Keywords
Challenges, Opportunities, Bites, Stings, Animal-related injuries, Rural, and Tanzania.
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Kilonzi M, Makoye PM, Aiko B et al. Managing Animal-Related Injuries in Rural Tanzania: Challenges and Opportunities from Healthcare Providers’ Experiences in Mkinga District [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:758 (https://doi.org/10.12688/f1000research.166768.1)
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Research Article
Managing Animal-Related Injuries in Rural Tanzania: Challenges and Opportunities from Healthcare Providers’ Experiences in Mkinga District
[version 1; peer review: awaiting peer review]
PUBLISHED 01 Aug 2025
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Abstract
Corresponding author:
Manase Kilonzi
Competing interests:
No competing interests were disclosed.
Grant information:
This work was carried out with financial support from the University of Rwanda, East Africa Community Regional Centre of Excellence for Vaccines, Immunisation, and Health Supply Chain Management (UR EAC RCE-VIHSCM) which is funded by the German Federal Ministry of Economic Cooperation and Development (BMZ) through the German Development Bank (KfW)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:
© 2025 Kilonzi M et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Kilonzi M, Makoye PM, Aiko B et al. Managing Animal-Related Injuries in Rural Tanzania: Challenges and Opportunities from Healthcare Providers’ Experiences in Mkinga District [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:758 (https://doi.org/10.12688/f1000research.166768.1)
First published: 01 Aug 2025, 14:758 (https://doi.org/10.12688/f1000research.166768.1)
Latest published: 01 Aug 2025, 14:758 (https://doi.org/10.12688/f1000research.166768.1)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Introduction
Animal-related injuries, particularly snakebites, scorpion stings, and dog bites, pose significant global health risks, particularly in South Asia, Africa, and Latin America.1 Each year, 5 million snakebite envenoming (SBE) incidents occur worldwide, causing 81,410–137,880 deaths and over 413,000 disabilities, with the highest fatality rates in South Asia.2,3 In Africa, between 435,000 and 580,000 cases of SBE are reported annually.4,5 Also, scorpion stings affect 1.5 million people yearly, leading to 2,600 deaths, with high case numbers in North and West Africa.6 For example, countries like Morocco, Algeria, and Tunisia report tens of thousands of cases annually, with children being the most vulnerable.6,7 Moreover, dog bites contribute to 10 million injuries globally, increasing the risk of rabies, which causes 59,000 deaths annually, mostly in Africa and Asia.8–10 The economic burden due to dog bites is significant; for instance, USD 8.6 million is spent annually on treatment and prevention in Central Asia and the Middle East.9 The burden of bites, stings, and other animal-related injuries in East Africa is underreported.11 For instance, in Uganda, the estimated incidence of SBE is 101 per 100,000 people; in some regions of Tanzania, 242 cases of SBE were reported between 2007 and 2012.12–14
The burden of animal-related injuries, particularly bites and stings, is high in low and middle-income countries (LMICs), especially in rural areas.1 This is due to the high prevalence of venomous snakes, scorpions, spiders, and insects, large populations of stray dogs, and rural communities’ dependence on pastoralism and agriculture.14,15 On the other hand, the literature suggests that many people in LMICs struggle to access healthcare services due to geographic barriers, service unavailability, poverty, and reliance on cultural and traditional practices.12,16
The limited availability of life-saving treatments such as rabies vaccines, antivenoms, and other essential therapeutics poses a major challenge in managing bites, stings, and other animal injuries in rural settings.1,6,17 Additionally, there is a shortage of trained HCPs with the necessary skills to provide first aid, identify venomous species, administer antivenoms, and monitor victims.1,12,18 These gaps in healthcare capacity contribute to higher mortality and disability rates among affected individuals.
Moreover, the lack of public awareness and education on matters related to bites, stings, and other animal injuries further jeopardizes the treatment of victims and prevention.4,19 Many people keep animals such as dogs without proper care and planning and engage in economic activities such as herding, firewood collection, charcoal production, and farming without taking the necessary precautions.3,9 This increases the risk of exposure to bites and stings.
