International Journal of Community Medicine and Public Health

Chandrachood MV et al. Int J Community Med Public Health. 2020 May;7(5):1936-1940

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20202009
Original Research Article

Knowledge, attitude and practices regarding snakes and snake bite

among students of industrial training institute in tribal area of
Maharashtra
Mandar V. Chandrachood1, Snehal P. Chavhan2*

1
Department of Community Medicine, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
2
Department of Community Medicine, BKL Walawalkar Rural Medical College, Sawarde, Chiplun, Maharashtra,
India

Received: 03 March 2020

Revised: 04 April 2020
Accepted: 07 April 2020

*Correspondence:
Dr. Snehal P. Chavhan,
E-mail: snchavan14787@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Snake bite is an important public health issue and an occupational hazard in India often faced by
farmers and villagers. Most vulnerable are people in rural and tribal area but they are poorly informed about the snake
bite. This study was undertaken with objective of assessing the knowledge, attitude and practices regarding snakes
and snake bite among students of Industrial Training Institute (ITI) in tribal area.
Methods: A cross sectional study was conducted in all students of the institute to assess the knowledge, attitude and
practices regarding snakes and snake bite. Data was collected in a predesigned and pretested proforma by oral
questionnaire method and was analyzed by SPSS software using descriptive statistics and appropriate statistical tests
of significance.
Results: Knowledge about identification of snakes was low. Most correctly identified snake was spectacled cobra
(92.3%). Snakes are fond of milk was the most prevailing myth (60%). There was inadequate knowledge about proper
first aid and treatment measures of snake bite. Participants from urban area and having higher secondary education
had significantly higher knowledge, (p=0.015, p=0.025 respectively).
Conclusions: Participants had inadequate knowledge about identification of snakes with various prevailing myths.
Most of the participants were not aware of proper first aid measures but all knew that the patient should be taken to a
hospital. There is a need to educate rural and tribal population about snakes and about first aid and treatment measures
for snake bite.

Keywords: Snakes, Snake bite, Myths, First aid, Treatment

INTRODUCTION deaths and around 3 times amputations and other

permanent disabilities.4 Snake bite is a major public
According to WHO snake bite is an important medical health problem in the rural tropics.5 The Indian snake bite
problem but it is also a neglected extrinsic injury in statistics are alarming as the figures are highest in the
tropical and subtropical developing countries.1,2 South world, though India does not host the largest number of
Asia, South-east Asia, Sub-Saharan Africa and Latin snakes in the world. The official records state about
America are most affected regions in the world.2,3 About 250,000 snake bite cases occur in India every year, of
5.4 million snake bites occur each year, resulting in up to which, over 50,000 die due to inadequate first aid or
2.7 million envenomings with at least 81,000-138,000 unscientific treatment methods.6

