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Background: Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020. Methodology: This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment. Findings: The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post/center, or hospital), while 87% sought informal care (family/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom. Conclusions: This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies. Author summary: Snakebites can be life-threatening, especially in places like sub-Saharan Africa. In Rwanda, there haven't been any studies to understand how many snakebites happen and where they happen. This study wanted to find out two main things: first, how many snakebites happened in different parts of the Eastern Province of Rwanda in 2020, and second, where people who got bitten by snakes went for help—to doctors or traditional healers. The study involved 390,546 people across 763 villages. It found that each year, about 4.3 out of 1,000 people in the province get bitten by snakes, but the numbers vary in different areas. Surprisingly, only 13% of the victims initially consulted formal healthcare providers like community health workers, health centers, or hospitals. In contrast, a larger group, 87%, sought informal care from family, friends, pharmacists, or traditional healers first. About half of the people bitten by snakes experienced severe symptoms. Unfortunately, many people used unsafe methods to treat snakebites, like cutting or burning the skin, tying a tight band around the bitten area, using black stones, or trying to suck out the venom. Only a very small number of cases, just 24 out of all 1,098 victims, received anti-venom. The study suggests we need to make sure anti-venom is easier to get and teach communities about the risks of unsafe practices and why it's important to get formal healthcare quickly. It's important for doctors, traditional healers, community leaders, and government officials to work together to make sure people get safe and appropriate treatment and learn how to prevent snakebites. [ABSTRACT FROM AUTHOR]