Fifth year technical report on Community Directed Treatment with Ivermectin (C.D.T.I.) implementation in Kogi State: Twelve (12) months technical report of the 5th year

',/' KOGI STATE A.P.O.C, PROJECT (NGKG) FIFTH YEAR TECHNICAL REPORT ON COMMUNITY DIRECTED TREATMENT WITH MRMECTIN (C.D.T.L) IMPLEMETTTATION IN KOGI STATE TWELVE (L2) MONTHS TECHNICAL REPORT OF sTH YEAR. ,; l .-Lr -rt. lll1r O)r,1 +-i',: f''1" '',i * .-,:;{tlion 1-''r JIA ni i: 2002 ' I , I .) )i I I ') II ,, iI I i KOGI STATE - A.P.O.C. PROJECT (NGKG) IFTH Y L REP .D.T.I KOGI STATE (7 MONTH REPORT) EXECUTIVE SUMMARY Kogi State is one of the highly endemic States with Onchocerciasis in Nigeria with over one million (1,000,000) persons at risk. The state is made up of twenty one (21) L.G.As all of which are endemic. The Kogi State Project was one of the first four (4) projects approved in Nigeria in L997. In the first year 1998, five (5) Local Government Areas (LGAs) namely, Yagba West, Yagba East, Olamaboro, Idah and Ofu LGAs were supported by APOC. In these LGAs, 223,558 p"rrfn, \/ere treated' In the second year 1999 of implementation, control activities expanded to cover eight (B) additional LGAs, which are Mopa-Muro, Lokoja (formerly Kogi LGA), Bassa, Dekina, Omala, Ankpa, Ibaji and Igalamela/Odolu LGAs. 638,492 persons were treated. In the third year 2000, the project was expanded to cover the remaining eight (B) LGAs, Kogi, Adavi, Ajaokuta, Okene, Okehi, Ogori-Magongo, Kabba/Bunu and Ijumu thus involving all the twenty one (21) LGAs. 1,011,361 persons were treated in the year. In the fourth year 2001, 1,058,813 persons were treated. Under this reporting period, various activities of capacity building towards sustainability were carried out. These activities included training and orientation workshop for 22 SOCT members, 365 LOCT members and 3434 CDDs. LGA Awareness/Orientation workshop for leaders drawn from various disciplines traditional rulers, religious leaders, influential persons, toP government officials and NGO the partner was carried out 261. persons attended the workshop. A stakeholders meeting was held, to solicit support and awareness creation towards programme sustainability. Targeted Community mobilization, health education and training of Community Directed Distributors (CDDs) were carried out in some communities. A total of 3fl[CDDs were trained. Treatment with Ivermectin was carried out in 24gO communities with a treatment objective of 1.2 million persons to be treated. A geographic coverage of 100% and therapeutic coverage of 86.80/o were attained I SECTION 1 BACKGR9gND INFoRMATION: Kogt State is located in the Middle Belt of Nigeria and shares common boundaries with Niger and Nassarawa states and the Federal capital Territory to the north. To the east, the State has boundary with Benue state and to the south'with Edo, Enugu, Anambra and ondo States while to the west it has a boundary with Kwara state. The two largest riversrin Nigeria, rivers Niger and Benue form a confluence at Lokoja, the state capital' There are also several other fast flowing rlvers namely, Ofu, Anambra, Ubele, Inachalo, Okura and oyi, which traverse the several endemic communities in the state' The main occupation of the people is farming, lumbering, fishing and trading' The vegetation is made up of rain forest in the western part of the state, wooded savanna and grassland in the east, forest savanna mosaic to the south and Guinea Savanna in the north. onchorcerciasis was first reported in Nigeria in Kogi State in 1907 at Lokoja. Onchocerciasis control with ivermectin started in the former Benue and Kwara states in the late 1g80s. However, this did not cover the greater part of the present Kogi State. Skin snipping to determine endemicity level had been conducted in Kogi LGA before the creation of Kogi State. UNICEF assisted onchocerciasis control in the former Benue State before parts of the state were carved into Kogi state, In the same wdY, AFRICARE supported the endemic areas that were in the then Kwara State. FT Lt MECTIZAN DISTRIBUTION Mectizan Distribution programme started in the present Kogi State in September, 1993 with support from Africare in Kogi (now Lokoja LGA) and Ijumu LGAs with 18,385 persons treated. In 1994, the programme expanded to 3 other LGAs with 108,885 persons treated. 