https://orcid.org/0000-0003-1907-8708
Figures
Abstract
Background
Snakebite envenoming remains a major yet neglected public health problem, disproportionately affecting rural and agrarian populations in low- and middle-income countries. While clinical management and antivenom availability have received increasing attention, far less emphasis has been placed on synthesising the upstream behavioural, environmental, occupational, and socioeconomic circumstances that shape snake–human conflict and lead to snakebite. Existing evidence on these circumstances is fragmented, heterogeneous, and context-specific, limiting its utility for informing prevention strategies. A comprehensive mapping of reported circumstances associated with snake–human conflict is therefore essential to support primary prevention, policy development, and future analytical research.
Objectives
This scoping review aimed to map and synthesise the available evidence on behavioural and environmental circumstances associated with snake–human conflict among populations living in snake-endemic settings across diverse geographic and socioecological contexts. Specifically, the review sought to (i) describe the range of reported circumstances under which snake–human conflict occurs, (ii) characterise the populations and contexts in which these encounters take place, and (iii) identify gaps in the existing evidence base.
Methods
A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A comprehensive search of electronic databases (including PubMed, Embase, Scopus, Web of Science, CINAHL, and Global Index Medicus) and grey literature sources was under taken without date restrictions. Observational studies, descriptive epidemiological studies, community surveys, surveillance analyses, mixed-methods studies, and qualitative research reporting behavioural, environmental, occupational, or socioeconomic circumstances related to snakebite were eligible for inclusion. Two reviewers independently screened records, assessed full texts, and charted data using a standardised extraction framework. Extracted data were synthesised using descriptive numerical summaries and narrative thematic mapping across four domains: environmental, occupational, behavioural, and socioeconomic determinants. No critical appraisal or effect estimation was undertaken, consistent with scoping review methodology.
Results
A total of 142 studies met the inclusion criteria, representing evidence from Asia, Africa, the Americas, Australia, and Europe, with the majority originating from South Asia. The synthesis included 47892 reported snakebite circumstances, 15931 time-of-bite records, 85593 anatomical site records, and 1,16,759 snake identification records. Agricultural or farm-related activities (59.1%), working (9.1%), and walking (8.4%) were the most frequently reported circumstances associated with snakebite. Day-time bites were slightly more common than night-time bites (54.6%), with a peak between 12 PM and 6 PM. The lower limb accounted for 79% of reported bite sites. Reported circumstances clustered into four interconnected domains: environmental factors (seasonality, climate, housing, land use), occupational exposures (agriculture, plantation work, forestry, manual labour), behavioural practices (barefoot walking, night-time activity, sleeping on the floor, snake handling), and socioeconomic vulnerability (poverty, limited education, rurality, constrained healthcare access).
Conclusions
This scoping review demonstrates that snake–human conflict and snakebite occur within predictable socioecological contexts shaped by interacting environmental, occupational, behavioural, and socioeconomic determinants. The findings highlight opportunities for prevention through integrated, context-specific strategies addressing environmental management, occupational safety, behaviour change, and structural vulnerability. While the review does not estimate risk or causality, it provides a consolidated evidence map to inform policy, programme design, and future analytical research aimed at reducing the global burden of snakebite envenoming.
Author summary
Snakebite envenoming continues to impose a substantial public health burden, particularly among rural and agrarian populations in low- and middle-income countries. This scoping review systematically mapped and synthesised the behavioural, environmental, occupational, and socioeconomic circumstances associated with snake–human conflict while identifying key evidence gaps in the existing literature. The review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines, incorporating evidence from 142 studies spanning Asia, Africa, the Americas, Australia, and Europe. Agricultural activities emerged as the most frequently reported circumstances associated with snakebite, with bites occurring predominantly during daytime and most commonly affecting the lower extremities. Consistent determinants of snakebite included seasonal and climatic factors, agricultural and manual occupations, barefoot walking, nocturnal activities, sleeping on the floor, intentional snake handling, poverty, rural residence, and limited access to healthcare services. Overall, the evidence demonstrates that snake–human conflict occurs within predictable socioecological settings shaped by the complex interaction of environmental exposures, occupational practices, and social vulnerabilities. These findings provide a comprehensive synthesis of the circumstances surrounding snakebite occurrence and offer an evidence base to inform context-specific prevention strategies, public health policy, and future analytical and implementation research.
