Compliance with National Snakebite Treatment Guidelines in Rural Sri Lankan Hospitals: A Cluster Randomized Controlled Trial of a Brief Educational Intervention

Background: Snakebite is a global health problem predominately occurring in rural areas. In Sri Lanka, the majority of snakebites first present to smaller rural primary hospitals. Improving care delivered at rural hospitals has the potential to reduce morbidity and mortality from snakebites. Objective: In this study, we evaluated whether an educational intervention would increase compliance with national snakebite treatment guidelines in primary hospitals. Methods: The hospitals were randomized into educational intervention (n=24) and control group (n=20). The intervention hospitals received a brief educational intervention based on Sri Lankan Medical Association (SLMA) guidelines on management of snakebites. Control hospitals had free access to the guidelines but no additional promotion. Four outcomes were assessed; Pre and Post-test knowledge at the completion of a one-day workshop of educational intervention (Intervention group only), Improvement of quality of the patients’ medical records, appropriateness of transfers to higher hospitals, and quality of overall management graded by a blinded expert. The data were collected for a period of 12 months. Results: All case notes of snakebite hospital admissions were reviewed. There were 1021 cases in the intervention and 1165 cases in the control hospitals. Four hospitals in the intervention and 03 hospitals in the control groups did not have snakebite admissions and were excluded from the cluster analysis. The absolute quality of care was high in both groups. Post-test knowledge was improved (p< 0.0001) following the intervention group’s educational workshop. There was no statistical difference between the two groups in the documentation of clinical data in hospital notes (scores, p=0.58), appropriateness of transfers (p=0.68) both of which were at significant variance to the guidelines Conclusion: Representative group education from primary hospitals had improved the immediate knowledge gaining. However, that failed to influence the record- keeping and treatment decisions, as all primary hospitals showed adequate compliance with the existing SLMA guidelines. Trial registration The study was registered with Sri Lanka Medical Associations’ clinical trial registry https://slctr.lk/trials . Reg. No SLCTR/2013/023. Registered: 30/07/2013.