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Healthcare 2022, 10, 2226. https://doi.org/10.3390/healthcare10112226 www.mdpi.com/journal/healthcare
Article
Knowledge and Attitude of First-Aid Treatments for
Snakebites, and the Perception of Snakes among the Students
of Health Sciences at Jazan University, Saudi Arabia
Saad S. Alqahtani 1,2,*, David Banji 2,3,*, Otilia J. F. Banji 1,2, Mamoon H. Syed 1,2, Nabeel Kashan Syed 1,2,
Abdulkarim M. Meraya 1,2, Ahmed A. Albarraq 1,2, Hilal A. Thaibah 1,2, Amani Khardali 1,2, Ibrahim A. Alhomood 2,
Aeshah M. Mahzari 2 and Omaymah M. Alshlali 2
1 Department of Pharmacy Practice, College of Pharmacy, Jazan University,
Jazan 45142, Saudi Arabia
2 Pharmacy Practice Research Unit, College of Pharmacy, Jazan University,
Jazan 45142, Saudi Arabia
3 Department of Pharmacology & Toxicology, College of Pharmacy, Jazan University,
Jazan 45142, Saudi Arabia
* Correspondence: ssalqahtani@jazanu.edu.sa (S.S.A.); dbanji@jazanu.edu.sa (D.B.)
Abstract: First aid is the most basic and life-saving service provided before emergency care is re-
ceived. This study aimed to assess students’ knowledge and attitudes about performing first aid for
snakebite emergencies and their perception of snakes. A cross-sectional study was conducted be-
tween January and March 2019 among upper-level students (3rd year and above) of health-related
courses at Jazan University, Saudi Arabia. Three hundred and nine students from four programs
responded to the self-administered questionnaire. The collected data were analyzed using SPSS
23.0. The highest percentage of the study sample comprised pharmacy students (44%), followed by
nursing (25.2%), medical (16.8%), and emergency medicine students (13.9%). Overall, the emer-
gency medicine students exhibited greater knowledge of snakebite first aid. However, over three-
fourths of the students were unaware of dry bites. Around two-thirds were sure that they should
not massage the bite site, while nearly one-fourth were not sure about the use of a tourniquet. The
fifth- and sixth-year students had extremely diverse perspectives on snakes. The majority of the
participants (92.8%) did not feel good about snakes. However, most of the students (95.2%) wanted
to learn about snakebite first aid and overcome their fear of snakes. Overall, the students had a
positive attitude towards first aid but lacked knowledge of snakebite emergencies. Public health
awareness is required to dispel first-aid myths about snakebites and misconceptions regarding
snakes.
Keywords: snakebite; first aid; students; venomous; perception; Saudi Arabia
1. Introduction
First aid is instant care given to the affected person before medical help arrives [1]
The main goal of first aid is to prevent deterioration, promote recovery, and save lives.
The rapidity with which first aid is provided is crucial for the survival of the individual
[2]. Snakebites are rare in urban regions but rampant in rural areas of Saudi Arabia [3]
and could occur when accidentally stepping on a snake while walking in the countryside,
working in the fields, or playing on the grass. Snakes are of two types—venomous and
non-venomous. Even though their appearance might seem the same to the victim, their
outcome differs; one induces harm by injecting its venom into the body, while the other
only frightens the victim. In both cases, first aid is a life-saving service [4].
Citation: Alqahtani, S.S.; Banji, D.;
Banji, O.J.F.; Syed, M.H.; Syed, N.K.;
Meraya, A.M.; Albarraq, A.A;
Thaibah, H.A.; Khardali, A.;
Alhomood, I.A.; et al. Knowledge
and Attitude of First-Aid Treatments
for Snakebites, and the Perception
of Snakes among the Students of
Health Sciences at Jazan
University, Saudi Arabia.
Healthcare 2022, 10, 2226.
https://doi.org/10.3390/
healthcare10112226
Academic Editor: Edberdt B. Hsu
Received: 1 September 2022
Accepted: 1 November 2022
Published: 7 November 2022
Publisher’s Note: MDPI stays neu-
tral with regard to jurisdictional
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tional affiliations.
Copyright: © 2022 by the authors. Li-
censee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and con-
ditions of the Creative Commons At-
tribution (CC BY) license (https://cre-
ativecommons.org/licenses/by/4.0/).
Healthcare 2022, 10, 2226 2 of 14
More than 3500 species of snakes exist worldwide, of which around 17% are venom-
ous, causing an annual death toll between 20,000 and 125,000. In addition, thousands de-
velop chronic disabilities, such as amputation and blindness [5,6]. Snakebite incidence
varies widely across geographical regions, but accurate estimates are difficult to obtain
due to insufficient documentation by healthcare practitioners and health facilities, lack of
collation of cases by central health authorities, and lack of formal documentation among
traditional healers [1,5].
