Cameroon South West 2 Community directed treatment with Ivermectin project report: may 2000

CAMERRON SOIJTHWEST 2 COMMI.II{ITY DIRECTED TREATMENT WITH IVERMECTNPROJECT REPORT RL F'or Acüon To: MAY 2OOO t'F I/L (v q.:/ c=-1"-t ,/ oÏj CoP cnÉ For lnformotion To, Àtr- n/n r. l i: ., ,Li 1 ? M,x, lili:'' 1., i' , r '' I Edid' tz.os: L,.ero SOUTH WEST 2 COMMLTNITY DIRECTED TREATMENT WITH IVERMECTIN PROJECT REpoRT (three months) Location : The s'ü/2 is situated between latitude 5o 12' and 6o 30'north and longitude go 30,and go 45,east' SW2 is made of three administrativedivisions §dian, Manyu and Lebialem), dividedinto l4 subdivisions (Bamusso, Ekondo Titi,Idabato,lsangele, Kombo Abedimo, KomboItindi, Mundembal.ryyaf, Eyumojock, Mamfe, Upper Bayang, Alou, Fontem andWarbane)' These division have been divided into 5 nâuttt distrüs .or.rirt +ô health areas.The health districts do not strictly follow the administrative units such that these 5 healthdistricts can sometimes cover more than one subdivision. The administrative headquarters ofthe province is Buea, located in SrWl project area. SW2 shares boundaries in the west with Nigeria, in particular Cross River,Taraba and Benue States; in the north with the Northwest province, in the east with the Westprovince and in the southeast with SV/l and is bordered in ttre ,orth by the Àtlantic ocean.The surface area covered by SW2 is approximately l0 610 sq.km anaihe estimated totalpopulation is 405 320 persons based on extrapolatlon from th; 1987..nru, fi!*es. We will use the population estimate of 316 443 persons provided by the provincial neâtn delegation of the Southwest province in their publication oi"Irfo..rrutioo on health districts,Southwest province 1997" Topography, climate, access. The bio-climatic zones of SV/2 range between the maritim e zone (mangrove vegetation) of the Ndian division through the tropical rain-forest to the Gùinea=saranna of theNorthern part of Manyu division. The area is moitly covered with hills and valleys. These valleys form beds for swift running rivers which uré dirpersed all through the area. In the southern part ofthe area, are creeks. The rivers beds are frequently rocky and sometime interrupted by falls all contributing to highly aerated waters which make a good habitat for Simulium, the vLctor for onchocerciasis. SW2 is vast and the undulating hills and valleys coupled with the dense tropical forest makes the terrain difficult to ply through. It is warm and very humid. The rainy season in SW2 runs from mid February through mid December. In the southem part, the rain can continue all through the year. There is very heavy rain fall between the months of May and October. Only 2 month of the year, January and february are without rains. In the northern part of SV/2, the rainy season extends from March through November and the dry season from December through February. Farming is carried out al-l through the year with maximum activities taking place during the months of tr,tarch through Apriiand August through September. In general the roads in SV/2 are in avery bad state. There are no tarred roads and the earth roads which exist become almost impracticable between the months of July and October which is usually the peek of the rainy season. To access the different health districts, one has to start off from Kumba in SWI Project area each time as there is no connection between the health districts. In the case of Fontem one has to go through the Littoral and V/est provinces. / Access road into Akwaya is through Nigeria via Amana, or going through theNorthwest province. However this is only acceJsible on foot. In ttre-ehiaya health district thehealth areas are linked by foot paths, there_are hardly any motor-able paths. During the rainy season traveling becomes diffrcult due to flooding of thé rivers. The area to be covered is alsovast and sparsely populated such that the distancÀ to b" covered to effectively implement theCDTI project are great. In Mamfe and Fontem the roads are impractr:*I. during the months of August throughNovember. Like in all the health districts of srü/2 most of the roads are iooffitn. orrtyaccessible by motorbikes. In Mundemba and Ekondo Titi, some of the health areas are accessible only by boat. Theother health areas have very hilly terrain and are accessible only in the dry season by either a4x4 vehicle, motorbike- or trekking. The roads are so bad that ii requires ;;t à"y for one tobe able to get to the villages. Funding: The first batch of funds were transferred-to the project by the NOTF on February 29 2OOO.Funds were only transferred to the field for fielâ aàtivitiés in May. Thtr;;;;Je to ttre factthat no project coordinator is yet available and we have to depenâ on SWI project coordinatorto assist in carrying out activities in SV/2.Training of the heaith personnel t aaio be donebefore funds be transferred to the field. Total number of communities in the hyper and meso-endemic districts : Given that the Southwest province fall within the REMO identified hyper/meso endemic zonefor oncho in Cameroon it is assumed that all435 communities fall *itÀin this category.However following REA we will be able to indicate the exact number of communities concemed. Number of villages receiving mectizan before and number now included in the ApO Cproject. This will be the first time that mass treatment is carried out in these communities. Mectizan has however been present in some of the health facilities of the project area. The number of communities to receive mass treatment cannot be determined as yei. Number of times the communities/villages in the project area have received treatment. The communities under this project will be treated as a community for the first time, however some persons in the project area have received Mectizan tluough passive distribution from the different health