Knowledge assessment of snake antivenom among healthcare practitioners involving educational intervention in northern Nigeria: a study protocol

Bala, Auwal Adam; Jatau, Abubakar Ibrahim; Yunusa, Ismaeel; Mohammed, Mustapha; Mohammed, AZ; Isa, Abubakar; Wada, Abubakar Sadiq; Gulma, Kabiru Abubakar; Bello, Inuwa; Michael, Godpower Chinedu; Malami, Sani; Chedi, Basheer

doi:10.1177/2042098620935721

Cited by 8 publications

(9 citation statements)

References 13 publications

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“…Furthermore, knowledge regarding prescription and antivenom administration was relatively poor among HCWs, with less understanding among "clinicians" than nurses. Similar findings have been reported in Ghana, where HCWs overestimated their knowledge about snakebite management [ 24 ], and in Nigeria, where the knowledge about SAV among HCWs was grossly inadequate [ 28 ]. Patterns of lack of knowledge among HCWs on snakebite and SAV prescription and administration have also been reported in Brazil, Palestine, Kenya, Uganda, and Zambia [ 16 , 18 , 33 ].…”

Section: Discussionsupporting

confidence: 82%

“…Health care workers’ (HCWs’) knowledge and compliance with standardized protocols for diagnosis and treatment remain crucial for managing snakebites [ 24 – 27 ]. Studies performed in Cameroon, Nigeria, and Lao PDR have shown that the level of knowledge among HCWs on snakebites remains poor [ 15 , 28 , 29 ]. In Bhutan, a study found that only 23% of HCWs had an adequate understanding of the management of snakebite envenoming, while in Ghana, a study showed a slightly higher level of knowledge at 48.2% [ 24 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

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Health care workers’ knowledge on identification, management and treatment of snakebite cases in rural Malawi: A descriptive study

et al. 2022

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Snakebite envenoming remains a public health threat in many African countries, including Malawi. However, there is a shortage of literature on the knowledge of Health Care Workers (HCWs) and the prevalence of snakebite cases in Malawi. We interviewed HCWs in Neno District to assess their knowledge of snake identification and management of snakebites. We further reviewed patient registers from 2018 to 2021 in all 15 health facilities in the district. We used descriptive statistics to characterize the survey population, knowledge, snake antivenom (SAV) administration, and snake identification. Using "shapefiles" from Open Street Maps, we mapped villages with snakebite cases. Of the 105 HCWs interviewed, 58% were males, and 60% had worked for less than five years. The majority (n = 93, 89%) reported that snakebite envenoming was a problem in the district. Among the clinicians, 42% said they had prescribed SAV previously, while among nurses, only 26% had ever administered SAV. There were discrepancies among clinicians regarding the dosing of snake antivenom. Significant gaps in knowledge also existed regarding snake identification. While two-thirds of HCWs could correctly name and identify venomous snake species, most (> 90%) failed for non-venomous snakes. Most (n = 100, 95%) reported that snakebite victims visit traditional healers more than the hospital. Between 2018 and 2021, the Neno District registered 185 snakebites with a yearly average of 36 cases per 100,000 population. Fifty-two percent (n = 97) were treated as an inpatient; of these cases, 72% were discharged in less than three days, and two died. More snakebite cases were recorded in the eastern part of the district. Significant knowledge gaps exist among HCWs in Neno regarding prescription and administration of SAV and snake identification, which likely challenges the quality of services offered to snakebite victims.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Health care workers’ knowledge on identification, management and treatment of snakebite cases in rural Malawi: A descriptive study

et al. 2022

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“… 25 – 27 Both the AKAT and the study protocol have been published elsewhere by the same authors. 22 , 24 …”

Section: Methodsmentioning

confidence: 99%

“…[25][26][27] Both the AKAT and the study protocol have been published elsewhere by the same authors. 22,24 The ASV tool consists of a total of 28 items covering knowledge (19 items), availability, cost, and logistics (9 items) of ASV in northern Nigeria. The availability, cost, and logistics were presented as frequencies and percentages.…”

Section: Asv Assessment Toolmentioning

confidence: 99%

Knowledge assessment of anti-snake venom among healthcare practitioners in northern Nigeria