Human–snake interactions have always resulted in negative outcomes for humans
and snakes alike. As far as agriculture workers are concerned, snakebites are emerging as
an occupational hazard [7]. If anyone is bitten by a venomous or suspected venomous
snake, it is vital to transport the affected person to the hospital as quickly as possible. The
Hemotoxins in snake venom can have deleterious effects on the circulatory system, usu-
ally by attacking the body’s clotting capabilities. In cases of cytotoxic envenoming, there
is usually painful swelling at the site, progressive blistering, and bruising, leading to lo-
calized tissue damage if left untreated [8–10]. First aid for snakebites delays the systemic
absorption and the spread of the venom while transporting the victim to a nearby hospital
for adequate treatment [11,12].
Despite their disrepute, snakes contribute to biodiversity and are an essential part of
natural ecosystems [13]. The ecological value of snakes is now recognized, as they are
crucial in reducing the number of rodents, which spread disease and destroy crops [14].
More importantly, the venom of a variety of snakes has medicinal qualities. The anti-tu-
mor effects of some snake venoms [15] have been examined in addition to their anti-bac-
terial and pain-relieving properties. Hemotoxins have been used to treat heart attacks and
blood diseases. The neurotoxins in snake venom are utilized to develop treatments for
Alzheimer’s disease, Parkinson’s disease, stroke, and brain trauma [11,12,16,17]. As a re-
sult, not only do snakes play a vital role in nature, but they are also very important to
humans due to the medical relevance of their venom. Apart from their use in producing
anti-venom, snake venoms are a rich source of enzymes, peptides, and proteins with sig-
nificant pharmacological activities [18]; hence, people’s attitudes toward them should
change.
In Saudi Arabia, most snakebites are reported by agricultural and desert dwellers.
These dwellers have limited access to medical care. In addition, students attending health-
related courses at Jazan University come from distant parts of the province. They can be
trained to be first-aid providers in areas where medical care is not easily accessible, as well
as to educate and impart knowledge about the significance of snakes in nature. Students
of health-related courses can change the health scenario of society if they are properly
trained. However, they need to have basic skills and knowledge to minimize the injuries
that are due to snakebites and save lives. Hence, the current study was undertaken to
assess the knowledge and attitudes of upper-level students (3rd year and above) of health-
related courses at Jazan University on performing first aid for snakebite emergencies and
their perception of snakes.
2. Materials and Methods
The study was designed to assess the knowledge of handling snakebite emergencies
and the attitudes while providing first aid, as well as students’ perceptions of snakes
among medical, pharmacy, emergency medicine, and nursing students at Jazan Univer-
sity, which is a public university located in the Jazan province. Jazan province is one of
the 13 provinces in Saudi Arabia, and it is located in the southwest region of the country
[19].
Healthcare 2022, 10, 2226 3 of 14
2.1. Inclusion and Exclusion Criteria
To be included in this study, the participants had to be senior students (third year
and above) in the medical, pharmacy, nursing, or emergency medicine of applied medi-
cine colleges of Jazan University. Students who were in their first and second years of
college or who returned incomplete questionnaires were not included in the study.
2.2. Study Design
This present study was descriptive, cross-sectional, and questionnaire-based, which
employed convenience sampling to recruit participants from the health science colleges
of Jazan University, Saudi Arabia. The participants included students studying in their
third or higher year of the medical, pharmacy, nursing, and medical emergency programs
of applied medicine at Jazan University. The study was conducted from January 2019 to
March 2019.
2.3. Study Questionnaire
The items in the questionnaire were designed based on the management of snake-
bites, the general awareness of snakes in the surrounding area, and the general perception
of snakes [20,21]. The questionnaire met all of the first-aid requirements outlined by the
WHO protocol for treating snakebites [22]. After its preparation, the questionnaire was
sent to three experts, one each from the College of Medicine, the College of Nursing, and
the College of Emergency Medicine, to verify the content and face validity of the ques-
tionnaire. After that, the questionnaire was translated into Arabic by a professional expert.
At the end, the Arabic version of the questionnaire was forward–backward translated to
confirm its correctness and uniformity across the languages. The internal consistency of
the different sections of the questionnaire was evaluated by the Cronbach’s alpha coeffi-
cient, where a value of 0.7 and above was considered satisfactory [23–25]. The Cronbach’s
alpha values of 0.82, 0.87, and 0.84 for the knowledge, attitudes, and perception questions
indicated excellent internal consistency. The pilot testing of the questionnaire was per-
formed on a focus group of fifteen students, who were not included in the final analysis
[26], and the suggestions received were discussed among all of the authors and incorpo-
rated into the final version of the questionnaire.