Despite WHO efforts like reclassifying SBE as a neglected tropical disease (NTD) in 2017,11 information on challenges and opportunities in managing bites, stings, and other animal-related injuries in endemic regions, particularly in Sub-Saharan Africa (SSA), remains limited. This study aimed to explore the experiences of HCPs on the challenges and opportunities in managing bites, stings, and other animal-related injuries in a rural setting in Tanzania.
Methods
Study design
An exploratory qualitative case study was conducted from 12th to 23rd February 2024 in Mkinga District, Tanga Region, Tanzania. Grounded theory was used to analyze participants’ experiences and perspectives on the challenges and opportunities in managing animal-related injuries in a rural setting. In-depth interview (IDI) was the adopted qualitative method.
Public healthcare system in Tanzania
The healthcare system in Tanzania is organized in a pyramidal structure. At the base are dispensaries, followed by health centers and district hospitals, which together constitute the PHC level and serve as the first point of contact for most patients. When cases require more specialized care than can be provided at the PHC level, patients are referred to regional referral hospitals, which represent the secondary level of care. For complex or highly specialized medical conditions, further referrals are made to tertiary facilities, including zonal, specialized, and national referral hospitals.20
Study setting
This study was conducted in the Mkinga District in the Tanga Region of Tanzania. According to the 2022 census, Mkinga District had a population of 146,802.21 Covering an area of 2,712 square kilometers along the Indian Ocean. The region experiences a tropical climate characterized by high humidity with two main seasons; rainy and dry. The local economy is largely sustained by sisal cultivation, small-scale agriculture, fishing, livestock rearing, and petty trade. These livelihood activities frequently expose residents to environments where animal bites are common. Mkinga District was purposively selected for this study following a prior study that revealed a high burden of animal bite incidents in the area.22
Study population
The study targeted heads of PHC facilities in Mkinga District. As of 2024, the district had 42 PHC facilities, of which 29 (3 health centers and 26 dispensaries) had been operational for at least three years. This criterion ensured participants had adequate experience managing animal-related injuries. IDIs were conducted with heads of all three health centers, which were purposively selected for their higher patient volume and broader service scope. An additional seven dispensaries were randomly selected from the remaining 22 to enhance representativeness and reduce selection bias.
Description of participants characteristics
Out of the 10 participants, six were males. Their professional backgrounds included three enrolled nurses with certificate qualifications, two diploma-holding nurse assistants, and five clinical officers trained at the diploma level in clinical medicine. Participants reported work experience ranging from two to ten years.
Data collection procedure
An interview guide was developed, reviewed by the investigators, and piloted within the study team. It consisted of probe-based questions designed to explore participants’ experiences in managing animal-related injuries, with a focus on existing challenges and opportunities. The guide was initially drafted in English and later translated into Kiswahili for clarity and relevance. Before data collection began, the principal investigator oriented the team on the guide, and the investigators practiced using the tool among themselves.
Three investigators (MK, PMM, and BA) conducted the interviews. MK and PMM are male, and BA is female. All are academic staff at Muhimbili University of Health and Allied Sciences (MUHAS), involved in teaching, research, and consultancy. MK holds an MSc in Pharmacology and Therapeutics, while PMM and BA hold Master’s degrees in Medicinal Chemistry and Pharmaceutical Management, respectively. MK has over 8 years of research experience, while PMM and BA each have more than 4 years of experience in the field.
Participants were notified of our presence in the district through the District Medical Officer (DMO), who oversees all health-related activities in the area. We obtained a field guide from the DMO’s office to assist with local coordination. One day prior to visiting each facility, the field guide contacted the respective participants, explained the purpose of the visit, and arranged a suitable time for the interview.
On the day of the interview, participants were asked to provide written informed consent before commencing the discussion, which was conducted in their respective offices and audio-recorded. Each interview lasted between 60 and 90 minutes. To refine the interview guide, the three investigators met in the field after completing one interview each to discuss any misunderstandings regarding the questions or probes. Necessary adjustments were made before proceeding with the remaining interviews. Data collection continued until thematic saturation was achieved. The selected facilities represented a range of geographic and operational contexts, allowing for a reasonable degree of heterogeneity.
