Knowledge of health workers on snakes and snakebite management and treatment seeking behavior of snakebite victims in Bhutan.
Knowledge of health workers on snakes and snakebite management and treatment seeking behavior of snakebite victims in Bhutan.
复制标题
DOI：
10.1371/journal.pntd.0008793
复制
发表时间：
2020-11
影响因子：
3.8
通讯作者：
Gurung DB
中科院分区：
文献类型：
--
作者：
Sapkota S;Pandey DP;Dhakal GP;Gurung DB
在不丹，关于蛇咬伤的公开信息很少，尽管其他南亚国家报告的蛇咬伤和相关死亡人数明显较高。采用结构式问卷调查方式，了解医务人员对蛇伤处理知识的掌握情况和蛇伤患者的就医行为。在有目的地抽样的10个县（县级行政单位）进行了研究，蛇咬伤的发病率较高。卫生工作者在52个与蛇识别和蛇咬伤管理相关的问题中得分为27 - 91%（平均63%，SD = 14）。在118名受访的卫生工作者中，23%的人对蛇和蛇咬伤管理有足够的知识，而77%的人对蛇和蛇咬伤管理的知识不足。在32名医生中，63%的人得分高于或等于75%。Sarpang的卫生工作者得分高于其他县（76%，SD = 11）。75名（63%）卫生工作者观察到蛇咬伤受害者在从医院寻求医疗帮助之前访问当地（传统）治疗师。51%的卫生工作者观察到患者接受当地方法治疗，如使用称为Jhhar Mauro的黑色石头（据信可以吸收蛇毒），应用蜂蜜，摩擦由Khenpa Shing（Artemisia myriantha Wallich ex Besser var.）制成的绿色草药膏。paleocephala [Pamp] Ling）和由印楝叶（Azadirachta indica Juss）制成的流体的消耗。80%的卫生工作者观察到使用紧止血带作为蛇咬伤的急救措施。卫生工作者对蛇咬伤管理缺乏信心。蛇咬伤的受害者很可能受到当地有害习俗和当地治疗做法的传统信仰的影响。需要赋予卫生工作者足够的蛇咬伤管理知识，并使当地人了解蛇咬伤的院前护理，以改善不丹蛇咬伤的院前和院内管理。蛇咬伤影响着包括不丹在内的全球人民，蛇是恐惧和兴奋的来源。大部分不丹人（62.7%）以农业耕作、饲养牲畜和寻找森林产品为生，他们面临着蛇毒液中毒的风险。蛇咬伤导致的死亡取决于急救类型的使用、卫生设施提供的物品以及蛇咬伤受害者的就医行为。这项多中心研究旨在评估卫生工作者的知识水平及其与人口统计学特征和卫生工作者使用调查员管理的结构式问卷观察的蛇咬伤受害者的就医行为的关系。我们包括12家医院和一个基本卫生单位（BHU），来自10个容易被蛇咬伤的Dzongkhags，从2013年1月到2017年12月，该国有962例（84%）蛇咬伤。在118名受访的卫生工作者中，27人（23%）的知识水平足够，其余91人（77%）的知识不足。男性卫生工作者和医生的知识水平高于其他研究组。Sarpang的卫生工作者得分高于其他县。共有42%（n = 50）的卫生工作者得分低于60%（31个或更少的52个问题的正确答案），这需要培训和纳入实践为导向的课程，在培训课程的卫生专业人员蛇咬伤管理的要求。5%（n = 6）的受访者经常使用传统药物，很少遵守世卫组织建议的急救措施。采用非推荐的治疗方法似乎会延误适当的治疗，导致坏疽和相关并发症。
Published information on snakebite is rare in Bhutan although remarkably higher number of snakebites and associated deaths are reported from other South Asian countries. Structured questionnaire was used to collect knowledge of health workers in snakebite management and health seeking behavior of snakebite victims as observed by health workers. Study was conducted in purposively sampled 10 Dzongkhags (district level administrative units) with higher incidence of snakebites. Heath workers scored 27–91% (with an average of 63%, SD = 14) for 52 questions related to snake identification and snakebite management. Among 118 health workers interviewed, 23% had adequate knowledge on snakes and snakebite management while 77% had inadequate knowledge. Among 32 Doctors, 63% of them scored above or equal to 75%. Health workers from Sarpang scored higher (76%, SD = 11) than those from other Dzongkhags. Snakebite victim's visit to local (traditional) healers prior to seeking medical help from hospital was observed by 75 (63%) health workers. Fifty one percent of health workers observed patients treated with local methods such as the use of black stone called Jhhar Mauro (believed to absorb snake venom), application of honey, rubbing of green herbal paste made up of Khenpa Shing (Artemisia myriantha Wallich ex Besser var. paleocephala [Pamp] Ling) and consumption of fluid made up of Neem leaf (Azadirachta indica Juss). Use of tight tourniquet as a first aid to snakebite was observed by 80% of the health workers. Health workers lack confidence in snakebite management. Snakebite victims are likely to suffer from harmful local practices and traditional beliefs on local treatment practices. Empowering health workers with adequate knowledge on snakebite management and making locals aware in pre-hospital care of snakebites are needed to improve the pre- and in-hospital management of snakebite in Bhutan. Snakebites affect people globally including Bhutan and snakes are source of fear and excitement. Major proportion (62.7%) of Bhutanese population who thrive on agro-farming, rearing livestock, and searching forest products are at risk of snake envenomations. Deaths due to snakebites are dependent upon use of first aid type, provisions available with the health facilities, and health seeking behaviors of snakebite victims. This multi-center study was conducted to assess the level of knowledge of health workers and its association with their demographic features and health seeking behavior of snakebite victims as observed by health workers using investigator administered structured questionnaire. We included 12 hospitals and a Basic Health Unit (BHU) from 10 snakebite prone Dzongkhags with 962 (84%) snakebites from January 2013 to December 2017 in the country. Among 118 health workers interviewed, 27 (23%) had adequate level of knowledge with remaining 91 (77%) having inadequate knowledge. Male health workers and Doctors had better level of knowledge than other study groups. Health workers from Sarpang scored higher compared to those from other Dzongkhags. A total of 42% (n = 50) health workers scored below 60% (31 or less correct responses for 52 questions), which demands requirement of training and inclusion of practice-oriented courses in training curriculum of health professionals for snakebite management. Often, use of traditional medication and less frequent adherence to WHO recommended first aid measures was observed by 5% (n = 6) respondents. The adoption of non-recommended treatment practices seems to delay proper treatment resulting in gangrene and associated complications.
登录
查看更多内容
南亚的蛇咬人：评论。
影响因子：
3.8
作者：
Alirol E;Sharma SK;Bawaskar HS;Kuch U;Chappuis F
通讯作者：
Chappuis F
影响因子：
1.4
作者：
Fung, Hin T. J.;Lam, Shing K. T.;Simpson, Ian D.
通讯作者：
Simpson, Ian D.
影响因子：
2.9
作者：
Davidson-Hunt, Iain J.;Jack, Phyllis;Wapioke, Brennan
通讯作者：
Wapioke, Brennan
DOI：
10.1051/jbio/2009043
发表时间：
2010-01-01
期刊：
Biologie Aujourd hui
影响因子：
--
作者：
Chippaux, Jean-Philippe
通讯作者：
Chippaux, Jean-Philippe
影响因子：
15.8
作者：
Kasturiratne A;Wickremasinghe AR;de Silva N;Gunawardena NK;Pathmeswaran A;Premaratna R;Savioli L;Lalloo DG;de Silva HJ
通讯作者：
de Silva HJ