# A country-wide survey of knowledge and practice regarding prevention, snake identification and pre-hospital management of children with snakebites amongst Public Health Midwives in Sri Lanka

## TL;DR

This study finds that Sri Lankan midwives lack proper training on treating children bitten by snakes, leading to harmful practices and a need for better education.

## Contribution

The study is the first country-wide survey assessing Sri Lankan Public Health Midwives' knowledge and practices in pediatric snakebite management.

## Key findings

- Most PHMs endorsed harmful snakebite practices like venom sucking and cutting bite sites.
- PHMs with prior training or experience showed significantly better knowledge and confidence.
- Snake identification accuracy was high for cobras but low for other medically significant species.

## Abstract

Snake envenoming remains a major public health problem in Sri Lanka, disproportionately affecting rural children. Timely and appropriate pre-hospital management is crucial to reducing morbidity and mortality. Public Health Midwives (PHMs), as frontline community health workers, are strategically positioned to contribute to snakebite prevention and early management. However, their knowledge and confidence regarding paediatric snakebite care have not been systematically evaluated.

A cross-sectional, country-wide survey was conducted among PHMs across all 25 districts of Sri Lanka using a stratified random sampling approach. Data were collected through a validated, self-administered online questionnaire designed to assess knowledge and practices related to paediatric snakebite prevention, snake identification, and pre-hospital management. A total of 1,706 PHMs participated. Although most respondents correctly identified essential first-aid measures such as reassuring the patient (95.9%) and prompt hospital transfer (95.8%), a substantial proportion endorsed harmful practices, including sucking the venom (71.6%), applying herbs (73.2%), or cutting the bite site (64.4%). Only 48.7% recognized immobilisation as an appropriate first aid. Snake identification accuracy was high for the cobra (94%) but low for other medically significant species such as kraits and vipers. Awareness of national guidelines (14.7%) and emergency contact services (11.9%) was also poor. PHMs with prior training, awareness of national information services, or previous experience providing first aid demonstrated significantly higher knowledge scores (p < 0.001).

Despite their key role in community health, PHMs in Sri Lanka exhibit major knowledge gaps in evidence-based first aid, snake identification, and awareness of national support systems for snakebite management. These deficits, coupled with widespread misconceptions and low confidence, highlight the need for structured training, curriculum integration, and ongoing professional development. Strengthening PHMs’ capacity in snakebite prevention and early management can significantly enhance community preparedness and reduce the burden of paediatric snakebite envenoming in Sri Lanka.

Snakebites cause substantial illness and death in Sri Lanka, particularly among children in rural areas. Public Health Midwives (PHMs) are the main community-based health workers in the country and play a vital role in health education and emergency response. This nationwide study, conducted among 1,706 PHMs, explored their knowledge and practices related to snakebite prevention, identification, and pre-hospital management in children. We found that while most PHMs understood the importance of calming the victim and taking the child promptly to a hospital, many continued to endorse traditional but harmful first-aid practices such as applying herbs and tourniquets, making cuts, or sucking out venom. Very few were aware of national snakebite guidelines or emergency information services. Those who had received any form of prior training were more confident and demonstrated better knowledge. The study highlights a critical need for national training programs, inclusion of snakebite modules in PHM education, and integration of snakebite awareness into community health promotion. Empowering PHMs with accurate knowledge and confidence can improve early management, reduce complications, and save lives of children affected by snakebites in Sri Lanka.