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Of the 283 species of snakes in India, 179 are non- to the study participants while assessing the knowledge
venomous and 62 are venomous. The common species in about identification of snakes.
India which are deadly to man are only 4: The Indian
cobra, the Russell’s viper, the saw scaled viper and the Data entry was done using microsoft excel. While
common Indian krait. These are known as the ‘big four’. assessing the knowledge on ‘Snakes and Snake bite',
42 Indian snakes are “mildly venomous”-in the sense that scores were given as 1 for correct answer and 0 for
their bite may not result in fatalities in humans but only incorrect/partially correct/don’t know answer. All
cause mild local symtopms.7 A snake bite is an acute life- responses were tabulated. Data was analyzed by SPSS
threatening medical emergency often faced by farmers, software version 16. Descriptive statistics like frequencies
villagers, hunters, and a migrating population and has and percentage were used. Chi square test and Fisher
been listed as an occupational hazard.8,9 Over years, this exact test were used as tests of significance to determine
neglected tropical disease has emerged as an important the association of knowledge with different variables.
established cause of morbidity and mortality among the P<0.05 was considered statistically significant.
poor, rural and tropical population.2
RESULTS
Misbeliefs and superstitions about snakes across the globe
and across the cultures are numerous - about snakes in Total 65 students took part in the study and majority of
general and about particular species.7 Such factors play the students (78.5%) were adolescents and studied up to
part in determining attitude and practices of people in 10th standard (66.2%). Most of the students (83.1%) were
general and about health seeking behaviour in particular. from rural background and 84.6% students were
belonging to backward castes like other backward caste
Industrial training institute (ITI) in tribal area of Thane (OBC), scheduled caste (SC) and scheduled tribe (ST)
district, Maharashtra comes under the western Ghats while remaining 15.4% students belonged to open
characterized by high rainfall and wet evergreen hill category (Table 1).
forest areas which is home to various venomous and non-
venomous snakes. The present study was therefore Table 1: Distribution of participants by age,
undertaken in students of ITI to assess the knowledge, education, caste and place of residence (n=65).
attitude and practices regarding snakes and snake bite and
to suggest recommendations based on findings of the Variable Frequency Percentage
study. ≤19 51 78.5
Age
(in years) >19 14 21.5
METHODS
Secondary 43 66.2
A cross sectional study was conducted among students in Education Higher
22 33.8
the industrial training institute, Sakwar. It is located in the secondary
field practice area of rural health and training center, OBC 35 53.8
Sakwar of Department of Community Medicine, Seth GS Open 10 15.4
Medical College and KEM Hospital, Mumbai, located at Caste
SC 3 4.6
a distance of 75 kilometres from the teaching institution. ST 17 26.2
The study was conducted over a period of three months
from June to August 2011. Universal sampling method Place of Urban 11 16.9
was used and all those students in ITI willing to residence Rural 54 83.1
participate were included in the study. Sample size was
65. All were male students as there was no female student To assess the knowledge regarding species identification
enrolled in the Sakwar ITI. Permission from ITI authority and venomosity of snakes, 10 images of locally prevalent
was taken before collecting required data. Informed venomous and non-venomous snakes were shown to the
verbal consent was taken from all the participating study participants. Correct identification of both image
students before the start of the study and after telling and venomosity was highest for spectacled cobra, where
them about objectives of the study. 60 (92.3%) of the study participants could identify it
correctly. Among venomous snakes correct identification
Data was collected using the predesigned, pre-tested of both image and venomosity was lowest for common
proforma by oral questionnaire method. After establishing krait, where 16 (24.6%) of the study participants could
good rapport with study group, demographic profile in identify it correctly. Among non-venomous snakes
form of name, age, sex, caste, education and place of correct identification of both image and venomosity was
residence was taken. Questionnaire was in the form of 30 highest for checkered keelback 29 (44.6%) and it was nil
multiple choice questions and few open-ended questions for wolf snake. Wolf snake was confused with common
for assessing the knowledge, attitude and practices of krait by most of the participants because of their similar
study participants regarding snakes and snake bite. Ten appearance (Table 2).
images of commonly found venomous and non-venomous
snakes in the ITI campus and nearby forests were shown

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 Chandrachood MV et al. Int J Community Med Public Health. 2020 May;7(5):1936-1940

Table 2: Distribution of participants according to knowledge regarding identification of snakes (n=65).

Image and Image and Only Only venomosity

S.
Snake species venomosity - both venomosity - none image identified identified
no.
identified correctly identified correctly correctly correctly
N (%) N (%) N (%) N (%)
1 Spectacled cobra 60 (92.3) 0 (0) 5 (7.7) 0 (0)
2 Common krait 16 (24.6) 39 (60) 4 (6.2) 6 (9.2)
3 Russell’s viper 21 (32.3) 6 (9.2) 13 (20) 25 (38.5)
4 Saw scaled viper 35 (53.8) 3 (4.6) 19 (29.3) 8 (12.3)
5 Rat snake 28 (43.1) 4 (6.2) 20 (30.7) 13 (20)
6 Worm snake 4 (6.2) 25 (38.5) 11 (16.8) 25 (38.5)
7 Wolf snake 0 (0) 43 (66.2) 0 (0) 22 (33.8)
8 Indian rock python 10 (15.4) 4 (6.2) 48 (73.8) 3 (4.6)
9 Checkered keelback 29 (44.6) 13 (20) 21 (32.3) 2 (3.1)
10 Green keelback 22 (33.8) 17 (26.2) 13 (20) 13 (20)

Table 3: Distribution of participants according to assessment regarding myths and facts related to snakes and snake
bite (n=65).

