Exploring an Interplay of Sociocultural Contexts and Health Systems in Snakebite Envenoming Management in Rural Himachal Pradesh: A Qualitative Study of Community Perspectives and Practices

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This qualitative study, employing focus group discussions and key informant interviews in rural Himachal Pradesh, India, investigated community perceptions, knowledge, and practices surrounding snakebite envenoming. Thematic analysis revealed that the communities employed a dual healthcare strategy for snakebites, blending traditional healing methods like herbal remedies and faith-based rituals with, or preceding, the use of conventional medical treatments. Awareness of government healthcare did not translate to accurate snakebite treatment knowledge, as ineffective practices like tourniquets and herbal remedies were common. Consequently, the study underscores the necessity for targeted public health interventions to enhance community education, improve access to appropriate medical care, and facilitate the integration of validated traditional practices within a contemporary healthcare framework to mitigate snakebite-related morbidity and mortality. Figures Figure 1 Figure 2 Introduction Snakebite envenoming is a neglected tropical disease, afflicting people especially those living in rural areas and poverty. Worldwide, nearly 1.8-2.7 million people are envenomed annually. The Southeast Asia Region is a biodiversity hotspot for venomous snakes and is also home to some of the world’s most densely packed agrarian communities. Snakebite in this region contributes almost 70% of the estimated global snakebite-related mortality. In India, 0.77–1.24 million cases of snakebite envenoming occur annually, resulting in 58,000 deaths. Like other neglected tropical diseases, the morbidity and mortality due to snakebite are preventable with appropriate awareness, and safe and effective treatment. Yet many rural communities continue to suffer disproportionately from snake bite envenoming due to lack of awareness, vivid perceptions, inequitable access to appropriate treatment, and socioeconomic challenges. 1 Snakebite is an occupational hazard affecting agricultural workers and farmers. 2 Working in the fields, fetching potable water, going to school or outdoor activities without footwear, outdoor toilets, kutcha houses, and keeping grass in the courtyard are some of the activities that are associated with a higher incidence of snakebites in rural and tribal areas. 3,4 Besides, inappropriate perception, practice of unproven traditional methods of treatment, and inadequate knowledge about snakes and snakebites may increase the mortality due to snakebite envenoming. 5, 6 It is quite evident from the previous literature that the research on snakebite cases has been predominantly confined to hospital settings, 7 neglecting cognitive and affective domains that provide insight into the knowledge and perceptions prevailing in the community. Considering this, the present study is an attempt to explore the perception, awareness, knowledge, practices, and healthcare-seeking behaviour of the community for snakebite prevention and management that are prevalent in the region. It intends to delve into the factors influencing these behaviours, such as cultural beliefs, access to healthcare resources, and the effectiveness of existing prevention and management strategies. Methods Study site The study was conducted in the subtropical districts of Kangra, Una, and Chamba in the northern state of Himachal Pradesh, India (figure 1). These regions exhibit significant environmental diversity, characterized by high-temperature zones, semi-arid hills, and numerous rivulets, creating ideal conditions for a thriving snake population. 8 Study Design Exploratory qualitative research was employed with the constructivist/interpretivist paradigm, recognizing that knowledge and perceptions about snake bites are socially constructed and context-dependent. Research Team and Reflexivity The interviews were conducted by three female assistants/coordinators, each holding graduate or post-graduate degrees in Medicine or Science, with three years of professional experience. They were supported by field workers who were graduates in Science or GNM nursing. The study team also comprised of public health experts with extensive experience in snake bite research, as well as clinical research specialists. The study team had no prior relationships with the participants. Study methodology 6 health blocks from these three districts were selected using the simple random technique as detailed below. This included three blocks from Kangra, two from Chamba (one tribal and one non-tribal), and one from Una, reflecting varying geographical and demographic contexts (Figure 2). Data Collection Data was collected through Focus Group Discussions (FGDs) and semi-structured Key Informant Interviews, with a primary focus on understanding community awareness, beliefs about snakes and snake bites, perception and health-seeking behavior, and knowledge about first aid procedures for managing snake bites. A total of 36 FGDs were used to capture community perspectives, while 71 KIIs provided in-depth insights from experts and individuals with relevant experiences. The development, standardization, and contextualization of the qualitative tools (FGD and KII guides) are detailed elsewhere. 9 The study was conducted between June and October 2022. The current study was undertaken as a preamble to an Indian Council Medical of Research (ICMR) led task force project for estimating the burden of snakebite in India of which the study site is a participating centre. The coordinators, field workers, health workers, and ASHAs were trained to conduct FGDs and KIIs, as well as to engage in data collation, Information Education and Communication (IEC) efforts on snakebite prevention and management, and record-keeping. Each FGD comprised 8-16 participants representing a range of ages, educational backgrounds, and socio-economic statuses. Sessions were conducted in the vernacular language, lasting no longer than 45 minutes. With the consent of participants, FGDs and KIIs were audio-recorded and supplemented with notes. The facilitators encouraged open, in-depth discussions to ensure comprehensive insights. Key informants, including medical officers, pharmacists, community leaders (Pradhans), and traditional healers, were selected based on their relevant expertise and roles concerning snakebites. The study adhered to the Standards for Reporting Qualitative Research guidelines (Annexure I) to ensure the qualitative data collection and reporting process's transparency, rigor, and trustworthiness. Analysis An inductive thematic analysis was carried out to explore the emergent themes from the data. This approach was used to derive the findings grounded entirely in the qualitative data, without imposing a priori theoretical frameworks. The analysis includes the following stages: Transcription, and Familiarization with the Data: The recordings of FGDs and KIIs were transcribed into text. The research team proofread and then translated the transcripts into English to ensure the accuracy of the participants' dialogue/statements. Transcriptions were then reviewed to gain an in-depth understanding of participants' perspectives on snakebite management, prevention, and treatment. Selection of Keywords: The qualitative data from discussions and interviews was closely examined to identify recurring patterns, and terms, and designate them as keywords. These keywords encapsulated participants’ experiences and perceptions and were directly derived from the data and help to convert raw data into insightful, manageable units. Coding: Codes i.e. short phrases or words were assigned to sections of the collected data that captured its core message, significance, or theme. Codes for emerging patterns like "faith healer reluctance to share methods" and "use of modern first-aid techniques by ASHA workers" were developed. It simplified complex textual data by transforming it into a theoretical form and assisted in identifying elements related to the research questions. Theme Identification: Codes were grouped into broader themes such as Knowledge and Practices of Healthcare Workers, Community Beliefs, Traditional