Saturday, October 23, 2010

Dengue, Malaria and Other Infectious Diseases Killing Millions in South Asia

There have been 1200 confirmed cases of dengue fever and 12 deaths in Pakistan after the recent heavy monsoon rains and massive floods, according to media reports.

A.C. Dhariwal, director of India's National Vector-Borne Disease Control Program, told AFP recently that dengue cases in India were at a 20-year high with 50 people dead and 12,000 reported infections. The number of actual infections is likely to be far higher.

A recent global Hygiene Home Truths Study says India is among the worst when it comes to hygiene, according to a report published in Times of India.

Two-thirds of India's population lacks basic sanitation facilities. They are exposed to a variety of infectious diseases claiming 1.3 million lives a year, accounting for the largest number of victims of infections any where in the world. Studies indicate the prevalence of infections may be contributing to lower IQ of Indians.

In addition to malaria, dengue fever, and cysticercosis, India also has a huge disease burden of rabies, caused by dog bites. In India, 20,000 rabies deaths (that is about 2/100,000 population) are estimated to occur annually, according to Times of India. According to the World Health Organization (WHO) which describes the dog population in India as "getting out of hand", roughly 36% of rabies deaths in the world occur in India.

India might be an emerging economic power, but it is way behind Pakistan, Bangladesh and even Afghanistan in providing basic sanitation facilities, a key reason behind the death of 2.1 million children under five in the country.

Lizette Burgers, chief of water and environment sanitation of the Unicef, says India is making progress in providing sanitation but it lags behind most of the other countries in South Asia. A former Indian minister Mr Raghuvansh Prasad Singh told the BBC that more than 65% of India's rural population defecated in the open, along roadsides, railway tracks and fields, generating huge amounts of excrement every day, and causing disease.

A recent meeting of experts hosted by the National Institute of Health in Islamabad has warned that although dengue was a risk, another mosquito-borne disease malaria, posed a much more serious threat especially in the flood-affected areas. World Health Organization-Pakistan representative Guido Sabatinelli said that even at the start of the malaria season there were “300,000 suspected cases” nationwide.

A US NIH funded study published in Lancet says over 200,000 Indians die of Malaria among 1.3 million infectious disease deaths reported in the country, according to a report by the BBC:

"The number of people dying from malaria in India has been hugely underestimated, according to new research.

The data, published in the Lancet, suggests there are 13 times more malaria deaths in India than the World Health Organization (WHO) estimates.

The authors conclude that more than 200,000 deaths per year are caused by malaria.

The WHO said the estimate produced by this study appears too high.

The research was funded by the US National Institutes of Health, the Canadian Institute of Health Research and the Li Ka Shing Knowledge Institute.

The new figures raise doubts over the total number of malaria deaths worldwide.
Difficult diagnosis

Calculating how many people die from malaria is extremely difficult. Most cases that are diagnosed and treated do not result in fatalities.

People who die of extremely high fevers in the community can be misdiagnosed and the cause of death can be attributed to other diseases and vice versa.

As most deaths in India occur at home, without medical intervention, cause of death is seldom medically certified.

There are about 1.3 million deaths from infectious diseases, where acute fever is the main symptom in rural areas in India.

In this study, trained field workers interviewed families, asking them to describe how their relative died. Two doctors then reviewed each description and decided if the death was caused by malaria. This method is called verbal autopsy.

Some 122,000 premature deaths between 2001 and 2003 were investigated.

The data suggests that 205,000 deaths before the age of 70, mainly in rural areas, are caused by malaria each year."

While a mere 14 percent of people in rural India - that account for 65 percent of its 1.1 billion population - had access to toilets in 1990, the number had gone up to 28 percent in 2006. In comparison, 33 percent rural Pakistanis had access to toilets in 1990 and it went up to an impressive 58 percent in 2006, according to UNICEF.

Why is it that Pakistan has had more success than India in improving sanitation?

