Abstract
Visceral leishmaniasis (VL) is endemic to 54 districts in 4 states of India. Poor awareness of the disease and inappropriate health-seeking behavior are major challenges to eliminating the disease. Between February 2016 and March 2017, we implemented a behavior change communication (BCC) intervention in 33 districts of Bihar, 4 districts of Jharkhand, and 3 districts of West Bengal using a mix of channels, including group and interpersonal communication, to improve knowledge, attitudes, and practices of communities, frontline health workers, and opinion leaders. We conducted an impact assessment in October 2016, after the second indoor residual spraying (IRS) round, in Bihar and Jharkhand to evaluate the effect of the BCC intervention. Villages in 10 districts of Bihar and 4 districts in Jharkhand were selected for inclusion in the assessment. Selected villages were categorized as either intervention or control based on where project activities were conducted. Households were randomly selected proportional to caste composition, and interviewers surveyed the head of the household on whether the house was sprayed during the last IRS round and on knowledge, attitudes, and practices related to VL. We interviewed 700 households in intervention villages and 350 households in control villages and conducted correlation analysis to explore the association between IRS refusal and socioeconomic variables, and tested for association between IRS refusal and exposure to BCC activities. Odds ratios (ORs) were calculated. We reached an estimated 3.3 million contacts in Bihar and Jharkhand through the intervention's BCC activities. IRS refusal rates were significantly lower in intervention households than control households (mean=7.95% vs. 24.45%, respectively; OR, 0.27; 95% confidence interval [CI], 0.11 to 0.62; P<.001). Households in intervention villages were more aware than those in control villages that VL is spread by sand flies (68.4% vs. 7.4%, respectively; P<.001) and of IRS as an effective control measure (82.3% vs. 41.7%, respectively; P<.001). A greater percentage of households in intervention villages than control villages indicated they would encourage a patient to go to primary health centers for diagnosis and treatment of VL (77.0% vs. 39.4%, respectively) and to encourage others to accept IRS (78.6% vs. 44.6%, respectively; P<.001). Households that were exposed to community-based BCC activities largely using group and interpersonal communication had better knowledge, attitudes, and practices related to VL, including acceptance of IRS as a preventive measure, than households not exposed. BCC activities are thus an important component of VL elimination strategies.
Highlights
Visceral leishmaniasis (VL) is endemic to 54 districts in 4 states of India
Our compared with evaluation found that households in VL-endemic households in villages exposed to health communication activities control villages. had greater acceptance of indoor residual spraying (IRS), awareness of the disease, and willingness to prevent and treat it compared with households in VL-endemic villages that were not targeted with these communication activities
KNOWLEDGEb What causes VL? Insects Mosquitos Sand fly Other Don't know Is VL contagious and spread by touching? Yes No Don't know What are the symptoms of VL? Fever >2 weeks Loss of appetite Enlargement of spleen Weakness and anemia Don't know Do you know IRS prevents VL? Yes No Don't know What is effective treatment of VL? Local/traditional treatment Malarial medicine 1-day medicine that is given in government hospital No need for medicine Other Don't know Do you know that complete treatment of VL is available? Yes No Don't know Do you know that complete treatment of VL is free? Yes No Don't know
Summary
Visceral leishmaniasis (VL) is endemic to 54 districts in 4 states of India. Poor awareness of the disease and inappropriate health-seeking behavior are major challenges to eliminating the disease. Poor awareness of the disease coupled with inadequate health-seeking behaviors are considered to be major challenges to achieving elimination of VL. Influence of BCC on Visceral Leishmaniasis in India www.ghspjournal.org health intervention and developed the National Road Map for Kala-azar Elimination 2014. In this policy guideline, communication and social mobilization for behavioral impact, along with integrated vector management through indoor residual spraying (IRS), are among the 5 priority elimination strategies to bring incidence of VL cases below 1 per 10,000 persons annually in India.[3]. In the state of Bihar, most of the households in the intervention and control households were Hindu and largely from the Other Backward Caste and Scheduled Caste. In Jharkhand the majority of the households were split between Hindu, Christian, and Sarna (indigenous group of religions) faiths and the large majority belonged to the Scheduled Tribe.
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