Mpox and Health Literacy: Educating Communities.

Author: Dr Agatha Ugboma DVM, MVPH, MSc (IPH)

Reviewed by : Dr Azuka Ezeike, MBBS, FWACS, FMCOG, MSc(PH)

Understanding Mpox: What You Need to Know.                                  

 Mpox (formerly known as monkeypox) is a viral disease caused by the monkeypox virus (MPXV). In 1958, two outbreaks of a disease resembling pox in colonies of monkeys kept for a study led to the discovery of Mpox. Amidst intensified efforts to eradicate smallpox, the first human case was documented in the Democratic Republic of the Congo in 1970 [1]. It spreads through close contact with an infected person or animal. Mpox can lead to a rash, fever, swollen lymph nodes, and fatigue [2].                                    

There are two types of Mpox viruses:                                          

• Clade I from Central Africa 
• Clade II from West Africa;

 The latter is responsible for recent global outbreaks [2].                                    

Though mostly found in Africa, Mpox has recently spread to other parts of the world. [3].      

Mpox spreads through:                                          

• Close contact with someone who has the virus,                                 
• By touching, kissing, or being close to their face when they talk or breathe. [2].
• It can also spread during sex, mostly among people with multiple partners.                          
• Contaminated items like clothes or bedsheets can also carry the virus [3].
• Squirrels, rodents, monkeys, and other animals can also spread Mpox to humans through bites or scratches, although the exact animal source remains unknown. Research is ongoing to better understand how the virus spreads [2].

Pregnant women can pass the virus to their unborn baby, leading to possible complications. [2]      Anyone can get Mpox. In Africa, children under 15 are mostly affected, while outside Africa, it's more common among men who have sex with men. [3].                                    

Symptoms of Mpox:  

Symptoms usually appear 1 to 21 days after exposure and can last 2 to 4 weeks.  

Common symptoms include:                                          

•  Fever, 
• Headache, 
• Muscle aches, 
• Swollen lymph nodes

Rash, which begins as a flat sore and progresses into a blister that is filled with liquid, may show up on the face, palm, sole of the feet, or genital areas. [2]. Some people experience only the rash, while others may not show any symptoms. [3]                              

 The Power of Health Literacy in Disease Prevention:    

Educating the public about the transmission risks and early symptoms of Mpox, preventive measures, and the importance of vaccination can;                                          

• Improve a community’s knowledge and awareness about Mpox [4]. 
• Help individuals easily recognize symptoms with clear and simple information and take necessary action [4].
• Help people stay away from infected persons and therefore avoid spreading the virus [5].

To prevent Mpox, people should:  

• Wash their hands often 
• Avoid sharing personal items like clothes or bedding and sharp objects an infected person has used. 
• Avoid close contact with those who are infected [5].
• Avoid multiple sex partners and practice safer sex, especially among men who have sex with men to limit the risk of contracting the disease [6].
• Those who handle animals closely should wear the right protective clothes, take extra care, and practice good hygiene after handling an animal [5].

With proper information, people know when to see a doctor and understand the importance of vaccination during outbreaks [7]. Making sure everyone has the right information protects vulnerable communities and reduces the spread of Mpox, therefore keeping communities safe [7].

Challenges in Educating African Communities about Mpox:                              

Educating African communities about Mpox can be challenging due to the following factors:                                          

• Social and behavioral factors: Such as the hunting and consumption of wild game, also known as bushmeat, without proper cooking and poor hygiene practices [8]. 
• Lack of formal education: Many people in African communities need help understanding medical information due to low literacy levels and a lack of materials in their local languages. This makes it difficult for them to follow advice on methods to prevent or treat Mpox [9].
• False information and stigma: Misinformation, especially on social media, contributes to stigma and discrimination. Myths, such as linking Mpox to witchcraft or certain behaviors, prevent people from seeking help and make it difficult to educate communities [10].
• Cultural Beliefs: Living closely together, touching people, and handling animals without precautions can spread Mpox faster. Some cultural or religious beliefs also lead to resistance to vaccines and modern treatments [11].
• Poor Healthcare Systems: In many parts of Africa, especially the rural areas, healthcare is underfunded. There are few healthcare workers trained to educate the public about Mpox [12].
• Poverty: Many people need help to afford basic hygiene products or healthcare, and this prevents people from following health advice. Limiting the success of health campaigns [11]
• Instability:  Wars and conflicts in some regions have forced people to flee and live in bushes or forests [11].

