Public Health Midwives' perspectives on paediatric snakebite prevention and management in rural Sri Lanka: A...

Snake envenoming remains a significant yet under-addressed public health issue in rural Sri Lanka, where children face disproportionately severe outcomes. Public Health Midwives (PHMs) serve as trusted community health workers. While they may be well placed to support paediatric snakebite prevention and early response, their actual capacity and role in this regard remain underexplored.

This qualitative study explored PHMs' insights into paediatric snakebite prevention and management in two high-incidence districts-Ampara and Polonnaruwa. A total of 74 PHMs participated in 11 focus group discussions (FGDs) guided by a semi-structured thematic framework. Thematic analysis revealed five major themes. PHMs reported limited awareness of paediatric-specific snakebite risks and described frequent community reliance on traditional beliefs that delayed care. Their first-aid knowledge was often outdated or incomplete, and they lacked practical training. Operational challenges-such as excessive workload, language barriers, and poor infrastructure-limited outreach. Despite these constraints, PHMs expressed strong motivation to engage in prevention through schools and home visits. They proposed feasible solutions including targeted training, improved transport and referral systems, and culturally appropriate health education materials, highlighting their readiness to contribute if supported with system-level interventions.

Public Health Midwives in rural Sri Lanka have potential to reduce paediatric snakebite harm but face key systemic barriers. Effective prevention requires targeted training, supportive tools, and integration into existing services without adding workload. Strengthening PHM capacity through brief educational interventions within primary care systems offers a practical, sustainable approach to improve outcomes in these communities.