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Fulltext Knowledge assessment of snake antivenom among healthcare practitioners involving educational intervention in northern Nigeria: a study protocol

Bala AA, Jatau AI, Yunusa I, Mohammed M, Mohammed AH, Isa AM, et al.

Ther Adv Drug Saf, 2020;11:2042098620935721.
PMID: 32944213 DOI: 10.1177/2042098620935721

Introduction: Snakebite envenoming (SBE) is an important occupational and public health hazard especially in sub-Saharan Africa. For optimum management of SBE, adequate knowledge of Snake antivenom (SAV) is very critical among the healthcare practioners in this region. Information related to the knowledge of SAV use in the management of SBE, as well as SAV logistics is scarce among the Health Care Professionals (HCPs) in Nigeria, particularly in the northern region. We therefore aimed to develop, validate and utilize a tool to assess the SAV knowlegde among HCPs in northern Nigeria. We also sought to implement and evaluate an intervention that could improve the SAV knowledge among the HCPs.
Methods: The proposed study will be conducted in three phases: Phase I will involve the development of the item-pool to be included in the tool, followed by a face, content validity and construct validity. The tool reliability, readability and difficulty index will be determined. Phase II will involve the utilization of the tool to assess baseline SAV knowledge among the HCPs followed by an educational intervention. Multiple Linear Regression analysis will be used to determine the factors associated with SAV knowledge among the HCPs. Lastly, Phase III which will be a repeat of Phase II to assess and evaluate the knowledge after the intervention.
Discussion: The study design and findings may guide future implementation and streamline the intervention of improving SAV knowledge in HCPs training and practice.
Lay Summary: Knowledge assessment and educational intervention of snake antivenom among healthcare practitioners in northern Nigeria: a study protocol Snakebite envenoming (SBE) is an important occupational and public health hazard especially in sub-Saharan Africa. For optimum management of SBE, adequate knowledge of snake antivenom (SAV) is very critical among the healthcare practitioners. The baseline knowledge SAV dosage, mode of administration, availability, and logistics is very relevant among healthcare professionals, particularly those that are directly involved in its logistics. It is paramount that SAV is handled and used appropriately. The efforts and advocacy for the availability for more SAV will be in vain if not handled appropriately before they are used. This study protocol aims to develop a tool, to assess SAV knowledge and effects of educational interventions among healthcare professionals (HCPs) in northern Nigeria. This protocol suggests conducting studies in three phases: (a) Development and validation of SAV knowledge assessment tool, (b) Baseline assessment of SAV knowledge assessment tool among HCPs, and (c) Development, implementation and evaluation of an educational intervention to improve SAV knowledge among HCPs in northern Nigeria.
Fulltext Development and validation of antisnake venom knowledge assessment tool (AKAT) for healthcare practitioners

Bala AA, Jatau AI, Yunusa I, Mohammed M, Mohammed AH, Isa AM, et al.

Toxicon X, 2020 Dec;8:100064.
PMID: 33319211 DOI: 10.1016/j.toxcx.2020.100064

Antisnake venom (ASV) is the only specific and standard treatment for snakebite envenoming worldwide. The knowledge of antivenom dosage, mode of administration, availability, and logistics is essential to the healthcare practitioners (HCPs) in the management of snakebites. It is vital for the HCPs involved in the handling of ASVs to have its basic knowledge. The ASV contains proteins and can, therefore, easily get denatured if not handled appropriately, leading to poor therapeutic outcome. It is also essential for clinicians to be aware of the tendency of ASV to cause a severe life-threatening hypersensitivity reaction. There is currently no validated tool for assessing the knowledge of ASV among HCPs. Therefore, we developed and validated a tool for evaluating the HCPs knowledge of ASV. The items included in the tool were first generated from a comprehensive literature review. Face validity were conducted by presenting the drafted tool to ten experts on the subject matter. A validation study was conducted among doctors, pharmacists, nurses, pharmacy technicians, and the general public. The objectives of the study were to test the tool for content validity using the content validity index (CVI), construct validity using contrast group approach, difficulty index, readability, and reliability test using the test-retest method. We developed and validated a final tool containing thirty-three items. The tool was valid for face validity and had a scale-level (average) content validity (S-CVI/Ave) of 0.91. The ASV knowledge of pharmacists was higher than that of doctors, pharmacy technicians, nurses, and the general public (p
Fulltext Knowledge assessment of anti-snake venom among healthcare practitioners in northern Nigeria

Bala AA, Jatau AI, Yunusa I, Mohammed M, Mohammed AH, Isa AM, et al.