The questionnaire comprised 34 items, which were divided into two main sections.
The first section included 5 questions pertaining to the participants’ demographic charac-
teristics (gender, age, college, and year of study). The last question in this section was
close-ended (“Yes”/”No”) and asked the respondents if they had received any training for
snakebite management.
The second section of the questionnaire was further divided into 5 sub-sections. The
first sub-section comprised 19 close-ended (“Yes”/”No”, “I Don’t Know”) questions re-
lated to the first-aid knowledge of snakebite emergencies, the identification of venomous
and non-venomous snakes, and the immediate response to snakebites. The second sub-
section tested the attitudes of the respondents with 6 close-ended (“Yes”/”No”, “I Don’t
Know”) questions. Each item represented the individual’s attitude in a specific situation
described by the statement. For the knowledge and attitudes sub-sections, the Bloom cut-
off point [24,27] was employed to determine the level of knowledge or attitude, where
>80% of correct responses were considered “Good”, 60% to 80% were considered “Mod-
erate”, and <60% were deemed “Poor”. For each correct answer, the response was coded
as 1, and an incorrect/I don’t know response was coded as 0. For the negative questions,
a correct response (“No”) was coded as 1, and an incorrect response (“Yes” or “I Don’t
Know”) was coded as 0.
The third sub-section included a single question on a 5-point Likert scale, which re-
quired the respondents to state the extent of their fear of snakes in the wild. The fourth
and fifth sub-sections pertained to the perception of health science students’ perceptions
towards encountering different types of snakes. We asked the respondents to indicate
Healthcare 2022, 10, 2226 4 of 14
what action they would take if they encountered snakes in the wild and in their home or
yard, respectively. The snakes were categorized as large venomous, small venomous,
large non-venomous, and small non-venomous.
The last sub-section included a single open-ended question eliciting different meth-
ods or approaches the respondents believed would increase their support or respect for
snakes. Based on the open-ended responses received, we grouped them under 7 catego-
ries.
2.4. Data Collection
For ease of data collection, the Arabic version of the questionnaire was entered onto
Google Forms. Convenience sampling was used for the participant recruitment. The
online questionnaire link was then sent as an email and through various student groups.
The questionnaire link was accompanied by an invitation for all upper-level male and
female students to participate in the study, who were also requested to forward it to their
fellow students in their course.
The first page of the online version of the questionnaire informed the respondents of
the background and objectives of the study. It was clearly mentioned that participation in
the survey was completely voluntary and that the respondents were free to withdraw at
any time they wanted. The respondents were also informed that all of their responses
would remain confidential and anonymous and that the data generated from the study
would only be used for scientific purposes. The inclusion criteria were also mentioned to
ensure appropriate participation and they had to agree to the informed consent in order
to proceed to the other sections of the questionnaire [26,28,29].
2.5. Statistical Analysis
The data from the Google Forms were first entered into Microsoft Excel and then
exported to the Statistical Package for Social Sciences, Version 23.0 (SPSS 23.0) for further
analysis. The participants’ demographics were analyzed using descriptive statistics,
which were then expressed as frequencies and total percentages. The significant associa-
tions between the variables were assessed using the Pearson’s chi-square test. The level of
significance was set at p < 0.05.
2.6. Ethical Considerations
The study was conducted according to the ethical considerations of the university,
which was in line with the Declaration of Helsinki. This research protocol was reviewed
and approved by the institutional ethics committee of Jazan University; approval number
REC41/1-053. In addition, consent was obtained from the study subjects prior to answer-
ing the questionnaire.
3. Results
3.1. Internal Consistency Measures: Cronbach’s Alpha
The reliability of the different sections of the questionnaire was assessed using the
Cronbach’s alpha coefficient, which measures the internal consistency; the results are
shown in Table 1. The alpha coefficients for all of the sections of the questionnaire were
found to be greater than 0.82 (i.e., above the 0.70 threshold), indicating an excellent degree
of internal consistency and reliability of the developed questionnaire. The reliability stud-
ies were carried out on the pilot sample, which was subsequently deleted from the final
analysis [24].
Healthcare 2022, 10, 2226 5 of 14
Table 1. Reliability Analysis.
Section Cronbach’s Alpha
Knowledge about snakebite first-aid management 0.83
Attitude about first-aid management and snakes 0.87
Perception towards encountering types of snakes in the wild, home/yard 0.84
Table 2 summarizes the description of the sample, with more males (55%) than fe-
males responding to the questionnaire. Most of the respondents (86.4%) were within the
age group between 20 and 25 years, followed by respondents over 25 years (8.1%), while
those below 20 years were only 5.5%. Most of the respondents were undertaking the phar-
macy program (44%), followed by nursing (25.2%), medicine (16.8%), and emergency
medicine (13.9%). The sample represents a good distribution across the year of study, with
31.4% fourth-year students, 22.3% fifth-year students, 21% third-year students, 18.4%
emergency medicine team members, and 6.8% sixth-year students. In addition, most of
the respondents reported that they had received training in the management of snakebites
(81.6%).
