Development and validation of antisnake venom knowledge assessment tool (AKAT) for healthcare practitioners

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

doi:10.1016/j.toxcx.2020.100064

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…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.…”

Section: Downstream: Prescribing and Dispensing/usementioning

confidence: 99%

Access to antivenoms in the developing world: A multidisciplinary analysis

et al. 2021

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Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming.

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Section: Downstream: Prescribing and Dispensing/usementioning

confidence: 99%

Access to antivenoms in the developing world: A multidisciplinary analysis

et al. 2021

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“…We utilized a validated anti-snake venom knowledge assessment tool (AKAT) to conduct the knowledge assessment of ASV among HCPs which is presented in the attached Supplemental Appendix 2 . 24 The AKAT was validated using extensive psychometric tests as recommended in previous studies. 25 – 27 Both the AKAT and the study protocol have been published elsewhere by the same authors.…”

Section: Methodsmentioning

confidence: 99%

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

Section: Methodsmentioning

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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Development and validation of antisnake venom knowledge assessment tool (AKAT) for healthcare practitioners

Cited by 7 publications

References 22 publications

Access to antivenoms in the developing world: A multidisciplinary analysis

Access to antivenoms in the developing world: A multidisciplinary analysis

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

Clinical management of snakebite envenoming: Future perspectives

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