{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T18:26:36Z","timestamp":1773685596159,"version":"3.50.1"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011614","name":"University of Kelaniya","doi-asserted-by":"publisher","award":["RC\/2025\/PPCR02"],"award-info":[{"award-number":["RC\/2025\/PPCR02"]}],"id":[{"id":"10.13039\/501100011614","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"\n Background<\/jats:title>\n Snake envenoming remains a major public health problem in Sri Lanka, disproportionately affecting rural children. Timely and appropriate pre-hospital management is crucial to reducing morbidity and mortality. Public Health Midwives (PHMs), as frontline community health workers, are strategically positioned to contribute to snakebite prevention and early management. However, their knowledge and confidence regarding paediatric snakebite care have not been systematically evaluated.<\/jats:p>\n <\/jats:sec>\n \n Methodology\/Principal findings<\/jats:title>\n A cross-sectional, country-wide survey was conducted among PHMs across all 25 districts of Sri Lanka using a stratified random sampling approach. Data were collected through a validated, self-administered online questionnaire designed to assess knowledge and practices related to paediatric snakebite prevention, snake identification, and pre-hospital management. A total of 1,706 PHMs participated. Although most respondents correctly identified essential first-aid measures such as reassuring the patient (95.9%) and prompt hospital transfer (95.8%), a substantial proportion endorsed harmful practices, including sucking the venom (71.6%), applying herbs (73.2%), or cutting the bite site (64.4%). Only 48.7% recognized immobilisation as an appropriate first aid. Snake identification accuracy was high for the cobra (94%) but low for other medically significant species such as kraits and vipers. Awareness of national guidelines (14.7%) and emergency contact services (11.9%) was also poor. PHMs with prior training, awareness of national information services, or previous experience providing first aid demonstrated significantly higher knowledge scores (p\u2009<\u20090.001).<\/jats:p>\n <\/jats:sec>\n \n Conclusions\/Significance<\/jats:title>\n Despite their key role in community health, PHMs in Sri Lanka exhibit major knowledge gaps in evidence-based first aid, snake identification, and awareness of national support systems for snakebite management. These deficits, coupled with widespread misconceptions and low confidence, highlight the need for structured training, curriculum integration, and ongoing professional development. Strengthening PHMs\u2019 capacity in snakebite prevention and early management can significantly enhance community preparedness and reduce the burden of paediatric snakebite envenoming in Sri Lanka.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014083","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T17:34:52Z","timestamp":1773682492000},"page":"e0014083","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A country-wide survey of knowledge and practice regarding prevention, snake identification and pre-hospital management of children with snakebites amongst Public Health Midwives in Sri Lanka"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0438-9837","authenticated-orcid":true,"given":"Kavinda","family":"Dayasiri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tharuka","family":"Perera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gihan","family":"Gunarathna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Achila","family":"Ranasinghe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indika","family":"Gawarammana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaluka","family":"Jayamanne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"issue":"1","key":"pntd.0014083.ref001","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1186\/s13104-024-07036-8","article-title":"Epidemiological 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Dayasiri","year":"2025","journal-title":"BMC Pediatr"},{"key":"pntd.0014083.ref005","doi-asserted-by":"crossref","first-page":"108410","DOI":"10.1016\/j.toxicon.2025.108410","article-title":"Challenges in paediatric snakebite management: physician perspectives from rural Sri Lanka","volume":"262","author":"Dayasiri Kavinda","year":"2025","journal-title":"Toxicon"},{"key":"pntd.0014083.ref006","doi-asserted-by":"crossref","first-page":"108459","DOI":"10.1016\/j.toxicon.2025.108459","article-title":"Training and educational needs for paediatric snakebite management among rural healthcare providers in Sri Lanka","volume":"264","author":"K Dayasiri","year":"2025","journal-title":"Toxicon"},{"issue":"5","key":"pntd.0014083.ref007","first-page":"1003","article-title":"Public health midwives as a family health care worker to promote vaginal health: evidence from a community study in Sri Lanka","volume":"49","author":"IMPS Ilankoon","year":"2020","journal-title":"Iranian J Public 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Myanmar","volume":"13","author":"MA Mahmood","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"pntd.0014083.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005079","article-title":"The treatment of snake bites in a first aid setting: a systematic review","volume":"10","author":"B Avau","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0014083.ref012","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/tmi.14071","article-title":"Knowledge of local snakes, first-aid and prevention of snakebites among community health workers and community members in rural Malawi: a cross-sectional study","volume":"30","author":"MB Aron","year":"2025","journal-title":"Trop Med Int Health"},{"issue":"12","key":"pntd.0014083.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008911","article-title":"Venomous snakebites: rapid action saves lives-A multifaceted community education programme increases awareness about snakes and snakebites among the rural population of Tamil Nadu, India","volume":"14","author":"SP Samuel","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014083.ref014","doi-asserted-by":"crossref","first-page":"100147","DOI":"10.1016\/j.toxcx.2022.100147","article-title":"Multifaceted community health education programs as powerful tools to mitigate snakebite-induced deaths, disabilities, and socioeconomic burden","volume":"17","author":"S Vaiyapuri","year":"2022","journal-title":"Toxicon X"},{"key":"pntd.0014083.ref015","first-page":"1","article-title":"Blockchain-enabled healthcare optimization: enhancing security and decision-making using the mother optimization algorithm.","author":"SR Addula","year":"2025","journal-title":"2025 International conference on intelligent and cloud computing (ICoICC)"},{"issue":"1","key":"pntd.0014083.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2025-003658","article-title":"Caught between fear and tradition: 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