Impact of Community Health Worker Training and Cash-incentives on Tuberculosis Knowledge and Attitudes among Community Members in Akwa Ibom State, Nigeria

Abstract

Introduction: Tuberculosis (TB) remains a public health crisis as it is the second leading cause of death from an infectious agent worldwide. Nigeria accounts for 4.5% of the global TB burden and has the 6^th highest TB burden. This study evaluates the effect of community health worker (CHW) training and cash incentives on TB knowledge and attitudes among community members in rural Akwa Ibom State, Nigeria.

Methods: A pre-and post-intervention study design was employed using a pretested, interviewer-administered structured questionnaire. The intervention involved training CHWs and providing them with cash incentives to enhance TB education outreaches and active case finding. Data was summarized using frequencies and percentages, and a comparison was made between pre- and post-intervention data using the chi-square test. Effect sizes were measured using odds ratio. Data analysis was conducted using SPSS version 28, at a 5% significance level.

Results: A total of 745 and 723 respondents participated in the pre-intervention and post-intervention surveys respectively. Post-intervention, significant improvements in TB knowledge were observed: The proportion of respondents with good overall TB knowledge increased from 67.8% pre-intervention to 83.7% post-intervention (OR: 1.474; p<0.0001). However, correct knowledge of TB prevention decreased from 58.4% to 35.8% (OR: 0.639; p<0.0001), and knowledge of TB susceptibility slightly declined from 93.2% to 89.5% (OR: 0.776; p=0.012). There was significant improvement in TB health-seeking behaviors, with more respondents willing to visit a health facility if they thought they had TB (90.3% vs. 80.4%) and to advise others to do the same (81.5% vs. 16.4%).

Conclusion: The CHW training and cash incentive program significantly enhanced overall TB knowledge and health-seeking behaviors among rural community members in Akwa Ibom State. These findings reiterate the importance of CHWs in TB control efforts in high-burden settings. Continuous evaluation and adaptation of such programs are recommended to sustain and further enhance their impact.