Table 2. Respondents’ Characteristics.
Demographic Details Variable
N
(%)
Gender Male 170 (55)
Female 139 (45)
Age
<20 years 17 (5.5)
20–25 years 267 (86.4)
>25 years 25 (8.1)
Profession
Medical 52 (16.8)
Nursing 78 (25.2)
Pharmacist 136 (44)
Emergency medicine 43 (13.9)
Year of study
Third year 65 (21)
Fourth year 97 (31.4)
Fifth year 69 (22.3)
Sixth year/Internship 78 (25.2)
Training received in the
management of snakebite
Yes 252 (81.6)
No 57 (18.4)
3.2. Knowledge about Snakebite First-Aid Management
The respondents’ knowledge regarding snakebite first-aid management is depicted
in Table 3. The majority of the respondents could differentiate between different types of
snakes (93.5%), thought that first aid is essential in the case of a snakebite (95.8%), and
knew that the snakebite victim should be transported to the hospital as soon as possible
(92.6%). Nearly two-thirds (65%) knew that snakebite victims should immobilize the bit-
ten part. The least knowledge pertained to the question regarding “dry snakebite”, where
only 8.4% of the respondents had knowledge regarding it.
Table 3. Participants’ knowledge about snakebite first-aid management
Items Yes% No% I Don’t
Know%
Do you think “first aid” is essential in snakebite cases? 95.80 1.30 2.90
Do you know that there are two types of snakes–a) venomous and non-venomous? 93.50 3.20 3.20
Should the snakebite patient be transported to the hospital soon after the bite? 92.60 1.30 6.10
Do you know the ambulance number to be dialed during an emergency? 71.20 20.40 8.40
Have you ever heard the word “first aid” in the management of snakebite? 67.30 22.70 10.00
Do you advise the snakebite victim to immobilize the bitten part? 65.00 7.80 27.20
Healthcare 2022, 10, 2226 6 of 14
Do you know the differences between venomous and non-venomous snakebites? 42.40 46.00 11.70
Should pressure immobilization bandages be applied around the bite site? 40.80 27.80 31.40
Do you think that intramuscular injection of analgesics can be performed for first aid in snakebite
victims? 32.70 19.10 48.20
Do you know who is most bitten by venomous snakes? 17.20 68.60 14.20
Do you know of “dry snakebite”? 8.40 79.60 12.00
* Do you advise massaging the bitten part? 6.10 62.80 31.10
* Should healthy volunteers suck the venom out of the wound? 24.60 43.40 32.00
* Do you advise to suck the bitten site soon after snakebite to remove poison? 37.50 36.60 25.90
* Do you advise to incise or pricks/punctures the bite site soon after the snakebite? 27.20 35.00 37.90
* Is electric shock at the site of snakebite useful 3.90 30.40 65.70
* Is it required to kill the snake after it bites the victim? 48.50 21.40 30.10
* Do you advise tying tight bands (tourniquet method) soon after the snakebite? 54.00 20.70 25.20
* Is topical instillation or application of herbs beneficial? 23.60 14.60 61.80
* indicates questions with negative connotations and were reverse scored (No = 1, Yes = 0, I don’t know = 0).
Table 4 depicts the descriptive statistics of the knowledge categories, whereas Table
5 illustrates the association between the participants’ demographics and the different cat-
egories of the participants’ knowledge (good, moderate, and poor) on first-aid manage-
ment in snakebite emergencies. The different categories of knowledge were found to be
significantly associated with the gender of the participants (χ2 = 8.28; p = 0.02), their college
(χ2 = 25.38; p < 0.001), and their year of study (χ2 = 12.07; p = 0.03). The participants’ age
group was not significantly associated with their knowledge of first-aid management in
snakebites.
Table 4. Descriptive statistics of the knowledge categories.
Knowledge Category N (%)
Good Knowledge 7 (2.3)
Moderate Knowledge 90 (29.1)
Poor Knowledge 212 (68.6)
Table 5. Cross-tabulations between the participants’ demographics and the knowledge categories.
