Zero snakebite death initiative; community empowerment and engagement for mitigation of snakebite envenoming. SARPA (Snakebite Awareness, Response, Prevention and Action)
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 1,400
- 试验地点
- 7
研究概览
简要总结
Background:
Snakebite envenomation (SBE) is a neglected tropical disease responsible for an estimated 58,000 deaths annually in India, disproportionately affecting rural, tribal, and marginalized populations. Despite the availability of effective treatment with anti-snake venom (ASV), systemic gaps in awareness, timely access, and care coordination contribute to high mortality and morbidity. Fragmented local initiatives have demonstrated promise but lack scalability and integration. The Snakebite Awareness, Response, Prevention and Action (SARPA) protocol proposes an evidence-based, community-centred model to bridge these gaps through integrated prevention, preparedness, and health system strengthening.
Objectives:
To design, implement, and evaluate a scalable, adaptive, and community-driven intervention for snakebite prevention and management using the RE-AIM framework. The primary objective of the study is to co-develop, pilot and implement a replicable composite model of community engagement and empowerment for the prevention and mitigation of snakebite envenoming across diverse geographical settings of India. The secondary Objectives are : 1) To assess changes in awareness and knowledge related to snakebite envenoming (SBE) across the entire continuum of care — from community volunteers and first responders to doctors and paramedical staff managing SBE — using a pre- and post-intervention evaluation design.2) To develop and operationalise an iterative, digital snakebite dashboard for real-time documentation and monitoring of snake rescues, kills, sightings, envenoming cases, and related deaths across study sites, enabling data-driven decision-making and surveillance.
Methods:
This multicentre implementation research uses a mixed-methods approach to co-develop and evaluate a scalable, community-engaged model for snakebite prevention and health system strengthening in two blocks within seven states across the five zones of India. The study comprises three phases: a preparatory-adaptive phase (8 months), a piloting and model optimization phase (11 months), and a full implementation phase (24 months). Interventions will combine behaviour change communication, digital innovations (AI-assisted snake identification, real-time surveillance dashboards, 24×7 helpline), and structured health system capacity building. Evaluation will integrate the RE-AIM and Proctor’s frameworks to assess reach, effectiveness, adoption, implementation fidelity, and maintenance. Quantitative and qualitative analyses—including logistic regression, mixed-effects modeling, and longitudinal focus group discussions—will measure changes in awareness, preventive practices, time-to-treatment, and mortality reduction.
Expected Outcomes:
The SARPA protocol is expected to generate a replicable model for snakebite prevention and management adaptable across diverse ecological and health system contexts. By integrating community empowerment, digital technologies, and health system strengthening, the study aims to produce scalable evidence to inform India’s national snakebite strategy and contribute to the WHO’s 2030 target of halving global snakebite mortality.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 盲法
- None
入排标准
- 年龄范围
- 18.00 Year(s) 至 80.00 Year(s)（—）
- 性别
- All
入选标准
- •The intervention targets all relevant stakeholders across the snakebite care pathway, from prevention and early response to hospital-based treatment and policy integration.
- •Participants are grouped into the following categories: a.
- •Community Members: Residents of high-burden snakebite areas, particularly those whose occupations increase exposure risk, such as agricultural workers, forest gatherers, and outdoor labourers.
- •These populations are central to both prevention and early detection strategies.
- •Community Volunteers (Sarpa Mitras): Locally identified individuals trained to serve as first responders.
- •Sarpa Mitras will be selected from established networks such as self-help groups (SHGs) and grassroots health workers’ collectives.
- •They will be trained in recognizing venomous species, providing correct first-aid, stabilizing victims, ensuring safe transport, and conducting community awareness sessions.
- •Healthcare Providers: A wide spectrum of providers will be engaged, including medical officers, nurses, pharmacists, ambulance personnel, Accredited Social Health Activists (ASHAs), and Auxiliary Nurse Midwives (ANMs).
- •These individuals will receive refresher training on evidence-based snakebite management and referral protocols.
- •Policy and System-Level Stakeholders: State and district health officials, Panchayat Raj Institutions (PRIs), and NGO representatives will be involved to facilitate system-level integration, policy alignment, and sustainability planning.
- •For the project, the intervention will be implemented across 14 blocks in 7 states, targeting all key stakeholders along the snakebite care pathway.
- •The study population will include (I) Community members residing in high-risk areas, sampled through household surveys at baseline and endline to capture changes in awareness and practices.
- •Approximately 100 households per block will be surveyed, yielding about 1,400 households in total.
- •(II) Community volunteers (Sarpa Mitras): Five Sarpa Mitras will be identified from each panchayat, with the total number varying depending on the number of panchayats within a block.
- •This approach ensures representation across villages while creating a strong local network of trained volunteers.
- •(III) Healthcare workers: Training will be extended to different cadres of health providers, with approximate targets per block of 15–20 medical officers, 20–25 nurses and pharmacists, 10–15 ambulance personnel, and 20–25 frontline workers (ASHAs, ANMs).
- •The final numbers will vary according to the number of CHCs, PHCs and rural hospitals in each block, but overall coverage across all sites is expected to be comprehensive.
- •(IV) Policy and system-level stakeholders, including district health officers, PRI members, and NGO representatives, with at least 5–6 per district engaged in workshops and consultations.
排除标准
- •Individuals who are unwilling or unable to participate in the study will be excluded.
研究者
Jaideep C Menon
Amrita Institute of Medical Sciences, Kochi