Healing Practices, and Referral to Government Health Facilities. Themes were analyzed to understand underlying beliefs, gaps in knowledge, and the interaction between traditional and modern healthcare systems in snakebite management and accordingly were organized hierarchically into Primary Themes (Healthcare Workers' Practices, Traditional Beliefs) and Sub-Themes (First Aid Practices, IEC Material Availability, Referral Systems). Thus, by transcending the conventional descriptive approach, underlying themes and sub-themes were finally recognized by delving deeper into the data. Ethical statement The study was conducted following the ethical standards set by the institutional ethics committee, and approval was obtained before commencement, as per letter No. HFW-H DRPGMC/Ethics/ 2020/001 Dated: 10.02.2020. Informed consent was obtained from all human participants, and the confidentiality of their data was maintained throughout the study process. Results A total of 565 participants participated in FGDs and 71 interviews were conducted across the study areas. About one-third of them had personally experienced an encounter with the snakes. Table 1 demonstrates the key themes identified about perceptions, context, beliefs, traditional methods of prevention and treatment preferred, and health-seeking behaviour. A total of 71 individuals participated in the Key Informant Interviews (KIIs), including 16 Medical Officers, 16 Pharmacists, 19 ASHA workers, 14 community representatives (Pradhan’s), 5 traditional faith healers, and 1 snake rescuer. Among the Medical Officers, 75% had experience managing snakebite cases, and all were proficient in performing the Whole Blood Clotting Test (WBCT). However, only 50% had received formal training on snakebite management, and 80% were unaware of the National Snakebite Management Protocol (2009) and Standard Treatment Guidelines for Snakebite Management (2017). Approximately 63% had administered Anti-Snake Venom (ASV) before referring patients to higher healthcare facilities. None of the 16 pharmacists had independently managed a snakebite case, and only 50% were aware of appropriate first-aid measures. None had received formal training on snakebite management, although 88% were knowledgeable about the stock status of ASV in their facilities. Of the 19 ASHA workers, 90% knew snakebite treatment was available at government health facilities, and 63% had attended at least one training session on snakebite prevention and first aid. However, only 21% knew that nothing should be applied at the bite site, and 26% had access to IEC materials on snakebite management. Among the 14 community representatives, 90% supported seeking medical treatment for snakebites, although one favored traditional remedy, and another believed initial home management was acceptable. The 5 traditional faith healers, with over 10 years of experience, provided treatment as a social service. While they commonly referred patients to healthcare facilities, if necessary, they were reluctant to disclose their methods, which included the use of 'banna,' mantras, and gems. The snake rescuer, with over 10 years of experience, used various methods, including cobra-derived ‘mani,’ medicinal herbs, incisions, and suctioning venom. He was aware of medical treatment availability and referred cases to healthcare facilities if conditions worsened. Table 1. Description of a framework with key thematic areas identified after inductive thematic analysis Theme Subtheme Description Quotes Snake Species Identification and Perceptions Local Nomenclature and Traditional Knowledge Different snake species were identified in common and vernacular language. (Table 2) The community identified three snake species: Daboia russelii (Russell's viper), Naja naja (common Indian Cobra), and Bungarus caeruleus (common krait). Perceptions of Venomous Snakes Snake species were recognized based on color, size, and habitat, often associating black, green, yellow, and black-white snakes with toxicity. In contrast, brown and white snakes, along with water and tree-dwelling species, were deemed non-venomous. Cobras were universally recognized as highly venomous, with smaller snakes believed to be less dangerous than larger ones. One-third mentioned, " If a poisonous snake bites body turns blue, froth appears from the mouth, and vision is also impaired.” Snakebite Incidence and Context Context of Encounters Snakebite incidents were more frequent during agricultural activities, especially in monsoon season. Snakes were commonly sighted inside kutcha houses, on slate roofs in rural areas, near water bodies, and on trees. One of the respondents said, “M ore is the temperature in the area, the more poisonous is the snake. ” Beliefs and Cultural Practices Religious and Mythological Context The community revered “Naag Devta,” believing that snake appearances in their homes signified the presence of Nagini Mata's successors, prompting them to build temples and worship them. “A festival called Nag panchmi is celebrated here during the rainy season, during which sweet milk, rice or sour buttermilk to seek divine protection from snake intrusions and bites.” Views on Coexistence vs. Conflict Balancing reverence for snakes with practical concerns regarding public safety. Acceptance of snake removal or killing when they invade homes. We celebrate “Guga Navmi'' (Naag Panchmi- a festival of snakes) so we don’t kill snakes. “ If a snake bites a person and it is killed, then the poison of snake increases in a person bitten and causes death .” Traditional Treatment Approaches Methods of Traditional Healing Use of local plants, such as banna ( Vitex negundo ), and reliance on traditional healers ( Sori ). Belief in efficacy is tied to rituals, such as applying plants at bite sites and the role of gems in drawing out poison. “We place daali (branch) of banna at the bite site, & if its green leaves turn black, it confirms snake bite. After that vibhuti/jaadibooti/shakkar (soil)is applied at the bite site and the person is made to do panadi (rounds of temple). A soil from naag mandir mixed with water (pyaas) is also used and it is given to drink. It takes 7 to 10 days to heal and a person must visit the temple twice a day. When healing starts the colour of daali becomes less black.” “ When mani (gem) is applied at the bite site, it sticks, swells up and sucks out the poison. It takes 4-5 days for this process when mani comes out or falls on its own.” After that, the gem is kept in the milk and the poison gets removed.” Traditional faith healers S ori performs “A procedure called phaanda, where a herb is placed at the bite site and it dries up if there is poison in the body.” Then some mantras are chanted using a branch of banna (Vitex negundo) with a black thread tied a little behind the bite site and it is recited at least 8 to 10 times. Afterward, a small cut/incision is given near the bite site to remove poison in the blood.” Cultural Practices Surrounding Healing Rituals associated with snakebite, and its recovery, including temple visits and specific dietary restrictions. “I f a person gets bitten by a snake, he/she should not be allowed to sleep and salt is restricted to prevent the spread of poison in the body. ” “To confirm whether a victim has been bitten by a snake or not , we give back pepper to eat and if one does not feel the spice, they consider it to be a snake bite and treat accordingly.” Snakebite Prevention and First Aid Snakebite Prevention Practices Traditional methods of keeping snakes away from homes include placing ash and onion peels around the perimeter, which are believed to repel snakes. Some use phenol, locally available herbicide roundup , and DDT, to deter them from entering the house. “We use and spread naagni mata mandir shakkar (soil mixed with water) inside and outside houses and in the fields to avoid snakes. ” “Use mor pankh in our houses and due to this snake don’t come within an area of 10-12 km.” “Use mosquito nets for the prevention of snakebites .” Knowledge and Practices Related to First Aid A tourniquet/bandage at and above the bite site was the most common first aid method reported. The application of salt, red chilies, ghee, paste of reetha seed, and some local herb at the bite site was also cited by the participants. “We put an incision