Toxicon: X最新文献

{"title":"Artemia salina as an animal model for the preliminary evaluation of snake venom-induced toxicity","authors":"Mitchel Otieno Okumu ,&nbsp;James Mucunu Mbaria ,&nbsp;Joseph Kangangi Gikunju ,&nbsp;Paul Gichohi Mbuthia ,&nbsp;Vincent Odongo Madadi ,&nbsp;Francis Okumu Ochola ,&nbsp;Mercy Seroney Jepkorir","doi":"10.1016/j.toxcx.2021.100082","DOIUrl":"10.1016/j.toxcx.2021.100082","url":null,"abstract":"<div><p>Lethality and cytotoxicity assays of snake venoms and their neutralization by antivenom require many mice for the experiments. Recent developments have prompted researchers to seek alternative strategies that minimize the use of mice in line with Russel and Burch's 3Rs philosophy (Replacement, Reduction, and Refinement). <em>Artemia salina</em> is an animal model widely used for toxicity screening. However, its use in snake venom toxinology is limited by a lack of data. The present study compared the toxicity of venoms from <em>Bitis arietans</em>, <em>Naja ashei,</em> and <em>Naja subfulva</em> using mice and <em>Artemia salina.</em> In the <em>Artemia salina</em> test at 24 h and the dermonecrotic test in mice, the toxicity of the venoms was in the order <em>Naja ashei ~ Naja subfulva</em> &gt; <em>Bitis arietans</em>. In the lethality test in mice, the toxicity of the venoms was in the order <em>Naja subfulva</em> &gt; <em>Naja ashei &gt; Bitis arietans</em>. These findings suggest that the toxicity of the venoms in <em>Artemia salina</em> and the dermonecrotic bioassay in mice have a similar trend but differ from the lethality test in mice. Therefore, it may be relevant to further explore the <em>Artemia salina</em> bioassay as a potential surrogate test of dermonecrosis in mice. Studies with more venoms may be needed to establish the correlation between the <em>Artemia salina</em> bioassay and the dermonecrotic assay in mice.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"12 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39392747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the practicalities of joint snakebite and dog rabies control programs: Commonalities and potential pitfalls","authors":"Terence P. Scott ,&nbsp;Sanjib K. Sharma ,&nbsp;Ryan M. Wallace ,&nbsp;Louis H. Nel ,&nbsp;Samir K. Adhikari ,&nbsp;Bernadette Abela-Ridder ,&nbsp;S.M. Thumbi","doi":"10.1016/j.toxcx.2021.100084","DOIUrl":"10.1016/j.toxcx.2021.100084","url":null,"abstract":"<div><p>Both rabies and snakebite primarily affect underserved and impoverished communities globally, with an estimated 200,000 people dying from these diseases annually, and the greatest burden being in Africa and Asia. Both diseases have been neglected and have thus been denied appropriate prioritization, support, and interventions, and face many of the challenges common to all neglected tropical diseases (NTDs). In line with the call for integrated approaches between NTDs in the recent NTD Roadmap, we sought to build upon previous conceptualizations for an integrated approach by identifying the commonalities between snakebite and rabies to explore the feasibility of an integrated approach. While multiple areas for potential integration are identified, we highlight the potential pitfalls to integrating rabies and snakebite programs, considering the nuances that make each disease and its intervention program unique. We conclude that health system strengthening, and capacity building should be the focus of any integrated approach among NTDs, and that by strengthening overall health systems, both rabies and snakebite can advocate for further support from governments and stakeholders.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"12 ","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/15/38/main.PMC8482506.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39496464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local inflammatory mediators alterations induced by Daboia siamensis venom","authors":"Suchitra Khunsap ,&nbsp;Kanyanat Promruangreang ,&nbsp;Sunutcha Suntrarachun ,&nbsp;Jureeporn Noiphrom ,&nbsp;Orawan Khow","doi":"10.1016/j.toxcx.2021.100085","DOIUrl":"10.1016/j.toxcx.2021.100085","url":null,"abstract":"<div><p>The ability of Russell's viper (<em>Daboia siamensis</em>) venom (total RVV) and phospholipase A₂ (purified PLA₂) to induce the local pathological effects were investigated by the local inflammatory events and the release of inflammatory mediators. Both 0.5 μg of total RVV/mouse and 0.15 μg of purified PLA₂/mouse were administered via intra-peritoneal injection. After 30 min, 1 h, 2 h, and 4 h incubation time, the peritoneal cavity was flooded with normal saline and the total leukocytes were collected. The eicosanoids (lipid mediators) and the leukocyte expression of cyclooxygenase (COX-1 and COX-2) were investigated by ELISA assay and western blotting, respectively. The amounts of total leukocytes were increased from 30 min to 2 h, then decreased at 4 h, by both total RVV and purified PLA₂. Both treatments also induced the expression of COX-2 which was increased at 2 h and then decreased at 4 h, whereas only purified PLA₂ induced the expression level of a COX-1 protein which was increased at 30 min, then constantly expressed until 4 h. In addition, total RVV and purified PLA₂ caused the release of the eicosanoids; PGE₂, TXB₂, and LTB₄, which reached the peak after 2 h. The findings of this study indicate that purified PLA₂ has the potential effects to induce the local inflammation relating the amounts of leukocytes cells, lipid mediators and COX-2 more than the total RVV.