Variables Poor Knowledge Moderate Knowledge Good Knowledge
Total N (%) (Chi square) χ2 p-Value
Gender
Male 105 (49.5%) 60 (66.7%) 5 (71.4%) 170 (55.0%) 8.28 p = 0.02
Female 107 (50.5%) 30 (33.3%) 2 (28.6%) 139 (45.0%)
College
Medical 44 (20.8%) 6 (6.7%) 2 (28.6%) 52 (16.8%)
25.38 p < 0.001
Nursing 60 (28.3%) 17 (18.9%) 1 (14.3%) 78 (25.2%)
Pharmacy 88 (41.5%) 47 (52.2%) 1 (14.3%) 136 (44.0%)
Emergency Medicine
20 (9.4%) 20 (22.2%) 3 (42.9%) 43 (13.9%)
Year of Study
Third Year 51 (24.1%) 13 (14.4%) 1 (14.3%) 65 (21.0%)
12.07 p = 0.03
Fourth Year 72 (34.0%) 25 (27.8%) 0 (0.0%) 97 (31.4%)
Fifth Year 42 (19.8%) 25(27.8%) 2 (28.6%) 69 (22.3%)
Sixth Year 47 (22.2%) 27 (30.0%) 4 (57.1%) 78 (25.2%)
Age Group
<20 14 (6.6%) 3 (3.3%) 0 (0.0%) 17 (5.5%)
1.74 p = 0.74 20–25 182 (85.8%) 78 (86.7%) 7 (100.0%) 267 (86.4%)
>25 16 (7.5%) 9 (10.0%) 0 (0.0%) 25 (8.1%)
Healthcare 2022, 10, 2226 7 of 14
3.3. Attitude towards Providing First-Aid Treatment to Snakebite Victims
As presented in Table 6, the majority of the respondents (95.15%) displayed a positive
attitude towards attaining knowledge about the first-aid management of snakebites.
However, less than two-thirds (59.87%) reported feeling tense while performing first aid
in an emergency condition. Most of the respondents (85.76%) reported having respect for
snakes. For the question “Have you ever killed a snake?”, nearly two-thirds (64%) of the
participants responded negatively.
Table 6. Participants’ attitude towards snakebite first-aid management.
Yes% No%
I Don’t Know%
Do you feel tense while performing first aid in an emergency
condition? 59.87 27.51
12.62
Have you ever touched a snake? 31.72 66.99
1.29
Do you feel good about snakes in general? 2.91 92.88
4.21
Do you have respect for snakes? 85.76 11.33
2.91
Have you ever killed a snake? 34.30 64.08
1.62
Will you show interest in attaining knowledge about first aid? 95.15 2.27 2.59
Table 7 shows the descriptive statistics of the three categories of attitude. Table 8 de-
picts the association between the participants’ demographics and the different categories
of attitude of the participants (good, moderate, and poor) about first-aid management in
snakebites. A significant association between the different categories of attitude was
found for gender (χ2 = 25.76; p < 0.001) and college (χ2 = 16.10; p = 0.009). The year of study
and age group were not significantly associated with the participants’ attitude to first-aid
management in snakebites.
Table 7. Descriptive statistics of the attitude categories.
Attitude Category N (%)
Good Attitude 16 (5.2)
Moderate Attitude 280 (80.9)
Poor Attitude 43 (13.9)
Table 8. Cross-tabulations between the participants’ demographics and the attitude categories.
Variables Poor Attitude Moderate Attitude
Good Attitude Total N (%) (Chi Square) χ2
p-Value
Gender
Male 38 (88.4%) 126 (50.4%) 6 (37.5%) 170 (55.0%) 25.76 p < 0.001
Female 5 (11.6%) 124 (49.6%) 10 (62.5%) 139 (45.0%)
College
Medical 9 (20.9%) 40 (16.0%) 30 (18.8%) 52 (16.8%)
16.10 p = 0.009
Nursing 4 (9.3%) 68 (27.2%) 6 (37.5%) 78 (25.2%)
Pharmacy 17 (39.5%) 114 (45.6%) 5 (31.3%) 136 (44.0%)
Emergency Medicine
13 (30.2%) 28 (11.2%) 2 (12.5%) 43 (13.9%)
Year of Study
Third Year 8 (18.6%) 55 (22.0%) 2 (12.5%) 65 (21.0%)
9.61 p = 0.13
Fourth Year 17 (39.5%) 72 (28.8%) 8 (50.0%) 97 (31.4%)
Fifth Year 5 (11.6%) 63 (25.2%) 1 (6.3%) 69 (22.3%)
Sixth Year 13 (30.2%) 60 (24.0%) 5 (31.3%) 78 (25.2%)
Age Group
<20 2 (4.7%) 14 (5.6%) 1 (6.3%) 17 (5.5%)
0.95 p = 0.95 20–25 39 (90.7%) 214 (85.6%) 14 (87.5%) 26 (86.4%)
>25 2 (4.7%) 22 (8.8%) 1 (6.3%) 25 (8.1%)
Healthcare 2022, 10, 2226 8 of 14
Figure 1 depicts the general perception of participants as how safe or afraid they
would feel around a snake in the wild. As presented in Figure 2, the most likely perception
among the students upon encountering a large venomous or large non-venomous snake
in the wild is to ask someone to kill the snake (49.8% and 30.7%, respectively) or kill the
snake themselves if it were a small venomous snake (28.2%). Around one-fourth of the
respondents would let a large non-venomous snake go away (25.9%), while a lesser num-
ber would scare off the snake into the bush (20.4%) or try to capture the snake (8.4%). The
most likely practical attitude among the students if encountered by a small non-venomous
snake in the wild was to let the snake go away (31.7%) or ask someone to kill it (25.2%).