and then tie the bite site using a tourniquet” stated one of the FGD respondents. Another participant said, “ We apply a paste made of leaves of the plant called BHERANG after washing the bite site with soap and water, then after 8 to 10 days poison dries up and a person is cured .” Another practice was observed in district Chamba, where the bite site was burnt using a hot object (like a coin) made of iron. “The bite site is scraped with a knife and then matchstick is applied on it and is burnt.” Healthcare Seeking Behaviour Preference for Traditional vs. Modern Medicine Exploration of healthcare-seeking behaviour. Community members mentioned that “ they preferred to visit local traditional faith healers, nagnimata temple or guga temple first and if it’s not cured then we visit government hospital .” Utilization of Government Healthcare Services Examination of factors influencing hospital use. Respondents preferred government healthcare facilities over private hospitals. Few of them approached nearby government healthcare facilities directly, as they were aware of the treatment available for snakebite. Table 2. Commonly found snakes in the community Local name in the community Common name Scientific name Toxicity Khadpa Common Indian cobra Naja naja Neurotoxic Laman Common Bronzeback Tree Snake Dendrelaphis tristis Non-venomous Kodi walasaanp Russell Viper Daboia russelii Hemotoxic Dinna Checkered keelback Fowlea piscator Non-venomous Saraal Python Python molurus Non-venomous Saldu Northern White-lipped pit viper Trimeresurusalbolabris Hemotoxic Dhai ghadi wala saanp Common Krait Bungarus caeruleus Neurotoxic Discussion The study reveals a limited understanding of the cognitive and affective domains related to snakebite prevention and management among community members in three districts of Himachal Pradesh. It underscores the insufficient knowledge, prevalent misconceptions, and the use of non-scientific methods for snakebite prevention and management within the community. The constructivist paradigm allowed themes to emerge inductively, capturing socially constructed meanings and experiences related to snake bites. The elements of a qualitative approach like phenomenology (exploring lived experiences) and ethnography (focus on community beliefs) were present but did not adhere strictly to a specific and single qualitative research tradition. What were the common perceptions regarding snakes and bites in the community? Belief in a snake god, offering them milk, and buttermilk, the ability of mani (gem), and chanting some mantras to reduce the venom effect were some of the superstitions reported in our study, which was also observed in a study conducted in Maharashtra. 10 The traditional knowledge regarding loss of taste following a bite by venomous snakes has a scientific base but needs further exploration as some in view of the available reports. What do locals do for snake bite prevention? Most of the people in the study areas were using and practicing different unproven household methods for the prevention of snakebites. They were using bleaching powder, mor pankh, carom seeds, soil from naag temples, and buttermilk. Besides, the use of insecticides like DDT, roundup, and phenol was also seen. There was some awareness of keeping the surroundings clean, using torchlight, and wooden sticks, wearing long plastic boots to work in the fields, and avoiding sleeping on the floor. Wearing long rubber shoes with enclosed toes, and using a mosquito net on a bamboo cot or bed above the ground level to prevent krait and cobra bites has been documented in other studies also 11,12,13 . Which treatment is preferred by the community members and why? The use of alternative and unproven methods for the treatment of snakebite patients is still followed in many countries including India 14,15 . Most of the snake bite victims and the community were tying a rope or a piece of cloth above the bite site as a tourniquet as a first aid method. The same has been observed in a study done in Myanmar. 16 There are reports on the use of gems obtained from snakes, and chanting mantras to treat snakebites, but the scientific literature on its therapeutic efficacy is lacking. A study was conducted on mice to determine the therapeutic efficacy of snake stones(gem), but it failed to show any such efficacy. 17 Such remedies being used since antiquity do not have any proven benefit in managing snakebites and it is recommended to avoid traditional first aid methods including black stones and alternative herbal therapy. The knowledge regarding the accurate use of first aid for snakebites was lacking in most of the study participants. In the present study, the community preferred local treatment with reetha seed, salt, red chilies, some local herb paste, and ghee, burning the bite site with a hot iron object, giving incision to reduce the effect of venom, and then approaching the traditional faith healers. The use of tamarind seed was observed in Bhil tribes of Rajasthan 18 . In case the victim does not recover, then only they prefer to transfer the patient to the nearby government healthcare facility. The use of such methods was associated with an increased risk of wound infection and long duration of hospitalization for the management of snakebite victims 19,20 . Therefore, IEC (information, education, and communication) to discard such practices and unproven methods for snakebite treatment, need to be emphasized. What were the reasons for seeking traditional treatment over allopathic? The various reasons for seeking treatment from traditional faith healers could be the strong belief of the community in traditional treatment, inadequate knowledge about the treatment, and associated complications. So, engagement of traditional faith healers and local community representatives for timely referral to the nearby health institution for anti-venom treatment could be leveraged. Similar efforts are ongoing in West Bengal, to engage the traditional faith healers for timely referral to the nearest hospital for anti-venom treatment 21 . Linkages need to be strengthened with community leaders and healthcare providers to gain the confidence of the community for timely referral and anti-venom treatment. Some people preferred going to the government health facilities, as they were aware that treatment for snake bites was available. However, interrupted public transport and ambulance services, scattered locations of hamlets, distantly located health institutions, unavailability of doctors (especially during night hours), and frequent referrals to higher institutions were hindering the community members from seeking the available allopathic treatment. What gaps were identified in healthcare service utilization? The availability of trained and experienced healthcare workers in tribal and rural areas is an important aspect of the prevention and control of snakebite cases. In the present study, around three-fourths of the medical officers have managed snake bite cases, and all knew the procedure to perform WBCT. Around 75% of the medical officers were able to differentiate between hemotoxic and neurotoxic bites. The formal training on the management of snakebite was attended by only 50% of the medical officers. The lack of confidence in administering the anti-venom was mainly due to a fear of anaphylaxis reaction and the absence of any formal training. Similar findings were seen in a study among healthcare providers of Dahanu block in Maharashtra. 22 About 20% of the frontline workers (ASHA) were aware of the first aid practices to be followed in snake bite cases, however nearly 60% have received formal training on snake bite prevention and management. This contrasted with the study in Maharashtra where nearly 50% of ASHAs were aware of first aid, although only 5.7% had received formal training on snake bite prevention and management. 