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"12 ","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d0/cc/main.PMC8517603.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39569202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing a 6-h endpoint observation time in the lethality neutralization assay used to evaluate the preclinical efficacy of snake antivenoms","authors":"Gina Durán,&nbsp;Gabriela Solano,&nbsp;Aarón Gómez,&nbsp;Daniel Cordero,&nbsp;Adriana Sánchez,&nbsp;Mauren Villalta,&nbsp;Melvin Sánchez,&nbsp;Cecilia Díaz,&nbsp;José María Gutiérrez,&nbsp;Guillermo León","doi":"10.1016/j.toxcx.2021.100087","DOIUrl":"10.1016/j.toxcx.2021.100087","url":null,"abstract":"<div><p>The lethality neutralization assay in mice is the gold standard for the evaluation of the preclinical efficacy and specification fulfillment of snake antivenoms. However, owing to the animal suffering involved, this assay is a candidate to be replaced by <em>in vitro</em> alternatives or, at least, improved by the reduction of the number of animals used per experiment, the introduction of analgesia, and the refinement of the test. Since these tests are usually run for 24 or 48 h, one possibility to refine it is to shorten the endpoint observation time of the assay and so limiting the duration of suffering. To assess the effect of this modification of the standard procedure on the analytical properties of the assay, we compared the median lethal dose (LD₅₀) and median effective dose (ED₅₀) values, estimated through observation times of 6, 24 and 48 h. We used African and Latin American snake venoms and several batches of two polyspecific antivenoms. A significant correlation was found between LD₅₀ and ED₅₀ values estimated at the three observation times. Although some LD₅₀ and ED₅₀ values were significantly different at these time points, results of 6 h were robust enough to be used in the characterization of new antivenoms, the verification of specification compliance, and the parallel comparison of formulations. Our observations support the modification of the standard procedures used for assessing neutralizing ability of antivenoms by carrying out the observations at 6 h instead of 24 or 48 h, with the consequent reduction in the suffering inflicted upon mice during these assays. However, the shortening of the observation time in the lethality tests must be validated for each venom and antivenom before its introduction in the routine procedures.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"12 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8634039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39710313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting co-existence between humans and venomous snakes through increasing the herpetological knowledge base","authors":"Anita Malhotra ,&nbsp;Wolfgang Wüster ,&nbsp;John Benjamin Owens ,&nbsp;Cameron Wesley Hodges ,&nbsp;Allwin Jesudasan ,&nbsp;Gnaneswar Ch ,&nbsp;Ajay Kartik ,&nbsp;Peter Christopher ,&nbsp;Jose Louies ,&nbsp;Hiral Naik ,&nbsp;Vishal Santra ,&nbsp;Sourish Rajagopalan Kuttalam ,&nbsp;Shaleen Attre ,&nbsp;Mahmood Sasa ,&nbsp;Carlos Bravo-Vega ,&nbsp;Kris A. Murray","doi":"10.1016/j.toxcx.2021.100081","DOIUrl":"10.1016/j.toxcx.2021.100081","url":null,"abstract":"<div><p>Snakebite incidence at least partly depends on the biology of the snakes involved. However, studies of snake biology have been largely neglected in favour of anthropic factors, with the exception of taxonomy, which has been recognised for some decades to affect the design of antivenoms. Despite this, within-species venom variation and the unpredictability of the correlation with antivenom cross-reactivity has continued to be problematic. Meanwhile, other aspects of snake biology, including behaviour, spatial ecology and activity patterns, distribution, and population demography, which can contribute to snakebite mitigation and prevention, remain underfunded and understudied. Here, we review the literature relevant to these aspects of snakebite and illustrate how demographic, spatial, and behavioural studies can improve our understanding of why snakebites occur and provide evidence for prevention strategies. We identify the large gaps that remain to be filled and urge that, in the future, data and relevant metadata be shared openly via public data repositories so that studies can be properly replicated and data used in future meta-analyses.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"12 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/86/b4/main.PMC8426276.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39416934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analgesic potential of different available commercial brands of botulinum neurotoxin-A in formalin-induced orofacial pain in mice","authors":"Thays Crosara Abrahão Cunha ,&nbsp;Ana Claudia Gontijo Couto ,&nbsp;Eduardo Januzzi ,&nbsp;Rafael Tardin Rosa Ferraz Gonçalves ,&nbsp;Graziella Silva ,&nbsp;Cassia Regina Silva","doi":"10.1016/j.toxcx.2021.100083","DOIUrl":"10.1016/j.toxcx.2021.100083","url":null,"abstract":"<div><p>The use of botulinum neurotoxin-A (BoNT-A) is an alternative for the management of orofacial pain disorders. Although only Botox has labeled, there are other commercial brands available for use, among them: Dysport, Botulift, Prosigne, and Xeomin. The objective of the present study was to evaluate the possible differences