USAID: Engaging Women in Zika Response

SSI and AMOS collaborated on a USAID funded project (2016-2020), engaging women in Managua in the fight against Zika. Using the Care Group method – a peer-based health promotion methodology to improve health behaviors and outcomes quickly and effectively in low-resource communities – the project empowered women to prevent mother-to-child transmission of Zika by removing mosquito breeding sites in the home and increasing the use of personal protections against infection. Target groups were pregnant women, and women of childbearing age, located in one semi-rural and one urban district with a combined population of 50,000.

In addition to peer-based health promotion, the project employed an mHealth tool, the Dengue/ZikaChat app, to enhance community engagement and track progress on key indicators in real time. Using these methods, the project aimed to increase the community’s capacity and self-efficacy in reducing their exposure to Zika.

Community Empowerment through the Care Group Method

Community members participated in the design, implementation and measurement of this intervention thus building on local strengths, resources, culture, and creating a double-loop learning and feedback process. Community members were equal partners and their valuable input led to intervention strategies tailored to community needs and context, community ownership of the intervention, and study flexibility and resilience. Brigades consisted of community volunteers and were composed of 82% women.

Building on SSI’s expertise in evidence-based community mobilization, ten community facilitators – women living in the study areas – were hired to supervise eight Care Groups each for a total of 80 Care Groups and 960 brigadistas reaching 9,600 homes. Brigadistas – 82% female – were community volunteers. They received trainings every two weeks from their facilitators and then visited homes in their Neighborhood Circles to pass on their knowledge to the community.

Brigadistas engaged families in the inspection of their homes for mosquito breeding sites. Using a net, pipet, and plastic tray, brigadistas displayed the immature mosquitos recovered from the family water-storage containers. They discussed the mosquito life cycle, the importance of eliminating vector breeding sites, any barriers that might exist and how to overcome them. Key interventions were covering water storage barrels with elasticized covers, and removing tires and plastic containers that could collect water.

Brigadistas delivered key messages and support to use personal protections again infection –condoms, mosquito repellent, bed netting. They provided a connection to health care services for the community, following up on suspected cases of Zika or Dengue infection, referring pregnant women and newborns to clinical care, and calculating household risk for mosquito-borne illness. Brigadistas also held community activities – health fairs and clean-ups – to raise community knowledge and concern about Zika, organize residents to remove breeding sites, and to work with the municipality to obtain better trash collection and water distribution services.

Innovative tools: The ZikaChat app

Brigadistas also encouraged community members to use the mobile app, ZikaChat or DengueChat. The app provided targeted messages, community engagement activities and real-time data illustrating progress on reducing key entomological indicators. Results, shown in real-time, acted as a potent motivator for action. 

Impact and Results

To evaluate changes in the use of personal protection, the study used a pre-experimental, pre-post test design with data collected using Knowledge, Attitudes and Practices (KAP) surveys. Surveys of 566 women (283 women surveyed twice) were conducted by brigadistas in July 2017 and March 2020. All desired behaviors significantly increased over the study period. For example, all groups increased their use of ways to prevent Zika infection, but pregnant women (one-third of the respondents) showed the greatest increase.

To evaluate changes in vector presence, a team of six trained entomologists conducted household entomological surveys five times between 2017 and 2020 in the dry and rainy seasons. Accompanied by the household respondent, the team tested all water-storage vessels inside and outside the home. Over the study period, households showed significant improvements in all entomological indicators.