Both India and Pakistan have Community-Led Total Sanitation (CLTS) campaigns supported by UNICEF, with the aim of creating open defecation free villages through education and funding. For reasons which are not obvious, it seems that the strategy has produced better results in Pakistan than in India so far. One possible reason may be that CLTS India is state driven while CLTS Pakistan is driven by community champions, according to a paper by Lyla Mehta that sheds light on how the CLTS campaigns work in India and Pakistan.

Given the high risk of dengue and malaria in the aftermath of unusually heavy monsoon rains and massive floods, it is important for CLTS campaign in Pakistan to extend its mandate to include anti-malaria efforts by draining puddles of water, or at least spraying stagnant water with disinfectants to eradicate mosquitoes and other disease-carrying insects.

Related Links:

Haq's Musings

Syeda Hamida of Indian Planning Commission Says India Worse Than Pakistan and Bangladesh

Global Hunger Index Report 2009

Grinding Poverty in Resurgent India

WRI Report on BOP Housing Market

Food, Clothing and Shelter For All

India's Family Health Survey

Hunger and Undernutrition Blog

Pakistan's Total Sanitation Campaign

Is India a Nutritional Weakling?

Asian Gains in World's Top Universities

South Asia Slipping in Human Development

What Does Democracy Deliver in Pakistan

Do South Asian Slums Offer Hope?


satwa gunam said...

In case of india we have to pay but pak is lucky that some body is paying. I have given details of aid per person comparison in ur other thread

India has a huge problem and opportunity in hand that is population. Singh is nice man and lucky mascot of india but we have democracy and it's weakness. We have come a long way and we have a long way to go

Strength of india is common man who is trying to move ahead with all limitation

Weakness is the greed politician and govt servant

Lat twenty years were good for india and hope the same continue which will remove all short coming

ReAlly sanitation is problem in urban and not in rural as it is done in remote place to become natural manual and the population is dwindling due to movement to city

However medical facility is something india has to go a long wAy. Basic problem is govt is not opening more colleges in towns and cost of medicine education is very high compared to cost ofengineering

Riaz Haq said...

gunam: "In case of india we have to pay but pak is lucky that some body is paying. I have given details of aid per person comparison in ur other thread"

Gates Foundation is spending $10 billion on vaccinations..much of it in India. And it is just example among many NGOs aiding the poor in your country.

satwa gunam said...


First in business complement is already priced in product. Same apply to any aid

Further aid to population and GDP, india is less lucky by more than 10 times than Pakistan

All aid to india is to see how much they can grab market. I read some where that india Suzuki contributes 80 percent of world profit

Riaz Haq said...

anon: "First in business complement is already priced in product. Same apply to any aid"

I think you are confusing Microsoft Corp with Gates Foundation. They are two distinct entities.

Besides, Microsoft revenue and profits are minuscule in India and other developing nations where Gates Foundation operates. It's a truly non-profit charitable foundation funded by rich people like Gates and Buffet.

It is a well known fact that Philanthropy by Indian billionaires is essentially non-existent. Gates and Buffet are now planning to get Indian billionaires to get involved in philanthropy.

Riaz Haq said...

Here are some comparisons of disease burdens in India and Pakistan as published by the World Health Organization in 2009:


DALYs/1000 cap.......65........58
(disability-adjusted life years)


Percent Total Burden...24%.....22%


satwa gunam said...


bill gate foundation donation is for research and development of vaccine for the whole world. Nothing specific for india. Even the research money will be spent in usa and nothing is going to come till the delivery of the medicine

With regard to the WHO report, i have downloaded the report of 2010. On the first level review of the report, out of 13 critieria pakistan has done well in seven and india in 6. I will put the details of the study in the my blog as i require to upload the picture file.

However from the development world perspective, both the countries have to go long way.

From pakistan perspective, these number are up to 2008. with the current scenario in 2009 and 2010, it would be great if it stays in the same position.

As far as india goes, india has enough money and congress has learnt that if it does not spend for people they will go the "india shine of bjp".

with the election in the near future, more social welfare scheme will come for implementation.

satwa gunam said...


Philanthropy from the old business house is nil. In the neo, it is only the software sector which does a great deal of work in public and in private.

