title: Health Promotion Through Existing Community Structures: A Case of Churches' Roles in Promoting Rotavirus Vaccination in Rural Zambia.
abstract: BACKGROUND
  Rural populations, particularly in Africa, suffer worse health outcomes from poor health services access. Community health workers (CHWs) effectively improve health outcomes, but the best means for CHWs reaching rural populations is unknown. Since Zambia is predominantly Christian, this study explored the use of CHWs through churches as an existing community structure for promoting preventive health behaviors, specifically rotavirus vaccine uptake.
  
  
  METHODS
  A noncontrolled cross-sectional study of 32 churches receiving a packaged intervention of diarrhea prevention and treatment messaging was conducted with repeated time points of data collection over 13 months (2013-2014) in the Kafue District of Zambia. Two churches were selected for each of the 17 catchment areas, and CHWs were identified and trained in the intervention of promoting 4 key messages related to diarrhea prevention and treatment: hand washing with soap, exclusive breast-feeding, rotavirus vaccination, and treating diarrhea with oral rehydration solution and zinc. The intervention was conducted within existing church's women's groups, and data was collected on attendance and the distribution of Rota Cards for tracking rotavirus immunizations.
  
  
  RESULTS
  Nineteen (59%) churches completed the study, and CHWs delivered health messages at a total of 890 women's group meetings. The overall reach of the intervention was to 37.0% of church-attending women, and the efficacy was 67.7% (317 of 468 Rota Cards collected at health centers).
  
  
  CONCLUSIONS
  Implementing community health programs is often expensive and unsustainable, but the reach and efficacy levels achieved through existing structures like churches are encouraging in resource-constrained countries. Churches can be effective channels for delivering health prevention strategies to often difficult-to-reach rural populations. Further research is needed to investigate the impact of the intervention on health outcomes.
authors.affiliation: Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: Austin
authors.initials: A
authors.lastname: Wesevich
authors.affiliation: Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia jenala.chipungu@cidrz.org.
authors.forename: Jenala
authors.initials: J
authors.lastname: Chipungu
authors.affiliation: Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
authors.forename: Mercy
authors.initials: M
authors.lastname: Mwale
authors.affiliation: Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bosomprah
authors.affiliation: Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
authors.forename: Roma
authors.initials: R
authors.lastname: Chilengi
mesh_terms: D000328:Adult; D002835:Christianity; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000517:prevention & control / Q000821:virology; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011634:Public Health; D012400:Rotavirus Infections / Q000517:prevention & control*; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data; D014611:Vaccination; D015024:Zambia
keywords: Zambia; church; community health; diarrhea; global health; rotavirus; rural health; vaccination