Experiences and practices of traditional healers on snakebite treatment and prevention in rural Malawi

Snakebite envenoming remains a public health threat in many tropical countries including Malawi. Traditional healers (THs) have been consulted by victims of snakebites as primary caregivers for millennia. There are no studies in Malawi to understand this phenomenon, therefore, our study aimed to explore the experiences and practices of THs regarding snakebite treatment and prevention in rural Malawi. Between August and September 2022, we conducted semi-structured interviews with 16 THs who were purposefully selected from various locations across Neno District, Malawi. We analysed the interview data using Dedoose software, where we generated codes and grouped them into themes. Out of the 16 THs interviewed, 68.8% (n = 11) were male, and 43.8% were aged between 40 and 60 years. Our study identified five themes: THs’ knowledge of snakes and treatment, the continuum of care they provide, payment procedures, snakebite prevention, and their relationship with health facilities. They claimed a good understanding of the snakes in their area, including the seasons with more snakebites, and were confident in their ability to provide treatment, however, this was not scientifically proven. They offered a comprehensive care package, including diagnosis, first aid, main treatment, and follow-up care to monitor the victim’s condition and adjust treatment as needed. THs provide free treatment for snakebites or use a “pay later” model of service delivery. All THs claimed a “vaccine” for snakebites that could prevent bites or neutralize the venom. However, no formal relationship existed between THs and Health Care Workers (HCWs). We recommend collaboration between HCWs and THs, establishing clear referral pathways for snakebite victims and educating THs on identifying danger signs requiring prompt referral to healthcare facilities.Author summary: Snakebite victims in the community continue to seek care from traditional healers for a variety of reasons including cultural influences, socio-economic factors, and the lack of snake antivenom in healthcare facilities among others. Thus, traditional healers play a vital role in the treatment of snakebites. However, one limitation of relying on traditional care is the potential delay or failure of patients to present themselves at hospitals for timely administration of antivenom for those who may require it. We interviewed sixteen traditional healers in Neno, Malawi, to explore their experiences and practices regarding snakebite treatment and prevention. The traditional healers displayed confidence in their treatment methods and offered a comprehensive approach to addressing snakebite cases from diagnosis to medication and follow-up, however, their claims were not scientifically proven. Some traditional healers provided their services free of charge, with some healers requesting payment only when their clients had recovered. Furthermore, traditional healers claimed to possess a snakebite vaccine, and there appeared to be no collaboration or relationship between them and healthcare workers for the management of snakebite cases. We recommend creating spaces for joint learning and collaboration between healthcare workers and traditional healers as they share a common goal of ensuring the recovery of snakebite victims.