S. no. Myth Correct answer Incorrect answer Don’t know

N (%) N (%) N (%)
1 Snakes are fond of milk 22 (33.8) 39 (60) 4 (6.2)
2 Snakes chase people 46 (70.8) 13 (20) 6 (9.2)
3 Snakes seek revenge 34 (52.3) 26 (40) 5 (7.7)
4 All snakes are poisonous 50 (76.9) 13 (20) 2 (3.1)
5 Charming of snakes by the music played on pipe 18 (27.7) 38 (58.5) 9 (13.8)
6 Cobra carries a precious stone on his head 46 (70.8) 4 (6.2) 15 (23)
7 Rat snake sucks milk from cows 32 (49.2) 21 (32.3) 12 (18.5)
8 Snakes found in water are non-poisonous 23 (35.4) 18 (27.7) 24 (36.9)

Table 4: Distribution of participants according to knowledge, attitude and practices regarding first aid and
treatment for snake bite (n=65).

S. no. Measures Correct answer Incorrect answer Don’t know

N (%) N (%) N (%)
1 Reassurance to the patient 58 (89.2) 0 (0) 7 (10.8)
2 Application of tourniquet 21 (32.3) 18 (27.7) 26 (40)
3 Immobilization of the bitten limb 33 (50.8) 20 (30.7) 12 (18.5)
4 Cleansing/washing of the bitten area 18 (27.7) 32 (49.3) 15 (23)
5 Sucking of blood by mouth 37 (57) 20 (30.7) 8 (12.3)
6 Cutting with blade near bite mark 15 (23) 18 (27.7) 32 (49.3)
7 Keeping the bitten area below the level of heart 25 (38.5) 23 (35.4) 17 (26.1)
8 Consuming alcohol 53 (81.5) 10 (15.4) 2 (3.1)
9 Application of native medicine 18 (27.7) 35 (53.8) 12 (18.5)
10 Take patient to faith healer/quack 33 (50.8) 25 (38.5) 7 (10.7)
11 Take patient to hospital 65 (100) 0 (0) 0 (0)
12 Anti-snake venom is the treatment 45 (69.2) 2 (3.1) 18 (27.7)

While assessing about myths and facts related to snakes other myths i.e. snakes are fond of milk (33.8%),
and snake bite; majority of participants correctly charming of snakes by music played on pipe (27.7%),
responded that snakes do not chase people (70.8%), sucking of milk from cows by rat snake (49.2%) and
snakes do not seek revenge (52.3%), all snakes are not about venomosity of snakes found in water (35.4%)
poisonous (76.9%) and cobra does not carry any precious indicating their poor knowledge or misbeliefs (Table 3).
stone on his head (70.8%); however, less than half of the
study participants responded with correct answers about

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 Chandrachood MV et al. Int J Community Med Public Health. 2020 May;7(5):1936-1940

