Guwahati: Demow Rural Hospital in Assam’s Sivasagar district has achieved a rare public health milestone by recording zero snakebite-related deaths for five consecutive years (2021–2025), demonstrating that timely, protocol-driven care can save lives even in resource-limited rural settings.
Snakebite continues to be a major public health challenge in Assam, particularly affecting rural and economically vulnerable communities.
Traditionally, such cases were referred to tertiary hospitals due to fear of complications and lack of confidence at peripheral facilities. Demow Rural Hospital has overturned this long-held assumption by successfully managing snakebite envenomation at the rural level through disciplined clinical protocols, trained manpower, and strong community engagement.
Snakebite treatment services were formally initiated at the hospital in 2018.
In the initial years, most patients were referred out. Over time, based on field experience and systematic case reviews, the hospital evolved a standardized management guideline now known as the “Demow Protocol.” The protocol emphasizes early hospital reporting through community participation, mandatory 24-hour observation after any snakebite, timely administration of anti-snake venom based on clinical indication, uniform treatment regardless of socioeconomic status, and clear identification and management of venom syndromes common in Assam.
Hospital records show that 3,560 snakebite cases were treated between 2018 and 2025. While one death was recorded in 2020, there have been no fatalities from 2021 onwards, even as the annual caseload rose sharply.
In 2025 alone, the hospital managed 882 cases. Of the total cases, 511 (14.33%) were venomous, including pit viper, monocled cobra, red-necked keelback and krait bites. Except for a single krait-related death in 2020, all venomous cases were managed without mortality.
At the state level, Assam reported over 11,000 snakebite cases in 2025, with deaths declining steadily from more than 150 in 2022 to 27 in 2025, reflecting broader improvements in care.
The Demow Model has received recognition from state, national and international platforms. The Indian Council of Medical Research (ICMR) has undertaken scientific evaluation of the approach, and elements of the model have since been replicated across rural and district hospitals in Assam.
Public health experts say Demow’s success proves that preventable snakebite deaths can be eliminated through protocol-based care, trained teams and community trust without relying solely on advanced infrastructure.