However exception to the rule is tata & sons, they are the greatest donor of india. You can see the good work of them in their site.

with regard to the concept of "giving back to society" queit a lot of people do their bit which i know very well from middle class. Further the first level of asistance is generally given to the relative and friend before moving into the society, which is also a wellcoming fact as they are also part of the same backward society.

In my experience, 75% of the middle class assistance go to relative and friends and 25% goes to society.

Riaz Haq said...

Gunam: "bill gate foundation donation is for research and development of vaccine for the whole world."

That's not entirely accurate. Gates Foundation has massive vaccination campaigns all over India going on right now.

On Indian philanthropy, or rather the lack of it, here is an excerpt from a NY Times report:

A recent Bain & Company study estimated that Indians give much less as a percentage of the country’s gross domestic product than Americans. Moreover, individual and corporate donations account for just 10 percent of the charitable giving in India, compared with 75 percent in the United States and 34 percent in Britain. The balance comes from the government and foreign organizations.

Rich Indians “are more into temple building and things like that,” said Samit Ghosh, the chief executive of Ujjivan Financial, a microlender based in Bangalore, “rather than putting their money into real programs, which will have real impact on poverty alleviation.”

satwa gunam said...


Even with statistics of bains, indians are giving at 27% of USA and among us,uk canada.

In my perception even this is a very positive note. Even the individual and corporate contribution are next only to usa and uk.

Incidentally no other country in the asia has come to this extent also speaks that india is picking up good points from the developed countries.

Riaz Haq said...

gunam: "On the first level review of the report, out of 13 critieria pakistan has done well in seven and india in 6."

The latest WHO's "Country Profile of Environmental Burden of Disease" reports that I have looked at shows Pakistan is doing better than India in 12 out of 14 disease groups ranging from diarrhea to heart disease to intentional injuries, and it is equal for the remaining two (Malaria and Asthma).

satwa gunam said...

I have taken the data and put into an excel sheet. Data is quiet interesting and yet to complete the same. I will put the data file in as it is much easier to upload data.

Page no. 12 starts with this category :

"1. Children aged <5 years underweight (%)"
and end with
19. Population using improved sanitation (%)

Out of this 19 categories, atleast six does not have complete data of either pakistan or india for comparision. The remaining 13 is what i had mentioned in my views.

satwa gunam said...

Interesting current reality with regard to dengue in pakistan

Riaz Haq said...

India is emerging as diabetes epicenter, according to Bloomberg:

More than 50 million Indians are struggling with the same frightening predicament. The International Diabetes Federation in October 2009 ranked India as the country with the most diabetics worldwide. The umbrella group of more than 200 national associations estimates that the disease will kill about 1 million Indians this year, more than in any other country.

With 7.1 percent of adults afflicted, India is on a par with developed countries such as Australia, where 7.2 percent of adults suffer. India now fares worse than the U.K., where 4.9 percent are diabetic. In the U.S., where more than two-thirds of adults are overweight or obese, 12.3 percent have diabetes.

Doctors say a perverse twist of science makes Indians susceptible to diabetes and complications such as heart disease and stroke as soon as their living conditions improve. As a decade of 7 percent average annual growth lifts 400 million people into the middle class, bodies primed over generations for poverty, malnutrition and manual labor are leaving Indians ill- prepared for calorie-loaded food or the cars, TVs and computers that sap physical activity.

Researchers are finding the pattern begins before birth: Underfed mothers produce small, undernourished babies with metabolisms equipped for deprivation and unable to cope with plenty. Sonar’s mother, a widow who spent her life in a village and raised seven children by doing farm work, was active and healthy into her 70s, Sonar says.

Riaz Haq said...

Here's a BBC report on resistant strains of TB growing in India:

On World Tuberculosis Day, health officials in the northern Indian state of Bihar are warning of an epidemic of a virulent form of multi drug-resistant TB unless cases are detected more quickly and accurately. The BBC's Geeta Pandey reports from the town of Hajipur, in Bihar, on a disease that kills two Indians every three minutes.

