UNITED NATIONS
ECONOMIC AND SOCIAL COUNCIL
Distribution: General
ECA-IFLA/CONF./2/12
27 April 2007
Original: English
ECONOMIC COMMISSION FOR AFRICA
Fifth Session of the Committee
on Development Information (CODI-V)
Addis Ababa, Ethiopia 29 April-04 May 2007
Communicating Evidence-Based Research Information for Change
of Behaviour - The case of Malaria and HIV/AIDS
COMMUNICATING EVIDENCE BASED RESEARCH INFORMATION FOR CHANGE OF BEHAVIOUR - THE CASE OF MALARIA AND HIV/AIDS
PAPER PRESENTED AT THE COLLOQUIUM ON INFORMATION LITERACY, HOLDING AT THE ECONOMIC COMMISSION FOR AFRICA (ECA), ADDIS ABABA
ETHIOPA, FROM THE 29th TO THE 31st OF MARCH 2007.
BY DR ACHIDI ERIC AKUM
I wish to extend my appreciation to the organizers for inviting me to share with participants of this colloquium my reflections on how information literacy can influence the health pattern/behaviour of Africans living south of the Sahara.
There is a popular assertion that information is power, wealth and most importantly good health and I add that good health is a prerequisite for wealth and power acquisition. Correct information has the ability to make a U-turn in the life of an individual, family, community, region and the nation at large if properly exploited. Information and consequently health is an indispensable instrument for individual/national/regional/global development. Sustainable development requires a healthy and vibrant workforce empowered with the right kind of information and tools.
Information Literacy and Health
Several strategies have been established to expound on the notion of good health through user friendly health information packages and these include the IEC (Information, Education and Communication) or CCB (Communication for Change of Behaviour) amongst others. To achieve better health for the greater majority of the population the right kind of information must be obtained through a variety of channels basically involving research. A well designed study will produce information that targets specific problems thus improving on decision making and consequently a positive quality of life. Conversely, poorly collected data misinforms and breeds bad policies with resultant adverse effects on the population. Once the right information has been generated, it has to be packaged in a user friendly manner that will be better understood by the end users or the community. Once this information is understood the resultant effect is appropriate health education of the individual, family or community. For example, in the past, children presenting with convulsions either from infections or particularly from cerebral malaria were taken to pit toilettes and their heads inserted through the hole for some period. This was thought to cure the child of some bad spirit or the underlying ailment. Thanks to information and
education, parents now know that convulsing children should be sponged with water to bring down their body temperature before they are rushed to the nearest health care facility. This information has reduced the high fatality rate of convulsing children as was the case in the past.
Furthermore during the Ebola epidemic in parts of Central Africa, it was discovered that the epidemic was due to the cultural practice of traditionally washing the corpses of victims that resulted in the contamination of healthy community members. Thus health education on how to handle corpses of victims of Ebola virus infection resulted in a containment of the epidemic. This is also the case with other epidemics such as meningitis, malaria and other infectious diseases.
Health information can therefore avoid health epidemics and also improve on the quality and efficiency of health care service delivery by providing tools to help health care professionals deliver the highest quality of care.
Health Education towards Better Quality Life
Health education is a continuum of learning experiences which enables people as individuals and as members of a social structure, to make informed decisions, modifies behaviours, and change social conditions, in ways which promote health. In other words a health educated person will be able to apply health promotion and disease prevention concepts and principles to personal, family, and community health issues; assess, achieve, and maintain health enhancing behaviours throughout life; identify and manage controllable health risks; respect and promote the health of others; and select, access, and use health services, products, and information. Advocacy roles in behavioural changes and health enhancement can contribute to a positive quality of life. Many diseases and injuries can be prevented through knowledge acquisition that will result in the reduction of harmful and risk taking behaviours. Proper information promotes individuals accepting personal responsibility for health and encourages the practice of healthy behaviours.
Research as a Toolfor Information Generation and Literacy
Operational research provides useful information for policy formulation or change. Evidence based policy has the potential to transform tremendously the health status of a community.
Consequently, researchers must work hand in gloves with policy makers/disease control teams so
that information generated from their studies could be transformed into policy and utilized to
bring about the desired change in the community.In the write up that follows I have attempted to illustrate how information generated from the community has been used to improve the health status of the individuals that make up these communities through health education. I intend to focus on Malaria and HIV/AIDS, two common diseases that afflict a large proportion of our populations in sub Saharan Africa.
Information Literacy on Malaria and Reduced Morbidity/Mortality
The Malaria Burden
Malaria remains one of the biggest public health problems of mankind and particularly in sub Saharan Africa where the disease is endemic. It has been estimated that some 300-500 million people are infected with the disease each year resulting in 1-3 million deaths annually mostly involving children below 5 years of age. The disease causes enormous medical, economic and emotional burdens in sub Saharan African countries where it is endemic and there is a positive correlation between poverty and malaria, accounting for a reduction of almost half the annual per capita gross domestic product of some endemic countries. About half of the world's population lives in 103 countries exposed to malaria infection, but at least 90% of morbidity and mortality due to malaria is registered in countries located in sub Saharan Africa.
