Snakebites may seem like random encounters, but a new review by Indian researchers has suggested that they are closely linked to where people work, when they move outdoors and the conditions in which they live.
The findings point to a shift in India's approach to snakebite — from relying largely on antivenom to preventing the encounter itself.
The review, published in PLOS Neglected Tropical Diseases, analysed evidence from 142 studies covering more than 200,000 snakebite cases worldwide, with data spanning several decades. It found that occupation, environmental conditions, time of day and socioeconomic circumstances repeatedly emerged as important risk factors.
Nearly 70% of reported bites occurred during outdoor activities, including farming and construction. Risk also increases during rainy periods and in the evening and early night, when snakes may be more active and people continue to work or walk outdoors in low-light conditions.
For India, where millions depend on agriculture and outdoor labour, the findings have particular relevance. India carries one of the world's largest snakebite burdens. Researchers estimate that around 58,000 people die from snakebite every year in the country, accounting for nearly half of global snakebite deaths. The victims are predominantly from rural and agrarian communities, including farmers, agricultural labourers and forest workers.
Globally, the World Health Organisation (WHO) estimates that around 5.4 million snake bites occur every year, resulting in up to 2.7 million cases of envenoming and between 81,000 and 138,000 deaths. Snakebite is classified by WHO as a neglected tropical disease, with its burden falling disproportionately on low- and middle-income countries.
The Indian review, led by Chandrashekhar Janakiram, Director, Amrita JBI Centre for Evidence Synthesis and Implementation, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, argues that the circumstances preceding a bite need greater attention.
“Limiting ourselves to antivenom will never address the behavioural and environmental factors that put people at risk in the first place,” the researchers said.
Farmers working in fields, labourers clearing vegetation, construction workers and people handling piles of wood or agricultural material may encounter snakes without adequate protection.
The review found that lack of protective footwear, poorly secured homes and inadequate health information were repeatedly associated with greater exposure.
For agricultural workers, simple measures such as wearing shoes or boots, using a torch after dark and avoiding bare-handed handling of piles of vegetation, firewood or other material where snakes may hide could reduce encounters.
The timing of bites is another important clue. With many incidents occurring during the evening and early night, avoiding barefoot movement outdoors after sunset and improving lighting around homes, farms and workplaces could make a difference.
The researchers also highlighted what they described as an “inverse care law” in snakebite: the people most exposed to snakes may also be those living furthest from hospitals capable of providing appropriate treatment.
This creates a dangerous combination — higher exposure, fewer preventive resources and longer journeys to medical care.
“You cannot fix that gap with antivenom alone; antivenom sits at the wrong end of the problem,” the authors said.
For India, this means snakebite prevention cannot remain confined to health facilities. Occupational safety programmes in high-risk districts could include snakebite education, while local campaigns could focus on monsoon preparedness, safe agricultural practices and first response.
But prevention does not replace emergency treatment. Once a venomous bite occurs, rapid transport to a facility equipped to manage envenoming remains critical. Strengthening referral systems, ambulance access and treatment availability in rural and remote areas is therefore equally important.
The study is part of the Zero Snakebite Death Initiative, an implementation research project funded by the ICMR Centre for Advanced Research.
The researchers said better data is also needed. Consistent information on the location, timing, occupation, circumstances and outcome of snakebites could help authorities identify high-risk communities and direct prevention and emergency resources more effectively.
The researchers summed up the study, saying that India cannot find its way out of the snakebite problem. Antivenom can save lives after envenoming, but safer workplaces, protective footwear, better lighting, improved housing, awareness and faster access to healthcare can help prevent the bite from happening in the first place.
Besides Chandrashekhar Janakiram, the other authors of the study were Arjun Satheesh Chandran Nair, Amrutha V. Nair, Ajay Pious, Geetha Gireesh Gyra, Anju James, Srikanta Kanungo, Rahul K. Gajbhiye, Nirmalya Mukherjee, Omesh Kumar Bharti, Surajit Giri, Sunil Panigrahi and Jaideep C. Menon, all from Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi.
