Healthcare workers' prioritization of snake antivenoms for the treatment of snakebite envenoming: Perspectives from Ghana

IntroductionIn low- and middle-income countries (LMICs) with tropical or subtropical climate and a high poverty rate the risk for snakebite envenoming (SBE) is high. Although patients ultimately receive antivenom treatment, healthcare workers are the primary end-users rather than the patients themselves. This study aimed to assess healthcare workers antivenom prioritization by providing quantitative evidence to guide policymakers to make better decisions to improve the procurement and supply of antivenoms, enhance the effectiveness of snakebite treatment, and improve patient care quality in health facilities in Ghana and other LMICs where SBE is common. MethodWe collected data by conducting an interview-based survey using questionnaires. We randomly selected 203 healthcare workers from the Kwahu Afram Plains North and South districts in the Eastern Region of Ghana in August 2023. We used the best-worst scaling experiment design method to assess healthcare workers prioritization of snake antivenoms available for use in sub-Saharan Africa. ResultAmong the antivenoms available for use in sub-Saharan Africa, participants highly prioritized Inoserp Pan-Africa polyvalent antivenom. Snake Venom Antiserum -PanAfrica is also commonly prioritized, followed by ASNA antivenom D, ASNA antivenom C, Snake Venom Antiserum African - 10, Anti Snake Venom Serum Pan Africa - 10, and Fav-Afrique. However, some antivenoms are least commonly prioritized, such as SAIMR Echis, Combipack of Snake Venom Antiserum, Anti Snake Venom Serum Central Africa -6, Anti-Snake Venom Serum Central Africa, Snake Venom Antiserum Echiven Plus, Antivipmyn-Africa, Menaven, Snake Venom Antitoxin, Snake Venom Antiserum (Echiven), Anti Snake Venom Serum Monovalent Echis ocellatus, EchiTAbG, and Snake venom antiserum Echis ocellatus (VINS-Echis). In comparison to other antivenoms, Inoserp Pan-Africa is more frequently prioritized. At the same time, Snake Venom Antiserum -PanAfrica is less frequently prioritized but still more likely than other options. EchiTabPlus (ET-Plus) is more likely to be prioritized than other antivenom options. ConclusionOur findings offer valuable insights to guide policy discussion on available antivenoms in treating SBE. There is an urgent need to implement regulations on antivenom products, improve procurement and supply, offer ongoing education, and provide training to healthcare workers to combat the burden of SBE. Author summaryHealthcare workers are the primary users of snake antivenoms rather than the patients who receive them. Therefore, their antivenom prioritization can help policymakers to make better decisions to improve the procurement and supply of quality antivenoms, enhance the effectiveness of snakebite treatment, and improve patient care quality in health facilities in Ghana and other low- and middle-income countries where snakebite envenoming is prevalent. To this end, we conducted a study to assess healthcare workers antivenom prioritization and provide policymakers with quantitative evidence to guide decision-making. Using an interview-based questionnaire, we surveyed 203 healthcare workers in the Kwahu Afram Plains North and South districts in Ghanas Eastern Region in August 2023. The best-worst scaling experimental design method was used to assess participants prioritization of different snake antivenom products available in sub-Saharan Africa. Most participants were female, aged 18 to 30 years old with 1-5 years of work experience. Many participants had received snakebite training and mostly lived in rural areas. The majority reported that farmers were the most commonly bitten population during the rainy season, in their farms or bush, between 9 am to 12 noon. Among the snake antivenom products in sub-Saharan Africa, polyvalent antivenoms were highly prioritized over monovalent ones. Inoserp Pan-Africa was the most frequently prioritized, followed by Snake Venom Antiserum -PanAfrica (Premium-A) and EchiTabPlus. Our findings provide valuable insights to guide policy discussions on available antivenoms in treating snakebite envenoming. We urge policymakers to implement regulations on antivenom products, improve quality antivenom procurement and supply, provide ongoing education, and offer training to healthcare workers to combat the burden of snakebite envenoming.