Assessing the Effectiveness of a Community Intervention for Monkeypox Prevention in the Congo Basin

Abstract

BackgroundIn 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 FindingsDuring 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/SignificanceThese 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.

The Effectiveness of Disaster Risk Communication: A Systematic Review of Intervention Studies

“…Two studies for pandemic influenza took place in high-income countries (Canada7 and Australia6), and one study for monkeypox took place in a low-income country (Republic of the Congo) 28. Both studies of interventions for pandemic influenza took place in 2008, before the 2009 H1N1 pandemic.…”

“…Dumais et al reported an educational intervention in a class of 35 female year 10 students in a private school in Canada 7. The intervention in Republic of the Congo was delivered on a much greater scale: approximately 23,860 people in 16 towns and villages received the intervention over a period of 90 days 28. Evaluation was by a survey of 271 people (57% male; mean age 33 years) before and after the intervention 28…”

“…The aim of this intervention was to improve understanding of viruses to facilitate response to risk communication about pandemic and epidemic influenza. The Roess et al intervention was an outreach education programme in villages in the Republic of Congo 28. Small group sessions were conducted using two specially made educational videos and discussions about monkeypox in each village.…”

“…Participants in the Canadian study of influenza increased their knowledge scores between a pre- and post-intervention test (with a significant change in mean score from 0.2 to 1.3, where 2.0 was the maximum possible score) 7. Roess et al analysed their before and after study using paired analyses 28. Significant improvements were noted in outcomes related to recognising monkeypox and knowledge of how it is transmitted.…”

“…Dumais et al reported significant improvements in knowledge for schoolchildren about influenza, which was intended only to facilitate further health education 7. The Roess et al study of a monkeypox intervention found modest improvement in knowledge outcomes and some behaviours, but did not successfully affect some high risk behaviours 28. Assessing the longer term effect of the programme is likely to be difficult.…”