Data analysis
All interviews were transcribed verbatim, and the analysis was conducted in Kiswahili to preserve the original meaning. Only the codes and selected quotes were translated into English to present the findings. Before coding began, a preliminary codebook was developed based on the study objectives and interview guide. The coding process was preceded by multiple readings of the full transcripts and field notes to ensure familiarity with the content and context.
Two pairs of researchers independently coded one transcript, after which the team convened to refine the codebook by incorporating emerging codes. Complete analysis commenced once consensus was reached on the codes and their definitions. Each researcher then independently coded their assigned transcripts. The generated codes were categorized according to the predefined codebook, with new codes added as needed or used to refine existing ones. Code abstraction was performed by comparing codes to identify patterns, similarities, and differences. These abstracted codes were then grouped into sub-themes and further synthesized into broader themes. Finally, the findings were presented with supporting quotes for clarity and emphasis.
Ethical considerations
The MUHAS Research and Ethics Committee (REC) granted ethical approval for the study under reference number MUHAS-REC-07-2023-1813 on 24th July 2023. Permission to conduct the research was obtained from the Tanzania Permanent Secretary of the President’s Office for Regional Administration and Local Government (POLARG), the Regional Administrative Secretary of Tanga Region, and the District Executive Director of Mkinga District. Before participation, IDI respondents were provided with detailed information about the study and asked to give written informed consent. The consent form also included approval for disseminating findings across various platforms. All procedures adhered to the ethical principles outlined in the Declaration of Helsinki throughout participant recruitment and data collection.
Results
Summary of the findings
Participants’ experiences of challenges were grouped into two main themes: community-related challenges, including social-behavioral and economic barriers; and healthcare system-related challenges, including limitations in infrastructure and systems, workforce shortages, and a lack of critical medical resources. Besides, opportunities were also categorized into two main themes: facility-related opportunities, including healthcare providers’ readiness, resource availability, and access to learning platforms; and policy-related opportunities, such as the presence of functional healthcare delivery systems and supportive financial policies ( Figure 1).
Figure 1. Summary of the findings.
Challenges of management of animal-related injuries in rural settings
Theme 1: Community-related challenges
Social and behavioral challenges
Participants stated that most animal-related injury victims first visit traditional healers to avoid hospital costs. Victims often arrive with remedies like herbs, ashes, or stones on the wound and community-level first aid such as incisions, tourniquets, or coins applied to the bite site.
“Patients from villages often arrive having received traditional first aid, such as tightly wrapped limbs, cuts at the bite site, or the application of snake stones, which are believed to be effective by the community” (Participant number 9)
Furthermore, participants emphasized that the community has limited knowledge regarding animal-related injuries and is poorly aware of the healthcare services available at nearby facilities.
“Our community lacks awareness that snakebites are emergencies. Instead of seeking immediate help, people often move around, which worsens the condition and sometimes leads to severe complications before reaching a healthcare facility” (Participant number 2)
Economic barriers
Participants stated that most victims of bites, stings, and other animal-related injuries rely on out-of-pocket payments. They emphasized that people in rural areas are reluctant to join insurance schemes, and those who do are not highly exposed to risky environments.
“Most community members pay for healthcare out-of-pocket, and despite efforts to promote health insurance schemes like the Improved Community Health Fund (iCHF, many remain reluctant to enroll” (Participant number 10)
Participants revealed that antivenom costs range from Tanzanian Shillings 150,000 to 300,000 (USD 62.50–125) per vial, while rabies vaccine treatment costs approximately Tanzanian Shillings 40,000 (USD 16.67) per dose. They stated that most victims of bites and stings cannot afford these life-saving treatments.
“Considering the local environment and people’s finances, one vial of antivenom costs TZS 140,000 (USD 58), which is unaffordable for most, especially those relying on charcoal production who may earn less than TZS 100,000 (USD 42) per round. Many suffer or die due to financial constraints” (Participant number 8)
Theme 2: Healthcare system-related challenges
System and infrastructure limitations
Participants reported that victims of animal-related injuries face barriers like long distances, poor roads, high transport costs, and limited transport options. Also, participants insisted that cold-chain storage is limited, with priority given to vertically supplied vaccines. Furthermore, frequent power outages compromise the storage of items like antivenoms and rabies vaccines.