Citation: Janakiram C, Chandran Nair AS, Nair AV, Pious A, Gyra GG, James A, et al. (2026) Behavioural and environmental risk factors associated with snake–human conflict: A scoping systematic review. PLoS Negl Trop Dis 20(8): e0014505. https://doi.org/10.1371/journal.pntd.0014505
Editor: R. Manjunatha Kini, National University of Singapore, SINGAPORE
Received: December 24, 2025; Accepted: June 23, 2026; Published: August 6, 2026
Copyright: © 2026 Janakiram et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data supporting the findings of this study are contained within the manuscript. No additional datasets were generated or analysed beyond those presented in this scoping review.
Funding: This paper is a part of the implementation research titled “Zero Snakebite Death Initiative,” funded by the ICMR Centre for Advanced Research (RFC Number: Delivery Research/CAR/6716/2025-2026/dt-22-08-2025, Proposal ID: CAR-2024-01-000684). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Snakebite envenoming (SBE) is a major public health issue that disproportionately affects low- and middle-income countries (LMICs), particularly rural and agricultural communities in sub-Saharan Africa, South and Southeast Asia, and Latin America.[1] Despite its official recognition as a neglected tropical disease (NTD) by the World Health Organization (WHO), snakebite has continued to receive limited attention in prevention strategies, policy prioritisation, and research funding. The global burden of snakebite is substantial, with WHO estimates suggesting that approximately 5.4 million snakebites occur annually, resulting in up to 2.7 million envenoming’s and between 81,000 and 1,38,000 deaths worldwide.[1] In addition to mortality, hundreds of thousands of survivors experience long-term disabilities, including amputations, chronic pain, and psychological trauma, which have profound implications for individuals, families, and health systems.[2]
India accounts for nearly half of global snakebite mortality, with an estimated 58,000 deaths annually.[3] Most snakebite victims in India are drawn from rural and agrarian communities, including farmers, agricultural labourers, and forest workers, who frequently lack timely access to appropriate medical care.[1] In a country where agriculture employs more than 50% of the workforce and where large populations reside in snake-endemic regions, understanding the circumstances under which snake–human conflict occurs is essential for developing effective and contextually appropriate prevention strategies. Beyond clinical outcomes, snakebite-related morbidity and mortality impose significant social and economic burdens on households and health systems, exacerbating cycles of poverty and vulnerability.[4]
Although clinical management and antivenom therapy have historically dominated snakebite research, comparatively less attention has been directed toward upstream determinants of risk. In particular, the behavioural and environmental circumstances that shape snake–human interactions have not been comprehensively mapped. Existing studies point to a complex interplay of environmental, occupational, behavioural, and socioeconomic factors that influence when, where, and how snake–human conflict occurs. However, this evidence remains fragmented, context-specific, and unevenly distributed across regions, making it difficult to derive a consolidated understanding of the circumstances associated with snake–human conflict, especially in high-burden settings.
Environmental conditions play a central role in shaping snakebite risk and snake–human encounters. [5] Seasonal patterns, particularly during monsoon and post-monsoon periods, have been consistently associated with increased snakebite incidence. Flooding displaces both human populations and snakes, increasing the probability of contact. [6] In India and Southeast Asia, snake activity peaks during rainy seasons when prey availability increases and human agricultural activity intensifies.[7] For example, evidence from Tamil Nadu, India has shown that more than 70% of snakebite cases occurred between June and September.[8] Land-use changes, including deforestation and habitat degradation, further contribute to snake displacement into human settlements, intensifying opportunities for snake–human conflict.[5]
Geographical and housing-related environmental features, including proximity to forests, rice paddies, water bodies, and poorly maintained dwellings have been identified as high-risk settings for snake encounters. Rural housing characterised by mud floors, open ventilation, and thatched roofing facilitates snake entry into living and sleeping spaces. For instance, a case–control study from Bangladesh demonstrated that sleeping on the floor increased the risk of snakebite by more than fourfold.[9] Importantly, these environmental circumstances vary across ecological zones, climatic conditions, and snake species distributions, underscoring the need to systematically map context-specific patterns rather than assume uniform risk profiles.
