Facing pediatric snakebites unarmed: knowledge gaps and first-aid response challenges among parents in rural Sri Lanka.

Pediatric snakebites remain a neglected public health threat in rural Sri Lanka, where limited access to emergency care places children at heightened risk. Despite the high burden, there is a striking lack of research focused on strengthening preparedness in vulnerable communities. A descriptive cross-sectional study was conducted in two high-incidence districts: Ampara and Polonnaruwa. Using cluster sampling, 518 parents of children aged <5 y completed structured, self-administered questionnaires assessing knowledge of snake identification and prehospital care interventions. Associations between sociodemographic variables and knowledge were analyzed using χ2 tests. Although 98.3% correctly identified the Indian cobra, only 34.6% recognized Russell's viper, and 82% misclassified the non-venomous rat snake as venomous. Prior first-aid training was significantly associated with improved knowledge on snake identification (p=0.02), symptoms and complications (p=0.00) and pre-hospital care (p=0.01). Misconceptions persisted: 29.3% believed antivenom should be given to all bite victims. Higher socioeconomic status was linked to better prehospital care knowledge (p=0.00), while lower parental education was associated with poorer knowledge (p=0.00). Personal or household snakebite experience showed no significant association (p>0.05). Despite high exposure risk, caregiver preparedness is low. Community-based education targeting high-risk families is urgently needed to reduce preventable pediatric snakebite morbidity and mortality.