Intended for healthcare professionals

Feature Snakebite

Why won’t people wear boots in the snakebite capital of the world?

BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r153 (Published 06 March 2025) Cite this as: BMJ 2025;388:r153
  1. Christianez Ratna Kiruba, freelance journalist
  1. Guwahati, India
  1. christianezdennis{at}gmail.com

Proven, cost effective interventions to prevent snakebites are failing to lower their toll in India. Why? Christianez Ratna Kiruba reports

In the farmlands of India—the country with the highest rate of snakebite deaths in the world, at nearly 58 000 a year—a unique initiative once held great promise. Gnaneswar CH, a wildlife conservationist, spearheaded a project in Tamil Nadu’s Tirunelveli district from December 2019 to May 2020 to equip farmers with simple tools designed to reduce the occurrence of snakebites: boots, gloves, flashlights, and mosquito nets. The kits, each costing about 1000 rupees (£10; €11; $12), aimed to protect members of vulnerable communities from deadly encounters with snakes.

Months later, however, Gnaneswar was left puzzled. The mosquito nets were being used for fishing and the boots lay untouched, gathering dust. What had gone wrong? The answer, he says, is an essential truth about public health interventions: even the best solutions can falter if they clash with local customs and practices.

Culture clash

India accounts for nearly half the global deaths from snakebite each year, and rural farmers are disproportionately affected. While prevention strategies such as boots, gloves, and mosquito …

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