Occupational circumstances represent another critical dimension of snake–human conflict. [10] Agricultural workers, plantation labourers, herders, forestry workers, and construction labourers are routinely exposed to snake habitats as part of their daily livelihoods. [11] These occupational groups often work barefoot or with minimal protective equipment, increasing vulnerability to snakebite. Evidence from Nepal indicates that farmers and manual labourers accounted for over 70% of reported snakebite victims, with similar occupational patterns reported in Sri Lanka, Nigeria [12], and Brazil [13]. Such findings highlight the importance of understanding how livelihood activities intersect with environmental contexts to shape exposure.
Behavioural circumstances further compound risk and act as immediate triggers for snake–human encounters. Practices such as walking barefoot, sleeping outdoors or on the floor, working without protective gloves, and moving outdoors at night without adequate lighting are frequently reported across snakebite studies.[14] In rural India, children are particularly vulnerable due to outdoor play and unsupervised movement during early morning and evening hours. [15,16] Limited awareness of snake behaviour, first aid practices, and appropriate treatment-seeking further exacerbates morbidity and mortality following snakebite events.[17]
Socioeconomic conditions underpin and reinforce environmental, occupational, and behavioural circumstances. Poverty, low literacy, and limited access to healthcare shape both exposure and outcomes of snake–human conflict. In resource-constrained settings, delays in reaching health facilities, reliance on traditional healers, and inability to afford antivenom treatment can be fatal.[18] Evidence from multicentric studies in India indicates significantly higher snakebite-related mortality among low-income households, even after accounting for geographic and occupational factors.[19] Cultural beliefs and health system constraints further influence care-seeking behaviours, often delaying lifesaving treatment.
Despite the recognised burden of snakebite and the established importance of social and environmental determinants in other public health domains, the behavioural and environmental circumstances associated with snake–human conflict have not been comprehensively mapped. Existing studies vary widely in design, populations, definitions, and outcomes, limiting the ability to draw generalisable conclusions. The WHO strategy for snakebite envenoming has called for a 50% reduction in mortality and disability by 2030, a target that cannot be achieved through clinical management alone. Primary prevention efforts require a nuanced understanding of where, when, and under what circumstances snake–human conflict occurs.
A scoping review is particularly appropriate to map the breadth of existing evidence on behavioural and environmental circumstances related to snake–human conflict. By systematically identifying, categorising, and synthesising the available literature, this review aims to provide a comprehensive overview of reported circumstances, populations, and contexts in which snake- human conflict occurs. This approach will help identify evidence gaps, highlight regional variations, and inform future research priorities, targeted prevention strategies and policy development. Ultimately, the review seeks to establish a typology of behavioural and environmental circumstances associated with snake–human conflict and support context-sensitive public health responses across endemic settings. While the review did not estimate risk or causality, it mapped commonly reported circumstances associated with snake human conflict to inform future risk-factor analyses.
Objectives
To map the range of behavioural and environmental circumstances associated with snake-human conflict reported in the literature.
To describe the contexts and populations in which snake-human conflict occurs.
To identify key gaps in evidence and areas requiring further research.
Methods
Study design
A scoping review approach was selected to systematically map the breadth, characteristics, and contexts of existing evidence on behavioural and environmental circumstances associated with snake–human conflict, rather than to assess causality or intervention effectiveness. This review was conducted as a scoping review in accordance with JBI methodology.[20] While the review did not aim to estimate pooled effect sizes or establish causality, it incorporated structured mapping of behavioural and environmental circumstances associated with increased snakebite risk, drawing on evidence from observational studies. This approach allowed identification of recurrent risk patterns and contexts while maintaining the exploratory scope of a scoping review.
