Knowledge and practices surrounding outbreaks and COVID-19 among community health workers in rural Rwanda: a cross-sectional mixed-methods study.

Introduction: Community Health Workers (CHW) are a critical resource for outbreak preparedness and response. However, CHWs´ ability to respond to outbreaks depends on their accurate knowledge of the disease and proper adoption of disease prevention practices. We explored knowledge and practices related to outbreaks in general, and COVID-19 among CHWs in Rwanda. Methods: this cross-sectional multimethod study used stratified simple random sampling to recruit three cadres of CHWs (agents de santé maternelle, female Binomes, and male Binomes) from three rural Rwandan districts. We used telephone-based data collection to administer quantitative surveys (N=292) and qualitative interviews (N=24) in September 2020. We calculated descriptive statistics and conducted thematic analysis of qualitative data. We assessed for associations between general outbreak-related knowledge and receipt of training using Chi-square tests and between COVID-19 related knowledge and CHW characteristics and adoption of prevention methods using linear regression models. Results: only 56.2% of CHWs had received training on any health topic in 12 months prior to COVID-19 pandemic and only 19.2% had specifically received training on outbreak preparedness. Almost all CHWs reported preventing COVID-19 by wearing facemasks (98%), washing hands (95%), and social distancing in crowds (89%) with fewer reporting staying at home (50%), sneezing or coughing into an elbow (38%) or using hand sanitizer (18%). Almost all CHWs in our study knew that COVID-19 transmits through respiratory droplets (98%) and by infected surfaces (98%) and that asymptomatic spread is possible (91%). However, fewer than half of community health workers correctly affirmed that children were at low risk of becoming severely ill (48%) and only 32% correctly rejected the misconception that everyone with COVID-19 would become severely ill. There was no association between COVID-19-related knowledge and adoption of COVID-19 preventative practices. Qualitative findings suggested that while CHWs possessed lots of correct information about COVID-19 and reported good adherence to COVID-19 prevention practices, they also commonly held misconceptions that over-exaggerated the dangers of COVID-19. Conclusion: gaps in knowledge, training, and access to information point to a need for additional investment in supervision and credible informational systems to support CHWs.

Knowledge and practices surrounding outbreaks and COVID-19 among community health workers in rural Rwanda: a cross-sectional mixed-methods study

Introduction: Community Health Workers (CHW) are a critical resource for outbreak preparedness and response. However, CHWs´ ability to respond to outbreaks depends on their accurate knowledge of the disease and proper adoption of disease prevention practices. We explored knowledge and practices related to outbreaks in general, and COVID-19 among CHWs in Rwanda. Methods: this cross-sectional multimethod study used stratified simple random sampling to recruit three cadres of CHWs (agents de santé maternelle, female Binomes, and male Binomes ) from three rural Rwandan districts. We used telephone-based data collection to administer quantitative surveys (N=292) and qualitative interviews (N=24) in September 2020. We calculated descriptive statistics and conducted thematic analysis of qualitative data. We assessed for associations between general outbreak-related knowledge and receipt of training using Chi-square tests and between COVID-19 related knowledge and CHW characteristics and adoption of prevention methods using linear regression models. Results: only 56.2% of CHWs had received training on any health topic in 12 months prior to COVID-19 pandemic and only 19.2% had specifically received training on outbreak preparedness. Almost all CHWs reported preventing COVID-19 by wearing facemasks (98%), washing hands (95%), and social distancing in crowds (89%) with fewer reporting staying at home (50%), sneezing or coughing into an elbow (38%) or using hand sanitizer (18%). Almost all CHWs in our study knew that COVID-19 transmit through respiratory droplets (98%) and by infected surfaces (98%) and that asymptomatic spread is possible (91%). However, fewer than half of community health workers correctly affirmed that children were at low risk of becoming severely ill (48%) and only 32% correctly rejected the misconception that everyone with COVID-19 would become severely ill. There was no association between COVID-19-related knowledge and adoption of COVID-19 preventative practices. Qualitative findings suggested that while CHWs possessed lots of correct information about COVID-19 and reported good adherence to COVID-19 prevention practices, they also commonly held misconceptions that over-exaggerated the dangers of COVID-19. Conclusion: gaps in knowledge, training, and access to information point to a need for additional investment in supervision and credible informational systems to support CHWs.

Rwanda's community health workers at the front line: a mixed-method study on perceived needs and challenges for community-based healthcare delivery during COVID-19 pandemic.

OBJECTIVE: During the COVID-19 pandemic, community health workers (CHWs) served as front-line workers in the COVID-19 response while maintaining community health services. We aimed to understand challenges faced by Rwanda's CHWs during a nationwide COVID-19 lockdown that occurred between March and May 2020 by assessing the availability of trainings, supplies and supervision while exploring perceived needs and challenges. DESIGN AND SETTING: This study was a mixed-method study conducted in three Rwandan districts: Burera, Kirehe and Kayonza. MAIN OUTCOME AND MEASURE: Using data collected via telephone, we assessed the availability of trainings, supplies and supervision during the first national lockdown, while exploring perceived needs and challenges of CHWs who were engaged in COVID-19 response, in addition to their existing duties of delivering health services in the community. RESULTS: Among the 292 quantitative survey participants, CHWs were responsible for a median of 55 households (IQR: 42-79) and visited a median of 30 households (IQR: 11-52) in the month prior to the survey (July 2020). In the previous 12 months, only 164 (56.2%) CHWs reported being trained on any health topic. Gaps in supply availability, particularly for commodities, existed at the start of the lockdown and worsened over the course of the lockdown. Supervision during the lockdown was low, with nearly 10% of CHWs never receiving supervision and only 24% receiving at least three supervision visits during the 3-month lockdown. In qualitative interviews, CHWs additionally described increases in workload, lack of personal protective equipment and COVID-specific training, fear of COVID-19, and difficult working conditions. CONCLUSION: Many challenges faced by CHWs during the lockdown predated COVID-19 and persisted or were exacerbated during the pandemic. To promote the resilience of Rwanda's CHW system, we recommend increased access to PPE; investment in training, supervision and supply chain management; and financial compensation for CHWs.