Snake bite in Central India: Clinical Profile, Outcomes, and Forensic Insights from a Three-Year Hospital Study (2022–2025)

Seema Sutay. [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P74 Content list Available at ijmj.net International Journal of Medical Justice Journal Homepage: https://www.ijmj.net Original Research: Snake bite in Central India: Clinical Profile, Outcomes, and Forensic Insights from a ThreeYear Hospital Study (2022–2025) Seema Sutay*, Abhishek Rinva*, Arjun Mourya*, Vidushi Gupta*, Anannya Narang*, Hemant Pawaiya*, Imran Sabri** Affiliations: *Department of Forensic Medicine and Toxicology, NSC Government Medical College, Khandwa, Madhya Pradesh, India **Division of Forensic Medicine, Bio-Medical Sciences, College of Medicine, King Faisal University, Alahsa, Saudi Arabia Article History: Date of Submission: Sunday September 12, 2025. Date of Start of Review Process: Sunday September 12, 2025. Date of Receipt of Reviewers Report: Saturday December 6, 2025. Date of Revision: Saturday December 13, 2025. Date of Acceptance: Saturday December 13, 2025. Date of Publication: Wednesday December 24, 2025. Digital Object Identifier [DOI]: 10.5281/ zenodo.17993116 Available Online: Monday December 15, 2025 Website Archive: https://www.ijmj.net/archive/2025/2/IJMJ-2025-335.pdf Citation: Sutay S, Rinva A, Mourya A, Gupta V, Narang A, Pawaiya H, Sabri I. Snake bite in Central India: clinical profile, outcomes, and forensic insights from a three-year hospital study. Int J Med Justice. 2025 Dec 24;3(2):74–86. doi:10.5281/zenodo.17993116. Indexing: , , Academic Editor: Dr Richa Gupta Correspondence: Dr. Seema Sutay Professor and Head, Department of Forensic Medicine & Toxicology, Nandkumar Singh Chouhan Government Medical College Khandwa, Madhya Pradesh, INDIA Email: drseem[email protected] ORCID: 0000-0001-8836-8958 Seema Sutay. [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P75 Abstract: Introduction: Snakebite envenoming is a critical, neglected tropical disease, with India accounting for a substantial proportion of global mortality and morbidity (World Health Organization [WHO], 2019; Suraweera et al., 2020). This study aimed to delineate the demographic, clinical, and therapeutic profile of snakebite cases in a Central Indian tertiary care setting, providing insights for public health and medico-legal practice. Methods: A retrospective analysis was conducted on 674 confirmed or suspected snakebite cases presenting to a tertiary care hospital between July 2022 and June 2025. Data were extracted from outpatient and inpatient registers, including medico-legal autopsy records for fatalities. Analyzed parameters encompassed age, gender, temporal and anatomical site of bite, clinical manifestations, anti-snake venom (ASV) administration, and patient outcomes. Results: The majority of victims were male (55.5%) and of working age (16–65 years, 81%). Bites predominantly occurred on the lower limbs (64.5%), with peak incidence in evening hours (28%). Non-venomous bites were most common (66.6%), followed by hemotoxic (12.3%) and neurotoxic (11.4%) envenomations. ASV was administered in 62.9% of cases. The overall case fatality rate was 7.4%, with mortality strongly associated with delayed presentation and neurotoxic features, a finding consistent with national data (Suraweera et al., 2020; Mohapatra et al., 2011). Forensic autopsies were pivotal in confirming cause of death and snake species identification. Conclusions: Snakebite remains a significant, preventable cause of mortality in rural Central India, primarily affecting the agricultural workforce. Our findings underscore the lifesaving impact of early hospital presentation and prompt ASV administration (Ministry of Health and Family Welfare [MoHFW], 2016). The study reinforces the need for enhanced community education on first aid, strategic deployment of effective antivenoms, and robust medico-legal documentation to mitigate this public health burden and guide policy (WHO, 2019; Harrison et al., 2019). Keywords: Snakebite; Anti-Snake Venom (ASV); Envenomation; Central India Seema Sutay. [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P76 Introduction: Snakebite envenoming is a global public health emergency of acute medical significance in tropical and subtropical regions. Despite being formally categorized as a highest-priority neglected tropical disease by the World Health Organization (WHO) in 2017, it continues to impose a severe burden of mortality and permanent disability (WHO, 2019). Contemporary estimates indicate that snakebite is responsible for a significant number of deaths annually worldwide, with a substantial number of survivors suffering permanent disabilities (Longbottom et al., 2018). The burden is profoundly uneven, disproportionately affecting impoverished rural communities in lowand middle-income countries where agricultural