in the antinociceptive effect evoked by different commercially available formulations of BoNT-A in an animal model of inflammatory orofacial pain induced by formalin injection. Male C57/BL6 mice (20–25 g) were submitted to the pre-treatment with five different commercial brands of BoNT-A (Botox, Botulift, Xeomin, Dysport, or Prosigne; with doses between 0.02 and 0.2 Units of Botulinum Toxin, in 20 μL of 0.9% saline) three days prior the 2% formalin injection. All injections were made subcutaneously into the right perinasal area. After formalin injections, nociceptive behaviors like rubbing the place of injection were quantified during the neurogenic (0–5 min) and inflammatory (15–30 min) phases. The treatment using Botox, Botulift, and Xeomin were able to induce antinociceptive effects in both phases of the formalin-induced pain animal model, however, Dysport and Prosigne reduced the response in neither of them. Our data suggest that the treatment using different formulations of BoNT-A is not similar in efficacy as analgesics when evaluated in formalin-induced orofacial pain in mice.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"12 ","pages":"Article 100083"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39420653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review of current practices on community engagement in rural East Africa: Recommendations for snakebite envenoming","authors":"Bethany Moos ,&nbsp;David Williams ,&nbsp;Isabelle Bolon ,&nbsp;Denise Mupfasoni ,&nbsp;Bernadette Abela-Ridder ,&nbsp;Rafael Ruiz de Castaneda","doi":"10.1016/j.toxcx.2021.100073","DOIUrl":"10.1016/j.toxcx.2021.100073","url":null,"abstract":"<div><p>Community empowerment and engagement is one of the four strategic aims highlighted in the WHO strategy to prevent and control snakebite envenoming. Inappropriate health-seeking behaviours contribute to adverse outcomes, and community engagement is key in driving behavioural change. WHO has highlighted East Africa as a geographical area of concern for snakebite envenoming. The overall aim of the project is to develop a community engagement toolkit for snakebite envenoming and other NTDs. The objective of this scoping review was to identify current practices in recent community engagement in rural East Africa; the applicability of these results to snakebite envenoming are discussed. <em>PubMed, Web of Science</em>, <em>PsycINFO</em> and <em>Google Scholar</em> were searched from 1 January 2017 to 3 September 2020. Search terms were used to identify publications which related to rural communities and health or disease, for both humans and animals. After reviewing the full papers for all geographical areas, 112 publications were included, 30 of which were conducted in East Africa. Papers included nine different countries and covered a broad range of health topics; notably, water, sanitation and hygiene, nutrition, and maternal and child health. Only one publication considered animal health. The most common form of engagement was in the context of a group meeting, lecture, presentation, discussion or question and answer session (63.3%). A variety of locations within the community were used to engage with people, the most common being an individual's household (23.3%). Communication factors was the key influencer for engagement, both positively and negatively. Key barriers to engagement include local languages and health beliefs, literacy levels, mobile phone ownership and the level of mobile Internet coverage, burden of agricultural work and weather conditions. This study provides an extensive overview of recent public health community engagement in East Africa, which will serve as a useful resource for any group seeking to plan an intervention in remote and rural areas in East Africa. Furthermore, it serves as a guide to help tailor community engagement to snakebite envenoming.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"11 ","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39303385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the global snakebite crisis with geo-spatial analyses – Recent advances and future direction","authors":"Anna F.V. Pintor ,&nbsp;Nicolas Ray ,&nbsp;Joshua Longbottom ,&nbsp;Carlos A. Bravo-Vega ,&nbsp;Masoud Yousefi ,&nbsp;Kris A. Murray ,&nbsp;Dileepa S. Ediriweera ,&nbsp;Peter J. Diggle","doi":"10.1016/j.toxcx.2021.100076","DOIUrl":"10.1016/j.toxcx.2021.100076","url":null,"abstract":"<div><p>Venomous snakebite is a neglected tropical disease that annually leads to hundreds of thousands of deaths or long-term physical and mental ailments across the developing world. Insufficient data on spatial variation in snakebite risk, incidence, human vulnerability, and accessibility of medical treatment contribute substantially to ineffective on-ground management. There is an urgent need to collect data, fill knowledge gaps and address on-ground management problems. The use of novel, and transdisciplinary approaches that take advantage of recent advances in spatio-temporal models, ‘big data’, high performance computing, and fine-scale spatial information can add value to snakebite management by strategically improving our understanding and mitigation capacity of snakebite. We review the background and recent advances on the topic of snakebite related geospatial analyses and suggest avenues for priority research that will have practical on-ground applications for snakebite management and mitigation. These include streamlined, targeted data collection on snake distributions, snakebites, envenomings, venom composition, health infrastructure, and antivenom accessibility along with fine-scale models of spatio-temporal variation in snakebite risk and incidence, intraspecific venom variation, and environmental change modifying human exposure. These measures could improve and ‘future-proof’ antivenom production methods, antivenom distribution and stockpiling systems, and human-wildlife conflict management practices, while simultaneously feeding into research on venom evolution, snake taxonomy, ecology, biogeography, and conservation.