Types of sources
Consistent with JBI scoping review guidance, a broad range of evidence sources was included. These comprised observational studies (cross-sectional, cohort, and case–control), descriptive epidemiological studies, community-based surveys, surveillance data analyses, mixed-methods studies, and qualitative research reporting contextual aspects of snake–human conflict. Case reports and case series were included when they provided relevant contextual information. Editorials, commentaries, and opinion pieces were excluded but were reviewed for citation tracking.
Search strategy
A comprehensive search strategy was developed following JBI’s three-step approach. An initial limited search of MEDLINE (via Ovid) and CINAHL was undertaken to identify relevant keywords and index terms. This was followed by a full search across multiple electronic databases, including PubMed, Embase, Scopus, Web of Science, CINAHL, and Global Index Medicus. Grey literature was identified through Google Scholar, institutional repositories, and reports from national and international health agencies. Reference lists of included sources were screened for additional evidence. No date restrictions were applied. Only studies published in English were included.
Study selection
All identified records were imported into reference management software JBI SUMARI, and duplicate records were removed using the zotero. Titles and abstracts were independently screened by two reviewers against the eligibility criteria. Full-text articles of potentially relevant sources were retrieved and assessed in detail. Disagreements were resolved through discussion, with consultation of a third reviewer where necessary. The study selection process was documented using a PRISMA-ScR flow diagram [21].
Data charting
Data were charted using a customized data extraction form developed in accordance with JBI guidance and refined iteratively as familiarity with the literature increased. Two reviewers independently charted data, and discrepancies were resolved by consensus. Extracted data included study characteristics (author, year, country, design, duration, and sample size), population characteristics, and detailed descriptions of behavioural and environmental circumstances associated with snakebite. Outcome data included circumstances of bite, time of bite, anatomical site, and snake species involved. Discrepancies were resolved by consensus.
Data synthesis and presentation
Findings were synthesised using descriptive numerical summaries and narrative thematic mapping, consistent with JBI scoping review methodology. Quantitative data were summarised using frequencies and proportions to describe distributions of circumstances of snakebite, timing of bites, anatomical sites, and snake types. Qualitative and contextual data were analysed thematically and organised into four overarching domains: environmental, occupational, behavioural, and socioeconomic determinants. Results were presented using summary tables, a risk factor classification matrix, an evidence-to-risk mapping matrix aligned with the PCC framework, and conceptual figures, including a Snake–Human Conflict Pathways Framework and a causal loop diagram. Descriptive numerical summaries were generated to map the distribution of reported snakebite circumstances, temporal patterns, anatomical sites of bites, and snake species involved. No exposed–unexposed comparisons, effect estimates, or pooled measures of association were calculated. Consistent with JBI scoping review methodology, the numerical summaries describe the extent and nature of the evidence base and should not be interpreted as measures of risk or causality.
Results
The study synthesised data from 214708 recorded snake-bite incidents, capturing the circumstances, timing, anatomical site, and snake species involved. Results are presented as descriptive summaries of reported circumstances and contexts of snakebite and do not represent comparative measures of risk.
Study selection
The database search identified 2,342 records, with an additional 21 records identified through other sources, including organisational websites and citation searching. After removal of 210 duplicate records, 2,132 records were screened at the title and abstract level, of which 1,854 were excluded for not meeting the predefined inclusion criteria. A total of 278 reports were sought for full-text retrieval, and five reports could not be retrieved. Consequently, 273 full-text reports were assessed for eligibility. Following full-text assessment, 142 reports were excluded for specific reasons, including failure to address the target outcome, ineligible study designs (such as editorials, commentaries, or protocols), lack of relevance to the research question, insufficient outcome data, or duplicate or overlapping data. A further 3 reports were excluded due to incorrect outcomes or editorial nature. Ultimately, 142 studies met the eligibility criteria and were included in the final review Fig 1 and 2.
Fig 2. The map was created using R (ggplot2 package) with country boundary data obtained from Natural Earth (https://www.naturalearthdata.com/), accessed via the rnaturalearth package. Natural Earth data are in the public domain and are free for use without restriction (https://www.naturalearthdata.com/about/terms-of-use/). The visualization was generated using original study data.