Bala

Jatau

Yunusa

et al. 2021

Therapeutic Advances in Infection

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Introduction: Anti-snake venom (ASV) is the standard therapy for the management of snakebite envenoming (SBE). Therefore, the knowledge of ASV among healthcare practitioners (HCPs) is essential for achieving optimal clinical outcomes in snakebite management. This study aimed to assess knowledge of ASV among the HCPs in northern Nigeria. Methods: We conducted a cross-sectional study involving eligible HCPs from different healthcare settings in northern Nigeria. The participants were recruited into the study using a combination of online (via Google Form) and face-to-face paper-based survey methods. The ASV knowledge of the respondents was measured using a validated anti-snake venom knowledge assessment tool (AKAT). Inadequate overall knowledge of ASV was defined as scores of 0–69.9%, and 70–100% were considered adequate overall knowledge scores. The predictors of ASV knowledge were determined using multiple logistic regression. Results: Three hundred and thirty-one (331) eligible HCPs were included in the study analysis (310 from online and 21 from paper-based survey). Overall, an estimated 12.7% of the participants had adequate knowledge of ASV. Adequate ASV knowledge was higher among physicians compared with other HCPs (21.7%; χ2 = 8.1; p = 0.04). Those without previous training on ASV (adjusted odds ratio [aOR], 0.37; 95% confidence interval [CI], 0.18–0.73; p = 0.004) and who have not previously administered/dispensed ASV (aOR, 0.31; 95% CI, 0.15–0.63; p < 0.001) were less likely to have adequate knowledge of ASV. Conclusion: The knowledge of ASV among healthcare practitioners in northern Nigeria is grossly inadequate. Experience with administering or dispensing ASV predicts ASV knowledge. Therefore, appropriate interventions are needed to improve ASV knowledge, particularly among the HCPs, for optimal healthcare outcomes.

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“…The clinical management of SBE entails hospitalization, administration of effective antivenoms, and provision of supportive care by Health Care Workers (HCWs). Studies have shown low levels of education among HCWs in developing countries ( Michael et al, 2018 ; Bala et al, 2020a , Bala et al, 2020b ), and it has been established in northern Ghana that the outcome of care, including deaths from SBE, depends partly on the knowledge of HCWs and their compliance to standardized protocols, and on the availability of effective antivenom. There, the impact of training of HCWs was shown to reduce mortality from SBE ( Visser et al, 2004 ).…”

Section: Improving Education and Trainingmentioning

confidence: 99%

Clinical management of snakebite envenoming: Future perspectives

et al. 2021

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Snakebite envenoming is a major cause of morbidity and mortality in rural communities throughout the tropics. Generally, the main clinical features of snakebites are local swelling, tissue necrosis, shock, spontaneous systemic hemorrhage, incoagulable blood, paralysis, rhabdomyolysis, and acute kidney injury. These clinical manifestations result from complex biochemical venom constituents comprising of cytotoxins, hemotoxins, neurotoxins, myotoxins, and other substances. Timely diagnosis of envenoming and identification of the responsible snake species is clinically challenging in many parts of the world and necessitates prompt and thorough clinical assessment, which could be supported by the development of reliable, affordable, widely-accessible, point-of-care tests. Conventional antivenoms based on polyclonal antibodies derived from animals remain the mainstay of therapy along with supportive medical and surgical care. However, while antivenoms save countless lives, they are associated with adverse reactions, limited potency, and are relatively inefficacious against presynaptic neurotoxicity and in preventing necrosis. Nevertheless, major scientific and technological advances are facilitating the development of new molecular and immunologic diagnostic tests, as well as a new generation of antivenoms comprising human monoclonal antibodies with broader and more potent neutralization capacity and less immunogenicity. Repurposed pharmaceuticals based on small molecule inhibitors (e.g., marimastat and varespladib) used alone and in combination against enzymatic toxins, such as metalloproteases and phospholipase A 2 s, have shown promise in animal studies. These orally bioavailable molecules could serve as early interventions in the out-of-hospital setting if confirmed to be safe and efficacious in clinical studies. Antivenom access can be improved by the usage of drones and ensuring constant antivenom supply in remote endemic rural areas. Overall, the improvement of clinical management of snakebite envenoming requires sustained, coordinated, and multifaceted efforts involving basic and applied sciences, new technology, product development, effective clinical training, implementation of existing guidelines and therapeutic approaches, supported by improved supply of existing antivenoms.

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Knowledge assessment of snake antivenom among healthcare practitioners involving educational intervention in northern Nigeria: a study protocol

Cited by 8 publications

References 13 publications

Health care workers’ knowledge on identification, management and treatment of snakebite cases in rural Malawi: A descriptive study

Health care workers’ knowledge on identification, management and treatment of snakebite cases in rural Malawi: A descriptive study

Knowledge assessment of anti-snake venom among healthcare practitioners in northern Nigeria

Clinical management of snakebite envenoming: Future perspectives

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