Figure 1.
Participants’ perceptions of snakes in the wild.
Figure 2. Participants’ perceptions towards encountering different types of snakes in the wild.
Figure 3 indicates the perceptions of the students if encountered by a large ven-
omous snake in their yard or home. A little more than a quarter said that they would
try to kill the snake themselves (26.9%) and around half would ask someone to kill it
(51.5%).
In the case of
encountering a
small
venomous snake in their yard or home,
their responses were also relatively similar, wherein they would ask someone to kill
the snake (43.7%) or try to kill the snake
themselves (35%).
15.50%
15.20%
4.90%
49.80%
14.60%
12.30% 12.00%
7.80%
39.80%
28.20%
25.90%
20.40%
8.40%
30.70%
14.60%
31.70%
14.60%
9.10%
25.20% 19.40%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Let the snake go
away
Scare off the
snake into the
bush
Try to capture it Ask someone to
kill
You kill the snake
What action would you take if you encountered the following types of snakes
in the wild?
A large venomous snake A small venomous snake
A large non-venomous snake A small non-venomous snake
Healthcare 2022, 10, 2226 9 of 14
Figure 3. Participants’ perceptions towards encountering different types of snakes in their home or
yard.
As shown in Figure 4, the most prominent approaches that would increase re-
spect for snakes among the students were
learning to handle snakes safely (35%), fol-
lowed by seminars on snake behavior, anatomy, and benefits of snakes (32.7%).
Figure 4.
Methods and new approaches that would increase respect for snakes.
4. Discussion
The present cross-sectional, questionnaire-based study was conducted among the
students at the health science colleges of Jazan University with the aim of assessing their
knowledge and attitudes toward providing first-aid services to snakebite victims and their
perception towards snakes in general. The essence of providing first aid during snakebites
is to conserve life, prevent further injury, and speed up recovery.
9.40%
6.10% 6.10%
51.50%
26.90%
6.10% 7.10% 8.10%
43.70%
35.00%
14.60%
9.10%
11.00%
36.90% 28.50%
16.80%
5.20% 11.30%
32.70% 34.00%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Let the snake go
away
Scare off the
snake into the
bush
Try to capture it Ask someone to
kill
You kill the snake
What action would you take if you encountered the following types of
snakes in your home/yard?
A large venomous snake A small venomous snake
A large non-venomous snake A small non-venomous snake
35
32.7
6.8 6.8 5.7 6.7 6.3
0
5
10
15
20
25
30
35
40
Learn to handle of
snakes
Seminars on
behavior,
anatomy, benefits
of snakes
Visiting a snake
exhibit at a zoo
Learn about how
other cultures
perceive snakes by
joining a Facebook
group
Playing video
games/watching
films/reading
stories
Creating
arts/photography
about snakes
Other
Percentage
Methods or new approaches suggested
Methods or new approaches to increase support or concern for snakes
Healthcare 2022, 10, 2226 10 of 14
On the basis of the responses provided by the participants, for some key questions
assessing their knowledge, it was shown that a good percentage gave the correct answer.
For example, when asked “Do you advise the snakebite victim to immobilize the bitten
part?”, nearly two-thirds of the participants (65%) responded positively, which was the
correct response. The same applies to the question “Do you advise massaging the bitten
part?”, for which the correct response was given by close to two-thirds (62.8%) of the par-
ticipants; thus, demonstrating good knowledge of first aid for snakebite victims and its
emergency management. This study, however, has also revealed a gap in the students’
knowledge of first-aid treatments for snakebites, as indicated by their responses to ques-
tions pertaining to advising tourniquets, sucking venom out of the wound, and knowing
what a dry bite is, which could help determine the level of training that should be pro-
vided in the future, evaluating myths and misconceptions about snakes and snakebites
among students, and promoting respect for snakes in the ecosystem.
