Enhancing Knowledge in Informal Settlements: Assessing Health Beliefs and Behaviors in Nigeria: A cross-sectional survey assessment of perceptions, practices, and resources in underserved urban communities in Lagos.

Background: Community Health Education (CHE) programs have been shown to be effective in relieving the burden on healthcare systems in Sub-Saharan Africa. Objective: This project aimed to determine the baseline level of health literacy, behavioral practices, and accessibility to resources in a set of 16 informal settlements located around Lagos, Nigeria in order to identify topics that should be emphasized in a new teaching curriculum directed at local Community Health Educators. Methods: In June of 2017, a unique cross-sectional survey composed of 37 questions was conducted in informal settlements around Lagos. Sites selected were areas in which future CHE trainings were planned to take place and survey participants were chosen by trained community health educators based on convenience sampling with snowball effect. Survey questions included both multiple-choice and open-ended questions and were asked in the local language. We collected demographic information and assessed health literacy, health behaviors, and community practices. Results were analyzed using descriptive statistics to assess for differences between demographic groups. Findings: Our survey collected 348 total responses. Respondents displayed a high level of knowledge regarding the benefits of hand washing (97.1%) and childhood immunizations (81.0%). Knowledge around infectious diseases and reproductive health was lower, including a large proportion of people (50%) incorrectly indicating that HIV could be spread through a mosquito bite. Malaria was reported to be the most prevalent disease affecting both adults (40.0%) and children (58.3%). Health access was limited, with most people not reporting access to a nearby health center (55.8%). Conclusions: Areas of knowledge that should be emphasized in future versions of CHE training curricula include infectious diseases, reproductive health, and reinforcement of the importance of sanitation and clean water. The curriculum should address the reality of limited health access and develop strategies to improve this.