“Infrastructure is a challenge; patients may need TZS 8,000 (USD 3.33) each way for transport before hospital costs. Faced with this, some turn to traditional healers or simply hope for the best” (Participant number 2)
And
“We have a fridge, but it’s shared for vaccines, antivenom, and other supplies, which isn’t ideal. With our large population and storage needs, we need separate fridges, one dedicated to vaccines and another for other drugs, including antivenom” (Participant number 3)
Participants stated that the referral system is time-consuming and inefficient. They highlighted the lack of ambulances; if available, they are often too small or out of fuel. Additionally, patients are required to purchase fuel or arrange their transportation. Furthermore, participants complained that the referral system is not digitized.
“The referral system faces challenges—long distances and transport costs lead many patients to bypass local facilities and go straight to the regional hospital, often using private transport” (Participant number 6)
Shortage of workforce
Participants stated that workforce shortages and heavy workloads negatively impact facility service delivery. Due to staff shortages, they complained of tight work schedules and demanding shifts.
“Staff shortages are a major challenge, particularly during emergencies like mass bee stings; two staff members can’t manage multiple patients at once” (Participant number 5)
Shortage of critical medical resources
Participants reported limited availability of antivenom and rabies vaccine, especially when a victim requires multiple doses or when multiple victims arrive within a short period. They stated that antivenoms are sometimes out of stock for over six months.
“Another challenge is limited emergency medication supplies—if a few patients need them, stocks run out quickly, and we must refer others without treatment while waiting for the next batch” (Participant number 5)
Participants reported a lack of critical medical equipment in their facilities, including oxygen machines and ventilators, which are essential during emergencies.
“We lack equipment for respiratory support, aside from anti-allergy and bronchodilator medications, we have no oxygen concentrator or related devices” (Participant number 6)
Opportunities for strengthening the management of animal-related injuries in rural settings
Theme 1: Facility-related opportunities
Readiness of HCPs to treat envenomation victims
Participants stated that HCPs working in public PHC facilities are always willing to treat victims of bites and stings. They mentioned that HCPs possess basic knowledge and skills to provide care, including first aid. Additionally, participants noted that referrals to higher-level facilities are issued when necessary.
“We have organized ourselves with skilled staff who can assist in one way or another to serve victims of animal attacks or envenomation” (Participant number 5)
Participants stated that PHC facilities usually collaborate with community health workers to disseminate various health information to the community. Participants emphasized that community health workers are familiar with the geographical, cultural, and traditional practices of the particular society, making it easy to disseminate health information to community members.
“Community health workers are based in neighborhoods; therefore, gathering health information, tracking conditions like red eye cases, and providing education and support at the community level becomes easy” (Participant number 10)
Presence of learning platforms
Participants stated that HCPs in PHC facilities utilize various platforms within their settings to share knowledge and mentor junior staff on managing animal-related injuries, including bites and stings. These platforms include ward rounds, morning reports, teamwork discussions, and consultations with experienced personnel in person or via phone.
“Healthcare providers work closely to support each other. When cases like snakebites arise, we consult, share information, and follow medical guidelines to ensure proper care” (Participant number 6)
Resource availability
Respondents noted that medications like steroids, antihistamines, and adrenaline are usually available year-round, along with basic supplies like gloves and syringes. However, life-saving treatments such as antivenom and rabies vaccines are stocked in limited quantities.
“We’ve organized well to ensure a supportive environment with life-saving medications for managing animal-related injuries” (Participant number 5)
Theme 2: Policy-related opportunities
Presence of functional healthcare delivery systems
Participants noted that PHC facilities have cold chain systems, some solar—or gas-powered, mainly for vaccines. They also emphasised that public PHC facilities use reliable HIMS to document animal-related injuries, including SBE cases, recorded in general registries and specific forms.
