Guidelines for the management of snakebite

 

Essentials:
Snakebites are environmental, occupational and climatic hazards, predominantly of rural areas. Bites are usually inflicted on lower legs, ankles and feet of agricultural workers and their families. Know  your local snakes, their favourite habitats, and times of day and seasons when they are most active. Never handle, threaten or attack snakes. Do not attract snakes to homes by keeping livestock indoors or leaving food unprotected, encouraging rodents.
Sleep under a well-tucked–in mosquito net, ideally on a raised bed. Clear rubbish and undergrowth  from around the house.
Always use a light and prod with a stick when walking outside at night, visiting the latrine or  relieving yourself in the open. Solid shoes or boots are recommended especially during agricultural  activities.
Fishermen should avoid touching sea snakes caught in their nets.  Community education reduces the risk of snakebites. Involve all community workers, traditional healers and villagers. 
Distribute leaflets, banners and posters. Reformat these SEARO recommendations for national or  local use as guidelines, training modules, leaflets, video clips or posters, displayed in hospital and  clinic waiting areas and disseminate them via radio, TV and social networks. 

Reducing the risk of snakebites 

Snakebite is an environmental, occupational and climatic hazard in rural and urban areas of many  SouthEast Asian countries where most bites are inflicted on the lower legs, ankles and feet of  agricultural workers and their families. Attention to the following recommendations for community education will reduce the risk of bites. Snakes have adapted to a wide range of habitats and prey  species. All snakes are predatory carnivores, none is vegetarian although some eat birds’ eggs. Since snakes are preyed upon by other animals, they tend to be secretive and have evolved many survival  strategies, including camouflage, making them difficult to see. By understanding something about snakes’ habits, simple precautions can be adopted to reduce the chance of encounters, and  consequently bites. Know your local snakes, the sorts of places where they prefer to live and hide, the  times of year and times of day and night, and the kinds of weather when they are most likely to be active. Many species are mainly nocturnal (night hunters) (e.g. kraits) while other species (e.g. Australasian brown snakes) are mainly diurnal (daylight hunters). Be particularly vigilant about the   risk of snakebites after rains, during flooding, at harvest time and at night and when walking to and from the fields before dawn and after dusk. Snakes prefer not to confront large animals such as  humans, and so avoid cornering them and give them every opportunity to escape.  20 Inside the house, where snakes may enter in search of food or to find hiding places, do not keep livestock, especially chickens, as they are potential prey for larger snakes and they may attract rodents upon which many species of snakes will prey. Store food in rodentproof containers. Regularly check houses for snakes and, if possible, avoid types of house construction that will provide snakes with  hiding places (e.g. thatched roofs with open eaves, mud and straw walls with large cracks and cavities, large unsealed spaces beneath floorboards). In South Asia, almost all krait (Bungarus) bites are inflicted on people sleeping in their homes, usually on the floor but sometimes even in beds and under pillows (e.g. in the Sundarbans). Ideally, avoid sleeping unprotected on the ground, but if you  do choose, or are forced, to sleep on the ground, or are able to sleep on a raised bed, use an insecticide-impregnated mosquito net that is well tucked-in under the mattress or sleeping mat.  This will protect against mosquitoes and other biting insects, centipedes, scorpions, and snakes (Chappuis et al., 2007). No chemical has yet been discovered that is effectively repellent to snakes without being  so toxic as to threaten the life of children and domestic animals.

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