216,388 persons were treated in 9 LGAs in 1995' while 2L3,g5g persons were treated in 1996' By September L997 following the desertification of Nigeria by USA, Africare withdrew its support to the State' The National onchocerciasis control (NocP) Programme approached Sight Savers International who provided support from October lggT ' By the end of 1997 ' 51,1,074 persons were treated in 19 LGAs' In 1998, a total of 847 '726 persons were treated in the state out of which 223,558 persons of this being from the first 5 Apoc_ assisted LGAs. with the expansion in the second year to eight (B) additional LGAs, 622,67L persons were treated in the 13 A.p.o.c assisted LGAs in 1999' In 2000, 1,011,361 persons were treated, 1,058,813 were treated in 2001' while 1,105,250 persons were treated in the reporting period' SECTION 2 IMPLEME TATI NOF c.D.T. -Y 5 L.G.As COVERED: \ This implementation covers the entire 21 LGAs of the state' These were Ankpa' Omala, Dekina, Bassa, Ofu, Olamaboro, Idah, Ibaji, Igalamela/Odolu' Lokoja' Mopa-Muro, Yagba East, Yagba west, Ijumu, Kabba/Bunu, ogori-Magongo, okene' Okehi, Adavi, Kogi and Ajaokuta' The implementation of GDTI in year 5 started actively in the month of February with some mobilization and health education activities viz marking of Onchocerciasis day with press briefing and flagging up of the year's dosing of Ivermectin by the Hon, commissioner. This was covered by mass media, (Radio, Terevision and Newspapers). This created more awareness for treatment with Mectizan in the state. This was crosery foilowed with the commencement of airing of radio jingles in B local languages; Igala, Bassa-Kwomu, Bassa-Nge, Ebirra, ogori, Yoruba, Hausa and Nupe during the distribution period. #m w -**.'*tt'"**i724' The Hon. Commissioner, Alhaji Suleiman Baba Ali, taking his own dose of Mectizan Tablet \"''\ "/a-:*) i:,' t,'-7 'tb"*l ,.' trlt",s'. ?. /".. ,r/" .!l ,?, ,,,,,' .*J.':,,,n:i W::-' ' ' Zq..t ?t " 1 * TAB I TABLE SHOWING IMPLEMENTATION OF C.D.T.I YEAR 5 NO. OF COMMUNITIES/ VILLAGES THAT COLLECTED DRUGS t64 27t 2155 NO OF COMMUNITIES/ VILLAGES THAT DECIDED ON METHOD OF DISTRIBUTION 94 s/N DISTRICT/LGA NO. OF COMMUNITIES/ VILLAGES NO. coMMUNII rES/ VILLAGES THAT SELECTED CDDS NO. OF COMMUNITIES/ VILLAGES THAT DECIDED ON MONTH OF DISTRIBUTION NO. OF COMMUNITIES/ VILLAGES WITH TRAINED CDDS NO. OF COMMUNITIES/ VILLAGES PAYING CDDS IN CASH OR KIND 1 OLAMBORO 193 193 186 278 169 193 293 110 t7L2 OFU 293 293 259 3 IDAH 7B 7B 7B 46 1B 77 52 71 7B 69 4 YAGBA EAST 52 52 52 52 46 5 YAGBA WEST 1B 1B 1B 19 1B 1B t4 6 MOPA-MURO 19 t9 19 19 19 15 7 LOKO]A 91 91 69 66 46 91 42 B BASSA 156, 156 B6 61 61 156 9 DEKINA 242 242 1BB 1BB 149 242 136 10 OMALA 120 120 714 274 113 103 t20 B9 11 ANKPA 214 214 196 tB7 214 186 72 IBAJI 172 t72 t43 159 t32 772 168 13 IGALAMELA/ ODOLU 170 170 770 43 42 153 153 t70 152 t4 A]AOKUTA 50 50 50 50 50 39 15 OKENE 60 60 60 57 60 13 16 ADAVI 5B 5B 39 51 33 5B 19 17 OKEHI 79 79 79 67 5B 79 47 1B KOGI 119 119 93 i01 9B 119 129 19 OGORI- MAGONGO 39 39 39 33 27 39 33 20 IJUMU 111 111 103 92 B9 111 96 21 KABBAi BUNU 156 156 137 136 t27 156 87 TOTAL 2490 2490 2150 1958 2490 L749 TABLE II: SHOWING THE TRAINING OF THE DIFFERENT LEVELS OF STAFF INVOLVED IN C.D.T.I IMPLEMENTATIO N. NO. OF TRAININGS UNDERTAKEN 23 NO. OF LOCTS TRAINED s/No DISTRICT/LGA NO. OF