Delays, fears and training needs: Perspectives of health workers on clinical management of snakebite revealed by a qualitative study in Kitui County, Kenya

Abstract

Key aims of the WHO Strategy to halve snakebite morbidity and mortality include health system strengthening and training of health workers. This requires knowledge of local health system needs and capacity, health worker training needs, and factors influencing health worker decision-making in snakebite management. This study explored health worker experiences and perceptions of snakebite management, both individually and in the context of their local health system. We used a qualitative study design with semi-structured interviews (n = 14) and focus group discussions (n = 4). We employed a combination of sampling strategies aiming to achieve maximum variation among key informants within resource limitations. We recruited health workers (n = 33) of varying roles from purposively selected tier 2, 3 and 4 health facilities (n = 12) and the community (tier 1) in four sub-counties in Kitui County, Kenya. We conducted inductive thematic analysis of all transcripts. The results identified that health workers recognised snake envenoming as a time-critical emergency in which delay in care seeking, sometimes exacerbated by health system referral delays, was a major barrier to effective management of patients. Clinicians strongly voiced a need for training in snakebite management, diagnosis and antivenom administration. Unexpressed needs for training were demonstrated in traditional remedy ineffectiveness, syndromic management, and critical appraisal of treatment effectiveness. Under-resourcing in antivenom, other medication, equipment, infrastructure and staffing also challenged management. Fear of snakebite and fear of antivenom, both linked to past experiences, influenced clinical decision-making. Our findings clearly indicate a need in Kitui County for training programmes that equip health workers for clinical decision-making in snakebite management. We further identify community intervention needs to facilitate prompt presentation to healthcare, including practical affordable transport solutions, and systematic health system resourcing needs. In addition, we recommend supportive supervision and further research in response to the emotional stress resulting from managing difficult cases in under-resourced settings.

“Then they prayed, they did nothing else, they just prayed for the boy and he was well”: A qualitative investigation into the perceptions and behaviours surrounding snakebite and its management in rural communities of Kitui county, Kenya

“…Reducing the burden of snakebites requires preventing them from occurring in the first place and managing them effectively when they do occur. Previous studies have revealed a delay in seeking hospital treatment following a snakebite, with patients using traditional early intervention measures such as tourniquets, incision at the bite site, ingestion of medicinal herbs or application of the black stone [9,10]. Some victims use these remedies at home while others prefer to consult traditional healers with experience in assisting snakebite victims.…”

Current Status and Influencing Factors of Snakebite Diagnosis and Treatment Knowledge Among Medical Staff in China: A Cross-Sectional Study

“…According to this survey, only 5,412 (43.02%) medical staff had received training in the diagnosis and treatment of snakebite, and the score of snakebite diagnosis and treatment knowledge of medical staff who had received training was only 3.77 ± 2.11. Snakebite is a critical emergency, and medical staff’s knowledge of diagnosis and treatment is a guarantee of the provision of high-quality medical services [ 22 ]. It is well-established that access to high-quality healthcare services can improve snakebite survival rates, reduce disability, and decrease sequelae [ 23 ].…”

Identifying high snakebite risk area under climate change for community education and antivenom distribution

“…Masoud Yousefi 1,2* , Saeed Hosseinian Yousefkhani 1 , Marc Grünig 3 , Anooshe Kafash 4 , Mahdi Rajabizadeh 5,6 & Eskandar Rastegar Pouyani 7 Snakebite is one of the largest risks from wildlife, however little is known about venomous snake distribution, spatial variation in snakebite risk, potential changes in snakebite risk pattern due to climate change, and vulnerable human population. As a consequence, management and prevention of snakebite is hampered by this lack of information.…”

“…Up to 5 million snakebites occur each year leading to about 100,000 deaths annualy 2,[4][5][6] . Despite recent attention to the challenge of snakebite 3,5,[7][8][9][10] little is known about the distribution of venomous snakes, and therefore the spatial variation in snakebite risk and accessibility of vulnerable human population to healthcare system 3 . Further, the potential shift of high risk areas for snakebite due to climate change remains unknown.…”