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.蛇咬伤中毒（snake envenoming）仍是斯里兰卡面临的重大公共卫生问题，对农村儿童的影响尤为不成比例。及时且恰当的院前救治（pre-hospital management）对降低发病率和死亡率至关重要。公共卫生助产士（Public Health Midwives, PHMs）作为一线社区卫生工作者，处于能够助力蛇咬伤预防与早期救治的战略位置。然而，目前尚未对其在儿童蛇咬伤护理方面的知识与信心开展系统性评估。 研究方法与主要结果：本研究采用分层随机抽样（stratified random sampling）方法，在斯里兰卡全部25个行政区的公共卫生助产士中开展了一项全国性横断面调查。研究通过一份经过验证的自填式在线问卷（self-administered online questionnaire）收集数据，该问卷用于评估与儿童蛇咬伤预防、蛇类识别及院前救治相关的知识与实践行为。最终共有1,706名公共卫生助产士参与本次调查。尽管多数受访者能够正确识别核心急救措施（first-aid measures），如安抚患者（95.9%）与及时转诊医院（95.8%），但仍有相当比例的受访者认可有害操作，包括吸吮毒液（venom）（71.6%）、涂抹草药（73.2%）或切割咬伤部位（64.4%）。仅48.7%的受访者知晓将伤肢制动（immobilisation）作为恰当的急救手段。蛇类识别准确率方面，眼镜蛇（cobra）的识别率高达94%，但对其他具有医学重要性的物种，如银环蛇（kraits）和蝰蛇（vipers）的识别率较低。受访者对国家指南（national guidelines）与应急联络服务（emergency contact services）的知晓率同样较低，分别仅为14.7%和11.9%。曾接受过相关培训、了解国家信息服务或具备急救实操经验的公共卫生助产士，其知识得分显著更高（p 结论与意义：尽管公共卫生助产士在社区卫生中发挥着关键作用，但斯里兰卡的公共卫生助产士在循证急救（evidence-based first aid）、蛇类识别以及对蛇咬伤救治国家支持体系的知晓度方面存在显著知识缺口。这些不足，加之普遍存在的认知误区与信心不足，凸显了开展结构化培训、课程整合以及持续专业发展（ongoing professional development）的必要性。提升公共卫生助产士在蛇咬伤预防与早期救治方面的能力，可显著增强社区的应对准备能力，并减轻斯里兰卡儿童蛇咬伤中毒的疾病负担。