23 Conclusions The present study generated evidence to empower the community by increasing awareness of preventing snakebites, first aid, and appropriate treatment-seeking behaviour. The communities affected by snakebites are often those with the least access to healthcare services and treatment. Strengthening information, education, and communication (IEC) efforts, along with improving healthcare access and support, is crucial in reducing the morbidity and mortality associated with snakebites in these vulnerable populations. The research warrants the development of a sustainable model, with flexible policies to accommodate the region-specific perceptions, community engagement, involvement of herpetologists, forest department officials, panchayat officials, traditional faith healers, and built resilient health system with trained health care workers. Study limitations The perceptions and awareness about snakebites could be region-specific and may not be representative of the entire community in India. The study's qualitative approach, while valuable, did not incorporate a follow-up mechanism or quantitative data, which would have provided a more comprehensive understanding of the effectiveness of snakebite management practices. All FGDs and interviews were conducted in the vernacular language (Pahadi and Hindi) and later translated into English. Hence, some interpretations might have been lost in translation. Declarations Acknowledgment: I sincerely thank other authors for their valuable insights and expert reviews, which significantly contributed to the development of this protocol. I gratefully acknowledge the dedicated field investigators for their invaluable data collection efforts. A special thank you to the participants, whose openness and insights made this research possible. Conflict of Interest : There are no conflicts of interest to disclose concerning this research. Funding : No involvement of any funding source Data Availability Statement: The datasets generated during the current study are available from the corresponding author upon reasonable request. 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Why snakebite patients in Myanmar seek traditional healers despite availability of biomedical care at hospitals? Community perspectives on reasons. PLoS Negl Trop Dis. 2018;12 (2): e0006299. Michael G, Thacher T, Shehu M. The Effect of Pre-hospital Care for Venomous Snakebite on Outcome in Nigeria. Trans R Soc Trop Med Hyg . 2011;105(2): 95–101. Bhaumik S. Snakebite: a forgotten problem. BMJ . 2013;346 Chaaithanya IK, Abnave D, Bawaskar H, Pachalkar U, Tarukar S, Salvi N, Bhoye P, Yadav A, Mahale SD, Gajbhiye RK. Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar District in Maharashtra, India. PLoS One . 2021 Aug 5;16(8): e0255657. Additional Declarations No competing interests reported. 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Worldwide, nearly 1.8-2.7 million people are envenomed annually. The Southeast Asia Region is a biodiversity hotspot for venomous snakes and is also home to some of the world\u0026rsquo;s most densely packed agrarian communities. Snakebite in this region contributes almost 70% of the estimated global snakebite-related mortality. In India, 0.77\u0026ndash;1.24 million cases of snakebite envenoming occur annually, resulting in 58,000 deaths. Like other neglected tropical diseases, the morbidity and mortality due to snakebite are preventable with appropriate awareness, and safe and effective treatment. Yet many rural communities continue to suffer disproportionately from snake bite envenoming due to lack of awareness, vivid perceptions, inequitable access to appropriate treatment, and socioeconomic challenges.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eSnakebite is an occupational hazard affecting agricultural workers and farmers.\u003csup\u003e2\u003c/sup\u003e Working in the fields, fetching potable water, going to school or outdoor activities without footwear, outdoor toilets, kutcha houses, and keeping grass in the courtyard are some of the activities that are associated with a higher incidence of snakebites in rural and tribal areas.\u003csup\u003e3,4\u003c/sup\u003e Besides, inappropriate perception, practice of unproven traditional methods of treatment, and inadequate knowledge about snakes and snakebites may increase the mortality due to snakebite envenoming.\u003csup\u003e5, 6\u0026nbsp;\u003c/sup\u003eIt is quite evident from the previous literature that the research on snakebite cases has been predominantly confined to hospital settings,\u003csup\u003e7\u003c/sup\u003e neglecting cognitive and affective domains that provide insight into the knowledge and perceptions prevailing in the community. Considering this, the present study is an attempt to explore the perception, awareness, knowledge, practices, and healthcare-seeking behaviour of the community for snakebite prevention and management that are prevalent in the region. It intends to delve into the factors influencing these behaviours, such as cultural beliefs, access to healthcare resources, and the effectiveness of existing prevention and management strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy site\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was conducted in the subtropical districts of Kangra, Una, and Chamba in the northern state of Himachal Pradesh, India (figure 1). These regions exhibit significant environmental diversity, characterized by high-temperature zones, semi-arid hills, and numerous rivulets, creating ideal conditions for a thriving snake population.\u003csup\u003e8\u003c/sup\u003e\u003cins cite=\"mailto:hp\" datetime=\"2025-03-06T20:25\"\u003e\u0026nbsp;\u003c/ins\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExploratory qualitative research was employed with the constructivist/interpretivist paradigm, recognizing that knowledge and perceptions about snake bites are socially constructed and context-dependent. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Team and Reflexivity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe interviews were conducted by three female assistants/coordinators, each holding graduate or post-graduate degrees in Medicine or Science, with three years of professional experience. They were supported by field workers who were graduates in Science or GNM nursing. The study team also comprised of public health experts with extensive experience in snake bite research, as well as clinical research specialists. The study team had no prior relationships with the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy methodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e6 health blocks from these three districts were selected using the simple random technique as detailed below. This included three blocks from Kangra, two from Chamba (one tribal and one non-tribal), and one from Una, reflecting varying geographical and demographic contexts (Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was collected through Focus Group Discussions (FGDs) and semi-structured Key Informant Interviews, with a primary focus on understanding community awareness, beliefs about snakes and snake bites, perception and health-seeking behavior, and knowledge about first aid procedures for managing snake bites.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 36 FGDs were used to capture community perspectives, while 71 KIIs provided in-depth insights from experts and individuals with relevant experiences. The development, standardization, and contextualization of the qualitative tools (FGD and KII guides) are detailed elsewhere.\u003csup\u003e9\u003c/sup\u003e The study was conducted between June and October 2022.\u003c/p\u003e\n\u003cp\u003eThe current study was undertaken as a preamble to an Indian Council Medical of Research (ICMR) led task force project for estimating the burden of snakebite in India of which the study site is a participating centre. The coordinators, field workers, health workers, and ASHAs were trained to conduct FGDs and KIIs, as well as to engage in data collation, Information Education and Communication (IEC) efforts on snakebite prevention and management, and record-keeping.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Each FGD comprised 8-16 participants representing a range of ages, educational backgrounds, and socio-economic statuses. Sessions were conducted in the vernacular language, lasting no longer than 45 minutes. With the consent of participants, FGDs and KIIs were audio-recorded and supplemented with notes. The facilitators encouraged open, in-depth discussions to ensure comprehensive insights. Key informants, including medical officers, pharmacists, community leaders (Pradhans), and traditional healers, were selected based on their relevant expertise and roles concerning snakebites.