Inclusion of incorrect information on snakebite first aid in school and university teaching materials in Nepal

Abstract

In previous studies in Nepal, snakebite victims were found to either not have Pressure Immobilization Bandaging (PIB) or Local Compression Pad Immobilization (LCPI) performed for first aid, or had it performed incorrectly. The goal of this study was to evaluate training texts regarding first aid measures for snakebite and the rates of performance of both methods currently recommended, as well as ineffective or harmful practices. The study was conducted from September, 2009 to November, 2010. It evaluated the venomous snakebite first aid measures recommended in the 31 most recently published and commonly used Nepalese reference works and textbooks aimed at paramedical personnel, primary health care workers, medical undergraduates, and students of class five to bachelor´s degree. It compared the suggestions of these with those of published guidelines for the management of snakebite envenomation. Up to 100% of first aid measures advocated in these materials differed significantly from published guidelines. This included the omission of appropriate activities, misstatements and prescription of inappropriate treatments. Among appropriate recommendations that were missing was the advice to apply PIB or LCPI, and the suggestion to go to a snakebite treatment center. Fifty-five percent of the references did recommend emergency transport. Inclusion of accurate evidence-based information regarding first aid measures for venomous snakebite in commonly used texts could help to reduce the application of ineffective or harmful pre-hospital practices, their associated morbidity and mortality, and increase the use of appropriate methods.

Knowledge of first aid methods and attitude about snake bite among medical students: a cross sectional observational study

“…This indicates that the curriculum in private and public schools both of Nepal does not significantly include appropriate information which is supported by studies using textbooks from primary to university level [14, 15]. Almost all the students were positive about the transfer of the snakebite patients to the hospital soon after the bite.…”

“…The faulty and inappropriate first aid methods mentioned in the textbooks from primary to the bachelor’s level [14, 15] can be an important contributing factor that has caused such deep rooted faulty knowledge.…”

“…The main reason behind this faulty knowledge to the students could be due to the incomplete and inappropriate first aid methods mentioned in the textbooks of primary to university level. Such textbooks published from Nepal provide incorrect information up to 100% errors [14, 15]. It is very important to provide updated and accurate information in the textbooks so that the students will acquire proper information of first aid of snake bite and they can also disseminate the information to the public in society.…”

“…Improper first aid in snake bites causes more harm rather than improvement [13]. The textbooks mentioning the first aid measures of snake bite published from Nepal advocate up to 100% different than the published guidelines, omitting the indicated ones and recommending faulty and deleterious methods [14, 15]. This can lead to deep rooted false knowledge about first aid of snake bite to the people, deleteriously affecting the prognosis of the snake bitten victims if such techniques are used.…”

Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal

“…Of the 33 questions, 26 were designed to test belief in popular, deep-rooted, and widely-held traditional beliefs or misconceptions regarding snakes ( n  = 13) and pre-hospital care of snakebites ( n  = 13). Two questions tested belief in doubtful benefits of pre-hospital care in the context of Nepal [45, 46], and five questions were related to first aid measures (i.e., pressure immobilization bandaging (PIB) and local compression pad immobilization (LCPI)) recommended by the World Health Organization and the Government of Nepal [44, 47–49]. …”