Background: Responding to the shortage in healthcare workforce (HCW) in rural areas, the Ethiopian government introduced the Women’s Development Army (WDA) in 2011, consisting of adult women over 18 years. These volunteers support the HCW primarily in health education and promotion, where one woman out of every five households works under the supervision of a HCW to spread awareness in her community about household hygiene, vaccination, antenatal care, and institutional childbirth among other topics. To address prevalent periodontal disease, poor oral hygiene and harmful traditional practices (e.g. oral infant mutilation), we involved the WDA in designing, training and dissemination of a customized, evidence-based, and culturally adapted oral health curriculum.
Methods: We trained 209 WDA leaders from the Koraro Millennium Village Cluster in Northeastern Ethiopia to test the feasibility, cultural-appropriateness and comprehensibility of the curriculum.
Results: Pre/post-test changes were assessed using a paired t-test. We found a significant increase of 5.73 points in overall knowledge score (p<0.001). Individual knowledge questions were compared using Mcnemars tests showing highest knowledge gain for questions pertaining to dispelling myths regarding causes of oral diseases (e.g. worms causing decay, p<0.0001). Mixed linear models assessed the association between the participants’ knowledge and individual-level characteristics with fixed level effects. Older participants showed more average knowledge change, while those with children showed less gain (p <0.001).
Conclusion: The format of the education session should consider family structure affording more leeway to women leaders with children to maximize their knowledge gain.