Kishori Rai, 42, looks emaciated and his entire body shakes when he coughs.

He stands in a corner of the dark and dingy hospital room, shifting uneasily from one foot to another, his mouth covered with a white handkerchief which has turned muddy with grime and blood.
Day labourer Kishori Rai is a classic TB patient. The search for work takes poor people like him to cities like Delhi where they are forced to live in cramped slums and shanties - a hotbed of infectious diseases like TB.

India gets nearly two million new TB cases every year - the highest in the world - and the disease, which is fully curable, kills at least 280,000 people annually.

"TB is the largest killer of Indians between 15 and 45 years," Dr Mannan says.

In the past decade, India has made major strides in bringing down the numbers of deaths by aggressively following DOTS or "directly observed treatment, short course" - a programme instituted by the WHO where patients must swallow their medicines every day, watched by health workers or volunteers, until they complete their treatment.

But the authorities admit that the disease remains a major public health challenge and an enormous drain on the economy.

And the huge number of drug-resistant cases is threatening to undo the progress made so far - in 2007, India reported 131,000 drug-resistant cases and that number is steadily rising.

Riaz Haq said...

Among inherited diseases, sickle cell is one reported mainly in Africa, India and the Mediterranean countries, according to an Emory University study:

Millions of people worldwide suffer from the affects of sickle cell anemia – especially those of African, Mediterranean and Indian descent. According to CDC, more than 70,000 people in the United States have sickle cell disease, mostly African Americans. Each year more than 1,000 babies are born with sickle cell disease.

The inherited disorder affects the blood’s hemoglobin, which produces stiff, misshapen red blood cells that deliver less oxygen and can disrupt blood flow, resulting in joint and organ damage and potential clots and strokes. The sickling of red blood cells is aggravated by infections, extreme hot or cold temperatures, poor oxygen intake, not drinking enough fluids and stress.

Eckman says his Center is a unique resource – the only place in the world where patients can be treated 24 hours a day, seven days a week for sickle cell. He notes that the Center functions with admissions, emergency room and short-stay center. A patient can be admitted in 10- to 15-minutes, versus three hours in an ER. Eckman says the more quickly you treat the pain, the more likely it is to be controlled.

Facts About Sickle Cell Anemia

* Sickle cell disease is an inherited disorder involving the chemical known as hemoglobin contained in red blood cells. Hemoglobin carries oxygen to all parts of the body. When sickle hemoglobin loses its oxygen, it forms long rods inside the red blood cells. This causes the red blood cell to lose its round, donut shape and form a hard, sickle, crescent shape.
* Unlike normal red blood cells that are disc-shaped and move easily through the blood vessels, sickle cells are stiff and sticky and tend to form clumps and get stuck in the blood vessels.
* The clumps of sickle cells block blood flow in the blood vessels that lead to the limbs and organs. Blocked blood vessels can cause pain, serious infections and organ damage.
* Sickle cell disease primarily affects individuals of African descent, but can affect people from Italy, Greece, Israel, India, Pakistan, Spain, Central America, the Caribbean and many other ethnic groups.
* Sudden pain throughout the body is a common symptom of sickle cell anemia. This pain is called a “sickle cell crisis.” Sickle cell crises often affect the bones, lungs, abdomen and joints.
* Early diagnosis of sickle cell anemia is very important. Children who have the disease need prompt and proper treatment.

Mayraj said...
Tackling dengue — too late, too little
Dengue: 'Corrupt health officials playing with lives of innocent people'

Riaz Haq said...

Pakistan's private health care spending rises to $7.3 billion, reports Express Tribune:

Pakistanis are increasingly spending more on health, with spending rising to a total of Rs665 billion in 2011, up 14.5% over the previous year, according a to research report released by Business Monitor International (BMI), a UK-based research and consulting firm.

Within the overall sector, the largest in terms of total spending was that of hospitals and other healthcare facilities, which saw their total revenues rise to Rs456 billion in 2011, up 14.1% from the year before. The fastest growing segment was medical devices, which saw sales rise 18.1% to Rs35.5 billion. Pharmaceuticals grew a little slower, at 13.1%, to reach Rs173 billion in gross sales in Pakistan.