More participation was seen from the students in the pharmacy program than from
the students of medicine, emergency medicine, and nursing. A higher proportion of the
students (81.6%) had received training in providing first aid for snakebites during their
study program. As a first step in preparing the students for community service, Jazan
University, Saudi Arabia, has adopted and incorporated essential life-saving skills into
the graduate curriculum. In contrast to many universities located in urban areas and other
parts of the Gulf, the students of Jazan University have the advantage of receiving first-
aid training for snakebite emergencies [30,31].
The majority of the students (more than 90%) were aware of the basics of first aid,
such as its importance, the different types of snakes, and transportation of the victim to
the hospital, as indicated by their responses to these questions. This could be due to the
training received on first aid for snakebites by these students. Just over half (54%) of the
study participants said “Yes” to the question of tying a tourniquet near the snakebite area.
These findings are similar to those of Subedi et al., who reported a very high percentage
of their sample saying “Yes” to the application of a tourniquet near the site of the snakebite
[32]. In rural areas, people generally apply a tourniquet unscientifically to reduce the
blood flow at the bitten site, which might result in devastating outcomes [1]. In contrast,
more than half of the medical students in India think that it is good to use a tourniquet as
a first-aid strategy for snakebite victims [33]. A study found that more than half of the
snakebite victims used ineffective and harmful first aid in South Asia, with tourniquets
being used by a larger proportion of the patients [34]. When used around the proximal
sections of a limb, tight (arterial) tourniquets can cause significant discomfort due to the
progressive development of ischemia on the limbs, which can lead to gangrene if left in
place for a long time [22]. More than half (62%) of the health science college students at
Jazan University, Saudi Arabia, were unsure about massaging the bite location. Only a
meagre 6.1% of the participants responded correctly to the question “Do you advise mas-
saging the bitten part?”, and this was the question with the lowest correct responses. This
highlights a key knowledge gap in the first-aid management of snakebites. Massage at the
bitten place improves blood circulation, and the injected venom would be absorbed faster;
hence, it is not advisable to massage the bitten area or increase the mobility of the affected
part. Similar results were observed among Nepalese medical students, who believed var-
ious myths and misconceptions were part of effective snakebite treatments [32]. Medical
students in Nepal were aware of applying pressure immobilization or bandages before
enrolling in medical programs [35].
Similarly, the participants provided a skeptical response to questions pertaining to
incision at the bitten site for blood oozing, sucking the venom by a healthy volunteer,
applying an electric shock to the bitten region, and applying herbal medicines. Incising,
rubbing, vigorously washing, using chemicals and herbs, and other methods of interfering
with the snakebite wound can result in infection, improve absorption of the snake venom,
and increase local bleeding. Even though traditional remedies are outdated for snakebites,
many students were still confused about the idea, which is evident by their responses,
Healthcare 2022, 10, 2226 11 of 14
where less than two-thirds (61.8%) responded with an “I Don’t Know” response to this
question. Regarding the question about sucking out the venom by a healthy volunteer,
less than half (43.4%) gave the correct answer. The students probably believe that sucking
or slitting the affected area will stop the venom from spreading throughout the body.
Similar findings were seen in other research studies, where students were more likely to
remove poison from the body during the first-aid procedure [36–40].
Furthermore, most of the students were unsure about dry snakebites. This is another
question where students gave the least correct answers (8.4%). Although dry bites are still
delivered by venomous snakes, they are different as the venom is not injected into the
body (as opposed to a bite by a non-venomous snake). Unfortunately, most of the time,
the victims’ conduct will be similar as they are unaware that they have been bitten by a
non-venomous snake. The resemblance in bite response could be the source of confusion.
Fear, not venom, causes the reactions to dry bites. The students will benefit from more
clarity on venomous and dry bites, which will aid them in saving many lives that perish
due to fear. Hence, knowing the different types of snakes present in the locality would
help to provide appropriate first-aid management.
The students of the emergency medicine program had a much higher level of
knowledge compared to the other health science college students, plausibly due to their
hospital exposure to emergencies. It was shown that more than three-fourths (85.7%) of
the fifth- and sixth-year study participants displayed good knowledge, possibly due to
their professional maturity.
More than half of the students (59.9%) responded in affirmative that they would feel
tense while performing first aid to a snakebite victim in an emergency situation. This
seems understandable, as the majority of the students (92.9%) did not feel good about
snakes in general. Feeling uncomfortable at the thought of snakes might lead to a stressful
situation during a snakebite scenario. This was corroborated by the responses of the par-
ticipants about their perception of encountering different types of snakes in the wild,
home, or yard. Nearly half of them stated that they would ask someone to kill large or
small venomous snakes if they encountered them in their home or yard (51.5% and 43.7%,
respectively). When asked what they would do if they came across a snake in the wild,
they gave similar unfavorable replies. Only a small percentage of the students reported
that they would let a non-venomous snake go if they came across it in the wild, at home,
or in their yards. Snakes are one of nature’s wondrous creatures, and they do not attack
unless their habitats are disturbed, or they are accidentally stepped on. Most of the time,
they would do it as a form of defense. Snakes are vital to people for various reasons, in-
cluding keeping rodents at bay and offering therapeutic value; thus, they must be con-
served. According to estimations, around 17% of more than 3500 snake species identified
worldwide are venomous [6], with the rest being non-venomous. Antivenom therapy is
the ultimate treatment when a snakebite is linked with envenomation and should be de-
livered appropriately (Regional Office for South-East Asia 2016). People have a proclivity
to kill snakes, which is especially true when the snake bites [40].
