First-aid, pre-hospital care, and harmful indigenous practices in pediatric snakebite envenomation: A systematic review of global evidence from 1973 to 2025.

backgroundSnakebite envenomation is a neglected tropical disease that disproportionately affects children in low- and middle-income countries. Pediatric patients are uniquely vulnerable due to smaller body mass, increased venom-to-body-weight ratios, and behavioral risk factors such as outdoor play. The pre-hospital phase is critical in determining outcomes, yet inappropriate first-aid and harmful indigenous practices often characterize it. Despite the recognized importance of early interventions, global evidence on pediatric-specific pre-hospital care remains fragmented. This systematic review synthesizes available literature on first-aid measures, pre-hospital interventions, and harmful traditional practices in pediatric snakebite envenomation.

methodFollowing PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed/MEDLINE, Scopus, and Lens.org, covering publications from 1973 to December 2025. Eligible studies included children and adolescents (0-18 years) with snakebite envenomation, reporting first-aid or pre-hospital practices and associated outcomes. Observational, interventional, and qualitative designs were included, while case reports, reviews, and non-English publications were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale, Joanna Briggs Institute checklist, and CASP qualitative tool. Due to heterogeneity, findings were synthesized narratively.

resultsForty-four studies were included, representing South Asia, Sub-Saharan Africa, Latin America, the Middle East, Europe, and North America. Harmful practices were most prevalent in South Asia and Africa, where tourniquet use ranged from 38-78%, incision and suction from 22-64%, and herbal remedies from 28-58%. Consultation with traditional healers was frequent, reported in 40-73% of cases. Median delays in hospital presentation were longest in Africa and South Asia, often exceeding 6-18 hours, and each hour of delay increased severity odds by 1.4‑fold. Mortality varied regionally, from 0.06% in North America to 8-10% in Africa, with inappropriate first‑aid identified as an independent predictor of poor outcomes. Knowledge gaps were consistent across regions, with fewer than 20% of parents able to identify appropriate first‑aid and 67% of healthcare providers reporting inadequate training.

conclusionThis review demonstrates that harmful indigenous practices remain pervasive in pediatric snakebite management worldwide, contributing to preventable morbidity and mortality. Evidence underscores the urgent need for standardized, evidence-based pre-hospital guidelines, culturally sensitive community education, and targeted training for healthcare providers. Addressing these gaps through policy development and educational interventions is essential to reduce the global burden of pediatric snakebite envenomation.