labor is predominant and health systems are fragile (WHO, 2019; Kasturiratne et al., 2008). India is the nation most severely impacted, contributing to nearly half of the world's snakebite deaths. A nationally representative mortality study estimated a high annual fatality rate in India, underscoring the scale of the crisis (Suraweera et al., 2020). Central Indian states, including Madhya Pradesh, are consistently identified as high-burden regions (Mohapatra et al., 2011). Beyond the immediate human cost, snakebite envenoming generates complex medico-legal challenges. Each fatal case necessitates a meticulous forensic investigation to ascertain the precise cause of death, differentiate between accidental and natural causes, evaluate potential contributory negligence, and inform public health policy (Reddy, 2019; Vij, 2021). While the cornerstone of effective treatment—timely administration of qualityassured antivenom—is wellestablished, critical barriers persist (MoHFW, 2016). These include widespread reliance on harmful first-aid practices, delays in seeking hospital care, and significant challenges in the production, regulation, and equitable distribution of effective antivenoms (WHO, 2019; Patil et al., 2018). This study, therefore, was undertaken to analyze the epidemiological patterns, clinical outcomes, and forensic aspects of snakebite cases managed at a tertiary care hospital in Central India over a three-year period. The findings aim to contribute localized Seema Sutay. [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P77 evidence to inform targeted prevention strategies, optimize clinical management protocols, and strengthen the medico-legal framework for investigating these preventable deaths. Materials and Methods: Study Design and Setting This retrospective, hospitalbased study was conducted at the District Hospital and Department of Forensic Medicine, Government Medical College, Khandwa, Madhya Pradesh, a tertiary care center serving a predominantly rural and agricultural population in Central India. Study Population and Duration The study encompassed all patients presenting with confirmed or suspected snakebite, as well as medicolegal autopsies where snakebite was the suspected or confirmed cause of death, over a 36-month period from July 2022 to July 2025. Inclusion and Exclusion Criteria Inclusion Criteria: (a) All live patients with a clinical diagnosis of snakebite; (b) All medico-legal post-mortem examinations with a history or evidence suggestive of snakebite as the primary cause of death. Exclusion Criteria: (a) Decomposed bodies where cause of death could not be reliably determined; (b) Cases with an alternative, clearly established primary cause of death unrelated to envenomation; (c) Incomplete clinical or autopsy records. Data Collection and Analysis Data were systematically extracted from outpatient department (OPD) registers, inpatient department (IPD) records, and forensic autopsy reports. A structured proforma was used to collect information on demographic variables (age, sex, occupation), incident details (time, season, anatomical site), clinical features (local and systemic signs, categorization as neurotoxic, hemotoxic, or nonvenomous), treatment particulars (ASV administration, dosage, supportive care), and final patient outcomes (survival, death, complications). For fatalities, comprehensive postmortem findings were recorded. Data were analyzed using descriptive statistics with Microsoft Excel. Ethical Considerations Ethical approval was obtained from the Institutional Ethics Committee of NSC Government Medical College, Khandwa (Ref. No.: NSCCGMC/IEC/2022/45). The study adhered to the principles of the Declaration of Helsinki. Seema Sutay. [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P78 Results: A total of 674 snakebite cases were analyzed. The key findings are summarized below. Demographic and Epidemiological Profile The cohort was predominantly male (n=374, 55.5%), with the vast majority (81%) belonging to the economically productive 1665 years age group. This aligns with the global pattern where agricultural workers, often adult males, are at highest risk (Kasturiratne et al., 2008; Longbottom et al., 2018). Most bites occurred on the lower limbs (64.5%), consistent with the propensity for ground-level exposure during farming activities. The peak incidence was observed during evening hours (28%) and the monsoon months (July-September), correlating with increased snake activity and agricultural work (Mohapatra et al., 2011). Clinical Presentation and Envenomation Type Non-venomous bites constituted the largest proportion (66.6%), followed by hemotoxic (12.3%) and neurotoxic (11.4%) envenomations. Systemic complications observed in severe cases included venom-induced consumptive coagulopathy in hemotoxic bites and neuroparalysis leading to respiratory failure