Core outcome set for research on snakebite management in South Asia

Background

Snakebite is a public health problem in many low- and middle-income countries in leading to estimated 138,000 deaths and leaving four lakh people with permanent disabilities. Most of the snakebite burden is from South Asia. The WHO strategy on snakebite (2019) suggests ‘safe and effective treatment of snakebite’, as one of the key pillars to reduce snakebite burden globally.  

In 2020, our research group conducted an overview of systematic reviews and identified the need for more clinical trials to inform clinical practice around snakebite management. The overview also found that the use of varied outcomes and their non-standardised measurement and reporting is an important gap which limits the ability of researchers, healthcare providers, decision makers, and patients to undertake meaningful comparisons and understand benefits or harms of different treatments.

The current project aims to fill this gap by developing a ‘core outcome set’ (COS), for research on snakebite management in South Asia (Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka). A COS is a minimal list of consensus outcomes which should be measured in clinical trials and evidence synthesis in a particular domain

Aim

1. To identify a consensus list of ‘what’ outcomes should be minimally measured for research on snakebite management in the South Asian region; and
2. to provide consensus recommendations on ‘how’ outcomes included in the COS should be measured such that they are feasible for use in research on snakebite management in South Asia

Research Methodology

The COS will be developed in three phases -

• In phase 1, outcomes that has been used in medical research previously through a global systematic review will be identified. The long list of the identified outcomes from the systematic review will serve as the basis of the initial list of outcomes which will be ranked in the Delphi survey in Phase 2. 
• In Phase 2, a two-stage Delphi and an online consensus meeting will be held to develop a consensus COS of ‘what’ outcomes should be minimally measured for research on snakebite management in South Asia.
• In Phase 3, an online workshop will be organised to develop consensus recommendations on “how” outcomes as part of the COS (developed in Phase 2) should be measured.

Phase I and II of the project are complete

Potential Impact

A COS developed by researchers for South Asia through an evidence-informed and through consensus building approaches will help the snakebite research community in better design, conduct and quality of trials and evidence synthesis. Using outcomes, which are relevant to all stakeholders, including patients, is important for research to improve management of snakebite, particularly for comparative effectiveness studies (clinical trials).