA (1969). The treatment of snakebite. S. Afr. Med. J. 43(41):1253-1258.
PMid:5348272
 
CSL (2008). Snakebite management (Poster). CSL Limited, Melbourne, Australia.
 
CTEVT 2011. Council for Technical Education and Vocational Training: a glimpse. Part 3. CTEVT, Sanothimi, Bhaktapur, Nepal. pp. 11-13.
 
Currie BJ (2003). Snakebite in Australia: moving from anecdotes to prospective studies. Emerg. Med. 15(5-6):406-408.
http://dx.doi.org/10.1046/j.1442-2026.2003.00492.x
 
Currie BJ (2006). Treatment of snakebite in Australia: the current evidence base and questions requiring collaborative multicentre prospective studies. Toxicon 48(7):941-956.
http://dx.doi.org/10.1016/j.toxicon.2006.07.015
PMid:16930660
 
Currie BJ, Canale E, Isbister GK (2008). Effectiveness of pressure-immobilization first aid for snakebite requires further study. Emerg. Med. Aust. 20(3):267-270.
http://dx.doi.org/10.1111/j.1742-6723.2008.01093.x
PMid:18549384
 
EDCD (2011). Annual report. Epidemiology and Disease Control Division, Nepal Government. Kathmandu. pp. 43-46.
 
German BT, Hack JB, Brewer K, Meggs WJ (2005). Pressure-immobilization bandages delay toxicity in a porcine model of Eastern Coral Snake (Micrurus fulvius fulvius) envenomation. Ann. Emerg. Med. 45(6):603-608.
http://dx.doi.org/10.1016/j.annemergmed.2004.11.025
PMid:15940092
 
Harris JB, Faiz MA, Rahman MR, Jalil MMA, Ahsan MF, Theakston RDG, Kuch U (2010). Snake bite in Chittagong Division, Bangladesh: a study of bitten patients who developed no signs of systemic en-venoming. Transact.Royal Society Trop. Med. Hyg. 104(5):320-327.
http://dx.doi.org/10.1016/j.trstmh.2009.12.006
PMid:20096910
 
Hati AK, Mandal M, De MK, Mukherjee H, Hati RN (1992). Epidemiology of snake bite in the district of Burdwan, West Bengal. J. Indian Med. Assoc. 90(6):145-147.
PMid:1522302
 
Heap BJ, Cowan GO (1991). The epidemiology of snake bite presenting to British military hospital Dharan during 1989. J. R. Army Med. Corps 137:123-125.
http://dx.doi.org/10.1136/jramc-137-03-03
PMid:1744818
 
Howarth DM, Southee AE, Whyte IM (1994). Lymphatic flow rates and first aid in simulated peripheral snake or spider envenomation. Med. J. Aust. 161(11-12):695-700.
PMid:7830641
 
Inamdar IF, Aswar NR, Ubaidulla M, Dalvi SD (2010). Snakebite: admissions at a tertiary health care centre in Maharashtra, India. S. Afr. Med. J. 100(7):456-458.
PMid:20822595
 
Kulkarni ML, Anees S (1994). Snake venom poisoning: experience with 633 cases. Indian Pediatr. 31(10):1239-1243.
PMid:7875785
 
Lawrence WT, Giannopoulos A, Hansen A (1996). Pitviper bites: rational management in locales in which copperheads and cottonmouths predominate. Ann. Plast. Surg. 36(3):276-285.
http://dx.doi.org/10.1097/00000637-199603000-00009
PMid:8659952
 
Leopold RS, Huber GS (1960). Ineffectiveness of suction in removing snake venom from open wounds. U. S. Armed Forces Med. J. 11 (6):682-685.
PMid:14415856
 
Michael GC, Thacher TD, Shehu MIL (2011). The effect of pre-hospital care for venomous snake bite on outcome in Nigeria. Trans. R. Soc. Trop. Med. Hyg. 105(2):95-101.
http://dx.doi.org/10.1016/j.trstmh.2010.09.005
PMid:21035155
 
Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, Rodriguez P S, Mishra K, Whitaker R, Jha P (2011). Snakebite mortality in India: a nationally representative mortality survey. PLoS Neglected Trop. Dis. 5(4):e1018.
 
Murrell G (1981). The effectiveness of the pressure-immobilization first aid technique in the case of a tiger snake bite. Med. J. Aust. 2(6):295-295.
PMid:7300764
 
NHRC (2012). National health research priority areas. Available at: http://www.nhrc.org.np/index.php?option=com_content&view=article&id=46&Itemid=50. Accessed on: 07 April 2012.
 
