Abstract
Background: Community health workers (CHWs) are a trusted source of health care information for rural communities in many low- and middle-income countries. This became particularly relevant during the COVID-19 pandemic when individuals had restricted access to facilities and required sufficient knowledge to prevent infection. This paper assesses CHWs’ level of knowledge, attitudes, and risk awareness towards COVID-19 and willingness for and concerns about vaccination against COVID-19 among CHWs in Rwanda, Malawi and Haiti.
Methods: Between June 2023 and October 2023, we surveyed 525 CHWs – 175 CHWs per country in Haiti, Malawi, and Rwanda – affiliated with 54 health care facilities. Data on CHWs’ demographics, COVID-19 knowledge, attitudes, risk perceptions, and vaccine intention were collected. Participants indicated on a Likert scale their perception of COVID-19 in terms of its risk-worry-severity-control. We analyzed mean trust scores, correct answer rates and answer frequencies and reported global p-values, assessing any difference and pairwise p-values, assessing country-specific differences, using rank-based and ANOVA tests.
Results: Across all countries, CHWs perceived COVID-19 as a relatively controllable disease of little worry and considered their risk of contracting the virus lower than or average as compared to other diseases. In Rwanda and Haiti, CHWs showed strong knowledge of COVID-19 and the COVID-19 vaccine (correct answer rate Rwanda: 87.5%; Haiti: 81.3%), while CHWs knew considerably less in Malawi (correct answer rate: 12.9%). The vast majority of CHWs believed COVID-19 presents a serious threat to the public (Haiti: n=168, 96.0%; Malawi: n=159, 91.0%; Rwanda: n=173, 99.0%) and were confident that their country would win the battle against the COVID-19 virus (Haiti: n=149, 85.0%; Malawi: n=133, 76.0%; Rwanda: n=171, 98.0%).
Conclusions: The knowledge of COVID-19 and the COVID-19 vaccine among CHWs, along with their attitudes and perceptions of the virus, varies across countries and is likely influenced by cultural and political factors. Given the CHWs’ roles to disseminate knowledge among communities in Haiti, Malawi, and Rwanda, targeted CHW education and communication training could improve community responsiveness in the future.