Determinants of seeking or foregoing allopathic treatment after snakebite: a population-based study from rural Sri Lanka.

Background: Despite the availability of antivenom, not all snakebite victims choose to seek allopathic care. This choice of care is likely to be determined by unexplored personal and external factors. We studied the factors influencing the choice of treatment and first aid measures among snakebite victims.

Methods: We conducted a population-based study integrating quantitative and qualitative research methods among snakebite victims in the preceding 12 months, selected from 8707 residents in Ampara District, representing typical rural Sri Lanka with a high snakebite burden. Interviewers collected data using questionnaires and in-depth interviews. Logistic regression and thematic analysis were performed.

Results: Among the 153 victims, 57.5% were farmers. As first aid, 19.6% practiced the application of tourniquets. The treatment choices were allopathic medicine (65.4%), ayurvedic/traditional (26.1%), faith healing (3.3%), self-medication (2.0%) and none (3.3%). Visible ambient light at the time of bite (adjusted odds ratio [aOR] 2.3 [95% confidence interval {CI} 1.1 to 4.7]), absence of local swelling (aOR 2.5 [95% CI 1.1 to 5.3]) and prolonged bleeding (aOR 8.6 [95% CI 1.9 to 33.3]) determined failure to seek allopathic treatment, while personal characteristics showed no influence. Qualitative inquiry revealed that the treatment choice was influenced by the ability of the victim or others to recognize envenoming features and the snake as venomous and awareness of the facilities available in hospitals.

Conclusions: The time of snakebite, recognition of the snake/envenoming and awareness of accessible medical services determined the treatment choice following snakebite.