\u003c/p\u003e\n\u003cp\u003eThe study adhered to the Standards for Reporting Qualitative Research guidelines (Annexure I) to ensure the qualitative data collection and reporting process\u0026apos;s transparency, rigor, and trustworthiness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn inductive thematic analysis was carried out to explore the emergent themes from the data. This approach was used to derive the findings grounded entirely in the qualitative data, without imposing a priori theoretical frameworks. The analysis includes the following stages:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eTranscription, and Familiarization with the Data: The recordings of FGDs and KIIs were transcribed into text. The research team proofread and then translated the transcripts into English to ensure the accuracy of the participants\u0026apos; dialogue/statements. Transcriptions were then reviewed to gain an in-depth understanding of participants\u0026apos; perspectives on snakebite management, prevention, and treatment.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSelection of Keywords: The qualitative data from discussions and interviews was closely examined to identify recurring patterns, and terms, and designate them as keywords. These keywords encapsulated participants\u0026rsquo; experiences and perceptions and were directly derived from the data and help to convert raw data into insightful, manageable units.\u003c/li\u003e\n \u003cli\u003eCoding: Codes i.e. short phrases or words were assigned to sections of the collected data that captured its core message, significance, or theme. Codes for emerging patterns like \u0026quot;faith healer reluctance to share methods\u0026quot; and \u0026quot;use of modern first-aid techniques by ASHA workers\u0026quot; were developed. It simplified complex textual data by transforming it into a theoretical form and assisted in identifying elements related to the research questions.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTheme Identification: Codes were grouped into broader themes such as Knowledge and Practices of Healthcare Workers, Community Beliefs, Traditional Healing Practices, and Referral to Government Health Facilities. Themes were analyzed to understand underlying beliefs, gaps in knowledge, and the interaction between traditional and modern healthcare systems in snakebite management and accordingly were organized hierarchically into Primary Themes (Healthcare Workers\u0026apos; Practices, Traditional Beliefs) and Sub-Themes (First Aid Practices, IEC Material Availability, Referral Systems).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThus, by transcending the conventional descriptive approach, underlying themes and sub-themes were finally recognized by delving deeper into the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted following the ethical standards set by the institutional ethics committee, and approval was obtained before commencement, as per letter No. HFW-H DRPGMC/Ethics/ 2020/001 Dated: 10.02.2020. Informed consent was obtained from all human participants, and the confidentiality of their data was maintained throughout the study process.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 565 participants participated in FGDs and 71 interviews were conducted across the study areas. About one-third of them had personally experienced an encounter with the snakes. Table 1 demonstrates the key themes identified about perceptions, context, beliefs, traditional methods of prevention and treatment preferred, and health-seeking behaviour.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 71 individuals participated in the Key Informant Interviews (KIIs), including 16 Medical Officers, 16 Pharmacists, 19 ASHA workers, 14 community representatives (Pradhan\u0026rsquo;s), 5 traditional faith healers, and 1 snake rescuer.\u003c/p\u003e\n\u003cp\u003eAmong the Medical Officers, 75% had experience managing snakebite cases, and all were proficient in performing the Whole Blood Clotting Test (WBCT). However, only 50% had received formal training on snakebite management, and 80% were unaware of the National Snakebite Management Protocol (2009) and Standard Treatment Guidelines for Snakebite Management (2017). Approximately 63% had administered Anti-Snake Venom (ASV) before referring patients to higher healthcare facilities.\u003c/p\u003e\n\u003cp\u003eNone of the 16 pharmacists had independently managed a snakebite case, and only 50% were aware of appropriate first-aid measures. None had received formal training on snakebite management, although 88% were knowledgeable about the stock status of ASV in their facilities.\u003c/p\u003e\n\u003cp\u003eOf the 19 ASHA workers, 90% knew snakebite treatment was available at government health facilities, and 63% had attended at least one training session on snakebite prevention and first aid. However, only 21% knew that nothing should be applied at the bite site, and 26% had access to IEC materials on snakebite management.\u003c/p\u003e\n\u003cp\u003eAmong the 14 community representatives, 90% supported seeking medical treatment for snakebites, although one favored traditional remedy, and another believed initial home management was acceptable.\u003c/p\u003e\n\u003cp\u003eThe 5 traditional faith healers, with over 10 years of experience, provided treatment as a social service. While they commonly referred patients to healthcare facilities, if necessary, they were reluctant to disclose their methods, which included the use of \u0026apos;banna,\u0026apos; mantras, and gems.\u003c/p\u003e\n\u003cp\u003eThe snake rescuer, with over 10 years of experience, used various methods, including cobra-derived \u0026lsquo;mani,\u0026rsquo; medicinal herbs, incisions, and suctioning venom. He was aware of medical treatment availability and referred cases to healthcare facilities if conditions worsened.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Description of a framework with key thematic areas identified after inductive thematic analysis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"980\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubtheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDescription\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuotes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSnake Species Identification and Perceptions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eLocal Nomenclature and Traditional Knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eDifferent snake species were identified in common and vernacular language. (Table 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003eThe community identified three snake species: \u003cem\u003eDaboia russelii\u003c/em\u003e (Russell\u0026apos;s viper), \u003cem\u003eNaja naja\u003c/em\u003e (common Indian Cobra), and \u003cem\u003eBungarus caeruleus\u003c/em\u003e (common krait).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePerceptions of Venomous Snakes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eSnake species were recognized based on color, size, and habitat, often associating black, green, yellow, and black-white snakes with toxicity. In contrast, brown and white snakes, along with water and tree-dwelling species, were deemed non-venomous.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCobras were universally recognized as highly venomous, with smaller snakes believed to be less dangerous than larger ones.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003eOne-third mentioned, \u0026quot;\u003cem\u003eIf a poisonous snake bites body turns blue, froth appears from the mouth, and vision is also impaired.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSnakebite Incidence and Context\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eContext of Encounters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eSnakebite incidents were more frequent during agricultural activities, especially in monsoon season. Snakes were commonly sighted inside \u003cem\u003ekutcha\u003c/em\u003e houses, on slate roofs in rural areas, near water bodies, and on trees.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003eOne of the respondents said, \u0026ldquo;M\u003cem\u003eore is the temperature in the area, the more poisonous is the snake.