{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:13:40Z","timestamp":1785248020126,"version":"3.55.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0008793","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T00:00:00Z","timestamp":1607558400000}}],"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T00:00:00Z","timestamp":1606694400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Published information on snakebite is rare in Bhutan although remarkably higher number of snakebites and associated deaths are reported from other South Asian countries.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Aims and methodology<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Result<\/jats:title>\n<jats:p>Heath workers scored 27\u201391% (with an average of 63%, <jats:italic>SD<\/jats:italic> = 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%, <jats:italic>SD<\/jats:italic> = 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 <jats:italic>Jhhar Mauro<\/jats:italic> (believed to absorb snake venom), application of honey, rubbing of green herbal paste made up of <jats:italic>Khenpa Shing<\/jats:italic> (<jats:italic>Artemisia myriantha<\/jats:italic> Wallich ex Besser var. paleocephala [Pamp] Ling) and consumption of fluid made up of Neem leaf (<jats:italic>Azadirachta indica<\/jats:italic> Juss). Use of tight tourniquet as a first aid to snakebite was observed by 80% of the health workers.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0008793","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T19:27:23Z","timestamp":1606764443000},"page":"e0008793","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":37,"title":["Knowledge of health workers on snakes and snakebite management and treatment seeking behavior of snakebite victims in Bhutan"],"prefix":"10.1371","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7943-6699","authenticated-orcid":true,"given":"Sunil","family":"Sapkota","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deb P.","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3207-0743","authenticated-orcid":true,"given":"Guru P.","family":"Dhakal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8082-5181","authenticated-orcid":true,"given":"Dhan B.","family":"Gurung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"pntd.0008793.ref001","author":"DA Warrell","year":"2010","journal-title":"Guidelines for the management of snake-bites"},{"key":"pntd.0008793.ref002","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/S0140-6736(09)61754-2","article-title":"Guidelines of Management of Snake bite","volume":"375","author":"DA Warrell","year":"2010","journal-title":"Lancet"},{"key":"pntd.0008793.ref003","article-title":"Knowledge of health workers, health seeking behavior of snakebite victims and retrospective study of snakebites in Bhutan","author":"S. 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Available from: http:\/\/www.dofps.gov.bt\/wp-content\/uploads\/2017\/07\/National-Forest-Inventory-Report-Vol1.pdf."},{"key":"pntd.0008793.ref007","first-page":"20","article-title":"The status of herpetofauna of Bhutan","volume":"1","author":"JT Wangyal","year":"2014","journal-title":"J Bhutan Ecol Soc"},{"key":"pntd.0008793.ref008","doi-asserted-by":"crossref","first-page":"12489","DOI":"10.11609\/jott.3849.10.11.12489-12498","article-title":"The herpetofauna of Jigme Singye Wangchuck National Park in central Bhutan: status, distribution and new records","volume":"10","author":"S Tshewang","year":"2018","journal-title":"J Threat Taxa"},{"key":"pntd.0008793.ref009","first-page":"39","volume-title":"Reptiles of Bhutan. An Introduction to the Biodiversity of Bhutan in the Context of Climate Change and Economic Development","author":"JT Wangyal","year":"2017"},{"key":"pntd.0008793.ref010","first-page":"261","article-title":"Additions to the herpetofauna of Royal Manas National Park, Bhutan, with six new country records","volume":"9","author":"A Das","year":"2016","journal-title":"Herpetol Notes"},{"key":"pntd.0008793.ref011","volume-title":"\u201cVenomous Bites from Non-Venomous Snakes: A Critical Analysis of Risk and Management of \u201cColubrid Snake Bites","author":"SA Weinstein","year":"2011"},{"key":"pntd.0008793.ref012","volume-title":"Annual Health Bulletin 2018","author":"Ministry of Health","year":"2018"},{"key":"pntd.0008793.ref013","volume-title":"Guidelines for the management of snake bites","author":"DA Warrell","year":"2010"},{"key":"pntd.0008793.ref014","article-title":"WHO Guidelines for the production, control and regulation of snake antivenom immunoglobulins","author":"J-P Chippaux","year":"2016","journal-title":"Biologie aujourd\u2019hui"},{"key":"pntd.0008793.ref015","volume":"331","author":"DA Warrell","year":"2005","journal-title":"Clinical review Treatment of bites by adders and exotic venomous snakes"},{"key":"pntd.0008793.ref016","first-page":"1","article-title":"The timing is right to end snakebite deaths in South Asia","volume":"364","author":"R Ralph","year":"2019","journal-title":"BMJ"},{"key":"pntd.0008793.ref017","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000603","article-title":"Snake bite in south asia: A review.","volume":"4","author":"E Alirol","year":"2010","journal-title":"PLoS Negl Trop Dis."