Systematic method in preventing COVID-19 spread

The outbreak of coronavirus disease (COVID-19) has been declared a Pandemic as the virus has now spread to many countries and territories. As at April 8th2020, there were 276 confirmed cases of the virus in Nigeria and the community transmission of the disease is on the increase (Punch newspaper, April 9th, 2020). While COVID-19 continues to spread it is important that communities take action to prevent further transmission, reduce the impacts of the outbreak and support control measures. Although a lot is still unknown about the virus that causes COVID-19, it is known that it is transmitted through direct contact with respiratory droplets of an infected person (generated through coughing and sneezing). Individuals can also be infected from touching surfaces contaminated with the virus and touching their face (e.g., eyes, nose, mouth). The protection of vulnerable group is particularly important. Precautions are necessary to prevent the potential spread of COVID-19 in their settings. It is important to remember that COVID-19 does not differentiate between borders, ethnicities, disability status, age or gender. Measures taken by communities where these vulnerable live can prevent the entry and spread of COVID-19 by people who may have been exposed to the virus. As with other respiratory infections like the flu or the common cold, public health measures are critical to slow the spread of illnesses. Public health measures are everyday preventive actions that include: staying home when sick; covering mouth and nose with flexed elbow or tissue when coughing or sneezing. Dispose of used tissue immediately; washing hands often with soap and water; and cleaning frequently touched surfaces and objects.

Children, pregnant women, elderly people, malnourished people, and people who are ill or immunocompromised, are particularly vulnerable when a disaster strikes, and take a relatively high share of the disease burden associated with emergencies (World Health Organization, 2020). Poverty – and its common consequences such as malnutrition, homelessness, poor housing and destitution – is a major contributor to vulnerability (WHO, 2020). However, it was suggested that the population most at risk of COVID-19 may be people with poor immune function such as older people and those with renal and hepatic dysfunction (Li, Guan, Wu, Wang, Zhou, Tong, et al, 2020). Globally, the population of elderly is increasing and their well-being is becoming a public health concern. In Nigeria, COVID-19 is spreading and elderly persons are at higher risk. Unfortunately, Nigerian Government does not provide social security to elderly and the supports from the family are fading out. Therefore, the well-being and health of elderly is compromised (Adebowale, Atte & Ayeni, 2012). Thus, making them very vulnerable to the disease as the virus can be fatal in rare cases, so far mainly among older people with pre-existing medical conditions.

The roles of elderly in nation building at the various stages of their life cannot be over-emphasized. They are the custodians of culture and tradition, mediators during conflict resolution and contributors in enforcing peace in their various communities. The younger generation will know little or nothing about culture and tradition if the elderly who are to educate them are not been properly preserved. The elderly have served their motherland when they were young and active (Asiyanbola, 2009). Many elderly reach retirement age after a lifetime of poverty and deprivation, poor access to health care and poor dietary intake. These situations leave them with insufficient personal savings to meet their daily needs (Charton & Rose, 2001). They are most at times denied of their right to receive their pension resulting on their poor well-being due to poverty and poor medical attention. Therefore, health and wellness of the elderly is of paramount importance. Youths migrate to cities while the elderly move back to the rural areas. Elderly persons in Nigeria reside more in rural communities, particularly those who have retired from their place of work.

Many older people do not access health services due to inability to prove their age, aggravated by the limited availability of health services, equipment and expertise. In Nigeria, poverty and poor infrastructural development which perpetrated rural communities where most elderly people reside constraint them getting adequate and up to date information on COVID-19 especially on the preventive measure.

Purpose of the project

Today, elderly people (vulnerable) in developing countries are global citizens who have served the society during their youth and are epitome of knowledge of the past. Any crisis presents the opportunity to help them cultivate compassion and increase resilience while building a safer and more caring community. Having information and facts about COVID-19 will help diminish their fears and anxieties around the disease and support their ability to cope with any impacts in their lives. This project seek to provides key messages, relief materials and follow up for community members and elderly themselves in promoting safe and healthy society. The purpose of this project is to provide clear and actionable guidance for safe operations through the prevention, early detection and control of COVID-19 in rural communities where the elderly live. Education of the youth, adults and elderly in their local dialects can encourage them to become advocates for disease prevention and control at home and in their community by talking to others about how to prevent the spread of viruses. In order to improve the preventive practice and awareness of COVID-19 this project is organized by the Department of Health Safety and Environmental Education, University of Benin, Nigeria. This program is organized around the process model of social marketing program development and will cover approximately a one year span.

The following are the steps to be taken in this project

Review of background information:

An extensive review was conducted by the researchers in the project on knowledge, attitude and prevention practice of COVID-19 in Edo State, Nigeria. Because of the novel nature of the virus, no related research was found in this locality. The need to design appropriate awareness creation intervention strategies.

Set communication objectives

From the review of the background data which emphasis the novel nature of the virus and its pandemic status, the communications objectives for the project is established. They include increasing awareness of the key latest facts of the virus, improving knowledge and ensuring adherence to preventive practices, ensuring safe community environment, provision of the virus prevention equipment (hand sanitizer, soaps, hand washing dishes, face mask and others) and provision of relief materials (food item, toiletries amongst others).

Audience segmentation

The primary target audience will be focused mainly on elderly people (60 years and above) residing in the area. Thereafter, the households with at least one elderly person in each rural area will listed to constitute a frame for the distribution of relief materials. Five rural communities in Edo State, which were Udo Community, Usen Community, Ehor Community, Oko Community, and Iguomo community will be selected initially for the project. Subsequently, more rural communities will be included. Before the commencement of the project, the Edo government and the community heads of each community will first be approached by the research coordinator and briefed on the purpose of the project. Also permission will be sought from them. Hence two persons from each of the community visited will be selected by the community heads to be part of this project.

