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      Knowledge, attitude and practices of snakebite management amongst health workers in Cameroon: Need for continuous training and capacity building

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          Abstract

          Background

          Snakebite has only recently been recognized as a neglected tropical disease by the WHO. Knowledge regarding snakebites and its care is poor both at the population level, and at the health care staff level. The goal of this study was to describe the level of knowledge and clinical practice regarding snakebite among health care staff from Cameroon.

          Methods

          A two-day training dedicated to snakebite and its care was organized in 2015 in Yaoundé, capital city of Cameroon. A total of 98 health care staff from all over Cameroon attended the training. Prior to and after the training, an evaluation quantified the attendees’ level of knowledge. Pre- and post-training evaluations were compared to assess knowledge improvement.

          Results

          Overall, prior to the training knowledge regarding snakebite and care was poor, and wrong beliefs that “pierre noire” or tourniquet were useful in case of snakebite were common. Knowledge was statistically improved after the training.

          Conclusion

          Trainings dedicated to all type of health care staff towards snakebite to improve care are needed, this training must take into consideration the context and the targeted population.

          Author summary

          In this manuscript, I report the general knowledge regarding snakebite envenomation and its care before and after a two-day course that was organized in Yaounde, the capital city of Cameroon, in late 2015. Snakebite is a public health issue, particularly in sub-Saharan Africa, where access to antivenoms is dramatically insufficient. Anticipating the decision of the World Health Organization that added snakebite envenomations to the list of neglected tropical diseases in June 2017, Cameroon has joined the African Society of Venimology and several Non-Governmental Organizations, including Médecins sans Frontières, to put in place a national snakebite envenomation control strategy. The article describes the state of knowledge of health care workers who participated in the training about snakebite envenomations in Cameroon at the time of the launching of the National Snakebite Envenomation Control Program. It also describes the improvement of knowledge thanks to the training. In conclusion, the results obtained highlight the need for continuous training of the health care staff and capacity building over the next few years.

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          Most cited references17

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          Snake-bites: appraisal of the global situation.

          J Chippaux (1998)
          The true global incidence of envenomations and their severity remain largely misunderstood, except for a few countries where these accidents are rare or are correctly reported. Nevertheless, this information is essential for drawing up guidelines for dealing with snake-bites, to plan drug supplies, particularly antivenin, and to train medical staff on snake-bite treatments. Since the comprehensive review by Swaroop & Grab in 1954 no global survey has been carried out on snake-bite epidemiology. The present article is an attempt to draw the attention of health authorities to snake envenomations and urges them to prepare therapeutic protocols adapted to their needs.
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            Priority Actions and Progress to Substantially and Sustainably Reduce the Mortality, Morbidity and Socioeconomic Burden of Tropical Snakebite

            The deliberations and conclusions of a Hinxton Retreat convened in September 2015, entitled “Mechanisms to reverse the public health neglect of snakebite victims” are reported. The participants recommended that the following priority actions be included in strategies to reduce the global impact of snake envenoming: (a) collection of accurate global snakebite incidence, mortality and morbidity data to underpin advocacy efforts and help design public health campaigns; (b) promotion of (i) public education prevention campaigns; (ii) transport systems to improve access to hospitals and (iii) establishment of regional antivenom-efficacy testing facilities to ensure antivenoms’ effectiveness and safety; (c) exploration of funding models for investment in the production of antivenoms to address deficiencies in some regions; (d) establishment of (i) programs for training in effective first aid, hospital management and post-treatment care of victims; (ii) a clinical network to generate treatment guidelines and (iii) a clinical trials system to improve the clinical management of snakebite; (e) development of (i) novel treatments of the systemic and local tissue-destructive effects of envenoming and (ii) affordable, simple, point-of-care snakebite diagnostic kits to improve the accuracy and rapidity of treatment; (f) devising and implementation of interventions to help the people and communities affected by physical and psychological sequelae of snakebite.
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              The prevalence and morbidity of snake bite and treatment-seeking behaviour among a rural Kenyan population.

              Snake-bite mortality among a rural population in Kenya was estimated to be 6.7/100,000 people each year, representing 0.7% of all deaths. A community-based retrospective survey of 4712 households provided estimates of the incidence of snake bite in this population. Although 151/100,000 people are bitten each year, only 19% of these are bitten by potentially venomous snakes. When those who had been bitten were shown photographs of a range of locally prevalent snakes, most indicated that both venomous and non-venomous snakes were capable of causing death. Most (68%) of bite cases sought treatment from a traditional healer who invariably used local herbal preparations applied to the bite site and/or in a ring around the bitten limb. Local skin incisions were also commonly practised. The use of traditional medicine for snake bite is a feature of most areas of the developing world where venomous snakes are prevalent. Improvements in early referral and appropriate care will only occur when traditional healers are integrated into primary health care and hospital-based health systems.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Role: SupervisionRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: Project administration
                Role: ConceptualizationRole: ValidationRole: Writing – review & editing
                Role: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                plosntds
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, CA USA )
                1935-2727
                1935-2735
                25 October 2018
                October 2018
                : 12
                : 10
                : e0006716
                Affiliations
                [1 ] Emerging Diseases epidemiology unit, Institut Pasteur, Paris, France
                [2 ] Centre for Translational Science, Institut Pasteur, Paris, France
                [3 ] « Mother and Child facing Tropical Infections » unit, Institut de Recherche pour le Développement, Paris, France
                [4 ] Mosaic, Yaounde, Cameroon
                [5 ] Metabiota, Yaounde, Cameroon
                [6 ] IECD, Institut Européen de Coopération et de Développement, Paris, France
                [7 ] Distant Production House University, Yaounde, Cameroon
                [8 ] Cameroon Society of Epidemiology, Yaounde, Cameroon
                [9 ] MSF Access Campaign, MSF, Paris, France
                [10 ] Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
                [11 ] Centre International de Recherches, d'Enseignements et de Soins (CIRES), Yaounde, Cameroon
                [12 ] Center for Global Health, Indiana University, Indianapolis, IN, United States of America
                College of Health Sciences, Bayero University Kano, NIGERIA
                Author notes

                The following institutions/pharmaceutical Companies also contributed for the smooth running of the training: the Centre for Research on Filariasis & other tropical Diseases (CRfilMT), The Research Foundation for Tropical Disease and Environment – Buea (REFOTDE), the Laboratoire National Veterinaire du Cameroun (LANAVET), the Multilateral Initiative on Malaria in Africa (MIM), the FAIRMED, the Centre Pasteur du Cameroun (CPC), INOSAN BioPharma and VINS Bioproducts Limited. These companies had no input in content or in the decision to publish these findings. The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0941-2859
                http://orcid.org/0000-0002-1819-518X
                Article
                PNTD-D-18-00619
                10.1371/journal.pntd.0006716
                6219812
                30359385
                b54f59d0-7c91-4cff-a390-267aef200992
                © 2018 Taieb et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 April 2018
                : 23 July 2018
                Page count
                Figures: 0, Tables: 3, Pages: 10
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                Snakebite
                People and Places
                Population Groupings
                Professions
                People and Places
                Geographical Locations
                Africa
                Cameroon
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Nurses
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Nurses
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Medical Doctors
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medical Doctors
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Allied Health Care Professionals
                Medicine and Health Sciences
                Public and Occupational Health
                Global Health
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Custom metadata
                vor-update-to-uncorrected-proof
                2018-11-06
                Data analysed for the present article are available from https://osf.io/n2prg/

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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