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeliefs and Cultural Practices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eReligious and Mythological Context\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eThe community revered \u0026ldquo;Naag Devta,\u0026rdquo; believing that snake appearances in their homes signified the presence of Nagini Mata\u0026apos;s successors, prompting them to build temples and worship them.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;A festival called Nag panchmi is celebrated here during the rainy season, during which sweet milk, rice or sour buttermilk to seek divine protection from snake intrusions and bites.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eViews on Coexistence vs. Conflict\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eBalancing reverence for snakes with practical concerns regarding public safety.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAcceptance of snake removal or killing when they invade homes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003e\u003cem\u003eWe celebrate \u0026ldquo;Guga Navmi\u0026apos;\u0026apos; (Naag Panchmi- a festival of snakes) so we don\u0026rsquo;t kill snakes.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eIf a snake bites a person and it is killed, then the poison of snake increases in a person bitten and causes death\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTraditional Treatment Approaches\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eMethods of Traditional Healing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eUse of local plants, such as banna (\u003cem\u003eVitex negundo\u003c/em\u003e), and reliance on traditional healers (\u003cem\u003eSori\u003c/em\u003e).\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBelief in efficacy is tied to rituals, such as applying plants at bite sites and the role of gems in drawing out poison.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;We place daali (branch) of banna at the bite site, \u0026amp; if its green leaves turn black, it confirms snake bite. After that vibhuti/jaadibooti/shakkar (soil)is applied at the bite site and the person is made to do panadi (rounds of temple). A soil from naag mandir mixed with water (pyaas) is also used and it is given to drink. It takes 7 to 10 days to heal and a person must visit the temple twice a day. When healing starts the colour of daali becomes less black.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u003cem\u003eWhen mani (gem) is applied at the bite site, it sticks, swells up and sucks out the poison. It takes 4-5 days for this process when mani comes out or falls on its own.\u0026rdquo; After that, the gem is kept in the milk and the poison gets removed.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eTraditional faith healers \u003cstrong\u003eS\u003cem\u003eori\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eperforms \u003cem\u003e\u0026ldquo;A procedure called phaanda, where a herb is placed at the bite site and it dries up if there is poison in the body.\u0026rdquo; Then some mantras are chanted using a branch of banna (Vitex\u0026nbsp;negundo) with a black thread tied a little behind the bite site and it is recited at least 8 to 10 times. Afterward, a small cut/incision is given near the bite site to remove poison in the blood.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eCultural Practices Surrounding Healing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eRituals associated with snakebite, and its recovery, including temple visits and specific dietary restrictions.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003e\u0026ldquo;I\u003cem\u003ef a person gets bitten by a snake, he/she should not be allowed to sleep and salt is restricted to prevent the spread of poison in the body.\u003c/em\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;To confirm whether a victim has been bitten by a snake or not\u003c/em\u003e, \u003cem\u003ewe give back pepper to eat and if one does not feel the spice, they consider it to be a snake bite and treat accordingly.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSnakebite Prevention and First Aid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSnakebite Prevention Practices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eTraditional methods of keeping snakes away from homes include placing ash and onion peels around the perimeter, which are believed to repel snakes.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSome use phenol, locally available herbicide \u003cem\u003eroundup\u003c/em\u003e, and DDT, to deter them from entering the house.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;We use and spread naagni mata mandir shakkar (soil mixed with water) inside and outside houses and in the fields to avoid snakes.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Use mor pankh in our houses and due to this snake don\u0026rsquo;t come within an area of 10-12 km.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;Use mosquito nets for the prevention of snakebites\u003c/em\u003e.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eKnowledge and Practices Related to First Aid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eA tourniquet/bandage at and above the bite site was the most common first aid method reported.\u003c/p\u003e\n \u003cp\u003eThe application of salt, red chilies, ghee, paste of reetha seed, and some local herb at the bite site was also cited by the participants.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;We put an incision and then tie the bite site using a tourniquet\u0026rdquo;\u0026nbsp;\u003c/em\u003estated one of the FGD respondents.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAnother participant said, \u0026ldquo;\u003cem\u003eWe apply a paste made of leaves of the plant called BHERANG after washing the bite site with soap and water, then after 8 to 10 days poison dries up and a person is cured\u003c/em\u003e.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAnother practice was observed in district Chamba, where the bite site was burnt using a hot object (like a coin) made of iron.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;The bite site is scraped with a knife and then matchstick is applied on it and is burnt.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthcare Seeking Behaviour\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ePreference for Traditional vs. Modern Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eExploration of healthcare-seeking behaviour.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003eCommunity members mentioned that \u0026ldquo;\u003cem\u003ethey preferred to visit local traditional faith healers, nagnimata temple or guga temple first and if it\u0026rsquo;s not cured then we visit government hospital\u003c/em\u003e.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eUtilization of Government Healthcare Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 283px;\"\u003e\n \u003cp\u003eExamination of factors influencing hospital use.\u003c/p\u003e\n \u003cp\u003eRespondents preferred government healthcare facilities over private hospitals.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 443px;\"\u003e\n \u003cp\u003eFew of them approached nearby government healthcare facilities directly, as they were aware of the treatment available for snakebite.