Applying a knowledge‐to‐action framework for primary prevention of spina bifida in tropical Africa

Abstract

Maternal periconceptual folate supplementation reduces the incidence of neural tube defects; however, in settings where population-level food fortification is not available, it is not clear how best to promote this prevention strategy. Guided by a knowledge-to-action methodology, we used mixed quantitative and qualitative methods to define the local disease burden, then designed, implemented and evaluated a culturally tailored educational intervention in eastern Democratic Republic of Congo, where resource limitations and threats to human security contribute to restricted capacity for the prevention and management of congenital malformations. A descriptive case series of 27 patients undergoing surgery for spina bifida demonstrated a short-term mortality of 15% and long-term disability in survivors. A survey of knowledge, attitudes and practices demonstrated a low level of folate awareness (53%) among women of reproductive age. Focus group discussions revealed exotic aetiologic views, significant gender issues and several barriers to folate use. A culturally tailored radio broadcast and an educational video were designed and produced locally based on qualitative and quantitative findings. Evaluation of the video documented high levels of viewer satisfaction and unequivocal knowledge gain (P ≤ 0.001). We conclude that spina bifida poses a significant burden on affected patients and their families in the African context, but folate is underutilized as a prevention strategy. Patient education through video media results in increased awareness and understanding of spina bifida and folate, a first step in empowering women to reduce the risk of spina bifida in their children in the absence of population-wide food fortification.

Awareness and uptake of measures for preventing CNS birth defects among mothers of affected children in a sub-Saharan African neurosurgeon’s practice

“…The basic fact of the global extant low level of awareness of the place of periconceptional FA in the prevention of NTDs, more so in minority groups like women in sub-Saharan Africa, is well established [5,10,12,15,21,31]. The findings of this study reaffirm this fact.…”

Using the Knowledge to Action Framework in practice: a citation analysis and systematic review

“…Eight of the ten studies were conducted in Canada, one in the Democratic Republic of Congo [ 17 ] and one in Denmark [ 18 ]. Studies were published between 2007 and 2013.…”

“…Each implementation study was very different (see Table 3 ). Two were concerned with public health or health promotion [ 17 ],[ 20 ]; three focused on clinical academic or nurse education [ 18 ],[ 21 ],[ 22 ]. Others related to specific conditions, such as stroke [ 23 ],[ 24 ], children with cerebral palsy and motor difficulties [ 25 ] and osteoarthritis [ 26 ].…”

“…On this basis, all ten studies were judged as having described their projects clearly. Four of the ten studies [ 17 ],[ 19 ],[ 21 ],[ 23 ] reported gaining ethical approval, suggesting that these had been independently characterised as research.…”

“…Most studies focused on improving knowledge or awareness, supporting what we know about the preponderance of professional or educational knowledge translation strategies within interventions aiming to promote the uptake of evidence [ 31 ]. Nine of the studies reported assessing barriers to change [ 17 ]-[ 19 ],[ 21 ]-[ 26 ]. Knowledge-related barriers [ 32 ] were the most common, indicating the appropriateness of using educational strategies to address such barriers.…”