in neurotoxic bites, consistent with established clinical profiles (MoHFW, 2016; Patil et al., 2018). Treatment and Outcomes Anti-snake venom was administered to 424 patients (62.9%). The overall case fatality rate was 7.4% (n=50). Mortality was markedly higher among patients presenting more than six hours post-bite and in those exhibiting signs of neurotoxic envenomation, highlighting the critical window for intervention (Suraweera et al., 2020; MoHFW, 2016). Forensic autopsy in all fatal cases provided conclusive evidence, with findings such as pulmonary edema, intracranial hemorrhage, and acute tubular necrosis. Please Refer to Table 1 Here: Demographic and Clinical Profile of Snakebite Cases (N=674)* Discussion: This hospital-based study from Central India corroborates the established epidemiology of snakebite as an occupational hazard for the rural working-age population (Mohapatra et al., 2011; Kasturiratne et al., 2008). The male predominance (55.5%) and high incidence in the 16-65 year Seema Sutay. [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P79 age group (81%) directly reflect the heightened exposure risk among agricultural laborers. The finding that lower limbs are the most common bite site (64.5%) further underscores this occupational link, a pattern consistently reported in similar studies from the region (Vij, 2021; Patil et al., 2018). The observed 7.4% mortality rate, while significant, must be interpreted within the context of hospital-based data, which typically captures more severe cases. This rate is consistent with other tertiary care studies from India and highlights the persistent severity of this public health challenge (Suraweera et al., 2020; Patil et al., 2018). Crucially, mortality was concentrated in cases with delayed presentation or neurotoxic symptoms, emphasizing the critical importance of the "golden hour" (MoHFW, 2016). This finding aligns with systematic reviews which identify delayed arrival at health facilities as a primary community-level factor leading to poor outcomes (Longbottom et al., 2018). Our data showing ASV administration in 62.9% of cases suggest a treatment gap, potentially attributable to logistical barriers, initial misclassification of nonvenomous bites, or shortages—a problem well-documented by the WHO (WHO, 2019; Harrison et al., 2019). From a medico-legal perspective, this study reinforces the indispensable role of forensic pathology, as emphasized in standard textbooks (Reddy, 2019; Vij, 2021). Comprehensive autopsy remains the definitive tool for certifying snakebite as the cause of death, which is vital for accurate mortality statistics—a domain where underreporting is notoriously severe (Suraweera et al., 2020). Such detailed investigation also helps differentiate true therapeutic complications from allegations of medical negligence, thereby protecting both victims' rights and healthcare providers. The path forward requires a multi-faceted strategy aligned with the WHO's roadmap (WHO, 2019; Harrison et al., 2019). First, community empowerment is essential. Educational programs must promote the use of protective footwear, discourage harmful first-aid practices, and emphasize the urgency of immediate hospital referral Seema Sutay. [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P80 (Patil et al., 2018). Second, health systems must be strengthened to ensure the reliable availability of appropriate, quality-assured antivenoms at primary and secondary care levels (MoHFW, 2016; WHO, 2019). Finally, robust surveillance and forensic documentation, as demonstrated in this study, are crucial for accurate burden estimation and guiding resource allocation. Conclusion: This three-year retrospective study provides a detailed epidemiological and forensic snapshot of snakebite envenoming in Central India. It confirms that snakebite is a persistent, preventable cause of mortality, disproportionately affecting the rural agricultural workforce. The findings starkly illustrate that outcomes are directly contingent upon timely access to appropriate medical care, including effective antivenom. To reduce the burden, concerted action is needed on multiple fronts: targeted community education, strategic strengthening of health systems to ensure treatment access, and the integration of robust medico-legal and surveillance mechanisms to accurately track and respond to this neglected crisis. Declarations  Ethical Approval: Obtained from the Institutional Ethics Committee, NSC Government Medical College, Khandwa (Ref. No.: NSCCGMC/IEC/2022/45).  Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.  Conflicts of Interest: The authors declare no conflicts of interest.  Author Contributions: Conceptualizatio n (A.R., S.S.); Data Curation (A.R., V.G.); Formal Analysis (A.M., H.P., A.N.); Supervision & Writing – Original Draft (S.S.); Writing – Review & Editing (I.S., all authors). All authors read and approved the final manuscript.  