How do you change other people’s habits — from what they wear, to whether they use condoms — in the interests of their health and public health? In Puerto Rico, during the height of the Zika epidemic there, the stakes were high, as the devastating neurological impacts of the mosquito-born virus on children born to women infected during pregnancy including microcephaly, became increasingly clear. The findings from a study of interventions available to pregnant women in Puerto Rico from July 2016 to June 2017, underscore the importance of the obvious, in the measures that worked best: They were available where women already were receiving services, they gave the women what they need to adopt the recommended measures, and they made it easy.
The study, reported this week in the U.S. Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal, followed the outcomes of services, information and prevention tools provided to random sampling of pregnant women newly enrolled in Women, Infants and Children — WIC — clinics. All women attending the clinics for prenatal services received a 20-to-30 presentation on the consequences of Zika infection, and on ways to avoid infection. Those included 10 measures:
- using mosquito repellent,
- using condoms,
- abstaining from sex,
- wearing long-sleeved shirts,
- wearing long pants,
- sleeping under a bed net,
- removing or covering standing water,
- applying larvicide (in water that cannot be removed),
- putting screens on windows and doors,
- and spraying home and yard for mosquitoes.
When supplies were available, women were given “Zika Prevention Kits” — tote bags holding insect repellent, condoms, mosquito bed nets, larvicide tablets, and printed Zika education materials.
In addition, all women who came to the clinic for prenatal services were offered free residential spraying services from a company, which, if they accepted the service, contacted them.
At the same time, the Detén el Zika — Stop Zika — campaign rolled out Zika prevention messages on television, radio, print and social media channels showing people taking prevention steps, and showing healthy babies.
All of the measures were found to have some impact, and the WIC presentation was the most universally received. Of all of the interventions, however, the distribution of Zika Prevention Kits had the greatest impact in changing behaviors to ones that better protected against Zika infection, researchers found. The finding is consistent, the authors of the report note, with previous findings showing that distributing needed prevention items encourages prevention behavior, and should be considered best practice.