There are also several developments taking place within the sector that are likely to allow for even further expansion, according to BMI analysts.

In August 2011, the Drug Registration Board (DRB) approved the registration of 30 medical devices and 210 medicines after a meeting was held at the request of the Prime Minister Yousaf Raza Gilani, who called for the uninterrupted provision of medicines to patients. Products approved for registration included vaccines, biologicals, cancer therapeutics, drugs for the treatment of blood disorders such as thalassaemia, and devices used in cardiac procedures.

BMI points out that there are many reasons why investors, particularly those outside the country may want to consider investing in this sector. “Pakistan has one of the most liberal foreign investment regimes in South Asia, with a commitment to low tariffs and 100% foreign equity permitted,” said BMI analysts in the report.

The analysts also note that Pakistan’s rapidly growing population – currently closing in on 190 million – should also be considered an asset. “A growing population is feeding increased demand for pharmaceuticals.”
Pakistan’s overall business environment gets a poor rating from BMI, which ranks the economy 16th out of the 18 economies that it tracks in the Asia-Pacific region. The only two economies behind Pakistan are Sri Lanka and Cambodia. “The business environment still suffers from poor infrastructure and, most problematically, an uncertain security situation that has declined considerably since March 2007,” said BMI analysts.

In addition, there are several structural challenges to the Pakistani healthcare industry itself that have little to do with the external environment of Pakistan that they operate in. “Procurement processes are bureaucratic and often lack transparency, raising the risks of corruption,” said BMI in its report.

Riaz Haq said...

Here's Kantawala in Friday Times on India's Dengue outbreak killing Yash Chopra:

I'm still not over Yash Chopra dying from Dengue disease. I just thought I'd throw that out there. Of course it's sad that the Rom Com Don passed away and I do hope he is running through heavenly wheat fields while singing love songs to clouds and backup singers, like the many dream sequences he inspired in us all. But I would never have thought of Dengue and Bollywood in the same sentence until now (or Dengue and anything, really. It's still not so much a reality as a morbid punch-line). It just reminded me of how good India is at PR. During last year's Succubus Summer Solstice, when Dengue Mosquitoes hit the Punjab like a wife beater with Daddy Issues, we lost over 2,000 people to the disease. Judges, trainers, workers, rich, poor, women, men. We covered it (forgive me) to death in newspapers, and the news of the world was gripped with yet another Pakistan catastrophe. For six months it really was like the end of a disaster movie called Infection or Gestation Period or something clinically unimaginative.
Last year, around this time, a water-based brain disease killed 500 children in a town in Northern India in one week. One week! It comes every year, it's just that that year was particularly bad. Now, how does a deadly, brain-eating, child specialist disease that may or may not have "come from Japan" not make it to the world's news? How? PR people. That's how. Get on that.

Here's NY Times on dengue fever in India:

NEW DELHI - An epidemic of dengue fever in India is fostering a growing sense of alarm even as government officials here have publicly refused to acknowledge the scope of a problem that experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in just a handful of countries in the 1950s, dengue (pronounced DEN-gay) is now endemic in half the world's nations.

"The global dengue problem is far worse than most people know, and it keeps getting worse," said Dr. Raman Velayudhan, the World Health Organization's lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, which has reached the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

Here in India's capital, where areas of standing water contribute to the epidemic's growth, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets under the shade of a huge banyan tree outside the hospital entrance recently.


"I'd conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations," said Dr. Scott Halstead, a tropical disease expert focused on dengue research...

Riaz Haq said...

Here's a story of how Lahore fought dengue outbreak in 2011:

..“No one expected this kind of political commitment,” said Qutbuddin Kakar, who oversees programmes to combat malaria and dengue in Pakistan for the World Health Organization (WHO). “In this part of the world, at least, we had not seen this kind of response before.”

The anticipated 1,000-plus deaths did not occur, and since then, dengue fever cases have dropped - 200 in the province (Punjab) last year, without any reported deaths.


