# The Epidemiology of Snakebite in Bhutan: A Retrospective Study

## TL;DR

This study analyzes snakebite cases in Bhutan from 2018 to 2021, revealing a significant public health issue with underreporting and a need for better prevention and treatment strategies.

## Contribution

The study provides the first comprehensive epidemiological analysis of snakebites in Bhutan using hospital data from 2018–2021.

## Key findings

- Most snakebites occurred in southern and central Bhutan, with a peak during warmer months.
- Farming was the most common activity during snakebites, and the leg was the most frequent bite site.
- The majority of snakebites involved unidentified snakes, and non-medical home treatments were used by 11.6% of victims.

## Abstract

Bhutan is a tropical country where snakebite is supposedly common, but official data are scanty and unmethodical. Deaths from snakebites were reported from areas where snakebites are common. Four‐year (2018–2021) data of snakebite from 45 Bhutanese hospitals were collected and analysed to describe the burden and map by districts. A total of 371 snakebites were recorded from 45 hospitals during the 4 years. Most cases were seen in the southern and central parts of the country. There was a definite rise in the number of cases in the warmer months, starting from March and peaking between June and August. About 240 (65%) of the bites occurred in males, and the highest number of snakebites occurred during farming (n = 100, 27%), bush walking (n = 42, 11.3%), herding (n = 15, 4%) and trekking (n = 1, 0.2%). The most common anatomical bite site was the leg (n = 167, 45.01%), followed by the hand (n = 81, 21.8%), finger (n = 56, 15.09%), toes (n = 11, 2.96%), thigh region (n = 6, 1.6%), head and face (n = 3, 0.8%), chest and shoulder (n = 3, 0.8%) and abdomen (n = 1, 0.3%). Most snakes were unidentified (n = 266, 71.7%). Those identified were vipers (n = 74, 19.9%), rat snakes (n = 12, 3.2%), kraits (n = 7, 1.88%), cobras (n = 6, 1.61%), river snakes (n = 5, 1.34%) and wolf snakes (n = 1, 0.26%). Forty‐three (11.6%) of the bite victims had resorted to non‐medical home treatment. Even with an obvious underreporting, snakebite is a significant public health problem, and Bhutan should embrace more public health and clinical activities to prevent morbidities and mortalities from snakebite.

This study reports 371 cases of snakebites in 4 years (2018–2021) from 45 Bhutanese hospitals. Snakebite is a neglected public health problem with no consistent recording and reporting system, no national treatment guidelines and no public health program activities in Bhutan.