Challenges and opportunities in community education on paediatric snakebite prevention: Perspectives of Public Health Midwives in rural Sri Lanka.

Paediatric snakebite is a major public health concern in rural Sri Lanka. Community-based Public Health Midwives (PHMs) are central to community education on prevention and first aid. This study explored PHMs' experiences, challenges, and training needs in delivering snakebite education in rural settings. We conducted a qualitative exploratory study in seven Medical Officer of Health areas in the Ampara District, Eastern Sri Lanka. Seventy community-based PHMs who had completed structured training on paediatric snakebite prevention, first aid, and snake identification participated in nine focus group discussions. Five key themes emerged. PHMs integrated snakebite education into routine maternal and child health activities, including mothers' groups, antenatal clinics, and household visits. However, prevention efforts were constrained by structural and behavioural barriers such as livelihood pressures, incomplete housing, and the need for repeated reinforcement. PHMs reported limited confidence in teaching evidence-based first aid and relied heavily on videos due to insufficient hands-on training and demonstration materials. Teaching snake identification was particularly challenging because of inadequate visual aids and similarities between species. Deeply rooted cultural beliefs and reliance on traditional healers continued to influence community responses, although younger parents were more receptive to biomedical advice. PHMs are well positioned to deliver community-based paediatric snakebite prevention, but their effectiveness is limited by training gaps, resource constraints, socioeconomic factors, and cultural beliefs. Strengthening PHM capacity through practical skill-based training, high-quality visual resources, and context-sensitive education strategies is essential to improve prevention and first-aid practices in high-risk rural settings.