DISTRICT OR LGA STAFF TRAINED ON C.D.T.I 1 Olamaboro 22 22 248 2 Ofu 5 30 i6 16 12 30 30 20t 3 Idah 5 16 15 350 4 Yagba East 5 16 14r 82 5 Yagba West 6 72 t2 62 6 Mopa-muro 4 12 15 t2 72 720 7 Lokoja 4 15 15 122 B Bassa 4 1B 32 1B 1B 762 9 Dekina 4 32 31 380 10 Omala 4 1B 1B 15 t20 11 Ankpa 4 21 2L 19 233 t2 Ibaj i 4 4 16 16 15 19 292 13 Igalamela/Odolu 19 19 160 t4 Ajaokuta 3 72 72 11 27 56 15 Okene 3 1B 1B 720 16 Adavi 3 13 13 13 104 L7 Okehi 3 l4 14 15 108 1B Kogi 3 l4 t4 13 115 19 Ogori-Magongo 3 t2 72 11 3i 20 Ijumu 3 1B 1B 15 166 27 Kabba/Bunu 3 77 77 t7 202 TOTAL 36s 365 353 3434 in. number of CDDs trained from various communities this year has greatly improved. This could be traced to the success of re-orientation of the community ward heads as they now see the need for voluntary participation in CDTI programme. W 2'4i tirl L# W,@ . *), **,o' t 12,;, , b ffi.) A cross-section of meeting with Ward Heads in some communities. w '. .:. ". ;.'.:1 ," .:t .; ''/ 2 a: '1.i,.:, s/No DISTRICT/LGA NO. OF COMMUNITIES/ VILLAGES MOBILIZED NO. OF ADVOCACY VISITS TO STATE OR REGIONAL DIRECTORS OF HEALTH NO, OF MOH STAFF INVOLVED IN MOBILIZATION NO. OF NGDO STAFF INVOLVED IN MOBILIZATION 1 OLAMABORO 1BB 1BB 35 5 2 2 OFU 271 211 3 3 iDAH 7B 52 7B 52 5 1 4 YAGBA EAST 5 2 5 YAGBA WEST 18 1B 5 1 6 MOPAMURO 19 19 5 1 7 LOKOJA BASSA 9i 91 6 3 8 156 156 5 2\ 9 DEKINA 242 242 6 10 OMALA t20 120 5 11 ANKPA 214 274 5 3 12 IBAJ I t72 172 5 13 IGALAMELA/ODOLU 170 170 5 14 A]AOKUTA 50 50 4 15 OKENE 60 60 4 2 16 ADAVI 58 5B 4 L7 OKEHI 79 79 5 2 1B KOGI 119 119 39 5 2 19 OGORI-MAGONGO 39 5 1 20 iJUMU 111 111 5 2 2t KABBA/BUNU 156 156 5 2 TOTAL 2403 2403 L34 29 0 TABLE III: SHOWING MOBILIZATION AND EDUCATION OF TARGET COMMUNITIES NO. OF TARGET COMMUNITIES/ VILLAGES WHICH RECEIVED H,E ABOUT IMPORTANCE OF EXTENDED TREATMENT ND NIN ANNUAL TRATNTNG OBJECTTVE (A.T.O) TRAINING OBJECTIVES: The training objectives. for each training, awareness and advocacy workshops are as in the table above. Twenty two (22) S,O.C.T members were re-orientated on CDTI strategy with a coverage of 1000/0. The LOCTs trained on CDTI strategy were 365 as against the target of 353 (103.3%) , 3434 (105.6%) CDDs were also orientated and trained as against the training objective of 3,250 participants. ##@ Ae ..: f;.;"'.'5.',:'!4 r.twffi%#.47 N ffry *# B.{le V ...1 2.' i. t' ,' ,* * v s/No. ACTIVITY LGA Awarerress/ Orientation Works EXPECTED/ TARGET NO. OF PARTICIPANTS ACTUAL NO. OF PARTICIPANTS % SUCCEESS 62.8o/o 1 2t0 t32 7 T.O.T traini for SOCT 22 22 100% 3 T.O.T. traini for LOCT 353 365 103.3% 4 CDDs 3,250 3434 236 42 705.60/o 5 Stakeholders meeti 200 t78cto 6 Training on CSM/SHM 42 100% A Cross-section of some participants at the stakeholders' meeting ry'" # 3.14,". ; TRAINING /WORKSHOP MATERIALS The materials that were used for the training included: * Onchocerciasis health education posters * Flip Charts for training and advocacy workshops * CDTI Information Brochures for CDDs 'l( Television and video were useid to show the CDTIfilm and the'CDTI training of trainers' workshop * CDTI training manual * Monitoring and evaluation checklist * Community register * Marked measuring sticks * MIS forms:(a) Household.summarY forms(b) Community summarY forms(c) Adverse reaction forms(d) LGA summary forms(e) State summary forms(0 Role play on community self monitoring. Materials used - 50 10 2s60 1 360 406 10 5 360 360 360 100 10 SECTION 3 ACHIEVEMENTS: 1. Twenty two (22) SOCT, three hundred and fifty three (363) LOCTs and 3{3d CDDs were re-orientated for CDTI implementation this year. 2. The sum of two million naira (N2,000,000.00) i.e US$ 20,000.00 was approved by the State as counterpart fund but cne million US $10,000.00 was released. 