Assessment of knowledge, attitude, and practice of healthcare providers regarding snakebite envenomation: a cross-sectional study among Sub-saharan african countries.

内容摘要

Snakebite envenomation remains a critical health challenge across the culturally and ecologically diverse sub-Saharan Africa (SSA). This study examined healthcare providers' (HCPs') knowledge, attitudes, and practices (KAP), and their determinants towards snakebite envenomation. A cross-sectional study was conducted across nine SSA countries using the validated Knowledge, Attitudes, and Practices of Snake Envenomation - Healthcare Providers Questionnaire (KAPSE-HCPQ). The fractional logistic regression was conducted to identify the factors associated with KAP. A total of 3,544 HCPs were enrolled through professional and digital networks. General practitioners represented approximately half of the participants (50.1%), whereas toxicologists were 3.2%. Considerable variations were reported across sub-Saharan countries. Uganda and Sierra Leone attained perfect median knowledge scores (100%, range: 93-100, 73-100, respectively) yet both demonstrated marked deficiencies in practice (range: 0-25% and 0-75%, respectively). Attitude scores ranged from the lowest in Ethiopia (79%, range: 75-85%) to the highest in Uganda (91%, range: 87-95%). Higher knowledge was significantly associated with advanced training, antivenom availability, curricular inclusion of toxicology, and self-study. Positive attitudes were significantly associated with prior clinical exposure, faculty-based education, informal information sources, and participants' countries. HCPs demonstrated incorrect practices, such as applying a tourniquet above the bite site, attempting to suck out the venom, incising the bite wound, and asking to run to the nearest health facility, which may accelerate the systemic venom spread. In contrast, pharmacists and HCPs unaware of management guidelines demonstrated poorer practices. The study identifies a substantial gap between theoretical knowledge and clinical practice among HCPs across SSA, with variations by country, profession, training, and resource availability. Urgent interventions training, protocol standardization, and reliable antivenom supply are required to improve snakebite outcomes. Although healthcare providers across sub-Saharan Africa generally have good knowledge and favorable attitudes towards snakebite management, their actual practices remain persistently inadequate, irrespective of their country’s income level.Systemic barriers - limited formal training, absent institutional protocols, unreliable antivenom supply, and weak referral systems- are highly associated with inadequate clinical practice.Urgent standardization of training protocols and reliable antivenom supply are needed to improve snakebite outcomes across the SSA region.