Norris RL, Ngo J, Nolan K, Hooker G (2005). Physicians and lay people are unable to apply pressure immobilization properly in a simulated snakebite scenario. Wilderness Environ. Med. 16(1):16-21.
http://dx.doi.org/10.1580/PR12-04.1
PMid:15813142
 
Oxer HF (1982). Australian work in first aid of poisonous snakebite. Ann. Emerg. Med. 11(4):228.
http://dx.doi.org/10.1016/S0196-0644(82)80505-2
 
Pandey DP (2006). Epidemiology of snakebite based on hospital survey in Chitwan and Nawalparasi districts, Nepal. J. Nepal Health Res. Counc. 4(2):51-57.
Pandey DP (2007). Epidemiology of snakebites based on field survey in Chitwan and Nawalparasi districts, Nepal. J. Med. Toxicol. 3(4):164-168.
http://dx.doi.org/10.1007/BF03160933
PMCid:PMC3550019
 
Pandey DP (2012). Snakes in the vicinity of Chitwan National Park, Nepal. Herpetol. Conserv. Biol. 7(1):46-57.
 
Pandey DP, Thapa CL, Hamal PK (2010a). Impact of first aid training in management of snake bite victims in Madi valley. J. Nepal Health Res. Counc. 8(1):5-9.
PMid:21879005
 
Pandey DP, Shrestha BR, Pradhan, SK (2010b). Impact of delayed presentation, transport method, and first aid use on antivenom dosage at Bharatpur Hospital, Chitwan, Lowland Nepal. In: Seifert, S. (ed.) Abstracts from Venom Week 2009, June 1-4, 2009, Albuquerque, New Mexico. Pp. 234-266, J. Med. Toxicol. 6(2):251-252.
 
Pearn J, Morrison J, Charles N, Muir V (1981). First aid for snakebite: efficacy of a constrictive bandage with limb immobilization in the management of human envenomation. Med. J. Aust. 2:293-295.
PMid:7300763
 
Pochanugool C, Wildde H, Bhanganada K, Chanhome L, Cox MJ, Chaiyabutr N, Sitprija V (1998). Venomous snakebite in Thailand. II: Clinical experience. Mil. Med., 163(5):318-323
PMid:9597849
 
Quraishi NA, Qureshi HI, Simpson ID (2008). A contextual approach to managing snake bite in Pakistan: snake bite treatment with particular reference to neurotoxieity and the ideal hospital snake bite kit. J. Pakistan Med. Assoc. 58(6):325-331.
PMid:18988393
 
Rahman R, Faiz MA, Selim S, Rahman B, Basher A, Jones A, d'Este C, Hossain M, Islam Z, Ahmed H, Milton AH (2010). Annual incidence of snake bite in rural Bangladesh. PLoS Neglected Trop. Dis. 4(10):e860.
 
Republica Daily (2010). Documentary on newborn health. Republica Daily, 27 Jan. 1(272):2.
 
Russell FE (1982). Pressure and immobilization for snakebite remains speculative. Ann. Emerg. Med. 11(12):701-701.
http://dx.doi.org/10.1016/S0196-0644(82)80278-3
http://dx.doi.org/10.1016/S0196-0644(82)80277-1
 
Saul ME, Thomas PA, Dosen PJ, Isbister, GK, O'Leary MA, Whyte IM, McFadden SA, van Helden DF (2011). A pharmacological approach to first aid treatment for snakebite. Nat. Med. 17(7):809-811.
http://dx.doi.org/10.1038/nm.2382
PMid:21706027
 
Seifert SA, White J, Currie BJ (2011). Pressure bandaging for North American snake bite? No! J. Med. Toxicol. 7(4):324-326.
http://dx.doi.org/10.1007/s13181-011-0188-9
PMid:22065371 PMCid:PMC3550186
 
Seppa, N. (2011). Scooters save lives of snakebite victims. Available at: http://www.sciencenews.org/view/generic/id/336739; Accessed on: 07.07.2012.
 
Shah KB, Sherstha JM, Thapa CL (2003). Snakebite management guideline. Epidemiology and Disease Control Division (EDCD), Zoonoses Control Sub-section, Ministry of Health, Nepal Government. Kathmandu.
 
Shah KB, Tiwari S (2004). Herpetofauna of Nepal. The World Conservation Union (IUCN), Kathmandu, Nepal.
 
