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

Abstract

Snakebite envenoming (SBE) is a neglected tropical disease with significant global morbidity and mortality. Even when antivenom is available in low-resource areas, health workers do not receive adequate training to manage SBEs. This study aims to develop and validate a clinical practice guideline (CPG) for SBE management across Brazil. A panel of expert judges with academic and/or technical expertise in SBE management performed content validation. The content validity index (CVI) score was 90% for CPG objectives, 89% for structure and presentation and 92% for relevance and classified the CPG as valid. A semantic validation was performed by analyzing focus group discussions with doctors and nurses from three municipalities of the Brazilian Amazon, after a 5-day meeting during which the CPG was presented. Two central themes emerged: knowledge acquired during the meeting and recommendations for improving the CPG. Based on these results, the CPG was revised into a final version. This study presents the successful development and validation process of a CPG for SBE management, which is targeted to a specific low-resource, high-burden setting. This development and validation process can be adapted to other settings and/or other neglected tropical diseases.

Bibliometric Analysis of Literature in Snake Venom-Related Research Worldwide (1933–2022)

“…Our results showing that Brazil is the most prolific country in terms of snake venom research could be explained by the fact that Brazil is the home to a highly diverse species of snakes [ 114 , 115 ]. Additionally, the high prevalence of snake envenomation in Brazil promotes extensive efforts for prevention and management of snake bites, as well as elaborating the potential application of snake venom in medicine in this country [ 116 , 117 , 118 , 119 , 120 , 121 ]. Consistent with the result showing that Brazil is the most productive country, Brazil is home to 6 of the 10 institutions with the highest number of documents in snake venom-related research.…”

Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers

“…Our study was a secondary qualitative analysis. Data collection, study populations, and ethical approvals were previously described by Tupetz et al, 2022 and Rocha et al, 2022 . This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines ( Tong et al, 2007 ).…”

“…Participant selection and recruitment were previously described by Tupetz et al, 2022 and Rocha et al, 2022 . To summarize, in BR, health professionals from the municipalities Careiro da Várzea, Ipixuna, and Boa Vista do Ramos, in the state of Amazonas, who completed 75% of a five-day SBE training workshop at FMT-HVD were invited to participate.…”

“…We previously conducted exploratory descriptive studies in the US and BR to develop and validate a clinical practice guideline for community health centers ( Rocha et al, 2022 ) and understand factors influencing clinical decision making in antivenom administration ( Tupetz et al, 2022 ), respectively. The objective of this study was to use these qualitative datasets to comparatively analyze health provider perceptions regarding how to improve SBE clinical care across the US and BR.…”

Mapping of clinical management resources for snakebites and other animal envenomings in the Brazilian Amazon

“…Health professionals' perceptions and experiences : In the Brazilian Amazon, health professionals report insecurity when providing care to SBE patients, due to lack of training on VAE management during their medical and nursing undergraduate training programs ( Rocha et al, 2022 ). Some erroneous care practices including errors in the clinical classification of SBEs and in deciding antivenom dosage, use of non-validated premedication protocols for preventing adverse reactions, inappropriate use of preemptive antimicrobial therapy, and traditional practices such as use of black stones and advice for patients not to drink water were cited by the health staff.…”