Snakes contribute to the ecological balance and should be protected. Yet, in our sur-
vey, 48.5% of the respondents said that snakes should be killed when they bite, 21.4%
disagreed, and 30.1% were undecided. This suggests that the students lack the knowledge
of snake conservation in the ecosystem and their medical significance.
Learning through seminars about the safe handling of snakes and playing video
games with snake protagonists are among the different activities suggested to enhance
respect for snakes. However, the most important and positive finding was that they all
exhibited a strong desire to learn snakebite first-aid management.
Healthcare 2022, 10, 2226 12 of 14
5. Strength and Limitations
This was the first study in the Jazan province to test the expertise of medical, phar-
macy, nursing, and emergency medical students at Jazan University on providing first-
aid treatments to snakebite patients and managing emergencies. If properly trained, these
students could be valuable in preserving the lives of residents of rural areas while also
instructing them on how to conserve snakes to preserve biodiversity.
One of the study’s limitations is that we only tested the participants’ academic
knowledge of snakebites without examining their practical skills, particularly in terms of
first aid. Additionally, as our study population belonged to a single university in a single
province, it makes it difficult to generalize the findings to other parts of the country. Due
to the convenience sampling, the study participants might not have been representative.
Moreover, we did not measure the confidence level of the students in dealing with snakes.
Furthermore, a self-reported survey has a potential for recall bias, and convenience sam-
pling increases the potential for selection bias.
6. Conclusions
In conclusion, our research demonstrated gaps in the knowledge on how to deal with
snakebites appropriately and scientifically along with a lack of awareness about how vital
this subject is for medical, pharmacy, nursing, and emergency medicine students. This
research also revealed that the students did not fully comprehend the role of snakes in the
ecosystem and their medical impact. Given the significant chance that health science stu-
dents may have to deal with snakebites in their professional or personal lives, we recom-
mend the inclusion of snakebite training and management in the curriculum of the health
science programs. Our findings also identified areas where knowledge gaps existed for
our university students, stressing the necessity for future research into the understanding
and practices of health science students in other universities in Saudi Arabia, along with
the knowledge and awareness of healthcare professionals on the first-aid management of
snakebites.
Author Contributions: S.S.A., D.B., O.J.F.B., M.H.S., N.K.S., A.M.M. (Abdulkarim M. Meraya),
A.A.A., conceptualization, methodology, investigation, formal analysis, writing-original draft prep-
aration; S.S.A., D.B., O.J.F.B., M.H.S., N.K.S., methodology, investigation, formal analysis, valida-
tion; S.S.A., D.B., O.J.F.B., M.H.S., N.K.S., A.M.M. (Aeshah M. Mahzari), investigation, formal anal-
ysis; S.S.A., D.B., O.J.F.B., M.H.S., N.K.S., A.M.M. (Abdulkarim M. Meraya), A.A.A., H.A.T., A.K.,
I.A.A., A.M.M. (Aeshah M. Mahzari), O.M.A., formal analysis, data curation; S.S.A., D.B., O.J.F.B.,
M.H.S., N.K.S., A.M.M. (Abdulkarim M. Meraya), A.A.A., H.A.T., A.K., I.A.A., A.M.M. (Aeshah M.
Mahzari), O.M.A., supervision, project administration, writing-review, and editing. All authors
have read and agreed to the published version of the manuscript.
Funding: The present study was funded through the Deputyship for Scientific Research and Inno-
vation, Ministry of Education in Saudi Arabia, grant number RUP20-10.
Institutional Review Board Statement: The protocol was approved by the Institutional Review
Board bearing number REC 41/1/053.
Informed Consent Statement: Informed consent was obtained from all participants prior to the start
of data collection.
Data Availability Statement: Data of the present study can be made applicable upon reasonable
request to the corresponding author (S.S.A.).
Acknowledgments: The authors extend their appreciation to the deputyship for research and inno-
vation, Ministry of Education in Saudi Arabia, for funding this research work through project num-
ber RUP20-01.
Conflicts of Interest: We declare that we have no conflict of interest.
Healthcare 2022, 10, 2226 13 of 14
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