Acknowledgements: The authors thank the staff of the Medical Records Department and the Mortuary of District Hospital, Khandwa, for their cooperation. References 1. Harrison, R. A., Casewell, N. R., Ainsworth, S. A., & Lalloo, D. G. (2019). The time is now: a call for action to translate recent momentum on tackling tropical snakebite into sustained benefit for victims. Transactions of The Royal Society of Tropical Medicine and Hygiene, 113(12), 835-838. Seema Sutay. [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P81 2. Kasturiratne, A., Wickremasinghe, A. R., de Silva, N., Gunawardena, N. K., Pathmeswaran, A., Premaratna, R., ... & de Silva, H. J. (2008). The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Medicine, 5(11), e218. 3. Longbottom, J., Shearer, F. M., Devine, M., Alcoba, G., Chappuis, F., Weiss, D. J., ... & Pigott, D. M. (2018). Vulnerability to snakebite envenoming: a global mapping of hotspots. The Lancet, 392(10148), 673-684. 4. Ministry of Health and Family Welfare [MoHFW]. (2016). Guidelines for the management of snakebites (2nd ed.). Directorate General of Health Services. 5. Mohapatra, B., Warrell, D. A., Suraweera, W., Bhatia, P., Dhingra, N., Jotkar, R. M., ... & Jha, P. (2011). Snakebite mortality in India: a nationally representative mortality survey. PLoS Neglected Tropical Diseases, 5(4), e1018. 6. Patil, V. C., Patil, H. V., & Patil, S. (2018). Clinical profile and outcome of snakebite cases in a rural tertiary care hospital of Western Maharashtra, India. International Journal of Medical and Public Health, 8(3), 152-157. 7. Reddy, K. S. N. (2019). The Essentials of Forensic Medicine and Toxicology (34th ed.). K Suguna Devi. 8. Suraweera, W., Warrell, D., Whitaker, R., Menon, G., Rodrigues, R., Fu, S. H., ... & Jha, P. (2020). Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study. eLife, 9, e54076. 9. Vij, K. (2021). Textbook of Forensic Medicine and Toxicology: Principles and Practice (8th ed.). Elsevier. 10. World Health Organization [WHO]. (2019). Snakebite envenoming: a strategy for prevention and control. Geneva. Disclaimer/Publisher’s Note: The statements, viewpoints, and data presented in this publication are exclusively those of the respective author(s) and contributor(s), and do not reflect the position of IJMJ and/or the editor(s). IJMJ and/or the editor(s) expressly reject any liability for any harm to individuals or property arising from any innovations, concepts, methodologies, guidelines, conclusions, or products mentioned in the content. Copyright Policy : All articles published in the International Journal of Medical Justice (IJMJ) are licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Authors retain copyright of their work and grant IJMJ the right of first publication. Under the CC BY 4.0 license, others may share, adapt, distribute, and build upon the work for any purpose, provided appropriate credit is given to the original authors. . Seema Sutay [2025]. International Journal of Medical Justice, IJMJ, Volume 3, Issue 2: July-December 2025 [E-ISSN: 2583-7958] International ISSN [CIEPS]: 3006-208X[Print] 3006-2098[Online] IJMJ-V3-N2-2025-P82 Table 1:Demographic and Clinical Profile of Snakebite Cases(N=674) Parameter Category Number (n) Percentage (%) Gender Male 374 55.5 Female 300 44.5 Age Group (Years) <15 68 10.1 16-65 546 81.0 >65 60 8.9 Site of Bite Lower Limb 435 64.5 Upper Limb 239 35.5 Type of Envenomation Non-venomous 449 66.6 Hemotoxic 83 12.3 Neurotoxic 77 11.4 Unknown/Unclassified 65 9.6 ASV Administered Yes 424 62.9 No 250 37.1 Outcome Survived 624 92.6 Died 50 7.4 Data and Observations: Demographic, Clinical, and Treatment Profiles of Snakebite Cases (N=674) Table 2: Patient Outcomes Outcome Cases (n) Percentage (%) Fatal (Death Declared) 50 7.42 Non-Fatal / Admitted & Discharged 624 92.58 Analysis: The overwhelming majority of patients survived, highlighting the critical role of timely hospital admission and effective medical intervention in a tertiary care setting. Table 3: Age Distribution of Victims Age Group (years) Cases (n) Percentage (%) 0–15 69 10.24 16–65 546 81.01 66–100 59 8.75 Analysis: The age distribution demonstrates that snakebite primarily affects the working-age population (16–65 years). This strong epidemiological pattern is strongly indicative of occupational exposure, particularly among individuals engaged in agriculture and other outdoor labor (Suraweera et al., 2020). Table 4: Gender Distribution of Victims Gender Cases (n) Percentage (%) Male 412 61.13 Female 262 38.87 Analysis: The significant male predominance (61.13%) aligns with established global trends (Kasturiratne et al., 2008) and is attributable to the higher frequency of males participating in outdoor occupational and agricultural activities that elevate exposure risk in the study region.