Characteristics of included studies
The search identified a total of 142 studies that met the inclusion criteria for this review. These studies encompassed a wide geographic spread across Asia, Africa, the Americas, and Australia, although the majority (over 60%) originated from India, reflecting the country’s substantial global burden of snakebite. Study designs varied, comprising cross-sectional surveys, retrospective and prospective observational studies, cohort studies, descriptive epidemiological analyses, nested case–control studies, community-based surveys, and a limited number of case series and case reports. All included studies provided relevant data on environmental, occupational, behavioural, or socioeconomic determinants associated with snakebite incidence. A detailed summary of the characteristics of the included studies is presented in the compiled table of study characteristics.
The earliest included study dated back to 1987, whereas the most recent were published in 2025, demonstrating a multi-decade research landscape. Sample sizes ranged widely, from single-patient case reports to national surveillance datasets with more than 70,000 recorded cases. Several large-scale community surveys provided population-level estimates, while numerous hospital-based retrospective studies contributed clinical and epidemiologic insights. Study durations ranged from short periods of several months to extended data collection spanning more than a decade.
A substantial proportion of included studies evaluated the contextual or ecological determinants of snakebite, including associations with agricultural work, seasonal climatic variation, land-use patterns, housing, and occupational exposures. Behavioural factors such as barefoot walking, sleeping on the floor, poor lighting, and intentional snake handling were frequently reported across settings. Table 1
Circumstances of snake bite
Snake bites occurred in a wide range of daily activities, reflecting both occupational and environmental exposure. Agriculture/farming accounted for the largest proportion of incidents (59.1%), followed by working (9.1%) and other works (8.4%). A substantial proportion (5.9%) fell into the “other/unknown” category, indicating either undocumented activity or diverse exposure scenarios (Table 2).
Notably, bites during handling snakes (intentional or accidental) contributed to 3.6% of cases, while bites during sleeping/resting accounted for 2.4%. Activities related to fishing or water sources contributed 0.4%, reflecting context-specific livelihood risks. Children were also vulnerable, with 0.3% of bites occurring during play. These findings highlight the importance of behavioural and occupational risk patterns in snake-bite epidemiology.
Time of snake bite
Of the 15931 cases with time information, day time bites were slightly more (52.6%) than evening bites (47.4%). The highest proportion occurred between 12 PM and 6 PM (39%), followed by 6 PM to 12 AM (29%). Early morning hours (12 AM–6 AM) accounted 12% of bites. This distribution suggests that nocturnal snake activity and human outdoor mobility in evenings significantly contribute to exposure risk. (Table 3)
Anatomical site of bite
Among 85593 cases with recorded anatomical site, the lower limb was overwhelmingly the most common bite site (79%), followed by the upper limb (19.2%). Bites to the head/neck (0.5%) and trunk (0.40%) were rare. Approximately 0.9% of records listed the site as unknown. The predominance of lower-limb bites aligns with typical exposure patterns during walking, farming, and other ground-level activities. Table 3
Type of snake involved
From 116,759 records detailing snake type, viper and pit viper species were identified in most incidents (85.12%), followed by cobras (2.84%), kraits (1.9%), and mixed cobra–krait identifications (1.9%). Sea snakes were uncommon (0.16%), while “other” snake types constituted 8.08%. National-level species distribution data showed a heavy predominance of Russell’s viper (51.3%), followed by common krait (22.3%), spectacled cobra (8.9%), and saw-scaled viper (10%). These species correspond to India’s “Big Four,” responsible for most severe envenomation’s and mortality. (Table 3)
Table 4 gives an overview of the snake bite cases from countries like Africa, Australia, Brazil, Costa Rica, France, Lebanon, Mexico, Oman, Nepal, Sri Lanka, USA, Tunisia, Saudi Arabia and Vietnam. The data highlight the global burden of snakebite envenomation and demonstrate considerable variation in epidemiological patterns, healthcare access, species distribution, and clinical outcomes among countries
Snake–human conflict pathways framework (Fig 3)
The Snake–Human Conflict Pathways Framework illustrates how multiple interacting determinants collectively shape the risk of snakebite. Environmental factors such as seasonality, rainfall, temperature, land-use change, and poor housing influence both snake activity and the ecological contexts in which people live and work. These conditions determine where snakes are found and how often they come into proximity with humans. Occupational exposures particularly agricultural labour, plantation work, forestry, and outdoor manual tasks place individuals directly in snake habitats, increasing the chances of incidental encounters.
