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Evaluating temporal patterns of snakebite in Sri Lanka: the potential for higher snakebite burdens with climate change.

  • Ediriweera, Dileepa Senajith1, 2
  • Diggle, Peter John2
  • Kasturiratne, Anuradhani3
  • Pathmeswaran, Arunasalam3
  • Gunawardena, Nipul Kithsiri4
  • Jayamanne, Shaluka Francis5
  • Isbister, Geoffrey Kennedy6, 7
  • Dawson, Andrew6, 8
  • Lalloo, David Griffith9
  • de Silva, Hithanadura Janaka5
  • 1 Centre for Health Informatics, Biostatistics and Epidemiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. , (Sri Lanka)
  • 2 Centre for Health Informatics, Computing and Statistics, Lancaster University Medical School, Lancaster, UK.
  • 3 Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. , (Sri Lanka)
  • 4 Department of Parasitology, University of Kelaniya, Ragama, Sri Lanka. , (Sri Lanka)
  • 5 Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. , (Sri Lanka)
  • 6 South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka. , (Sri Lanka)
  • 7 Clinical Toxicology Research Group, University of Newcastle, Waratah, Australia. , (Australia)
  • 8 Addiction Medicine, Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia. , (Australia)
  • 9 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Published Article
International Journal of Epidemiology
Oxford University Press
Publication Date
Dec 01, 2018
DOI: 10.1093/ije/dyy188
PMID: 30215727


Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165 665 individuals living in 44 136 households and recorded all recalled snakebite events that had occurred during the preceding year. Log-linear models were fitted to describe the expected number of snakebites occurring in each month, taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and of recall bias amongst survey respondents. Snakebite events showed a clear seasonal variation. Typically, snakebite incidence is highest during November-December followed by March-May and August, but this can vary between years due to variations in relative humidity, which is also a risk factor. Low relative-humidity levels are associated with high snakebite incidence. If current climate-change projections are correct, this could lead to an increase in the annual snakebite burden of 31.3% (95% confidence interval: 10.7-55.7) during the next 25-50 years. Snakebite in Sri Lanka shows seasonal variation. Additionally, more snakebites can be expected during periods of lower-than-expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.

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