Table 3.

Some pressing needs in Costa Rica, Sri Lanka, and Nigeria to reduce the impact of snakebite envenoming.

Issue	Costa Rica	Sri Lanka	Nigeria
Antivenom production	-Consolidate production for local needs and for other countries in Latin America and elsewhere. -Improvements in the manufacturing facilities.	-Consolidate the local serpentarium. -Introduce local antivenom production through technology transfer programs.	-Development of local serpentarium to provide venoms. -Develop a strategy for local manufacture.
Antivenom availability and accessibility	-Expand distribution to primary health centers in areas of high incidence of snakebites.	-Design distribution strategies based on sound epidemiological data.	-Ensure acquisition of adequate volume of antivenom for the country's needs. -Design models of distribution based on sound epidemiological data, ensuring access in regions of high incidence of envenomings.
Quality control of antivenoms	-Develop in vitro assays that could reduce the use of mice.	-In country implementation of control of imported antivenoms using Sri Lankan venoms.	-In country implementation of control of imported antivenoms using Nigerian venoms.
Training of health workers	-Expand the teaching of this subject to all university medical schools. -Update of national guidelines for diagnosis and treatment. -Expand the use of digital tools in permanent education programs.	-Consolidate teaching in universities and in permanent education programs. -Update of national guidelines for diagnosis and treatment. -Expand the use of digital tools in permanent education programs.	-Consolidate teaching in universities and in permanent education programs. -Update of national guidelines for diagnosis and treatment. -Expand the use of digital tools in permanent education programs.
Prevention and early management	-Expand the design and implementation of prevention and early management campaigns to groups and regions of high snakebite incidence, paying attention to local cultural contexts and with strong involvement of local communities.	-Expand the design and implementation of prevention and early management campaigns to groups and regions of high snakebite incidence, paying attention to local cultural contexts and with strong involvement of local communities. -Dialogic approaches with traditional healers for improving the access of patients to health facilities.	-Expand the design and implementation of prevention and early management campaigns to groups and regions of high snakebite incidence, paying attention to local cultural contexts and with strong involvement of local communities. -Dialogic approaches with traditional healers for improving the access of patients to health facilities.
Clinical management	-Improve clinical management through training of health professionals and the introduction of evidence-based interventions for managing the complications of envenomings.	-Improve clinical management through training of health professionals and the introduction of evidence-based interventions for managing the complications of envenomings.	-Improve clinical management through training of health professionals and the introduction of evidence-based interventions for managing the complications of envenomings.
Follow up of sequelae	-Introduce legislation and programs to deal with the physical and psychological sequelae of envenomings, -Develop rehabilitation and economic compensation programs to mitigate the consequences of envenomings.	-Introduce legislation and programs to deal with the physical and psychological sequelae of envenomings, -Develop rehabilitation and economic compensation programs to mitigate the consequences of envenomings.	-Introduce legislation and programs to deal with the physical and psychological sequelae of envenomings, -Develop rehabilitation and economic compensation programs to mitigate the consequences of envenomings.
Research	-Consolidate the local strengths in basic and technological research in venoms and antivenoms. -Strengthen epidemiological and clinical research. -Promote inter-disciplinary research. -Consolidate international research cooperation activities and develop new initiatives with countries from all continents.	-Improve the national capacities to develop basic and technological research in venoms and antivenoms. -Strengthen epidemiological and clinical research. -Promote inter-disciplinary research. -Establish novel international cooperation programs.	-Improve the national capacities to develop basic and technological research in venoms and antivenoms. -Strengthen epidemiological and clinical research. -Promote inter-disciplinary research. -Consolidate international cooperation programs and develop new initiatives with countries in sub-Saharan Africa.