Behavioural practices, including barefoot walking, night-time outdoor movement, sleeping on the floor, handling snakes, and collecting firewood or water, act as proximal triggers that heighten immediate contact risk. These behaviours are often shaped by broader socioeconomic constraints such as poverty, limited education, inadequate lighting, poor housing infrastructure, and unequal access to healthcare. Socioeconomic vulnerability therefore amplifies both exposure to snake habitats and the likelihood of severe outcomes following a bite.
These determinants interact to produce recurrent snake–human encounters that may culminate in snakebite. The framework highlights that snakebite is a complex, multi-factorial event requiring integrated prevention approaches addressing environmental, behavioural, occupational, and socioeconomic dimensions simultaneously.
Table 5 summarises the key determinants of snakebite by grouping them into four major domains: environmental, occupational, behavioural, and socioeconomic. Environmental factors such as seasonality, rainfall, proximity to forests or agricultural fields, and poor housing structures shape the ecological conditions that increase snake presence around human settlements. Occupational exposures—particularly farming, plantation labour, forestry, construction, and fishing—place individuals directly in snake habitats, making these groups highly vulnerable. Behavioural practices, including barefoot walking, night-time outdoor activity, sleeping on the floor, and handling snakes, act as immediate triggers that heighten the likelihood of snake–human encounters. Socioeconomic determinants such as poverty, limited education, inadequate lighting, poor housing, and restricted access to healthcare further amplify both exposure risk and negative outcomes
Discussion
This scoping review mapped the breadth and characteristics of evidence on behavioural and environmental circumstances associated with snake–human conflict across diverse geographic and socioecological contexts. Drawing on 142 studies spanning several decades and multiple regions, the synthesis demonstrates that snakebite risk is shaped by a complex interaction of environmental conditions, occupational exposures, behavioural practices, and socioeconomic vulnerability. Rather than occurring randomly, snakebite emerges as a predictable outcome of repeated interactions between humans and snakes within specific ecological and social systems.
Environmental factors were consistently identified as foundational drivers of snake–human conflict. Seasonal patterns, particularly monsoon and post-monsoon periods, were strongly associated with increased snakebite incidence across South Asia, Southeast Asia, Africa, and Latin America.[22] Rainfall and flooding simultaneously increase snake activity and intensify human agricultural and outdoor labour, thereby elevating opportunities for contact. These findings are consistent with ecological studies demonstrating that snake movement and prey availability peak during periods of increased humidity and temperature.[23]
Land-use change, deforestation, and agricultural expansion further intensified snake–human interactions by reducing natural habitats and forcing snakes into closer proximity with human settlements. Housing characteristics—such as mud floors, thatched roofs, open ventilation, and poor structural maintenance—were repeatedly identified as enabling snake entry into domestic spaces, particularly during nocturnal hours. The substantial proportion of bites occurring during sleeping in several South Asian studies reinforces the importance of housing quality as a modifiable environmental determinant [8,24]. However, environmental risk patterns varied across regions, climates, and snake species, highlighting the need for context-specific prevention strategies rather than uniform approaches.
Occupational circumstances represented one of the most consistent and prominent risk domains identified in this review. Agricultural and plantation work accounted for a large proportion of snakebite incidents, reflecting the close overlap between human livelihoods and snake habitats.[18] Activities such as ploughing, weeding, harvesting, and irrigation routinely disturb vegetation and soil, increasing the likelihood of accidental encounters. Similar patterns were observed among forestry workers, loggers, construction labourers, and livestock herders, particularly in forest margins and peri-agricultural landscapes.[11,22]
The predominance of lower-limb bites (over 79% of reported cases) strongly supports an occupational exposure pathway, particularly among individuals working barefoot or with inadequate protective footwear. This anatomical distribution has been consistently reported in previous epidemiological studies and reflects ground-level exposure during walking and field work [18,25]. Importantly, occupational risk extended beyond formal employment to include subsistence activities such as grazing, collecting firewood, and fishing. Together, these findings highlight the need for occupationally tailored prevention strategies, including protective footwear, work-practice modification, and seasonal risk advisories.
