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USING THE KOWLEDGE ATTITUDE BELIEF AND PRACTICE (KABP) MODEL TO PREVENT AND CONTROL THE EBOLA VIRUS DISEASE

SEPTEMBER 29, 2014 By Tonya Musa, Lecturer in Mass Communication, FBC (musatonya@yahoo.com/+23276507160)

The research commissioned by UNICEF on the Ebola communicative needs was based on analyzing Knowledge Attitude and Practice (KAP) framework as the behavioral change communication or the BCC model. Now the factor missing in this approach regarding the SOCIAL MOBILIZATION theory for change is BELIEF which has significant relationship with ATTITUDE And PRACTICE on those matters that are culturally embedded.

The Knowledge factor is known as raising awareness or sensitization to prevent and control the Ebola disease. This aspect seeks to enhance public understanding of basic issues like what is Ebola? What are the signs and symptoms? Why to go for treatment if signs are noticed? Where to seek treatment? What are contacts for treatment or isolation centers e.g. 117? Is Ebola curable? Who are the survivors? How long does the virus live in survivors? What are the different roles of health workers? What are the roles of the family, neighborhoods in preventing and controlling the disease? Knowing the meaning of key words like isolation, quarantine, epicenter etc, who are contributing in diverse ways to control the spread of the disease etc?

Attitude refers to the mindset of the public regarding the reality of Ebola and their commitment to preventing the disease in line with the knowledge. The attitude includes individual compliance with the rules and regulations put forward by health workers for example and the laws including bylaws instituted by government and local authorities to prevent and control the Ebola disease. Some negative attitudes includes people refusing to report cases in time, people going to consult herbalists, people insist on body contact, people refusing to report deaths, people refusing to wash hands, people still going to attire base and bars or cinemas, people still eating bush meats, people still going to pepper doctors, people still hide Ebola victims, people still wash and bury Ebola infected remains, people still play with the body fluids or vomit of Ebola patient, people are  still having unprotected sex, people are misusing the funds meant for Ebola etc. Here is an example of the ATTITUDINAL SCENARIO by Idrissa Conteh posted on Facebook.

Dead Soothsayer’s Relatives Storm Connaught Hospital! A famous herbalist and soothsayer reportedly died of the Ebola epidemic disease at the Connaught Hospital after relatives had treated him in vain for other ailments at his Kroo Bay residence for several days. This afternoon, a crowd of relatives and sympathisers from Kroo Bay stormed the Connaught Hospital in Freetown demanding the late soothsayers Ebola test result.  The relatives said they wanted to give the soothsayer a decent burial if no result was presented to them to ascertain that cause of death was due to Ebola.  The police were called in to protect the medical personnel and the hospital. The crowd was dispersed without any major incident. The fortune teller has been laid to rest. This is just a peculiar case where transmission would be increased as a result of attitude. The best change tool for this aspect is information and enforcing legal instruments to prosecute and punish violators or perpetrators.

Together we can alter the attitude of denying the existence of the sick, the attitude of going to pepper doctor, or attitude of eating all of kinds of meat, the attitude of eating together in the same plate, the attitude of having multiple conjugal partners, the attitude of hand shake, the attitude of confronting health workers, the attitude of keeping health workers at Epicenters with their relatives while working, the attitude of blood transfusion without lab test, the attitude of keeping dead bodies at home, the attitude of congesting in a room, the attitude of not cleaning a surrounding etc.

Belief here connects with the mind set in terms of culture and traditions. Some of the negative beliefs to alter in order to control and prevent Ebola are: Ebola is a witch craft, Ebola can be cured by spiritualists or herbalists, that only God kills SO Ebola or not people have to die, Ebola is a political tool, Ebola should be made secrete, that the REMAINS of imams, pastors, and herbalists has power for protections, the belief that going to hospital is dangerous at this moment, the belief that eating government or donor foods may expose people to Ebola, the notion that multiple sex may cure the virus and in fact Ebola is destiny etc.  The best tool of communication to alter negative belief is interpersonal channel like Imams, pastors, herbalists, spiritualists, academics, and mass media including the use of social networks.

