title: The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths.
abstract: BACKGROUND
  Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burden due to snakebites.
  
  
  RESULTS
  The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant country-specific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the Global Burden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deaths were estimated on the basis of observed mortality rates and the at-risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact that envenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually.
  
  
  CONCLUSIONS
  Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa.
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Anuradhani
authors.initials: A
authors.lastname: Kasturiratne
authors.forename: A Rajitha
authors.initials: AR
authors.lastname: Wickremasinghe
authors.forename: Nilanthi
authors.initials: N
authors.lastname: de Silva
authors.forename: N Kithsiri
authors.initials: NK
authors.lastname: Gunawardena
authors.forename: Arunasalam
authors.initials: A
authors.lastname: Pathmeswaran
authors.forename: Ranjan
authors.initials: R
authors.lastname: Premaratna
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Savioli
authors.forename: David G
authors.initials: DG
authors.lastname: Lalloo
authors.forename: H Janaka
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D001208:Asia / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D015994:Incidence; D012909:Snake Bites / Q000453:epidemiology* / Q000401:mortality*; D012911:Snakes