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"11 ","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39320203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation","authors":"Romain Duda ,&nbsp;Wuelton M. Monteiro ,&nbsp;Tamara Giles-Vernick","doi":"10.1016/j.toxcx.2021.100077","DOIUrl":"10.1016/j.toxcx.2021.100077","url":null,"abstract":"<div><p>The WHO has identified the goal of halving deaths and disability from snakebite envenomation (SBE) by 2030 through a four-pillar program that promotes accessible and affordable treatments, strengthens health systems, promotes community and multi-level engagement, and mobilizes partnerships, coordination and resources to advocate for global action. This initiative could accelerate multi-disciplinary research and action in central Africa, a “hotspot” for SBE, but it offers little specific guidance about anthropological research to be conducted. This commentary develops that research agenda. It surveys anthropological, ethnohistorical investigations in the central African forest to elaborate the socio-cultural and historical significance and practices around snakes and snakebites. It draws from south and southeast Asian and Latin American literatures to illustrate anthropological contributions to SBE research. It then outlines a Central African research agenda employing ethnobiological investigation of snake ecologies, participatory evaluations of humans-snake contacts, and interviews and participant-observation of local prevention and treatment practices and knowledge. This research will co-develop policies and practices with forest communities and leaders and regional and national authorities to reduce the burden of SBE.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"11 ","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.toxcx.2021.100077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39303383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delays, fears and training needs: Perspectives of health workers on clinical management of snakebite revealed by a qualitative study in Kitui County, Kenya","authors":"Kieran Barnes ,&nbsp;Cecelia Ngari ,&nbsp;Stanley Parkurito ,&nbsp;Leo Wood ,&nbsp;Denis Otundo ,&nbsp;Robert Harrison ,&nbsp;George O. Oluoch ,&nbsp;Anna Trelfa ,&nbsp;Clare Baker","doi":"10.1016/j.toxcx.2021.100078","DOIUrl":"10.1016/j.toxcx.2021.100078","url":null,"abstract":"<div><p>Key aims of the WHO Strategy to halve snakebite morbidity and mortality include health system strengthening and training of health workers. This requires knowledge of local health system needs and capacity, health worker training needs, and factors influencing health worker decision-making in snakebite management. This study explored health worker experiences and perceptions of snakebite management, both individually and in the context of their local health system.</p><p>We used a qualitative study design with semi-structured interviews (n = 14) and focus group discussions (n = 4). We employed a combination of sampling strategies aiming to achieve maximum variation among key informants within resource limitations. We recruited health workers (n = 33) of varying roles from purposively selected tier 2, 3 and 4 health facilities (n = 12) and the community (tier 1) in four sub-counties in Kitui County, Kenya. We conducted inductive thematic analysis of all transcripts.</p><p>The results identified that health workers recognised snake envenoming as a time-critical emergency in which delay in care seeking, sometimes exacerbated by health system referral delays, was a major barrier to effective management of patients. Clinicians strongly voiced a need for training in snakebite management, diagnosis and antivenom administration. Unexpressed needs for training were demonstrated in traditional remedy ineffectiveness, syndromic management, and critical appraisal of treatment effectiveness. Under-resourcing in antivenom, other medication, equipment, infrastructure and staffing also challenged management. Fear of snakebite and fear of antivenom, both linked to past experiences, influenced clinical decision-making.</p><p>Our findings clearly indicate a need in Kitui County for training programmes that equip health workers for clinical decision-making in snakebite management. We further identify community intervention needs to facilitate prompt presentation to healthcare, including practical affordable transport solutions, and systematic health system resourcing needs. In addition, we recommend supportive supervision and further research in response to the emotional stress resulting from managing difficult cases in under-resourced settings.</p></div>","PeriodicalId":37124,"journal":{"name":"Toxicon: X","volume":"11 ","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/43/main.PMC8350493.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39320202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}