02855nas a2200253   4500000000100000008004100001653002800042653003900070653001500109653001400124100001800138700001900156700001900175700001900194700001700213700001400230700001300244245011300257856009800370300001300468490000700481520209900488022001402587       2017                            d10aHealth seeking behavior10aNeglected tropical diseases (NTDs)10aSnakebites10aSri Lanka1 aEdiriweera DS1 aKasturiratne A1 aPathmeswaran A1 aGunawardena NK1 aJayamanne SF1 aLalloo DG1 aSilva HJ00aHealth seeking behavior following snakebites in Sri Lanka: Results of an island wide community based survey.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006073&type=printable  ae00060730 v113 a<p><strong>INTRODUCTION: </strong>Sri Lanka has a population of 21 million and about 80,000 snakebites occur annually. However, there are limited data on health seeking behavior following bites. We investigated the effects of snakebite and envenoming on health seeking behavior in Sri Lanka.</p>

<p><strong>METHODS: </strong>In a community-based island-wide survey conducted in Sri Lanka 44,136 households were sampled using a multistage cluster sampling method. An individual who reported experiencing a snakebite within the preceding 12 months was considered a case. An interviewer-administered questionnaire was used to obtain details of the bite and health seeking behavior among cases.</p>

<p><strong>RESULTS: </strong>Among 165,665 individuals surveyed, there were 695 snakebite victims. 682 (98.1%) had sought health care after the bite; 381 (54.8%) sought allopathic treatment and 301 (43.3%) sought traditional treatment. 323 (46.5%) had evidence of probable envenoming, among them 227 (70.3%) sought allopathic treatment, 94 (29.1%) sought traditional treatment and 2 did not seek treatment. There was wide geographic variation in the proportion of seeking allopathic treatment from &lt;20% in the Western province to &gt; 90% in the Northern province. Multiple logistic regression analysis showed that seeking allopathic treatment was independently associated with being systemically envenomed (Odds Ratio = 1.99, 95% CI: 1.36-2.90, P &lt; 0.001), distance to the healthcare facility (OR = 1.13 per kilometer, 95% CI: 1.09 to 1.17, P &lt; 0.001), time duration from the bite (OR = 0.49 per day, 95% CI: 0.29-0.74, P = 0.002), and the local incidence of envenoming (OR = 1.31 for each 50 per 100,000, 95% CI: 1.19-1.46, P &lt; 0.001) and snakebite (OR = 0.90 for each 50 per 100,000, 95% CI: 0.85-0.94, P &lt; 0.001) in the relevant geographic area.</p>

<p><strong>CONCLUSIONS: </strong>In Sri Lanka, both allopathic and traditional treatments are sought following snakebite. The presence of probable envenoming was a major contribution to seeking allopathic treatment.</p>
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