Effective Strategies to Educate and Engage Communities:   

 Health messages must be tailored to each community's needs, beliefs, and literacy levels to effectively educate them about Mpox. Here are a few points to consider if you want your message to be heard:                                          

• Local leaders: Involving trusted local communities and religious leaders to deliver the message makes it easier for people to trust and accept the message [13].
• Tailoring Messages: Speak in local languages if possible and use simple words. In areas with low literacy, use pictures or videos to explain the message better. Respecting cultural practices while teaching about health can encourage communities to follow the advice more easily [14].
• Fighting Misinformation: It is important to address stigma, rumours, and wrong beliefs early and the information shared should be clear and truthful. Information should be shared, preferably through trusted individuals like community health workers or the local radio, as this can help correct these misconceptions [14].
• Community Involvement and Participation: Community involvement is key. There should be room for open discussions where people can ask questions and their worries are addressed [13].
• Access to Care and Hygiene: Provide access to healthcare and hygiene supplies, as poverty limits the success of a campaign and makes it difficult for people to follow preventive measures [13].

Mpox outbreaks can be prevented and controlled by adjusting education efforts and working directly with communities.

The Role of Healthcare Professionals in Mpox Education:   

Healthcare professionals play an important role in educating communities about Mpox.                      They teach people what clinical signs to look out for and how to prevent the disease from spreading.

• Doctors, nurses, and other health workers help people understand Mpox by sharing clear and correct information.                                   
• They explain how it spreads, the symptoms, and how people can protect themselves. This is important because misinformation can lead to fear and stigma.
• They can train local leaders and community members on how to recognize the symptoms of Mpox and respond efficiently. They also educate the people on what to do and how to follow hygiene and prevention tips.
• Health workers can engage directly with communities by listening to their concerns, answering their questions, and addressing any wrong ideas about Mpox. People are more likely to trust them and listen to advice [15].

Successful Initiatives in Mpox Education:    

Successful initiatives in Mpox education focused on providing accurate information in ways that people can easily understand. Combining culturally sensitive approaches, involving communities, and using what is available locally. In the Democratic Republic of Congo, health workers used local languages and pictures to teach people about Mpox.                                    

These helped to resolve myths like the belief that Mpox is caused by witchcraft and encouraged people to seek medical care [10].  In Nigeria, radio broadcasts and community health workers were used to spread accurate information about Mpox, even in rural areas. This helped to reduce fear and stigma [16]. In Central Africa, healthcare professionals worked with local leaders to get people to take the vaccine and other preventive measures [10]. These community leaders bridge the gap between modern medicine and traditional beliefs.

Conclusion: Enhancing Health Literacy to Combat Mpox:         

 Health messages about Mpox should be communicated in simple and clear language to successfully educate the community on how to prevent the disease.                                     

It is important to teach people how Mpox is transmitted, recognize its symptoms, and understand simple preventive measures, such as good hygiene practices and getting vaccinated.                          Involving community leaders is key to helping spread the message more widely, ensuring that the methods used are culturally appropriate and suitable to reach a larger audience.  By improving health knowledge within the community, individuals can better protect themselves and reduce fear surrounding the disease.

