Healthcare Worker Preparedness for Snakebite Management in Selected Zambian Hospitals: An Exploratory Study

Technical Summary: Healthcare Worker Preparedness for Snakebite Management in Selected Zambian Hospitals

Problem Statement
Snakebite envenoming remains a neglected tropical disease and a critical public health challenge in Zambia, particularly affecting rural and peri-urban farming communities. While the World Health Organization (WHO) has launched a global strategy to reduce snakebite-related mortality and disability by 50% by 2030, effective management in Zambia is hindered by systemic barriers. These include delays in seeking care, antivenom shortages, and, crucially, limited healthcare worker capacity. Despite the recognized importance of healthcare workers in diagnosis, antivenom administration, and complication management, there is a paucity of evidence regarding their specific preparedness, training levels, and adherence to national guidelines within the Zambian health system.

Methodology
This study employed an exploratory cross-sectional design to assess healthcare worker preparedness across seven selected hospitals in Zambia (including Chipata Central, Kabwe General, and Kitwe Central). The research was conducted between May and July 2025.

• Sampling: A purposive sampling strategy was used to recruit 21 healthcare workers (three from each facility), comprising senior clinicians, junior clinicians, and nurses directly involved in snakebite case management.
• Data Collection: Data were gathered via a structured questionnaire covering demographic characteristics, training history, clinical exposure, self-reported confidence, utilization of local treatment protocols, and awareness of national snakebite management guidelines.
• Analysis: Data were analyzed using descriptive statistics, presented as frequencies and percentages.
• Ethics: The study received approval from the Lusaka Apex Medical University Biomedical Research Ethics Committee and the National Health Research Authority (NHRA) of Zambia.

Key Results
The study revealed a significant disconnect between healthcare workers' self-perceived confidence and their actual preparedness regarding training and guideline adherence:

• Training Gaps: Formal training was limited. 38.1% of participants reported receiving no training in snakebite management. Only 28.6% reported learning through bedside training, and a mere 4.8% cited general surgery training. A significant portion (28.6%) could not recall their training status.
• Clinical Exposure: Despite training deficits, clinical exposure was high. 66.7% of participants had managed at least one snakebite case in the preceding year, with 28.6% managing cases within the last month.
• Confidence vs. Competence: A majority of participants reported high confidence levels; 47.6% were "very confident" and 23.8% were "exceptionally confident."
• Protocol and Guideline Utilization: Adherence to standardized care was low. Only 28.6% of participants reported using local treatment protocols, while 47.6% reported not using them. Awareness of national guidelines was similarly poor, with only 38.1% having seen the latest national snakebite management guidelines, and an equal proportion (38.1%) reporting they had never seen them.

Key Contributions
This paper provides the first exploratory assessment of healthcare worker preparedness for snakebite management in selected Zambian hospitals. Its primary contributions include:

1. Identifying the Confidence-Competence Gap: The study highlights a critical mismatch where high self-reported confidence exists alongside substantial deficits in formal training and guideline awareness.
2. Documenting Systemic Barriers: It quantifies the lack of structured professional development, noting that reliance on informal "bedside training" and experiential learning is the norm rather than evidence-based instruction.
3. Highlighting Guideline Dissemination Failures: The findings underscore that the mere existence of national guidelines is insufficient; there is a failure in the dissemination and implementation of these documents at the facility level.

Significance and Claims
The authors claim that these findings identify urgent opportunities to strengthen Zambia's snakebite control efforts. The study posits that the current reliance on informal learning and the lack of protocol utilization may lead to inappropriate clinical management and poor patient outcomes.

The paper argues that prioritizing the strengthening of healthcare worker training and improving the dissemination of national management guidelines are essential steps to align clinical practice with evidence-based standards. It suggests that capacity-building initiatives must move beyond guideline development to include targeted dissemination strategies, routine mentorship, and periodic competency assessments. The authors conclude that addressing these gaps is vital for improving the quality of snakebite care and contributing to national and global efforts to reduce snakebite-related morbidity and mortality.

Limitations
The authors acknowledge that the study's small, purposively selected sample limits generalizability to all Zambian healthcare workers. Furthermore, reliance on self-reported data introduces potential recall and social desirability biases, and the study assessed perceived preparedness rather than objective clinical competence. Future research is recommended to utilize larger, nationally representative samples and objective clinical scenarios.