Impact of a Group-Based Video and Interactive Group Session Addressing Diarrheal Disease, Helminthic and Schistosomiasis Infections, Hypertension and Diabetes on Improvement in Knowledge and Healthy Behaviors in HIV-Negative Zambian couples
Background: Non-communicable and neglected tropical diseases (NCD and NTD) contribute to high morbidity and mortality in Zambia. While the public health importance of NTD has long been recognized, prevalence of disease remains high. NCD are emerging as causes of morbidity and mortality. Knowledge of risk factors, diagnosis, management, and prevention of NCDs and NTDs in the general population is poor and as a result, low-cost commodities are insufficiently used.
Methods: Urban couples recruited in five government health centers (HC) participated in a video-based group intervention addressing hand washing, water treatment, routine deworming, and urinary schistosomiasis screening to prevent morbidity and mortality from NTD. Chlorine, soap, and deworming for the family were provided, along with schistosomiasis treatment. The intervention also promoted lifestyle changes to prevent and ameliorate hypertension and diabetes and emphasized the importance of medical management regardless of symptomatology. Blood pressure screening identified hypertensives that were given low-sodium salt and referrals. Those with glucose on urine dipstick were counseled and referred. Knowledge and observed and self-reported behaviors were measured 1-2 weeks and 6 months after the interventions. All activities took place in the HC and conducted by trained HC staff. A comparison group recruited at five matched HC was assigned to an HIV prevention intervention and completed the same surveys as the intervention group at baseline and 6 months.
Results: One to two weeks after the intervention, reported use of chlorine treatment for drinking water increased from 24% to 96%, with knowledge of correct volume for dilution of 20 L and 5 L containers improving from 29%-35% to 96%-98%. Knowledge of household deworming increased from 62% to 99%. Observed handwashing technique improved including duration (20 seconds) and scrubbing of back, palms, wrists, between fingers and under fingernails. Knowledge that hypertension and diabetes could be asymptomatic increased from 63% to 82% and recall of potential sequelae also improved including heart disease/ attack (14% to 41%), stroke (26% to 61%) and death (65% to 83%). Correct definition of hypertension (BP > = 140/90) increased from 6% to 54% and citing salt reduction as part of management increased from 31% to 85%. An increase in those reporting not adding salt (8% to 20%) corresponded with a decrease in those reporting > = 1/2 teaspoon (16% to 5%). Knowledge that diabetics should reduce sugar intake increased from 48% to 89% and the proportion reporting adding > = 3 tsp to their tea decreased from 42% to 26%. Taking prescribed medication and getting regular medical checks knowledge increased for both hypertension (38% to 73% and 28% to 66%, respectively) and diabetes (32% to 71% and 20% to 60%, respectively). These improvements were retained at 6-month follow-up and sharing-related household duties to prevent NTD and NCD improved. Comparison group surveys confirmed equivalency of NTD and NCD knowledge and behaviors between the two groups at baseline. Surveys at 6 months showed no improvement in the comparison group, confirming that secular trend did not play a role.
Conclusion: Video-based interventions are time and money-saving and ensure consistent messaging. Sustained improvements in knowledge and behavior were reported when low-cost commodities were provided.