Ther Adv Infect Dis, 2021 08 19;8:20499361211039379.
PMID: 34434552 DOI: 10.1177/20499361211039379

Introduction: Anti-snake venom (ASV) is the standard therapy for the management of snakebite envenoming (SBE). Therefore, the knowledge of ASV among healthcare practitioners (HCPs) is essential for achieving optimal clinical outcomes in snakebite management. This study aimed to assess knowledge of ASV among the HCPs in northern Nigeria.
Methods: We conducted a cross-sectional study involving eligible HCPs from different healthcare settings in northern Nigeria. The participants were recruited into the study using a combination of online (via Google Form) and face-to-face paper-based survey methods. The ASV knowledge of the respondents was measured using a validated anti-snake venom knowledge assessment tool (AKAT). Inadequate overall knowledge of ASV was defined as scores of 0-69.9%, and 70-100% were considered adequate overall knowledge scores. The predictors of ASV knowledge were determined using multiple logistic regression.
Results: Three hundred and thirty-one (331) eligible HCPs were included in the study analysis (310 from online and 21 from paper-based survey). Overall, an estimated 12.7% of the participants had adequate knowledge of ASV. Adequate ASV knowledge was higher among physicians compared with other HCPs (21.7%; χ2 = 8.1; p = 0.04). Those without previous training on ASV (adjusted odds ratio [aOR], 0.37; 95% confidence interval [CI], 0.18-0.73; p = 0.004) and who have not previously administered/dispensed ASV (aOR, 0.31; 95% CI, 0.15-0.63; p
Fulltext Non-compartmental toxicokinetic studies of the Nigerian Naja nigricollis venom

Bala AA, Malami S, Muhammad YA, Kurfi B, Raji I, Salisu SM, et al.

Toxicon X, 2022 Jun;14:100122.
PMID: 35402895 DOI: 10.1016/j.toxcx.2022.100122

Snakebite envenoming (SBE) is a neglected public health problem, especially in Asia, Latin America and Africa. There is inadequate knowledge of venom toxicokinetics especially from African snakes. To mimic a likely scenario of a snakebite envenoming, we used an enzyme-linked immunosorbent assay (ELISA) approach to study the toxicokinetic parameters in rabbits, following a single intramuscular (IM) administration of Northern Nigeria Naja nigricollis venom. We used a developed and validated non-compartmental approach in the R package PK to determine the toxicokinetic parameters of the venom and subsequently used pharmacometrics modelling to predict the movement of the toxin within biological systems. We found that N. nigricollis venom contained sixteen venom protein families following a mass spectrometric analysis of the whole venom. Most of these proteins belong to the three-finger toxins family (3FTx) and venom phospholipase A2 (PLA2) with molecular weight ranging from 3 to 16 kDa. Other venom protein families were in small proportions with higher molecular weights. The N. nigricollis venom was rapidly absorbed at 0.5 h, increased after 1 h and continued to decrease until the 16th hour (Tmax), where maximum concentration (Cmax) was observed. This was followed by a decrease in concentration at the 32nd hour. The venom of N. nigricollis was found to have high volume of distribution (1250 ± 245 mL) and low clearance (29.0 ± 2.5 mL/h) with an elimination half-life of 29 h. The area under the curve (AUC) showed that the venom remaining in the plasma over 32 h was 0.0392 ± 0.0025 mg h.L-1, and the mean residence time was 43.17 ± 8.04 h. The pharmacometrics simulation suggests that the venom toxins were instantly and rapidly absorbed into the extravascular compartment and slowly moved into the central compartment. Our study demonstrates that Nigerian N. nigricollis venom contains low molecular weight toxins that are well absorbed into the blood and deep tissues. The venom could be detected in rabbit blood 48 h after intramuscular envenoming.
Pre-clinical efficacy of African medicinal plants used in the treatment of snakebite envenoming: A systematic review

Bala AA, Mohammed M, Umar S, Ungogo MA, Al-Kassim Hassan M, Abdussalam US, et al.

Toxicon, 2023 Mar 01;224:107035.
PMID: 36706926 DOI: 10.1016/j.toxicon.2023.107035

The World Health Organization has listed Snakebite Envenoming (SBE) as a priority neglected tropical disease, with a worldwide annual snakebite affecting 5.4 million people and injuring 2.7 million lives. In many parts of rural areas of Africa and Asia, medicinal plants have been used as alternatives to conventional antisnake venom (ASV) due in part to inaccessibility to hospitals. Systemic reviews (SR) of laboratory-based preclinical studies play an essential role in drug discovery. We conducted an SR to evaluate the relationship between interventional medicinal plants and their observed effects on venom-induced experiments. This SR was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Modified collaborative approach to meta-analysis and review of animal data from experimental studies (CAMARADES) and SYRCLE's risk of bias tools were used to appraise the included studies. Data were searched online in Medline via PubMed, Embase via OVID, and Scopus. Studies reporting in vivo and in vitro pharmacological activities of African medicinal plants/extracts/constituents against venom-induced pathologies were identified and included for screening. Data from the included studies were extracted and synthesized. Ten studies reported statistically significant percentage protection (40-100%) of animals against venom-induced lethality compared with control groups that received no medicinal plant intervention. Sixteen studies reported significant effects (p ≤ 0.05) against venom-induced pathologies compared with the control group; these include hemolytic, histopathologic, necrotic, and anti-enzymatic effects. The plant family Fabaceae has the highest number of studies reporting its efficacy, followed by Annonaceae, Malvaceae, Combretaceae, Sterculiaceae, and Olacaceae. Some African medicinal plants are preclinically effective against venom-induced lethality, hematotoxicity, and cytotoxicity. The evidence was extracted from three in vitro studies, nine in vivo studies, and five studies that combined both in vivo and in vitro models. The effective plants belong to the Fabaceae family, followed by Malvaceae, and Annonaceae.