Pregnant Women and Young Children are most Vulnerable
In malaria endemic areas, children below 5 years of age and pregnant women (especially those experiencing their first pregnancies) are the most vulnerable groups. It has been reported that a child dies of malaria every 30 seconds resulting in a daily loss of more than 2000 young lives.
Malaria accounts for about 30% of mortality in children below 5 years of age in Africa.
Recommended control strategies for the disease include early diagnosis and prompt treatment, vector control through the environment and use of treated nets, and regular assessment of countries' malaria situation in particular the ecological, social and economic determinants of the disease.
Adverse Effects ofMalaria and Control Strategies
In endemic areas, malaria takes its toll in children on anaemia and severe forms of the disease (cerebral malaria). Malarial anaemia is complicated by the poor feeding that exist in the rural communities where exposure to malaria parasites is maximal. In pregnancy, malaria manifest itself as pregnancy wastage, low birth weight and maternal anaemia amongst others. Some of these adverse effects are preventable if only mothers who are custodians of the children are educated on malaria control measures to adopt. In several published studies, we have demonstrated high prevalence rates of anaemia in primary school children (40-75%) and young pregnant women at antenatal enrolment (50-69%). These data were presented at the Clinicians monthly meeting so as to educate health care providers of the necessity to address the problem.
Furthermore, these results were presented to the Regional Delegate for Education who in collaboration with other Health care providers stakeholders organized campaigns in schools and over the radio on the need for hygiene in schools and at home so as to prevent malaria infection including that from worm infestation which may complicate anaemia in young children.
The identification of vulnerable groups to malaria has led to their targeting for control. For example young children are usually given free insecticide treated bednets during vaccinations while pregnant women are issued these nets during antenatal enrolment. Use of treated nets has been shown to significantly reduce malaria infection rates, reduce morbidity and mortality rates and improve pregnancy outcomes including anaemia. Mothers now know that sleeping under a net with their children reduces the number of times a child is sick and reduces hospital expenditure thanks to education from community healthcare givers or home visitors. In further studies we are considering the possibility of using iron spoons and pots for cooking in rural settings since in one study we observed that over 60% of the anaemic cases were not associated with malaria. Results from experiemental animals are encouraging. If the result of the experiment turns out positive in humans then it will become possible to eliminate anaemia in vulnerable groups through a combination of malaria control and use of iron cooking utensils.
Access to Healthcare and Home Management ofMalaria
In one study it was shown that nearness to health care site reduces fatality outcome to malaria
since prompt treatment to malaria prevents the development of complications and fatal
outcomes. Consequently the concept of home management of malaria was investigated. Firstly
studies had to be conducted to demonstrate that mothers who are the caretakers in African communities can diagnose fever or malaria in their children. Results from this study showed that over 75% of mothers can diagnose malaria in their children. Next carefully packaged antimalarials with directive for administration based on movement of the sun were distributed to mothers to use for the treatment of malaria in their offspring. This trial also showed that a large number of rural women could correctly administer antimalarials to their sick children. This endeavor has significantly reduced malaria morbidity and particularly mortality in young children living in difficult to reach communities or where health facilities are very distant from settlement areas. An improvement to this strategy was the education of mothers in the use of rectal antimalarials to sick children for whom oral medication was impossible due to vomiting.
In this instances, mothers administered rectal antimalarials until the child was stable and it was convenient for her to visit a health facility.
It is evident from this submission that the identification of preventive (bed nets, chemoprophylaxis in pregnancy) and therapeutic measures (home treatment) against malaria when communicated in a user friendly manner to the grass root has the potential of reducing disease frequency and mortality. The outcome is an improvement of the health status of the community and family finances or poverty alleviation.
Information Literacy on HIV/AIDS and Prevention of Mother-to-ChiId Transmission of HIV.
The Burden ofHIV/AIDS
HIV/AIDS is one of the major public health problems in Africa. Sub Saharan Africa harbours the highest burden of the HIV/AIDS disease with country prevalence rates ranging between 1% to over 30%. Women are the most vulnerable including commercial sex workers, truck drivers and other mobile populations and military personnel. Transmission is mainly heterosexual with the most infected age group being 15-49 years old. Control of this pandemic has been hinged on Abstinence, Fidelity in relationships and Use of a preservative (e.g condoms) if the first two strategies are unlikely. In several studies conducted in Cameroon, it was observed that knowledge on prevention strategies increased with level of formal education in both sexes.