“We have no concerns about electricity for vaccine storage, as we use a solar-powered system” (Participant number 1)
And
“Our record-keeping is good, we use physical books to maintain patient records, as we haven’t fully transitioned to a digital system” (Participant number 6)
Participants also said that Public PHC facilities can buy medicines from private suppliers when public stock is unavailable, and surplus or near-expiry items can be redistributed. Patients may also purchase needed drugs from community pharmacies if not available at the facility.
“When public suppliers run out of stock, we use internal funds to buy from private vendors” (Participant number 5)
Supportive financial policies
Participants reported that public PHC facilities accept health insurance, mainly improved community health insurance fund (iCHIF) (regional) and national health insurance fund (NHIF) (nationwide with broader coverage). Also, participants revealed that there is an exemption policy that covers children under five, pregnant women, and adults over 60. Others may qualify through the social welfare office. Participants further insisted that if patients or their families can’t pay upfront, treatment is provided on credit, with repayment expected after discharge.
“We accept insurance services, and the two main types of insurance in our settings are: NHIF and iCHF” (Participant number 1)
And
“We follow guidelines to determine exemption eligibility. If unclear, we refer the case to the social welfare unit for guidance” (Participant number 5)
Discussion
This study analyzed the experiences of HCPs in managing bites, stings, and other animal-related injuries in rural settings of Tanzania, focusing on challenges and opportunities. Challenges identified were dependence on traditional treatments, delayed health-seeking behaviors, low community awareness of available healthcare services, reliance on out-of-pocket payments, inability to afford life-saving treatments, inadequate transport systems, inefficient referral system, unreliable cold storage, power shortages, limited antivenom and anti-rabies supply, and lack of critical medical equipment. Key opportunities included cold chain systems, efficient documentation, functioning health insurance schemes, exemption policies, deferred payment systems, HCPs’ readiness, and community health workforce engagement.
Poor health-seeking behaviour and reliance on traditional healers contribute to delays in accessing healthcare in rural communities, as observed in our study. In many LMICs, especially in Africa, traditional remedies remain a primary form of care.18 Studies show that over two-thirds of snakebite victims first seek traditional treatment before visiting health facilities. Many arrive at hospitals with traditional interventions such as tourniquets, incisions, or applications of snake stones, coins, or herbs believed to draw out venom.23,24 These practices, rooted in spiritual beliefs, often stem from the perception that hospitals cannot effectively treat such injuries.11 However, the WHO cautions that traditional methods can do more harm than good.25,26 Tourniquets can worsen envenomation, cause nerve damage, gangrene, or even lead to shock upon removal.24,26 Incisions increase venom absorption and infection risk, while herbal treatments lack scientific evidence and are often kept secret by healers.24 To address these challenges, educational initiatives targeting communities and traditional healers are recommended to promote timely medical care for bites, stings, and other animal-related injuries.
Our study revealed that over-reliance on out-of-pocket payments significantly limits access to essential care for victims of animal-related injuries. Participants highlighted that most of the victims cannot afford critical treatments like antivenom or rabies vaccines. In Africa, a single vial of antivenom can cost USD 50 –100, roughly three times the monthly income of many rural families who depend on farming and livestock for survival.1 This financial burden often results in delayed care, poor adherence to treatment, and a shift toward low-cost, often ineffective alternatives, such as traditional healers.18,27 Studies show that reliance on out-of-pocket payments contributes to the underutilization of healthcare services and worsens health outcomes.27 Therefore, refining healthcare financing is essential for achieving universal health coverage (UHC). Solutions should include expanding enrollment in health insurance schemes and subsidizing life-saving treatments like antivenom and rabies vaccines, especially for vulnerable rural populations.