The results they collect are processed on site by specially-designed Android based applications on their smartphones, and uploaded to a centralized dengue prevention centre.

There, analysts match the entomological data with reports from hospitals showing where dengue patients are being treated. Based on the findings, a team is sent to fumigate areas where aedes mosquitos seem to be breeding and infecting people, or to identify and remove sources of standing water.

The key season for infections comes with monsoon rains, when the aedes aegyptus and aedes albopictus mosquitoes, which can carry the virus, begin to appear.

Chronology of an outbreak

In August 2011 heavy monsoon rain dumped 13 inches in a week, leaving parts of Lahore with large bodies of standing water, and raising immediate concerns about disease.

By mid-October, the provincial government in Punjab reported that more than 11,000 dengue cases were recorded by the provincial government.

“It was an exponential increase in number, and it really frightened the government,” said Faran Naru, a consultant hired by the provincial government to tackle the problem. “And the issue was resonating in the media... so it created a panic in the public which had to be contained.”

Most people infected with dengue recovered on their own, said Naru, but once media outlets began reporting on the extent of the outbreak, thousands showed up at hospitals and laboratories to get tested.

An initial team of 70 entomologists conducted 12,000 spot-checks to track where aedes mosquitos were present. By mid-October, this data had been mapped, along with the locations of 11,000 reported dengue patients.

The results surprised the scientists. The worst affected areas were some of the wealthiest neighbourhoods of Lahore: Model Town, Race Course, Mozang, and Gulberg.

“I saw that in Model Town there is a big park, and in Race Course there are two of Lahore's biggest parks… and I believe lots of breeding was happening there and mosquitoes were leaving from there and infecting people,” said Naru.

The mosquitoes need fresh water to lay their eggs, and the large puddles in Lahore's biggest public parks proved to be ideal homes.

Another hotspot was the Mozang neighbourhood, home to one of Pakistan's largest graveyards. The 150-acre area was found to be a major breeding ground for mosquitos. Gravediggers had dug large pits to hold water, which they used to soften the dirt when digging.

“It's fresh water,” said Naur, “from the tap, and there were 70 pits, and all of those were infected, full of larvae.”

Back in the hospital, dengue patients were separated into special areas for treatment. The home of each dengue patient was fumigated, along with 12 surrounding houses, three in each direction.

Sanitation workers unclogged sewers and drains in an effort to clear areas of rainwater; and parks, gardens, and cemeteries were also sprayed. Thousands of Mosquitofish and Garden Carp - fish species known to attack mosquito larvae - were also released into ponds and ditch canals.

Within a few weeks, entomologists detected far fewer aedes mosquitoes, and the prevalence of dengue cases rapidly decreased.

Riaz Haq said...

Here's a Guardian story on how Pakistani Punjab is fighting dengue fever using tilapia fish:

On one side of the battle are the countless swarms of mosquitoes that thrive in Pakistan's steamy summer months. On the other, vast quantities of hungry fish conscripted into a fight against a deadly virus that is reaching epidemic proportions.

Authorities battling the menace of Dengue virus claim to have turned the tide against the mosquitoes that carry the disease with the help of 1.6m fish released this year into pools, puddles, fountains and any other potential insect breeding places they can find.

Punjab has waged an all-out campaign against Dengue – a potentially lethal disease spread by mosquito bites – since a major outbreak in 2011 infected tens of thousands and killed more than 300 people.

Software designers were tasked to make smartphone apps to track outbreaks, the government cracked down hard on anyone who left old tires in areas where they could collect rainwater, and areas of stagnant water were doused with tons of noxious chemicals.

But it's the release of huge numbers of fish, even into water that soon evaporates, that many credit with helping to beat back the disease, which is now surging in other areas of the country.

"It's much better than chemicals that poison the environment," said Dr Mohammad Ayub, the director general of Punjab's fisheries department. "And anyway, chemicals soon get washed away by the rain."

A typical target the Punjab's fish team is an acre of murky water that forms every year in a depression squeezed between a flyover and brick factory in an unlovely outskirt of Lahore.

