Department of Disease Control and Environmental Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
PLoS One. 2023 Sep 25;18(9):e0291032. doi: 10.1371/journal.pone.0291032. eCollection 2023.
Snakebites are a neglected public health problem that pose a significant burden on affected individuals and communities in many sub-Saharan African countries, including Uganda. However, the barriers and facilitators to snakebite management within healthcare settings are not as well understood and well-documented. The aim of this study was to explore the experiences and perspectives of healthcare workers involved in handling snakebite incidents at individual and health system levels in Arua and Gulu districts in Northern Uganda. We sought to understand how healthcare workers manage snakebite cases, what challenges they encounter, and what opportunities they perceive for improvement.
We conducted a qualitative study using in-depth interviews with 18 healthcare workers from different cadres, seniority levels, and facility types. We used iterative thematic analysis to explore the management procedures, challenges, and opportunities for snakebite management. Using thematic analysis, we identified the overarching themes and subthemes related to snakebite management and associated barriers and opportunities.
The main barriers to snakebite management identified by healthcare workers were inadequate knowledge and skills; limited availability of antivenom; lack of protocols for snakebite management; delayed treatment-seeking for patients; and poor referral systems. The main opportunities for improvement were regular in-service training; increasing public education and awareness about snakebite prevention and management; and increased funding and research.
This study highlights the need for interventions to address the identified barriers while leveraging the existing opportunities to enhance snakebite management in Uganda. Specifically, we recommend the provision of regular training and support to healthcare workers, developing clinical guidelines, and improving the availability of antivenoms.
在许多撒哈拉以南非洲国家，包括乌干达，蛇咬伤是一个被忽视的公共卫生问题，给受影响的个人和社区带来了巨大的负担。然而，医疗保健环境中处理蛇咬伤的障碍和促进因素还没有得到很好的理解和记录。本研究的目的是探讨乌干达北部阿鲁阿和古卢地区参与处理蛇咬伤事件的医疗保健工作者在个人和卫生系统层面的经验和观点。我们试图了解医疗保健工作者如何管理蛇咬伤病例，他们遇到了哪些挑战，以及他们认为有哪些改进的机会。
我们进行了一项定性研究，对来自不同职级、资历和医疗机构类型的 18 名医疗保健工作者进行了深入访谈。我们使用迭代主题分析来探讨蛇咬伤管理的管理程序、挑战和机会。使用主题分析，我们确定了与蛇咬伤管理相关的、与障碍和机会相关的总体主题和子主题。
医疗保健工作者确定的蛇咬伤管理的主要障碍是知识和技能不足；抗蛇毒血清供应有限；缺乏蛇咬伤管理方案；患者寻求治疗的时间延迟；转诊系统不良。改进的主要机会是定期在职培训；加强公众对蛇咬伤预防和管理的教育和认识；增加资金和研究。
本研究强调需要采取干预措施来解决已确定的障碍，同时利用现有的机会来加强乌干达的蛇咬伤管理。具体而言，我们建议向医疗保健工作者提供定期培训和支持，制定临床指南，并改善抗蛇毒血清的供应。