Identity message concept

The major languages in these communities are English, Pidgin, Bini and Esan. With a clear evolution in the target audience over the years, the messages designed to reach these elderly will be translated to pidgin, Bini and Esan.

Some messages that will be used in this study are categorized as

Know the latest fact: Messages will include basic information about coronavirus disease (COVID-19), including its symptoms, complications, how it is transmitted and how to prevent transmission. Stay informed about COVID-19 through reputable sources such as UNICEF and WHO and national health ministry advisories. Be aware of fake information/myths that may circulate by word-of-mouth or online.

Recognize the symptoms of COVID-19 (coughing, fever, shortness of breath): Seek medical advice by first calling your health facility/provider before going to the health center, if advised. Remember that symptoms of COVID-19 such as cough or fever can be similar to those of the flu, or the common cold, which are a lot more common.

Washing hands properly: Messages such as Wash your hands often, especially before and after eating; after blowing your nose, coughing, or sneezing; going to the bathroom/ toilets/latrines and whenever your hands are visibly dirty. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water, if hands are visibly dirty. Protect yourself and others

Stigmatization messages: Don’t stigmatize your peers or tease anyone about being sick; remember that the virus doesn’t follow geographical boundaries, ethnicities, age or ability or gender. Tell your family member, or a caregiver if you feel sick, and ask to stay home.

More awareness messages: Be a leader in keeping yourself, family and community healthy. Share what you learn about preventing disease with your family and friends, especially with younger children. Model good practices such as sneezing or coughing into your elbow and washing your hands, especially for younger family members

Social distance messages and others.

Selecting communication channels

To ensure broad impact of the project, variety of channels to reach the target audiences over the span of the project will be utilized. These channels includes print and broadcast media (both mainstream and minority); town crier method (megaphones); social media; mobile bulk text messages; intermediary groups such as primary health care centres, health professional (especially health educators), religious houses, peers, friend, family members amongst others.

Creating materials and pretest

The researchers in this project are health educators who are experts in designing health promotion messages. A range of educational materials are already developed for the programme and choice of materials depends on the target audience and selected channels. Some of the educational materials are brochures and videos; media materials such as print and broadcast public services announcements, press kits; community intervention guide books; intermediary programme activity kits; speaker kits and relief material such as rice, groundnut oil, palm oil, tin tomatoes, soap, hand sanitizers, face mask amongst others. Pretesting will be a component of the materials development process, addressing elements such as message comprehension, cultural appropriateness, reading level and user friendliness.

Develop promotional plan

In this project, an integrated approach using a combination of distribution channels will be chosen to realize maximum reach. The researchers in this project will take advantage of the pandemic status of this virus to release new materials, highlight a new activity or reemphasize a message. Other promotional items that will be produced and disseminated are clinic posters, flyers, booklets, flipcharts, advertising, poster (slogan “get information and services here”, “early detection is key to” “Stay at home”) and bill boards.

Implement communication strategies

The researchers in this programme (Department of Health Safety and Environmental Education) have already developed some effective and unique broadcast vehicles to reach elderly in rural areas. The first mass media campaign consisted of various spots broadcast in Benin City from March 2020 to March 2021. Each spot will have a TV, a radio and Social media version. One of such avenue is development of a 30minutes audio drama titled talk about your health that talks about various topical issues (presently on COVID-19) inline with the message concepts identified earlier. This radio drama is acted by health education students and directed by Independent Radio (92.3 Fm) in Benin City.

Short film clips done for the target audience will be distributed via social media platforms and television stations in the city (silverbird, ITV, NTA and EBS). These films will be created to facilitate the use of the programme in educational setting and the identified COVID-19 messages will be passed through them. The films will also be distributed to other organizations including hospitals, clinics, churches, mosques and institutions libraries.

The researchers in this programme will collaborate with the management of University of Benin Teaching Hospital, Lily specialist hospital, Specialist Hospital (Benin Central Hospital), St. Philomena Hospital, Primary Health Care centres (Oredo and Egor Primary Health Care Centres) and other public and private national and community groups. The town hall of each community will be used to distribute the relief materials.

Monitoring and assessing effect

Throughout the implementation phases, monitoring will be accomplished through meetings with local government officers in Primary Health Care centres, participant observations by trained research assistants such as watching individuals as they are exposed to the programme, cost data analysis to ascertain cost effectiveness of the programme and estimate the expenses for other programmes. Other ways of monitoring will be service statistics such as the volume of attendance at relief center where materials will be distributed to each household with a pass card given to them by the research team.

Obtaining feedback

Feedback will be done through two dimensions. The researchers and their assistants will utilize convenience sampling will be used to select at least 150 elderly in the target audience. Recall (spontaneous dimension) will be the first dimension to get feedback from the audience. This method will involve using unprompted generic questions (for example the respondents are asked if they heard or saw anything about the campaign in the past 3 or 6 months; then they are asked what they thought was the message in the spot that they heard or saw). The second dimension is the recognition (prompted dimension). Here pictorial, videos, aural cues taken from the campaign and replayed for the respondents, accompanied by questions concerning whether they remember hearing or seeing them.

Dissemination

The evaluation findings from this project will be disseminated through scientific meeting and technical report. Through scientific meeting such as conferences (Society of Public Health Educators, Nigerian Association of Health Educator, School Health Association of Nigeria, Nigerian Medical Association amongst others) will provide the opportunity to get feedback from colleagues that can improve exposition of the results or provide valuable advice on evaluation theory and methodology. However technical report is targeted to the study funder, the policy makers and other interest audiences.