Barriers and enablers of community engagement practices for the prevention of snakebite envenoming in South Asia: A qualitative exploratory study.

Snakebite envenoming (SBE) is a grossly neglected tropical disease (NTD) that predominantly affects those living in rural settings in low-and-middle income countries. South Asia currently accounts for the highest global SBE-related mortality, and substantial morbidity rates. To alleviate the high burden in the region, community engagement (CE) is considered to be an integral component for optimizing SBE prevention and control. To better understand existing CE practices for SBE in the region, the experiences of SBE-CE actors concerning the barriers to, and enablers of CE practices were captured through semi-structured interviews. Fifteen key informants from India, Bangladesh and Nepal participated in the study. Important enablers included providing innovative, inclusive and continuous methods and materials, carefully planning of programs, performing monitoring and evaluation, SBE data availability, motivated and trained staff members, good organizational reputations, communication with other SBE-actors, collaborations, and the involvement of the government. Substantial barriers comprised a lack of SBE data, lack of innovative methods and materials for educational purposes, a shortage of human and physical resources, community resistance, untrained health care workers (HCWs), and ineffective traditional healing practices. In order to optimize and sustain SBE-CE practices, context-sensitive, multi-faceted approaches are needed that incorporate all these factors which influence its sustainable implementation.

The Burden of Snakebite in Rural Communities in Kenya: A Household Survey.

Annually, about 2.7 million snakebite envenomings occur worldwide, primarily affecting those living in rural regions. Effective treatment exists but is scarce, and traditional treatments are commonly used. To inform context-specific policies in Kenya, this study aimed to determine the health-seeking behavior and the health, social, and economic burden of snakebites in rural communities. Nonprobability sampling was used to survey 382 respondents from four snakebite-endemic counties, from February to August 2020, using a structured questionnaire. Descriptive statistics, Fisher's exact tests, binary logistic regressions, and Mantel-Haenszel tests were used for analysis. Life-time experience with snakebites included 13.1% of respondents who reported being personally bitten and 37.4% who reported knowing of a community member being bitten. Respondents reported death after a snakebite in 9.1% of bitten community members and in 14.6% of bitten family members. Risk of snakebite was not significantly associated with sex, educational level, or occupation. Snakebite victims were most often walking (38%) or farming (24%) when bitten. Of those bitten, 58% went to a health facility, 30% sought traditional treatment, and 12% first went to a traditional healer before visiting a facility. Significant differences existed in perceptions on the financial consequences of snakebites among those who had been personally bitten and those who had observed a snakebite. Most commonly mentioned preventive measures were wearing shoes and carrying a light in the dark. Community engagement, including engagement with traditional healers, is needed to reduce snakebites. This should be done through education and sensitization to improve used preventive measures and effective health-seeking behavior.

An exploratory focus group study on experiences with snakebites: health-seeking behaviour and challenges in rural communities of Kenya.

BACKGROUND: Snakebite envenoming is a long-hidden public health threat in the rural communities of Kenya. This study aimed to shed light on the health-seeking behaviour of people bitten by snakes, views on prevention measures and community needs and the consequences for snakebite patients in these areas. METHODS: Six focus group interviews were conducted in communities in the Kajiado (n=3) and Kilifi (n=3) counties. RESULTS: Traditional first-aid practices such as the use of a tourniquet and/or cutting the wound, use of a black stone and a variety of other traditional remedies were common. Challenges with transportation to health facilities and inadequately resourced facilities complicated accessing medical care. Community members voiced a need to improve access to trained healthcare workers and snakebite treatments at health facilities. CONCLUSION: While communities had high trust in evidence-based medical care, traditional treatment was often sought, causing delays in timely medical attention. Traditional practices were often used in the home environment and these were not usually administered by a traditional healer. The findings illustrate the need to combine improving the availability of effective snakebite treatment and healthcare worker training on snakebite with community education to reduce the impact of snakebite.