Abstract
Background: Snakebite envenoming remains a significant yet neglected public health problem in tropical countries, particularly in rural South Asia. This study aimed to identify demographic characteristics, management practices, and the determinants of poor treatment outcomes among snakebite patients in Sindh, Pakistan. Methods: A prospective cohort study was conducted at Peoples Medical College Hospital (PMCH), Shaheed Benazirabad, Sindh, Pakistan, from July 1, 2023, to June 30, 2024. A non-probability purposive sampling technique was used for data collection, and all consecutive patients presenting with confirmed or suspected snakebite were included. Data were collected through a validated study tool on demographics, pre-hospital management, hospital care, and treatment outcomes. Categorical variables were tested with the Chi-square test, and Kaplan-Meier survival analysis was used to test the effect of exposure-to-reporting time and hospital stay time on outcomes using IBM SPSS V29. Results: A total of 320 patients were included; 74.7% were male, and 98.4% were from rural areas. Most victims were aged 20-29 years (31.9%) and engaged in farming or manual labor (67.2%). Nearly half (49.7%) of the bites occurred during summer. Delayed hospital presentation was common, with 22.8% arriving after six hours of the bite. The overall poor-outcome rate was 10.9%, and mortality was 1.9%. A significant association was found between exposure-to-reporting time (p = 0.040) and hospital stay duration (p < 0.001) with treatment outcomes. Conclusion: Delayed presentation to the hospital and prolonged hospitalization were major predictors of poor outcomes following snakebite. Strengthening emergency referral systems, ensuring timely antivenom availability, and promoting community awareness are essential to reduce morbidity and mortality in snakebite-endemic regions of Pakistan.