References:                                         

1. National Foundation for Infectious Diseases. Mpox. [Internet]. Updated 2023 Mar. Available from: https://www.nfid.org/infectious-disease/mpox/. Accessed 2024 Oct 12.
2. World Health Organization. Mpox: Overview. [Internet]. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/mpox. Accessed 2024 Oct 9.
3. Cleveland Clinic. Mpox. [Internet]. 2023. Available from: https://my.clevelandclinic.org/health/diseases/22371-monkeypox. Accessed 2024 Oct 12.
4. Castro-Sánchez E, Chang PWS, Vila-Candel R, Escobedo AA, Holmes AH. Review: Health literacy and infectious diseases: why does it matter? Int J Infect Dis. 2016;43:103-10.
5. U.S. Centers for Disease Control and Prevention. Clade I Mpox outbreak originating in Central Africa: What to know. [Internet]. 2024. Available from: https://www.cdc.gov/mpox/outbreaks/2023/. Accessed 2024 Oct 9.
6. European Centre for Disease Prevention and Control. Risk assessment: Monkeypox multi-country outbreak—23 May 2022. [Internet]. 2022. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Monkeypox-multi-country-outbreak.pdf.  Accessed 2024 Oct 12.
7. Center for Health Care Strategies. What is health literacy? [Internet]. 2024. Available from: https://www.chcs.org/media/What_is_Health_Literacy.pdf. Accessed 2024 Oct 10.
8. Tambo E, Noungoue Ngounou PJ, Njobet MP, Tappa NT, Ngogang J, Hunter M, et al. Assessment of risk perception and determinants of Mpox for strengthening community engagement in local populations in Cameroon. MedRxiv. 2024 Mar 21. Available from: https://doi.org/10.1101/2024.03.20.24304629.  Accessed 2024 Oct 12.
9. Amref Health Africa. Understanding Mpox: Challenges, solutions, and Amref’s response. [Internet]. 2023, Sep 23. Available from: https://amrefuk.org/blogs/2024/09/mpox-challenges-and-solutions. Accessed 2024 Oct 12.
10. Médecins Sans Frontières. Five questions about the Mpox outbreak in the DRC. [Internet]. 2024 Jul 30. Available from: https://www.msf.org/five-questions-about-mpox-outbreak-drc. Accessed 2024 Oct 12.
11. Ogunleye SC, Akinsulie OC, Aborode AT, Olorunshola MM, Gbore D, Oladoye M, Adesola RO, Gbadegoye JO, Olatoye BJ, Lawal MA, Bakare AB, Adekanye O, Chinyere EC. The re-emergence and transmission of Monkeypox virus in Nigeria: the role of one health. Front Public Health. 2024 Jan 5;11:1334238. doi: 10.3389/fpubh.2023.1334238. PMID: 38249416; PMCID: PMC10797020.
12. Oleribe OO, Momoh J, Uzochukwu BS, Mbofana F, Adebiyi A, Barbera T, Williams R, Taylor-Robinson SD. Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions. Int J Gen Med. 2019 Nov 6;12:395-403. doi: 10.2147/IJGM.S223882. PMID: 31819592; PMCID: PMC6844097. 
13. Hrynick T, Muzalia G, James M. Key considerations: Risk communication and community engagement for Mpox vaccination in eastern DRC. [Internet]. 2024. Available from: https://www.socialscienceinaction.org/resources/key-considerations-risk-communication-and-community-engagement-for-mpox-vaccination-in-eastern-drc/. Accessed 2024 Oct 12.
14. Ho K. Mpox, AIDS and COVID-19 show the challenges of targeting public health messaging to specific groups without causing stigma. [Internet]. 2022 Dec 14. Available from: https://theconversation.com/mpox-aids-and-covid-19-show-the-challenges-of-targeting-public-health-messaging-to-specific-groups-without-causing-stigma-188328.Accessed 2024 Oct 10.
15. U.S. Centers for Disease Control and Prevention. Preventing Mpox. [Internet]. 2024 Sep 12. Available from: https://www.cdc.gov/mpox/prevention/index.html. Accessed 2024 Oct 12.
16. World Health Organization. Rallying to defeat Mpox in Nigeria. [Internet]. 2022 Dec 6. Available from: https://www.afro.who.int/photo-story/rallying-defeat-mpox-nigeria.  Accessed 2024 Oct 12.
17. Centers for Disease Control and Prevention. Monkeypox lesions on a 4-year-old female, Liberia. 1971. Available from: https://en.wikipedia.org/wiki/File:Monkeypox.jpg. 

License: Public domain (Image produced by a U.S. federal government agency).