It is one of the hundreds of glorified puddles that fill during the monsoon season that are of little interest to anyone apart from wallowing water buffalos that make their home there.

Every few months a team led by a white bearded technician in an lab coat return to the pool, test the water and then release up to a thousand voracious tilapia fish from giant plastic bags partially inflated with oxygen.

Immediately on their release the surface of the water ripples with fish rising to gobble insects and the larvae that would otherwise quickly mature into mosquitoes.

The war on mosquitoes has demanded a significant effort by Punjab's fisheries department, which runs hatcheries to breed the vast quantities of fish seed required to keep mosquitoes at bay.

The effect has been dramatic with just over 100 cases reported in Punjab this year, compared with 20,000 in 2011. Officials say it has also curbed other pests, not just the Aedes mosquito that carries Dengue.

"Previously people could not sit outside in evenings on lawns but now they can sit comfortably because there are no mosquitoes," said Ayub.

Riaz Haq said...

Overall mortality rate: India 7.32 vs Pakistan 6.49

Riaz Haq said...

World #SnakeDay: #India is the #Snakebite Capital of the World with one million reported snakebites every year that kill ~60,000 and leave 1.5 lakh to 2 lakh #Indians permanently disabled. There's deteriorating quality, rising costs of antivenom. #disease

Poor waste management practices in our cities lead to a thriving rodent population, which in turn leads to a thriving population of snakes, albeit those of just commensal species such as cobras, rat snakes, Russell’s vipers and a few others. Still, the urban residents have little to fear when it comes to snakebites.

The story in rural India is vastly different — akin to two diametrically opposite ‘Indias’ within the same geographic boundary. Our country leads the world in snakebite figures, deaths from snakebite, and even cases of loss of life function.

Now, on the occasion of World Snake Day — observed annually on July 16 to increase awareness about the different species of snake all around the world — we attempt to understand the ground reality of human-snake conflict in India.

India records over 10 lakh snakebites every single year, which kill ~60,000 individuals and leave another 1.5 lakh to 2 lakh people with permanent disabilities. Studies have demonstrated that 94% of the victims are farmers, most of which belong to the most economically productive age groups.

These are staggering figures for a disease that the World Health Organisation (WHO) rightly calls a ‘Neglected Tropical Disease’. However, they are only an unfortunate fraction when compared to the number of snakes that are cruelly and brutally killed in conflict every day across the country.

One cannot help but wonder how India, one of the first countries in the world to develop antivenom over a century ago, remains frozen in time when it comes to safeguarding its citizens from snakebite. A myriad of problems surround the issue of human-snake conflict, and very few have attempted to address it, unlike the conflicts with mega-fauna such as tigers, elephants, bears and others.

Challenges that coil the human-snake conflict in India
The complexity of snakebite begins with the very fact that India, as a tropical country, is blessed with a diversity of snakes rivalled by few others. Among more than 300 species of snakes found in the country, nearly 50 are venomous, of which 18-20 are medically significant — meaning they can cause loss of life or morbidity in their victims if untreated.

Despite these many medically significant species, the lone antivenom available in India only targets the four most commonly found venomous species. This effectively ignores those parts of the country where none of these four species are found. Further, for nearly a decade now, it has been common knowledge that the venom of snakes, even within the same species, varies by region significantly enough to render the antivenom ineffective in several places.

Snake venom, produced at the lone source in the country, has been severely critiqued for its deteriorating quality and increasing costs by the antivenom manufacturers. In turn, herpetologists and venom research scientists have long been urging the pharmaceuticals to upgrade their own processes for the manufacture of antivenom, which will need significantly lower quantities of venom and at least addresses the issue of costs of venom.

Beyond all of these issues, the major hurdle at the hospital stage for the victim, is the lack of availability of antivenom, and the fact that snakebite is a medico-legal case which hoists far more bureaucratic hoops for a victim and their family to jump through. If one were to bypass these hurdles still, they are often faced with a medical fraternity that is so poorly equipped to treat snakebites that victims are often shuttled between hospitals, only for several to succumb in transit.