Breakthrough ACTION Global Health Security Agenda Risk Communication and Community Engagement Reach and Recall Assessment Brief Report

"The results demonstrated that the project's messages effectively reached the majority of the intended recipients and brought about substantial enhancements in knowledge, attitudes, and practices concerning zoonotic diseases (ZDs)."



From October 1 2022 to September 30 2023, Johns Hopkins Center for Communication Programs implemented the Breakthrough ACTION Global Health Security Agenda (GHSA) Risk Communication and Community Engagement (RCCE) project in 21 woredas of 3 regions of Ethiopia: Amhara, Oromia, and Southern Nations, Nationalities and Peoples (SNNP). The goal of the project was to increase healthy practices by communities and households and to foster an environment that enables adoption of high-impact health behaviours and practices focusing on priority zoonotic diseases (PZDs) in the intervention woredas. This report shares a reach and recall assessment that monitored reach of the messages to the priority audiences, audiences' recall of the messages, and effectiveness of the messages in improving knowledge, attitude, and healthy practices.



The project: provided trainings on community engagement for frontline community workers, primarily health extension workers (HEWs) and animal health workers (AHWs); developed and distributed community engagement tools such as cue cards that facilitate interpersonal communication (IPC); distributed various fliers, leaflets, and posters; aired a radio spot that promotes healthy behaviour change across PZDs and gender equality; and supported community engagement activities such as house-to-house visits by HEWs and AHWs, family discussions, health education at health posts (HPs) and animal health clinics (AHCs), and community education at religious institutions and schools in the intervention regions.



The assessment involved administering a structured questionnaire to a randomly selected sample of 456 individuals (50% female) in August 2023. Key findings include:

• Study participants' demographics: The majority of the respondents (95%) owned at least one type of domestic animal. In terms of access to communication devices, 66% of the respondents had a functional mobile phone, while 27% had a radio at their homes.
• Gender: Over 75% of the respondents stated that women in their households are involved in decision- making regarding the purchase and sale of animals. However, in around 30% of cases, the decision to take sick animals to an animal clinic was made solely by the husband. The majority of respondents (85%) believed that husbands should participate in household chores. Tasks such as fetching water (84%), cleaning the yard (64%), buying food supplies from the market (55%), cleaning the house (36%), feeding children (32%), and cooking (32%) were mentioned as types of household activities that respondents believed men should engage in.
• Knowledge, attitudes, and practices on PZDs:
  • 78% of the respondents agreed that diseases can be transmitted from wild animals to domestic animals, while 59% agreed that the environment can harbor pathogens that can infect animals. - When asked about transmission routes for zoonotic diseases (ZDs), 74% of the respondents knew that consuming raw animal products is a major route of transmission, 61% were able to identify unsafe contact with animals, and 34% mentioned inhalation.
  • Regarding Anthrax, 57% of the respondents identified unsafe contact with infected meat or blood as a means of transmission, while 61% mentioned eating infected meat, and 46% reported drinking raw milk.
  • Concerning Brucellosis, 53% of the respondents recognised animal abortion as a symptom, while 43% mentioned consuming raw animal products and 36% mentioned unsafe contact with the blood or meat of infected animals as transmission routes.
  • For rabies, 88% of the respondents identified being bitten by an infected dog as a means of transmission, and 59% mentioned direct contact with an infected dog. In addition, 68% agreed that consuming the meat of a rabid animal is not medicinal, while 18% disagreed and 14% were unsure.
  • Approximately 72% of the respondents reported being aware of at least 2 prevention methods for ZDs, and 97% agreed that vaccination can prevent most ZDs.
  • As preventive measures for ZDs, 67.3% of the respondents mentioned ensuring proper vaccination of animals, 67% mentioned avoiding the consumption of raw animal products, 63% mentioned cleaning hands after contact with animals, and 47% mentioned properly disposing of carcasses.
  • The majority of respondents (79%) vaccinated their cow/ox, and 92% reported frequently washing their hands after contact with animals in the past 6 months. However, 24% of the respondents consumed raw meat, and 22% consumed raw milk during the same period.
• Exposure to messages: 40% of respondents were exposed to 1-2 interventions, 34% reported being exposed to 3+ interventions, and about 26% were never exposed. Exposure to 3+ messages was found among 57% of respondents in SNNP, 23% in Oromia, and 21% in Amhara. The main sources of the messages about PZDs were AHWs, HEWs, community volunteers, friends, and radio.
• Effectiveness of exposure to the messages on knowledge, attitudes, and practices:
  • The vaccination rate for cow/ox among respondents varied significantly depending on their level of exposure to the project interventions. Among those who had no exposure, 59% reported vaccinating their livestock. In comparison, 85% of those exposed to 1 to 2 interventions and 87% of those exposed to 3 or more interventions reported vaccinating their animals (P<0.000). According to the results of multivariate logistic regression analysis, respondents who were exposed to the interventions were 3 times more likely to vaccinate their livestock compared to those who were unexposed, with an adjusted odds ratio of 3.3 [95% confidence interval (CI): 1.67-6.93].
  • The percentage of respondents reporting handwashing after contact with animals also showed variation based on their exposure to the interventions. Among those with no exposure, 84% reported practicing handwashing. In contrast, 94% of those exposed to 1-2 interventions and 95% of those exposed to 3 or more interventions reported handwashing (P<0.01).
  • When it came to the transmission of PZDs, among the unexposed respondents, 55% named raw meat consumption as a means of transmission. This percentage increased to 71% among those exposed to 1-2 interventions and 72% among those exposed to 3 or more interventions (P<0.01).

Per Breakthrough ACTION, the utilisation of a combination of communication channels, including IPC and media, as well as the involvement of AHWs and HEWs, facilitated dissemination of the project messages. However, it should be noted that there were significant regional differences in terms of message reach and practices. Therefore, when designing strategies and messages for the prevention and control of ZDs, it is important for risk communication programmes to employ a mix of communication channels and take into account regional variations.