While assessing the knowledge, attitude and practices of common krait which could be because of their similar
the study participants regarding first aid and treatment for appearance. Such misrecognition usually results in many
snake bite; more than half of the study participants uncommon non-venomous snake species getting
correctly responded that reassurance to the patient misidentified as venomous and unfortunately gets
(89.2%), immobilization of the bitten limb (50.8%), no killed.13 In our study 76.9% of the total participants knew
sucking of blood by mouth from the bitten area (57%), no that all snakes were not venomous which was similar to
consumption of alcohol (81.5%), and not to take patient study done by Pathak et al but significantly less than the
to faith healer/quack (50.8%) should be practiced. All the study done by Pandey et al.12,14 In our study, it was
participants correctly mentioned that patient should be observed that various myths are prevailing and 60% of
taken to a hospital immediately and 69.2% were aware the participants had misbelief that snakes are fond of
about the ASV (Anti Snake Venom) as the treatment for milk. Our results were comparable with study done by
snake bite. However, majority of the students mentioned Pathak et al, who found that 76.25% of the total
that they don’t know or responded incorrectly about other participants offer milk to snakes brought by local snake
measures like application of tourniquet, charmers on ‘Nag Panchami’ festival which proves
cleansing/washing of the bitten area, cutting with blade detrimental to the snake’s health.12
near bite mark, keeping the bitten area below the level of
heart and about application of native medicine (Table 4). Findings of our study about practice of application of
tourniquet (32.3%) was less prevalent than findings of
While assessing the overall knowledge regarding snakes study done by Krishnaleela et al, where it was (69.5%)
and snake bite no significant association was observed but practice of application of native medicine (27.7%)
with age or caste of the study participants; however, was comparable (25.5%) with their study.11 In another
significant association was observed with place of study done by Chincholikar et al in Maharashtra among
residence and education. Participants from urban area and rural adults it was observed that awareness about first aid
having higher secondary education had higher knowledge measures was less in all subjects.15In our study all
(p=0.015, p=0.025 respectively) (Table 5). participants mentioned that snake bite patient should be
taken to hospital for medical treatment and 69.2% of
Table 5: Association of socio-demographic factors them were aware about the anti-snake venom (ASV) as
with knowledge about snakes and snake bite. the treatment; however, 50.8% of the participants also
showed misbelief in faith healers/quacks. In study done
S. no. Variable P value by Krishnaleela et al 62.5% preferred hospital treatment
0.88 and only 12% preferred traditional practices and 59.5%
1 Age (adolescent/adult) believed that ASV is effective which was lower than our
(Chi square)
0.25 study findings.11 In an another study done by Silva et al
2 Caste (OBC/Open/SC, ST) among the farmers in Sri Lanka found out that 86.8% of
(Chi square)
0.015 them preferred hospital treatment and only 11.5%
3 Residence (urban/rural) preferred traditional treatment which was also lower than
(Fisher exact)
Education findings of our study.16 Studies done by Pathak et al and
0.025 Pandey et al observed that all the participants knew about
4 (secondary/higher
(Chi square) medical treatment being available for snake bite and all
secondary)
said that they will rush to the health facility if a snake
bites them which was similar to our study findings.12,14
DISCUSSION
Use of ineffective first aid treatment and delay in getting
antivenom combined leads to systemic envenoming by
This study was done to know the awareness levels the time they seek medical treatment.17
regarding identification of snakes, myths and facts related
to them, and about proper first aid measures and
In our study knowledge regarding snakes and snake bite
treatment after snake bite. A study conducted on snake
was found to be significantly associated with place of
bite in rural Laos by Keooudom et al found that 90% of
residence and education. Participants from urban area and
the study population had knowledge to identify the snakes
having higher secondary education had higher knowledge
which was comparatively higher than our study
which may be because of better educational exposure. In
(34.61%).10 Our results were comparable to study done
another study done by Chincholikar et al, it was observed
in rural population of Tirunelveli district by Krishnaleela
that educated people had more knowledge about types of
G et al who found that 39.5% of the respondents had the
snakes as compared to uneducated.15 Therefore awareness
knowledge to identify the snakes.11 In our study, the most
camps for imparting basic knowledge to general
correctly identified snake was spectacled cobra (92.3%), population and especially to people in rural and tribal area
which could be because of its characteristic hood. Similar
about identification of snakes, snakebite prevention,
results have been found in the studies done by Pathak et
clearing misconceptions with demonstration of proper
al, Duminda et al and Pandey et al in Karnataka, Sri
first aid measures should be conducted through various
Lanka and Nepal respectively.12-14 In our study all the
outreach activities.
participants incorrectly identified non-venomous wolf
snake and majority of them confused it to be venomous

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 Chandrachood MV et al. Int J Community Med Public Health. 2020 May;7(5):1936-1940

This study has a limitation that the findings cannot be 5. Anjum A, Munawwar HHA. Epidemiological
generalized to the entire population, as it was specific to Profile of Snake Bite at Tertiary Care Hospital,
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