Knowledge Gained and Retained from a Video-Centered, Community-Based Intervention for Ebola Prevention, Congo.

There are few effective communication interventions to respond to Ebola Virus Disease (EVD) outbreaks, and their development is a continuing challenge. The largest outbreak of EVD was first recognized in 2014 and once again highlighted the need for health education communication campaigns. EVD emergence and transmission are associated with behaviors that increase exposure to infected individuals and infected wildlife. In 2008-2009, an educational video-centered intervention consisting of a film followed by a structured discussion was developed to improve EVD knowledge, attitudes, and behaviors (KABs) for prevention of EVD and care of infected people. The film was produced for a Congolese audience in local languages and features doctors and residents from the region. The objective of the study was to assess the effectiveness of this intervention to change KABs related to EVD. The intervention was conducted over 12 months and reached >60,000 people; 220 individuals were sampled before and immediately after the intervention, and a subsample of 53 who had received the intervention 1 year earlier were interviewed to assess changes in KABs related to EVD. Statistically significant improvements in EVD recognition, transmission, and mitigation of risk after the intervention were observed. This study also demonstrates significant retention of knowledge one year after the intervention. Overall, the intervention was effective in improving KABs among a limited literacy population and knowledge was retained for more than one year. The materials and approaches developed were used in 2014 as part of a social mobilization strategy in response to an Ebola outbreak in the Congo Basin.

Presumptive risk factors for monkeypox in rural communities in the Democratic Republic of the Congo.

Monkeypox virus (MPXV), a close relative of Variola virus, is a zoonotic virus with an unknown reservoir. Interaction with infected wildlife, bites from peri-domestic animals, and bushmeat hunting are hypothesized routes of infection from wildlife to humans. Using a Risk Questionnaire, performed in monkeypox-affected areas of rural Democratic Republic of the Congo, we describe the lifestyles and demographics associated with presumptive risk factors for MPXV infection. We generated two indices to assess risk: Household Materials Index (HMI), a proxy for socioeconomic status of households and Risk Activity Index (RAI), which describes presumptive risk for animal-to-human transmission of MPXV. Based on participant self-reported activity patterns, we found that people in this population are more likely to visit the forest than a market to fulfill material needs, and that the reported occupation is limited in describing behavior of individuals may participate. Being bitten by rodents in the home was commonly reported, and this was significantly associated with a low HMI. The highest scoring RAI sub-groups were 'hunters' and males aged ≥ 18 years; however, several activities involving MPXV-implicated animals were distributed across all sub-groups. The current analysis may be useful in identifying at-risk groups and help to direct education, outreach and prevention efforts more efficiently.

Collection and Utilization of Animal Carcasses Associated with zoonotic Disease in Tshuapa District, the Democratic Republic of the Congo, 2012.

The collection and consumption of animal carcasses is a common activity in forested areas of the Congo River basin and creates sustainability, conservation, and health concerns. Residents of the Tshuapa District reported collecting the remains of 5,878 animals from >30 species when surveyed about their wildlife consumption habits. Carcasses were discovered in varying degrees of decomposition and were often consumed at home or sold in local markets. The most commonly collected animals were Cricetomys gambianus (Northern giant pouched rat), Cercopithecus ascanius (red-tailed monkey), and Heliosciurus rufobrachium (red-legged sun squirrel). Many of the species recorded may be hosts of zoonotic pathogens, creating concern for spillover events.

Assessing the effectiveness of a community intervention for monkeypox prevention in the Congo basin.

BACKGROUND: In areas where health resources are limited, community participation in the recognition and reporting of disease hazards is critical for the identification of outbreaks. This is particularly true for zoonotic diseases such as monkeypox that principally affect people living in remote areas with few health services. Here we report the findings of an evaluation measuring the effectiveness of a film-based community outreach program designed to improve the understanding of monkeypox symptoms, transmission and prevention, by residents of the Republic of the Congo (ROC) who are at risk for disease acquisition. METHODOLOGY/PRINCIPAL FINDINGS: During 90 days, monkeypox outreach was conducted for ∼23,860 people in northern ROC. Two hundred seventy-one attendees (selected via a structured sample) were interviewed before and after participating in a small-group outreach session. The proportion of interviewees demonstrating monkeypox-specific knowledge before and after was compared. Significant gains were measured in areas of disease recognition, transmission, and mitigation of risk. The ability to recognize at least one disease symptom and a willingness to take a family member with monkeypox to the hospital increased from 49 and 45% to 95 and 87%, respectively (p<0.001, both). Willingness to deter behaviors associated with zoonotic risk, such as eating the carcass of a primate found dead in the forest, remained fundamentally unchanged however, suggesting additional messaging may be needed. CONCLUSIONS/SIGNIFICANCE: These results suggest that our current program of film-based educational activities is effective in improving disease-specific knowledge and may encourage individuals to seek out the advice of health workers when monkeypox is suspected.