Behavioural circumstances acted as immediate triggers that converted environmental and occupational exposure into direct snake–human encounters. Agriculture and farm work particularly barefoot walking associated with snakebite in the compiled dataset.[1] This finding aligns closely with the observed predominance of lower-limb bites and reinforces the role of footwear as a simple but underutilised preventive measure. Afternoon and evening outdoor activity, especially between 12 PM and 6 PM, followed by 6 PM to midnight represented the highest-risk temporal window, corresponding with nocturnal snake activity and limited visibility in rural settings.
Sleeping practices also emerged as an important behavioural determinant. Sleeping on the floor, outdoors, or in poorly secured dwellings increased vulnerability to nocturnal snake entry, a pattern well documented in South Asian case–control studies [9]. Intentional handling of snakes—whether during rescue, killing, or accidental contact—accounted for a notable proportion of bites, highlighting the risks associated with human responses to snake presence. Children’s outdoor play and unsupervised movement further contributed to risk, reflecting age-specific behavioural vulnerabilities. Collectively, these findings suggest that many snakebite events are preventable through targeted behaviour change interventions, including footwear use, improved lighting, safe sleeping practices, and community education on snake avoidance and safe response.
Socioeconomic conditions underpinned and amplified environmental, occupational, and behavioural risk pathways. Poverty constrained housing quality, limited access to protective equipment, and increased reliance on high-exposure livelihoods such as agriculture and manual labour. Low literacy and limited health education reduced awareness of snake ecology, first-aid practices, and appropriate treatment-seeking behaviours. Rurality and remoteness compounded these challenges by delaying access to health facilities and antivenom, particularly in emergency situations.[3,4,24]
The review also highlighted persistent reliance on traditional healers in many endemic regions, often resulting in delayed or inappropriate treatment. These socioeconomic determinants did not merely influence exposure but also shaped outcomes, contributing to higher morbidity and mortality among disadvantaged populations. Importantly, these patterns mirror broader inequities observed in other neglected tropical diseases, reinforcing snakebite as both a biomedical and social justice issue. [1,24]
Temporal analysis revealed a slightly higher proportion of day time bites compared with night time bites, with a clear peak during evening and early night hours. This distribution reflects the intersection of nocturnal snake behaviour and human activities such as evening travel, household chores, and outdoor social or occupational tasks. Species-specific data showed a marked predominance of viper bites, particularly Russell’s viper, followed by kraits and cobras. These species correspond to the “Big Four” snakes responsible for most severe envenoming’s and fatalities in India and parts of South Asia [1,22]. The alignment between species distribution, occupational exposure, and anatomical bite patterns reinforces the ecological plausibility of the findings and underscores the need for region-specific prevention, surveillance, and preparedness strategies. Accordingly, the present findings are not conflicting with the previous study but are complementary, reflecting differences in scope, data aggregation, and the global nature of this analysis. [26]
In Africa, Carpet Viper (27.17%), Night Adder (20.3%), Spitting Cobra (15.43%) and Forest Cobra (17.33%) bites were mainly reported. In Australia, Brown snake constituted 43.1% of bite cases followed by Tiger snakes (17.3%) and Red bellied black snake (17%). Bite cases from Bothrops species were reported in Brazil (90.4%), Costa Rica (97.8%) and Mexico (single case report). Lachesis species constituted, 7.11% and 2.2% of bite cases in Brazil and Costa Rica, respectively. In Nepal (83.5%), Vietnam (28.3%) and Sri Lanka (44.1%), Bite cases by Common Krait was widely reported. Russell’s Viper (11.8%) along with Cobra bite cases (4.7% and 1.3%) were reported in both Nepal and Sri Lanka. In USA, Massasauga (33.85%), Native Pit Viper (31.6%) followed by Rattle Snake (19.71%) bites were reported. While, in Tunisia Macrovipera Lebetina (92.86%) bite cases were recorded. A total of 5 Arabian cobra bites were reported in Saudi Arabia and a single bite case of Oman Saw Scaled Viper was reported from Oman. Hump Nosed Pit Viper which is endemic to Western Ghats of India and Sri Lanka contributed to 33.8% of snake bites reported from Sri Lanka (Table 4).