Practice refers to what the public is doing concerning their knowledge, attitude and belief. So I think together we can alter negative practices that can spread the Ebola virus.  Avoid the traditional burial practice, avoid the practice of hand shake and prostitution, and avoid consulting herbalists when signs of Ebola are noticed, avoid sleeping in congested environment, learn to wash your hands with soap and water regularly, report all matters about Ebola using the appropriate contacts. In Kenema for instance more people have been and would be infected by the VIRUS because of having direct contact with somebody who died of Ebola but the initial lab test shows negative and later was given to his family members who performed the traditional rite of passage and two days later some unfortunately were infected by the VIRUS and all lab tests proved that they were infected by the remains of their relative whose initial test was negative. The other situation was at Kalia in Bo district and Buyahromende in Port Loko district. It means government should do the following to stop this:

1. All burial should be done for now by the contracted health workers to be identified and recruited for this period. They should be deployed in all towns and villages in the country especially in MAJOR TOWNS and CITIES

2. Whether Ebola related cause or not let every deceased be buried immediately apart from criminal suspected cases.

3. All private Funeral Homes should be closed for now so that only government mortuary should preserve the dead. This can reduce the chances of more spread of the disease.

4. To sensitize religious communities on the need for this as a way to mitigate the virus

5. To train more health workers for the burial team on the ethics of religious befitting burial so that we can minimize the spread of the virus by through washing hands and playing with the remains

The time is ripe enough now to give the campaign “GUN Ebola or KILL Ebola” or “Drive Ebola or Action against Ebola” or “Mitigate the Ebola spread” or “Kick Ebola” etc a professional and intellectual face. Communicative response using coordinated messaging for behavioral change is very significant in SOCIAL MOBILIZATION but let me ask few questions concerning putting the message into practice:

1. Who is mobilizing traditional authorities in the communities and how? The critical factor is conflict on mandate and role to combat the Ebola disease.

2. Who is mobilizing the international community and how? The fact is even Obama the US President lamented to the Security Council that appropriate measures have been delayed regarding controlling the disease.

3. Who is mobilizing the intellectual community and how? The situation is that tertiary institutions, researchers and curriculum developers should be seeing giving the Ebola an intellectual face using mass media, social networks and doing dialogue based articles on the benefits of adopting the best practice.

4. Who is mobilizing floaters and how? The critical factor is that some are doing body contact, servicing OKADA transportation of infected persons, and accepting to be thugs to resist health workers in discharging functions.

5. Who is mobilizing estate owners (house, hotels, guest house, restaurants, etc) and how? The fact is most of them are hosting Ebola carriers without screening or reporting matters.

6. Who is mobilizing health workers and how? Because most of them are giving isolated treatment and having sexual relations or staying with relatives while working at Epicenters.

7. Who is mobilizing public workers and how? That critical factor is about sanitization of locations and interaction of staff members noting the measures of contact tracing.

8. Who is mobilizing footballers and how?

9. Who is mobilizing barbers/ hair dressers and how?

10. Who is mobilizing commercial sex workers and how? They are still searching for players who pay the cash and through they are exposed to the risks of being infected.

11. Who is mobilizing the physically challenged and how?

12. Who is mobilizing artists/ journalists/ actors and how? There are challenges regarding ethics in both print and electronic media. The same applies for users of social media.

13. Who is mobilizing dwelling units and how?

14. Who is mobilizing drug stores/ pharmacies and how? The danger is some are still selling drugs without prescriptions and in some cases giving secrete treatment to Ebola patients.

15. Who is mobilizing drivers/ apprentice and how? The situation is ugly regarding hiring vehicles and Okada to convey deliberately isolated Ebola cases by relatives.

16. Who is mobilizing politicians and how? The problem of resource mobilization and utilization is become crucial between members of parliament and councilors.

17. Who is mobilizing meat sellers? The critical factors is blood transmission and direct hand touch and saliva transfer for those selling roast meat through magi, onions, and seasons openly placed.

The “Ose to Ose” Ebola “tok” has increased public listening period to radio in order to understand the Ebola disease, its spread and implications but more so by understanding the PREVENTIVE measures. The Ose to Ose tok alos increased the Household unit dialogue on Ebola and how to mitigate it spread. It was a way for partners/ couples /spouses to understand that sexual intercourse is risky for now especially those in polygamous homes. A moment also to reflect that body contact like hair dressing, nail polishing, putting tattoos etc are risky. To tell kids not to play out of their doors for them not to contact the virus. The sensitization used the Knowledge, Attitude and Practice (KAP) model as the way to do the messaging on the Ebola control and prevention.

The Ose to ose Ebola tok took momentum from the looks of things. I think this might be one way for effective national census which might last for just for two days in future with government using Saturday and Sunday if they wish.

The Ose to Ose tok was very significant since everyone was asking each other questions:

1. Why are we at home today?

2. Is their cure for Ebola?

3. How does someone get infected?

4. What are the signs and symptoms of Ebola?

5. Who have died of Ebola?

6. Where this Ebola started?

7. What to do if signs are noticed?

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