Anonymous database.

BackgroundSnake envenoming remains a major public health problem in Sri Lanka, disproportionately affecting rural children. Timely and appropriate pre-hospital management is crucial to reducing morbidity and mortality. Public Health Midwives (PHMs), as frontline community health workers, are strategically positioned to contribute to snakebite prevention and early management. However, their knowledge and confidence regarding paediatric snakebite care have not been systematically evaluated.Methodology/Principal findingsA cross-sectional, country-wide survey was conducted among PHMs across all 25 districts of Sri Lanka using a stratified random sampling approach. Data were collected through a validated, self-administered online questionnaire designed to assess knowledge and practices related to paediatric snakebite prevention, snake identification, and pre-hospital management. A total of 1,706 PHMs participated. Although most respondents correctly identified essential first-aid measures such as reassuring the patient (95.9%) and prompt hospital transfer (95.8%), a substantial proportion endorsed harmful practices, including sucking the venom (71.6%), applying herbs (73.2%), or cutting the bite site (64.4%). Only 48.7% recognized immobilisation as an appropriate first aid. Snake identification accuracy was high for the cobra (94%) but low for other medically significant species such as kraits and vipers. Awareness of national guidelines (14.7%) and emergency contact services (11.9%) was also poor. PHMs with prior training, awareness of national information services, or previous experience providing first aid demonstrated significantly higher knowledge scores (p Conclusions/SignificanceDespite their key role in community health, PHMs in Sri Lanka exhibit major knowledge gaps in evidence-based first aid, snake identification, and awareness of national support systems for snakebite management. These deficits, coupled with widespread misconceptions and low confidence, highlight the need for structured training, curriculum integration, and ongoing professional development. Strengthening PHMs’ capacity in snakebite prevention and early management can significantly enhance community preparedness and reduce the burden of paediatric snakebite envenoming in Sri Lanka.