3. There is little improvement in the LGAs commitment than the previous years, L2 LGAs that promised to provide little imprest for the support of Onchocercia'sis activities in their areas did so. 4. LGA orientation meetings with ward heads resulted in the selection of more CDDs to be trained thereby increasing number of trained CDDs. I 56 The Honourable Commissioner visited some communities to advocate for more commitment to CDTI activities and also monitoring of Ivermectin distribution. This was funded from the counterpart funds' APOC management evaluated the project this year. The result of the evaluation suggested that the.project was on its way to sustainability. . ..*,..:...- r.- *oi{k*"u- . "'.,a, '''7(/L"/z/.2.",1, .,. i .. ..i& d# ."!. .i. { The Honurable Commissioner, Alhajl Suleiman Baba Ali taking a look at the Treatment Register in Oyobo Community in Kogi Local Government Area of the State. 9t' ":,'i,') *:....- ':.1t. W fu. . vj);) ,?/ ?i . \1 TABLE IV: ACHIEVEMENTS TABLE SHOWING IVER ECTIN DISTRIBUTION NO. OF TREATED COMMUNITIES/ VILLAGES WITH SUMMARY FUNOS COMMUNITIES/ VILLAGES IN WHICH COO IS A HEALTH WORKER NO. OF OISTIBUTION SUPERVISE BY HEALTH WORKER 5/NO. orsTRrcT/ L.G.a NO. OF TARGET COMMUNITIES/VILLA GES TREATED 5B50,787 TOTAL POPULATION 4i. ADAVI 5B 5054,345 43,096 44,801 NO OF EIIGIBI-E PERSONS TREATED B2. AJAOKUTA 50 7 2143. ANKPA 214 98,33 1 90,19 1 rJ i564. BASSA 156 82,270 62,879 24292,050 95 106,153 6 17277,6086 242 1 72 DEKINA IBAJI 7BB7 IDAH 7B 57,043 9 17070,576 14,r47 47,136 COST PER TREATMENT t l5 2.9 34 1B L4 3.2 74 1.9B IGALAMELA/ ODOLU 170 80,233 9 11154,57 5 J.Z9 iJUMU 111 67,695 1)O58,404 )a 610. KABBA/BUNU 156 67,493 5 1191i KOGI 119 10 91 42,664 43,979 35,85 s 39,150 J.f 3.7t2 LOKOJA 91 197TJ MOPAMURO 19 26,393 B 293BO,B74 22,853 6B,BBB 1.9 2.814. OFU 293 72,980 63,739 3.515. OLAMABORO 193 4 7 I 193 t2040,387 34,953 2.716. OMALA 120 5 6079,957 3.6L7 OKENE 60 79 74,117 44,557 a118. OKEHI 79 50,344 o 5 3925,883 1.419 OGORIMAGONGO 39 52752 42,734 2.620 YAGBA-EAST B 1QYAGBA.WEST 1B 24,75221 L43 2,49O 23,650 1,105,250 23,502 36,13 1 )-) 2.6TOTAL 2t49O L,272,905 covERATE o/o 84.8 82.4 91.7 96.4 86.7 95.5 82.6 87.9 80.6 86,5 84 B9 86.5 85.1 87.3 86.5 92.6 BB.5 90.8 84.5 95.5 a7.L t I WAYS TO IMPROVE P RAMME OWNERSHIP The following areas need to be addressed: is necessary to sustain pace of programme. 'r Reinforcement with health Education in churches and mosques in the various communities. SECTION 4: A \ STRENGTHS OF C.D.T.I PROGRAMME: levels. this year. But US$ 10,000 was released. '/, Integration and sustainability are more feasible because all the SOCT and LOCT members are also members of the Primary Health Care team in the State and Local Government. from agreed centers. orientation meeting. mobilization and training of CDDs by the LOCTS. WEAKNESS OF THE C,D.T.I PROGRAMME: contribution. LGAs inability to properly assume responsibility of tralning, monitoring of CDDs activities at the community levels. In accessibility of some communities especially during raihy season. B Health Facilities (FLHF). HELP NEEDED A. Government 'r Increased advocacy to LGAs/communities and stakeholders. ')> More political commitment to CDTI especially at the LGA level. B. APOC MANAGEMENT 1. Advocacy visit to State & LGAs. \ 2. To consider the replacement of some capital equipment like the 1't project vehicle, photocopier, motorcycles especially the 1't donate Honda Heros. 3. To consider supply of some essential equipments like overhead projector for easy presentation at targeted training, meetings and workshops. 4. To have a rethink on the extension of the assistance to the State to give room for proper sustainability footing. C. COMMUNITY 1. To look into CDDs compensation in either cash or kind. 2. To plan and organize a self-monitoring of Ivermectin distributlon in preparation towards programme sustainability. D. . Airrclife rE S't,t lt: Axt t /ir ttt lt-tr