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Therapeutic itineraries of children after snakebites in the Brazilian Amazon: A thematic drawing-and-story study

J. Cristino,A. Farias,É. S. Carvalho,J. Sachett,F. H. Wen,F. Murta,Vinícius Azevedo Machado,W. Monteiro

Published 2025 in PLoS Neglected Tropical Diseases

ABSTRACT

Background Snakebite envenomations (SBEs) impose a significant burden on children living in the Brazilian Amazon. In this region, children are at a higher risk of long-term disabilities and death. Therapeutic itineraries refer to the paths individuals take to seek and manage their health, encompassing both formal and informal healthcare systems. Even with an increasing interest in involving children in qualitative research in health sciences, researchers generally neglect children as subjects capable of reporting on their health status. The aim of this study was to describe the healthcare itineraries of children presenting at a tertiary hospital in Manaus, Brazilian Amazon, for medical assistance after snakebites. Methods A thematic drawing-and-story study was performed to explore the healthcare itinerary of children aged 4–12 years who were admitted with a diagnosis of SBE in a tertiary hospital in Manaus, Brazilian Amazon, from July 2022 to March 2024. Data was analyzed by deductive content analysis. Data collection involved drawing and storytelling based on the snakebite experience of the participant from the moment of the bite to hospital. Sample size was defined by saturation. Results Thirteen (65%) boys and seven (35%) girls, with an average age of 8.7 years, were recruited. Most of them were accompanied to the hospital by their mothers (65%). Time to medical care ranged from 1 to 84 hours. Data analysis highlighted five key themes: 1) Identification and understanding of SBEs in the process of initial parental care; 2) Children’s understanding of the SBE and their journey to care; 3) Children’s experiences with SBEs and their exposure to them in the environment; (4) Use of therapeutic practices during the children’s journey to care; and 5) Contingencies in the healthcare itinerary of the children. The initial response to SBE in children is marked by challenges in communication between them and adults, delaying proper care. The unexpected event is a traumatic experience for children, with intense pain and reactions such as fear. Fragmented itineraries significantly increase the time needed to access antivenom. In some cases, children try to take care of themselves, but parental care is still predominant. Conclusion The experiences of a snakebite in children reinforce the need for public policies, such as specific educational interventions, aimed at promoting early recognition of signs, validating children’s voices, and discouraging harmful practices. Strengthening culturally sensitive and child-focused strategies is important for public health, as it enables the transformation of long, fragmented and improvised therapeutic itineraries into more timely, safe, and effective care pathways for pediatric snakebite victims in the Amazon.

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