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Commonly found snakes in the community\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"656\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocal name in the community\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommon name\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScientific name\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToxicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eKhadpa\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eCommon Indian cobra\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cem\u003eNaja naja\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNeurotoxic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eLaman\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eCommon Bronzeback Tree Snake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cem\u003eDendrelaphis tristis\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNon-venomous\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eKodi walasaanp\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eRussell Viper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cem\u003eDaboia russelii\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eHemotoxic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDinna\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eCheckered keelback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cem\u003eFowlea piscator\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNon-venomous\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSaraal\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003ePython\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cem\u003ePython molurus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNon-venomous\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSaldu\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eNorthern White-lipped pit viper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cem\u003eTrimeresurusalbolabris\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eHemotoxic\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eDhai ghadi wala saanp\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 231px;\"\u003e\n \u003cp\u003eCommon Krait\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e\u003cem\u003eBungarus caeruleus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNeurotoxic\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study reveals a limited understanding of the cognitive and affective domains related to snakebite prevention and management among community members in three districts of Himachal Pradesh. It underscores the insufficient knowledge, prevalent misconceptions, and the use of non-scientific methods for snakebite prevention and management within the community. The constructivist paradigm allowed themes to emerge inductively, capturing socially constructed meanings and experiences related to snake bites. The elements of a qualitative approach like phenomenology (exploring lived experiences) and ethnography (focus on community beliefs) were present but did not adhere strictly to a specific and single qualitative research tradition.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat were the common perceptions regarding snakes and bites in the community?\u0026nbsp;\u003c/em\u003eBelief in a snake god, offering them milk, and buttermilk, the ability of mani (gem), and chanting some mantras to reduce the venom effect were some of the superstitions reported in our study, which was also observed in a study conducted in Maharashtra.\u003csup\u003e10\u003c/sup\u003e The traditional knowledge regarding loss of taste following a bite by venomous snakes has a scientific base but needs further exploration as some in view of the available reports.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat do locals do for snake bite prevention?\u0026nbsp;\u003c/em\u003eMost of the people in the study areas were using and practicing different unproven household methods for the prevention of snakebites. They were using bleaching powder, mor pankh, carom seeds, soil from naag temples, and buttermilk. Besides, the use of insecticides like DDT, roundup, and phenol was also seen. There was some awareness of keeping the surroundings clean, using torchlight, and wooden sticks, wearing long plastic boots to work in the fields, and avoiding sleeping on the floor. Wearing long rubber shoes with enclosed toes, and using a mosquito net on a bamboo cot or bed above the ground level to prevent krait and cobra bites has been documented in other studies also\u003csup\u003e11,12,13\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhich treatment is preferred by the community members and why?\u0026nbsp;\u003c/em\u003eThe use of alternative and unproven methods for the treatment of snakebite patients is still followed in many countries including India\u003csup\u003e14,15\u003c/sup\u003e. Most of the snake bite victims and the community were tying a rope or a piece of cloth above the bite site as a tourniquet as a first aid method. The same has been observed in a study done in Myanmar. \u003csup\u003e16\u003c/sup\u003eThere are reports on the use of gems obtained from snakes, and chanting mantras to treat snakebites, but the scientific literature on its therapeutic efficacy is lacking. A study was conducted on mice to determine the therapeutic efficacy of snake stones(gem), but it failed to show any such efficacy. \u003csup\u003e17\u003c/sup\u003e Such remedies being used since antiquity do not have any proven benefit in managing snakebites and it is recommended to avoid traditional first aid methods including black stones and alternative herbal therapy. The knowledge regarding the accurate use of first aid for snakebites was lacking in most of the study participants. In the present study, the community preferred local treatment with reetha seed, salt, red chilies, some local herb paste, and ghee, burning the bite site with a hot iron object, giving incision to reduce the effect of venom, and then approaching the traditional faith healers. The use of tamarind seed was observed in Bhil tribes of Rajasthan\u003csup\u003e18\u003c/sup\u003e. In case the victim does not recover, then only they prefer to transfer the patient to the nearby government healthcare facility. The use of such methods was associated with an increased risk of wound infection and long duration of hospitalization for the management of snakebite victims\u003csup\u003e19,20\u003c/sup\u003e. Therefore, IEC (information, education, and communication) to discard such practices and unproven methods for snakebite treatment, need to be emphasized.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat were the reasons for seeking traditional treatment over allopathic?\u0026nbsp;\u003c/em\u003eThe various reasons for seeking treatment from traditional faith healers could be the strong belief of the community in traditional treatment, inadequate knowledge about the treatment, and associated complications. So, engagement of traditional faith healers and local community representatives for timely referral to the nearby health institution for anti-venom treatment could be leveraged. Similar efforts are ongoing in West Bengal, to engage the traditional faith healers for timely referral to the nearest hospital for anti-venom treatment\u003csup\u003e21\u003c/sup\u003e. Linkages need to be strengthened with community leaders and healthcare providers to gain the confidence of the community for timely referral and anti-venom treatment. Some people preferred going to the government health facilities, as they were aware that treatment for snake bites was available. However, interrupted public transport and ambulance services, scattered locations of hamlets, distantly located health institutions, unavailability of doctors (especially during night hours), and frequent referrals to higher institutions were hindering the community members from seeking the available allopathic treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWhat gaps were identified in healthcare service utilization?\u0026nbsp;\u003c/em\u003eThe availability of trained and experienced healthcare workers in tribal and rural areas is an important aspect of the prevention and control of snakebite cases. In the present study, around three-fourths of the medical officers have managed snake bite cases, and all knew the procedure to perform WBCT. Around 75% of the medical officers were able to differentiate between hemotoxic and neurotoxic bites. The formal training on the management of snakebite was attended by only 50% of the medical officers. The lack of confidence in administering the anti-venom was mainly due to a fear of anaphylaxis reaction and the absence of any formal training. Similar findings were seen in a study among healthcare providers of Dahanu block in Maharashtra.\u003csup\u003e22\u003c/sup\u003e About 20% of the frontline workers (ASHA) were aware of the first aid practices to be followed in snake bite cases, however nearly 60% have received formal training on snake bite prevention and management. This contrasted with the study in Maharashtra where nearly 50% of ASHAs were aware of first aid, although only 5.7% had received formal training on snake bite prevention and management.