Analyzing Patient and Provider Perceived Delays to Snakebite Envenoming Care in Amazonas State, Brazil: A qualitative assessment using the Three Delay Model

Abstract

Background: This thesis describes the perceived delays faced by patients and providers in Amazonas, Brazil while seeking or providing snakebite envenoming care in the region. Additionally, we compare the delays described by indigenous and non-indigenous patients while seeking care. Methods: This study analyzed previously recorded data from snakebite envenoming (SBE) patients and indigenous health care providers with intent to discuss their experiences. In-depth interviews and focus group transcripts were analyzed using the Three Delay Model. This model groups data into three separate delays; deciding to seek care, arriving to care, and receiving adequate care. Results: From this analysis we found that patients described many different themes for their decisions to seek care including choosing alternative methods, cultural restrictions, refusing traditional medicines and many more. The reasons behind the decisions to seek care or not were different between indigenous and non-indigenous patients. While travelling to care both study groups described the need to use multiple means of travel to arrive to distribution hospitals and the unavailability of transportation and emergency services which caused delays. Finally, once they arrived to health care facility delays were again presented by the need for multiple facilities to receive adequate care. Conclusion: The findings of this study support public health researchers push for the decentralization of antivenom. Both survivors of SBE and health care providers in the region have expressed the need for treatment to be available in their region. Due to the population of the region, any interventions whether education or political will need to consider the culture of the indigenous people to ensure positive uptake.