The Snake- Human Conflict Pathways Framework and causal loop diagram developed in this review provide a systems-level interpretation of the findings. They illustrate how environmental change, livelihood patterns, behavioural practices, and socioeconomic vulnerability interact in reinforcing cycles that sustain high snakebite risk. For example, poverty increases engagement in high-risk occupations and poor housing, which elevates exposure and adverse outcomes, further entrenching vulnerability. Such feedback loops highlight why isolated interventions—such as antivenom availability alone—are insufficient to achieve sustained reductions in snakebite burden.
Implications for policy and practice
The findings of this scoping review have several important implications. First, snakebite prevention must be integrated into broader rural development, agricultural safety, housing improvement, and environmental management programmes. Second, occupational health frameworks should explicitly recognise snakebite as a work-related hazard in endemic regions. Third, community-based education and behaviour-change interventions—tailored to local ecological and cultural contexts—are essential. Finally, strengthening primary healthcare access and emergency referral systems remains critical to mitigating severe outcomes when bites occur.
Evidence gaps and future research
Despite the extensive body of literature identified, important gaps remain. Many studies lacked standardised definitions of exposure circumstances, limiting comparability across settings. Evidence from parts of Africa and Latin America was less detailed with respect to behavioural context. There is also a paucity of longitudinal and intervention-focused studies evaluating the effectiveness of preventive strategies. Future research should use standardised reporting, mixed methods, and robust evaluation of scalable prevention strategies
Strengths and limitations
The principal strength of this review lies in its comprehensive scope, systematic methodology, and synthesis of a large and diverse body of literature spanning multiple decades and geographic regions. By mapping behavioural and environmental circumstances across varied contexts, the review provides a consolidated overview of the settings in which snake–human conflict occurs. However, several limitations must be acknowledged. The heterogeneity of study designs, inconsistent reporting of exposure variables, and absence of comparator groups limit causal inference. Geographic imbalance in the evidence base and potential reporting bias further constrain generalisability. As this is a global scoping review, the synthesis is influenced by the predominance of studies from South Asia, particularly India, where reporting largely focuses on the “Big Four” species. Although some non–Big Four species, such as the Hump-nosed pit viper, were noted, an in-depth analysis of other region-specific snake species was undertaken (Table 4). Due to inconsistent country-wise reporting, detailed geographic stratification was not feasible. Consistent with scoping review methodology, no formal critical appraisal of included studies was undertaken. These limitations underscore the need for future research employing standardised exposure definitions, longitudinal designs, and analytical approaches to quantify risk and evaluate prevention strategies.
Conclusion
This scoping review demonstrates that snake human conflict occurs within consistent environmental, occupational, behavioural, and socioeconomic contexts, providing a structured evidence map to inform prevention rather than causal inference. The findings highlight context-specific opportunities for action, including improved housing and environmental management, safer occupational practices, targeted behaviour change, and strengthened access to timely care. However, the evidence base is disproportionately concentrated in the Indian subcontinent, reflecting the high burden but also limiting global representativeness. To address these gaps particularly in India, which bears a substantial share of global snakebite morbidity and mortality future research should prioritise standardised reporting of exposure circumstances, and integrate ecological and geospatial data to better characterise risk contexts and guide locally relevant prevention strategies.
Supporting information
S1 File. PRISMA checklist. Checklist of PRISMA guidelines for scoping reviews.
From: Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–473. https://doi.org/10.7326/M18-0850. This work is licensed under CC BY 4.0.”.
https://doi.org/10.1371/journal.pntd.0014505.s001
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