\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe present study generated evidence to empower the community by increasing awareness of preventing snakebites, first aid, and appropriate treatment-seeking behaviour. The communities affected by snakebites are often those with the least access to healthcare services and treatment. Strengthening information, education, and communication (IEC) efforts, along with improving healthcare access and support, is crucial in reducing the morbidity and mortality associated with snakebites in these vulnerable populations.\u003c/p\u003e\n\u003cp\u003eThe research warrants the development of a sustainable model, with flexible policies to accommodate the region-specific perceptions, community engagement, involvement of herpetologists, forest department officials, \u003cem\u003epanchayat\u003c/em\u003e officials, traditional faith healers, and built resilient health system with trained health care workers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy limitations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe perceptions and awareness about snakebites could be region-specific and may not be representative of the entire community in India. The study\u0026apos;s qualitative approach, while valuable, did not incorporate a follow-up mechanism or quantitative data, which would have provided a more comprehensive understanding of the effectiveness of snakebite management practices. All FGDs and interviews were conducted in the vernacular language (Pahadi and Hindi) and later translated into English. Hence, some interpretations might have been lost in translation.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eI sincerely thank other authors for their valuable insights and expert reviews, which significantly contributed to the development of this protocol. I gratefully acknowledge the dedicated field investigators for their invaluable data collection efforts. A special thank you to the participants, whose openness and insights made this research possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e: There are no conflicts of interest to disclose concerning this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No involvement of any funding source\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThe datasets generated during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003eConsent to Participate: Informed consent obtained from participants\u003c/p\u003e\n\u003cp\u003eConsent to Publish: Obtained from the participants\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRegional Action Plan for prevention and control of snakebite envenoming in South-East Asia 2022\u0026ndash;2030; World Health Organisation\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVaiyapuri S, Vaiyapuri R, Ashokan R, Ramasamy K, Nattamaisundar K, Jeyaraj A, et al. 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Public perceptions of snakes and snakebite management: implications for conservation and human health in southern Nepal. \u003cem\u003eJournal of Ethnobiology and Ethnomedicine\u003c/em\u003e. 2016; 12 (1): 22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKumar A, Raina SK, Raina S. Snakebite profile from a tertiary care setup in a largely rural setting in the hills of North-West India. \u003cem\u003eJ Family Med Prim Care\u003c/em\u003e. 2021 Aug;10(8):2793\u0026ndash;2797.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChauhan N, Thakur A, Raina SK. Preference for habitat contiguity: Geographical characterization of snake bite envenomation in Himachal Pradesh, India. \u003cem\u003eAmrita J Med, in print.\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChauhan N, Raina SK, Gupta R, Kumar D, Chauhan R, Chaudhary A, et al. Development, standardization, and contextualization of qualitative tools for possible use in the assessment and valuation of snakebite envenomation. \u003cem\u003eJ Family Med Prim Care\u003c/em\u003e 2023; 12:1315-9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChaaithanya IK, Abnave D, Bawaskar H, Pachalkar U, Tarukar S, Salvi N, Bhoye P, Yadav A, Mahale SD, Gajbhiye RK. Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar District in Maharashtra, India. \u003cem\u003ePLoS One\u003c/em\u003e. 2021 Aug 5;16(8).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBawaskar HS, Bawaskar PH.\u0026nbsp;Snakebite: simple steps to prevention and reduction of morbidity.\u0026nbsp;\u003cem\u003eLancet\u003c/em\u003e. 2010;375\u0026nbsp;(9717): 805.\u0026nbsp;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodrigo C, Kirushanthan S, Gnanathasan A.\u0026nbsp;Prevention of krait bites by sleeping above ground: preliminary results from an observational pilot study.\u0026nbsp;\u003cem\u003eJ Occup Med Toxicol.\u003c/em\u003e 2017;12: 10.\u0026nbsp;\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMallik S, Singh SR, Sahoo J, Mohanty MK.\u0026nbsp;Mosquito Net: An Underrecognized Protection Measure against Snakebites.\u0026nbsp;\u003cem\u003eInt J Prev Med\u003c/em\u003e. 2017;8: 1\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchioldann E, Mahmood MA, Kyaw MM, Halliday D, Thwin KT, Chit NN, et al.\u0026nbsp;Why snakebite patients in Myanmar seek traditional healers despite the availability of biomedical care at hospitals? 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Community perspectives on reasons.\u0026nbsp;\u003cem\u003ePLoS Negl Trop Dis.\u003c/em\u003e 2018;12\u0026nbsp;(2): e0006299.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichael G, Thacher T, Shehu M.\u0026nbsp;The Effect of Pre-hospital Care for Venomous Snakebite on Outcome in Nigeria.\u0026nbsp;\u003cem\u003eTrans R Soc Trop Med Hyg\u003c/em\u003e. 2011;105(2): 95\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhaumik S. Snakebite: a forgotten problem. \u003cem\u003eBMJ\u003c/em\u003e. 2013;346\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChaaithanya IK, Abnave D, Bawaskar H, Pachalkar U, Tarukar S, Salvi N, Bhoye P, Yadav A, Mahale SD, Gajbhiye RK. Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar District in Maharashtra, \u003cem\u003eIndia. PLoS One\u003c/em\u003e. 2021 Aug 5;16(8): e0255657.\u003c/span\u003e \u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6217248/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6217248/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIndia bears a disproportionate burden of global snakebite deaths, accounting for nearly 50%, yet knowledge and awareness of effective management practices remain critically low. This qualitative study, employing focus group discussions and key informant interviews in rural Himachal Pradesh, India, investigated community perceptions, knowledge, and practices surrounding snakebite envenoming. Thematic analysis revealed that the communities employed a dual healthcare strategy for snakebites, blending traditional healing methods like herbal remedies and faith-based rituals with, or preceding, the use of conventional medical treatments. Awareness of government healthcare did not translate to accurate snakebite treatment knowledge, as ineffective practices like tourniquets and herbal remedies were common. Consequently, the study underscores the necessity for targeted public health interventions to enhance community education, improve access to appropriate medical care, and facilitate the integration of validated traditional practices within a contemporary healthcare framework to mitigate snakebite-related morbidity and mortality.\u003c/p\u003e","manuscriptTitle":"Exploring an Interplay of Sociocultural Contexts and Health Systems in Snakebite Envenoming Management in Rural Himachal Pradesh: A Qualitative Study of Community Perspectives and Practices","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 15:50:48","doi":"10.21203/rs.3.rs-6217248/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"61ffde88-c8d8-4aad-8ade-da07bc1418ed","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-30T10:54:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 15:50:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6217248","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6217248","identity":"rs-6217248","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}