Sharma SK, Chappuis F, Jha N, Bovier PA, Loutan L, Koirala S (2004a). Impact of snake bites and determinants of fatal outcomes in southeastern Nepal. Am. J. Trop. Med. Hyg. 71(2):234-238.
PMid:15306717
 
Sharma SK, Koirala S, Dahal G, Sah C (2004b). Clinico-epidemiological features of snakebite: a study from eastern Nepal. Trop. Doct. 34(1): 20-22.
PMid:14959965
 
Simpson ID (2007). The pediatric management of snakebite: the national protocol. Indian Pediatr. 44(3):173-176.
PMid:17413192
 
Simpson ID, Tanwar PD, Andrade C, Kochar DK, Norris RL (2008). The Ebbinghaus retention curve: training does not increase the ability to apply pressure immobilisation in simulated snake bite- implications for snake bite first aid in the developing world. Trans. R. Soc. Trop. Med. Hyg. 102(5):451-459.
http://dx.doi.org/10.1016/j.trstmh.2008.01.014
PMid:18339412
 
Snow RW, Bronzan R, Roques T, Nyamawi C, Murphy S, Marsh K (1994). The prevalence and morbidity of snake bite and treatment-seeking behaviour among a rural Kenyan population. Ann. Trop. Med. Parasitol. 88(6):665-671.
PMid:7893182
 
Sutherland SK (1994). The pressure immobilization technique. Med. J. Aust. 161:700-701.
PMid:7830642
 
Sutherland S, Coulter A, Harris R (1979). Rationalisation of first aid measures for elapid snakebite. The Lancet 313(8109):183-186.
http://dx.doi.org/10.1016/S0140-6736(79)90580-4
 
Sutherland SK, Coulter AR, Harris RD, Lovering KE, Roberts ID (1981a). A study of the major Australian snake-venoms in the monkey (Macaca fascicularis). 1. The movement of injected venom, methods which retard this movement, and the response to antivenoms. Pathology 13(1):13-27.
http://dx.doi.org/10.3109/00313028109086826
PMid:7220094
 
Sutherland SK, Harris RD, Coulter AR, Lovering KE (1981b). First aid for cobra (Naja naja) bites. Indian J. Med. Res. 73:266-268.
PMid:7239610
 
Sutherland SK, Tibballs J (2001). Australian animal toxins. The creatures, their toxins and care of the poisoned patient. Second ed., Oxford University Press, Melbourne, Australia.
 
Thapa CL, Pandey DP (2009). Situation of snakebite envenomation in Nepal. J-NADEM & NewsHealth, 17 (7):96-100.
 
Theakston RDG (1997). An objective approach to antivenom therapy and assessment of first aid measures in snake bite. Ann. Trop. Med. Parasitol. 91(7):857-865.
http://dx.doi.org/10.1080/00034989760626
PMid:9625943
 
Tun-Pe, Tin-Nu-Swe, Myint-Lwin, Warrell, DA, Than-Win (1987). The efficacy of tourniquets as a first aid measure for Russell's Viper bites in Burma. Trans. R. Soc. Trop. Med. Hyg. 81(3):403-405.
http://dx.doi.org/10.1016/0035-9203(87)90150-7
 
Tun-Pe, Aye-Aye-Myint, Khin-Ei-Han, Thi-Ha, Tin-Nu-Swe (1995). Local compression pad as a first aid measure for victims of bites by Russell's Viper (Daboia russelii siamensis) in Myanmar. Trans. R. Soc. Trop. Med. Hyg. 89:293-295.
http://dx.doi.org/10.1016/0035-9203(95)90547-2
 
Tun-Pe, Sann-Mya, Aye-Aye-Myint, Nu-Nu-Aung, Khin-Aye-Kyu, Tin-Oo (2000). Field trial of efficacy of local compression immobilization first aid technique in Russell's Viper (Daboia russelii siamensis) bite patients. Southeast Asian J. Trop. Med. Public Health 31(2):346-348.
 
Warrell DA (2006). Australian toxinology in a global context. Toxicon 48(7):718-725.
http://dx.doi.org/10.1016/j.toxicon.2006.07.012
PMid:16920169
 
Watt G, Padre L, Tuazon MAL, Theakston RDG, Laughlin LW (1988). Tourniquet application after cobra bite: delay in the onset of neurotoxicity and the dangers of sudden release. Am. J. Trop. Med. Hyg. 38:618-622
PMid:3275141
 
WHO (1987). Zoonotic disease control: baseline epidemiological study on snake-bite treatment and management. Wkly. Epidemiol. Rec. 42:319-320.
 
WHO (2010). Guidelines for the management of snake-bites, 2nd ed. WHO, Regional Office for South-East Asia, New Delhi.
 

 


APA (2013). Inclusion of incorrect information on snakebite first aid in school and university teaching materials in Nepal. Journal of Toxicology and Environmental Health Sciences, 5(3), 43-51.
Chicago Deb P. Pandey, and Bishnu P. Khanal,. "Inclusion of incorrect information on snakebite first aid in school and university teaching materials in Nepal." Journal of Toxicology and Environmental Health Sciences 5, no. 3 (2013): 43-51.
MLA Deb P. P, et al. "Inclusion of incorrect information on snakebite first aid in school and university teaching materials in Nepal." Journal of Toxicology and Environmental Health Sciences 5.3 (2013): 43-51.
   
DOI 10.5897/JTEHS12.059
URL http://www.academicjournals.org/journal/JTEHS/article-abstract/32A29934520

Subscription Form