Knowledge of health workers on snakes and snakebite management and treatment seeking behavior of snakebite victims in Bhutan

Abstract

Background Published information on snakebite is rare in Bhutan although remarkably higher number of snakebites and associated deaths are reported from other South Asian countries. Aims and methodology Structured questionnaire was used to collect knowledge of health workers in snakebite management and health seeking behavior of snakebite victims as observed by health workers. Study was conducted in purposively sampled 10 Dzongkhags (district level administrative units) with higher incidence of snakebites. Result Heath workers scored 27–91% (with an average of 63%, SD = 14) for 52 questions related to snake identification and snakebite management. Among 118 health workers interviewed, 23% had adequate knowledge on snakes and snakebite management while 77% had inadequate knowledge. Among 32 Doctors, 63% of them scored above or equal to 75%. Health workers from Sarpang scored higher (76%, SD = 11) than those from other Dzongkhags. Snakebite victim's visit to local (traditional) healers prior to seeking medical help from hospital was observed by 75 (63%) health workers. Fifty one percent of health workers observed patients treated with local methods such as the use of black stone called Jhhar Mauro (believed to absorb snake venom), application of honey, rubbing of green herbal paste made up of Khenpa Shing (Artemisia myriantha Wallich ex Besser var. paleocephala [Pamp] Ling) and consumption of fluid made up of Neem leaf (Azadirachta indica Juss). Use of tight tourniquet as a first aid to snakebite was observed by 80% of the health workers. Conclusion Health workers lack confidence in snakebite management. Snakebite victims are likely to suffer from harmful local practices and traditional beliefs on local treatment practices. Empowering health workers with adequate knowledge on snakebite management and making locals aware in pre-hospital care of snakebites are needed to improve the pre- and in-hospital management of snakebite in Bhutan.

Access to antivenoms in the developing world: A multidisciplinary analysis

“…Health workers in remote settings may be apprehensive about treating snakebites, for fear of not being able to manage antivenom-associated adverse reactions should they occur ( Ralph et al, 2019 ). Knowledge about snakebite management, antivenom use and management of antivenom-associated adverse reactions is often poor ( Michael et al, 2018 ; Taieb et al, 2018 ; Bala et al, 2020 ; Sapkota et al, 2020 ; Ameade et al, 2021 ). Developing new or improved treatment guidelines, supporting training programs for public and private health workers and improving the quality, safety and effectiveness of antivenoms are key steps towards optimising use of antivenom and achieving consistent, improved outcomes.…”

Validation of a Culturally Relevant Snakebite Envenomation Clinical Practice Guideline in Brazil

“…Health professionals in remote settings may feel insecure about treating SBEs, due to the fear of not being able to manage antivenom-associated early adverse reactions [3]. Knowledge about SBE management, antivenom use and management of antivenomassociated adverse reactions is often poor [7,8]. Developing new or improved treatment guidelines and supporting training programs for health workers are key steps for improving outcomes.…”

“…Therefore, the expansion of antivenom therapy to health facilities in these remote areas would give these high-risk populations access to appropriate treatment. Yet, in snakebite-endemic countries, evidence suggests that health workers lack sufficient knowledge of SBE management and feel insecure when treating SBEs, which is driven by limited SBE training of these professionals during their clinical education [7,8]. In the presence of a validated protocol, health professionals other than physicians are able to prescribe timely life-saving medications/immunobiologicals, which already happens in cases of malaria, leishmaniasis, tuberculosis, etc.…”

Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation

“…High-risk regions of Asia and Latin America share some of the very same barriers to treatment for SBE as in Central Africa: long distances to health centers, insufficient numbers of hospitals, poor training of health workers, inaccessibility or underdosage of AV ( da Silva Souza et al, 2018 ; Inthanomchanh et al, 2017 ; Monteiro et al, 2020 ; Sapkota et al, 2020 ; Williams et al, 2017 ).…”

“…SBE literatures in Asia and Latin America have integrated qualitative methodologies to document local remedies to extract venom or to prevent its spread ( Barros et al, 2012 ; da Silva et al, 2019 ; Dharmadasa et al, 2016 ; Giovannini and Howes, 2017 ; Oliveira et al, 2013 ; Sapkota et al, 2020 ). One study examined wide-ranging healing practices of SBE victims among Amazonian indigenous peoples; such practices sought not only to treat the multifarious effects of venom on the integrity of victims’ body as well as on their kin and other social relations ( Monteiro et al, 2020 ).…”