Message packaging for delivery to the grass root that included means of transmission of the virus, voluntary counseling and testing sites and available treatment options was shown to adversely affect incidence in some communities. Communication for change of behaviour and social mobilization for greater use of health care services also had a positive impact on the HIV
status of the communities.Prevention ofHIV/AIDS
In ensuring that HIV/AIDS prevention reaches every household in the community, the Cameroon Government created Local AIDS Control Committees which comprised of mapped geographical areas, elites, community elders and elected representatives of households or streets. The mandate of this committee was to deliver user friendly message packages (posters, flyers, bill boards etc) on HIV/AIDS and Sexually Transmissible Infections (STIs) prevention, care of patients living with HIV/AIDS, available HIV/AIDS counseling and screening facilities to the communities so as to reduce the transmission of the HIV or cater for those who are already infected. With regards to HIV/AIDS my presentation on information literacy and the disease will focus on prevention of mother-to-child transmission (PMTCT) of the virus.
Prevention ofMother-to-Child Transmission (PMTCT) of HIV/AIDS
Women who are infected with HIV are usually counseled to avoid unwanted pregnancies since it has been documented that close to 15% of children born to HIV infected mothers also get infected either in utero, during birth or through breast milk. Thus HIV positive partners) who need a child can be counseled on safe procedures to adopt towards reducing the risk of infecting their baby. Consequently focal points for the implementation and evaluation of PMTCT strategies have been created in almost all health districts. Children occupy an important position in a typical African family and therefore PMTCT activities should be fully implemented to avoid the embarrassing situation of overburdening the health care system with HIV infected newborns since couples will always want children irrespective of their status.
Risk reduction in HIV transmission to the offspring is feasible and involves a collaborative effort
between the health care provider and the expectant mother/partner. Good or safe delivery
practices will eliminate the contamination of the newborn during delivery thus leaving the mother to make the wisest informed decision on the feeding option to adopt.
Safe Practicesfor Prevention ofHIV Transmission from Mother to Newborn.
An infected mother has the choice to make whether to infect her baby or not. During antenatal enrolment, it is currently the procedure to counsel and screen all pregnant women for HIV amongst others. Information is usually made available to the HIV infected mothers during post testing counseling on the available options that will prevent her baby from becoming infected.
Firstly the mother is counseled to deliver in a health care center where delivery facilities are optimal that ensures the newborn is not infected during delivery. Secondly the HIV seropositive mother is given different feeding options with varying risks of infecting the baby. These include in order of increasing risk exclusive bottle feeding (safest option), breastfeeding for the first four months and then bottle feeding thereafter, or exclusive breastfeeding throughout infancy. In our community, we observed that the majority of women prefer the second option: breastfeeding for 3-4 months and then bottle feeding which exposes their baby to some risk of HIV infection. This was associated with stigma since exclusive bottle feeding raises eyebrows in the community and reveals the HIV status of the mother. It is however, difficult to understand why a mother will choose an option that exposes her child to being infected instead of making the decision to prevent her baby from HIV infection. Is this due to lack of information or stigma? This observation inspired us to brainstorm and asked several research questions.
Informed Family Decision May Negatively impact MTCT ofHIV
It was evident from field data obtained from different sites that men are reluctant to participate in PMTCT of HIV activities either due to the 'male ego' or fear of stigma or other unknown reasons. The question arises therefore on how we can educate men to increase their participation in PMTCT programmes? We are interested in identifying barriers that hinder men from participating in antenatal care with their partners. Results from this study will provide the necessary support women need to make a wise family decision on delivery and feeding options that protect the child from being infected with the HIV. There is the absolute need to educate men on the need to support their partners
in making the right decisions towards protecting their offspring thus reducing the number
of infected newborns and subsequently improve on the finances of the family.We also observed that most HIV positive women prefer to breastfeed their babies for between 3-4 months before switching to bottle feeding. The question is why a mother will choose this option when there is a safer option for the newborn's protection. We plan
to investigate how stigma, availability of resources and messaging affect a woman's decision to comply with PMTCT interventions. We will identity barriers that preventwomen from making informed decisions regarding PMTCT interventions (relating to delivery at hospital and choice of infant feeding options). Information from this study will be packaged for delivery to HIV seropositive mothers in the community in order to
empower them make informed decisions on their child's welfare.Communicating to the 'Hard' to Reach in the Community
Information from these studies will be channeled to the households in the communities to bring about behavioural changes by using a community based model developed in Malawi and involving three tiers of personnel: Health Educators, Health Promoters and Care Givers. In this tested highly efficient model, information generated from the field can be communicated rapidly and to a wider population by the multiplier structure of the personnel involved. In this case one educator is responsible for passing useful information for change of behaviour to 5 health promoters each who in turn are responsible for 5 groups of 10 Care Givers who downstream each take responsibility for
10 households. Thus information from 3 Health Educators on what infant feeding optionto adopt by HIV seropositive mothers can reach 15000 households in a language they better understand within days and bring about a tremendous positive impact on the HIV
status of that community.In conclusion, properly collected health information can be communicated efficiently
using a caregroup 'hard' to reach model bringing about a change in behaviour that will
impact positively on the health status of the individual, family or community. This has far
reaching consequences on finances poverty alleviation and individual/national development.