Our study further observed that poor access to healthcare services in rural settings is largely attributed to inadequate infrastructure, including transportation and referral systems. Similarly, studies from other regions highlight transportation challenges as a significant barrier to timely care for victims of bites, stings, and other animal-related injuries.23 In Pakistan, long transport times have been cited as a key issue, while in Uganda, high transport costs and an inefficient referral system contribute to delayed healthcare access, increasing the risk of severe complications and death.12,28 Likewise, in Canada, victims of dog bites in remote areas struggle to access timely care due to geographical barriers that limit the availability of healthcare resources.16 To address these challenges, a community-friendly referral system should be developed, including a structured referral model that connects traditional healers and community healthcare providers to formal healthcare facilities. Additionally, improvements in road infrastructure and transportation services, in collaboration with the private sector, are essential to ensure that victims can access medical care promptly.
Consistent with other studies, our findings show that shortages of antivenom, rabies vaccines, and other essential supportive care severely affect access to treatment.6,27 Antivenoms and rabies vaccines are classified by WHO as essential medicines; they are currently the only effective post-exposure prophylaxis for snakebites and dog bites.29,30 However, persistent shortages in LMICs hinder timely care.27 These shortages are driven by multiple factors, including the limited number of manufacturers in endemic regions, inadequate data for demand forecasting, poor stock management, high treatment costs, and underutilization due to reliance on traditional remedies.6,9,12 The availability of substandard or regionally inappropriate antivenoms further exacerbates the problem.27 Nevertheless, rural areas often lack sufficient health facilities, reliable electricity, and cold chain systems, all crucial for storing these life-saving medicines.28 To address these challenges, there is a need to strengthen local production of antivenoms and rabies vaccines, digitize health information systems for better forecasting, and improve coordination between communities and the healthcare system.
Nevertheless, our study demonstrated that rural settings have existing policies, systems, and infrastructure that can be leveraged to improve access to effective management for bites, stings, and other animal-related injuries. A functioning documentation system, HCPs’ readiness, and the engagement of community health workers can be customized to bridge the gap between the true burden of animal-related injuries and the available data by developing appropriate models. Besides, participants in this study confirmed the availability of guidelines for managing bites and sting cases, a finding supported by a previous study conducted in Tanzania.24 However, these guidelines are not widely distributed to all facilities and are not organism-specific.24 Additionally, health insurance schemes, exemption policies, and deferred payment options should be better integrated to ensure that most victims can afford healthcare costs. Moreover, participants noted that a cold chain system is already in place through the immunization program. Therefore, integrating bites, stings, and other animal-related injury management into existing services, as recommended by WHO, should be emphasized to enhance access to healthcare in resource-limited settings.31,32
This study has some limitations. It focused solely on the perspectives and experiences of HCPs, excluding input from community members and policymakers. Additionally, as with all qualitative research, the findings are not generalizable. However, we ensured the trustworthiness of our findings by applying Guba’s four criteria: credibility, transferability, dependability, and confirmability. Credibility was achieved by using well-established qualitative data collection methods, including a semi-structured interview guide designed to explore experiences of HCPs on challenges and opportunities in managing bites, stings, and other animal-related injuries in rural settings. Transferability was supported by providing detailed descriptions of the rural context in which the study was conducted.
We documented the study design, setting, population, data collection tools, and analysis process to ensure dependability. To maintain confirmability, trained research assistants were involved to support adherence to data collection protocols and reduce bias. Both inductive and deductive approaches were used in data analysis to reflect participants’ experiences accurately.
Conclusion
Access to appropriate healthcare services for victims of animal-related injuries in rural settings is hindered by overreliance on socio-cultural practices, poverty, and inadequate infrastructure. Nevertheless, several opportunities exist to address these challenges, including the demonstrated readiness of HCPs, the presence of health insurance schemes, the availability of life-saving medications, and functional cold chain systems. Strengthening community awareness about the importance of timely medical care, improving road infrastructure, and strategically leveraging these existing resources could significantly enhance access to appropriate and timely healthcare services for victims of animal-related injuries, such as bites and stings.
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how to cite this article
Kilonzi M, Makoye PM, Aiko B et al. Managing Animal-Related Injuries in Rural Tanzania: Challenges and Opportunities from Healthcare Providers’ Experiences in Mkinga District [version 1; peer review: awaiting peer review]. F1000Research 2025, 14:758 (https://doi.org/10.12688/f1000research.166768.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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