},{"key":"pntd.0008793.ref018","volume":"5","author":"A Kasturiratne","year":"2008","journal-title":"The Global Burden of Snakebite: A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths"},{"key":"pntd.0008793.ref019","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3329\/jcamr.v4i1.36170","article-title":"Knowledge of Snake Bite Management among Health Service Providers at a Rural Community of Bangladesh","volume":"4","author":"HN Ahsan","year":"2018","journal-title":"J Curr Adv Med Res"},{"key":"pntd.0008793.ref020","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/S0140-6736(18)31224-8","article-title":"Vulnerability to snakebite envenoming: a global mapping of hotspots","volume":"392","author":"J Longbottom","year":"2018","journal-title":"Lancet"},{"key":"pntd.0008793.ref021","unstructured":"WHO. 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Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/snakebite-envenoming."},{"key":"pntd.0008793.ref022","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1580\/06-WEME-CO-023R1.1","article-title":"Snakes of medical importance in India: Is the concept of the \u201cBig 4\u201d still relevant and useful?","volume":"18","author":"ID Simpson","year":"2007","journal-title":"Wilderness Environ Med"},{"key":"pntd.0008793.ref023","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000569","article-title":"Snake envenoming: A disease of poverty","volume":"3","author":"RA Harrison","year":"2009","journal-title":"PLoS Negl Trop Dis."},{"key":"pntd.0008793.ref024","first-page":"299","article-title":"Assessment of knowledge about snakebite management amongst healthcare providers in the provincial and two district hospitals in Savannakhet Province, Lao PDR","volume":"79","author":"V Inthanomchanh","year":"2017","journal-title":"Nagoya J Med Sci"},{"key":"pntd.0008793.ref025","first-page":"31","article-title":"Knowledge and management of snake bite by general practitioners in rural Free State and Northern Cape","volume":"46","author":"G Stemmett","year":"2004","journal-title":"South African Fam Pract"},{"key":"pntd.0008793.ref026","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1580\/1080-6032-020.004.0364","article-title":"A survey of snakebite management knowledge amongst select physicians in hong kong and the implications for snakebite training","volume":"20","author":"HTJ Fung","year":"2009","journal-title":"Wilderness Environ Med"},{"key":"pntd.0008793.ref027","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1016\/j.trstmh.2008.04.013","article-title":"A study of the current knowledge base in treating snake bite amongst Doctors in the high-risk countries of India and Pakistan: does snake bite treatment training reflect local requirements?","volume":"102","author":"ID Simpson","year":"2008","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0008793.ref028","doi-asserted-by":"crossref","first-page":"43","DOI":"10.5897\/JTEHS12.059","article-title":"Inclusion of incorrect information on snakebite first aid in school and university teaching materials in Nepal","volume":"5","author":"DP Pandey","year":"2013","journal-title":"J Toxicol Environ Heal Sci Full Length Res Pap"},{"key":"pntd.0008793.ref029","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1093\/trstmh\/try028","article-title":"Knowledge of venomous snakes, snakebite first aid, treatment, and prevention among clinicians in northern Nigeria: A cross-sectional multicentre study","volume":"112","author":"GC Michael","year":"2018","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pntd.0008793.ref030","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pntd.0006073","article-title":"Health seeking behavior following snakebites in Sri Lanka: Results of an island wide community based survey","volume":"11","author":"DS Ediriweera","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0008793.ref031","doi-asserted-by":"crossref","first-page":"234","DOI":"10.4269\/ajtmh.2004.71.234","article-title":"Impact of snake bites and determinants of fatal outcomes in Southeastern Nepal","volume":"71","author":"SK Sharma","year":"2004","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0008793.ref032","author":"DP Pandey","year":"2010","journal-title":"Snake and Human Life: A Positive Quest"},{"key":"pntd.0008793.ref033","first-page":"00138","article-title":"Advances in Clinical Toxicology Retrospective Study of Snakebites in Nawalpur Snakebite Treatment Center, South-central Nepal","volume":"3","author":"BR Shrestha","year":"2018","journal-title":"Adv Clin Toxicol"},{"key":"pntd.0008793.ref034","first-page":"5","article-title":"Impact of first aid training in management of snake bite victims in Madi valley","volume":"8","author":"DP Pandey","year":"2010","journal-title":"J Nepal Health Res Counc"},{"key":"pntd.0008793.ref035","first-page":"51","article-title":"Epidemiology of Snake Bites Based on Hospital Survey in Chitwan and Nawalparasi Districts, Nepal.","volume":"4","author":"D. 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