structures. Definition of community or village base on the term you are using The village is made of people of the same tribe living as a group in a given setting. The number of persons in a village can be as small as 20 person to *or" than 2000 persons. ,A community is a group of persons living in the same vicinity who could be part of a village, or a quarter in town or more than one small village. The community should hàve around 250- 300 persons. Section 2 Implementation of CDTI (l't year) Decision on Method of distribution and treatment Training of the dffirent levels of staff involved in GDTI implementation All the provincial and district staff who were trained, were trained as trainers of trainers. Those at the provincial level trained those of the district level while those of the district level trained those of the health area level. The health centre staff who are responsible for training the CDDs are being trained at the moment. So far one training session has taken place in four of the districts. The district staff were trained together with the SWI district staff. ACTIVITIES CARRIED OUT UNDER THE SOUTH WEST 2 CDTI PROGRAM t t I I I t District #of communities / villages* #of communitie s / villages which selected CDDs #of communitie s / villages which collected drugs #of communitie s / villages that decided on method of distribution #of communitie s / villages which decided on months of treatment #of communitie s / villages with trained CDDs #of communitie s / villages paying CDDs in cash or kind Mundemba 89 Ekondo Titi Mamfe Akwaya Fontem District # of training undertaken # ofTOT trained # of district staff trained on CDTI # of health centre / post staff trained on CDTI # of CDDs trained Mundemba Ekondo Titi Mamfe Akwaya Fontem I I I ACTIVITES PARTICIPANTS & NUMBER DATE SESSI ONS FACILITATORS -7 -> I Introduction to CDTI, APOC Philosophy and micro- planning. Training workshop on the disease, CDTI and training of CDDs. Management of severe side effects. District level l0 8-10 September 1999 I SSI, Provincial team Training workshop on the disease, CDTI and training of CDDs. Management of severe side effects and palpation of nodules. Health area team & M.Ds* l2l 24-26 April 2000 27-29 April 2000 4-6May 2000 8-10 May 2000 15-17 May 2000 I 2 I District teams, OPC, NOTF Team Our intentions were to start with the SW2 project last year but this was not possible since funds were not available until February of 2000. The training of the districtitaff was done at the provincial level. While the second training was carried out at the district. All the medical doctors of the district were invited to participate in the training and emphasis was made on the management of case of severe adverse reaction. Activities in the SW2 project area start following the training in each district. The workshop on : The Introduction to CDTI, APOC Philosophy and Micro-planning of CDTI activities at the district level, involved those of the provincial level, the Districi Medical Officer and the Chief of health Offrcers of but SWI and WS2. The Training workshops on the disease, CDTI and training of CDDs were carried out in phases. The first phase involved the training of the Provincial team. They were then made responsible for training the district team. The NGO however participated in the sessions as facilitators to correct any possible mistakes. The District team was responsible in training the health area team who in turn would train the CDDs. The training involved informing the participants on: Introduction to CDTI, - APOC Philosophy and the role of the different partners, the Community, Ministry of Public health and the NGDO in CDTI in SWI project. The disease Onchocerciasis; - clinical manifestations and long term complications if no treatment is given, - Mectizan, the drug, dosage, possible side effects, - Management of side effects - Referral system for case with side effects. - Advantages of the drug. Meeting the Community - Approaching the communiÿ - Introduction of CDTI and the role of the community in the CDTI SWI project Mobilisation and sensitisation - IEC and Health education I II ru ry V Registration - Recording - Numbering of households - Registration of treatment. Reporting Monitoring, Supervision and Evaluation - the activities which need to be carried out within the program (meeting the community, sensitisation, mobilisation and health education, census, treatment monitoring for side effects and recording) - the content or information and techniques to be acquired by the cDDs. At the end of the each topic a role play session was carried out. The participants were also asked to come up with micro-plans for their health areas. The reports of the workshops for the health area level, are being written by the participants. This way we can determine what was understood by the participants during the training session. Projects annual training objective and the percentage of the objective achieved. Level of training # to be trained # trained Percentage achieved Provincial 0 0 0 District Health committee members l0 20 l3 0 130 0** Health centre staff lll 94 84+ CDDs 2532 0 0 + training is going on at the moment. ** health committee member are still to be trained Types of materials used for training health staff and CDDs. L Lecture notes on Onchocerciasis. 2. Lecture notes on Mectizan. 3. Report on Central nervous system (CNS) complications of Loiasis and adverse CNS events following treatment. 4. Brochure on CDTI. 5. Flyer on CDTI. 6. Poster with lesions caused by onchocerciasis. 7. Household census / Treatment form. 8. Census / treatment forms. 9. Community / village / quarter reporting form. 10. Health area reporting form. I l. District reporting form. 12. Supervision of health centre nurse forms 13. Adverse reaction medication form 14. Adverse reaction medication stock form VI VII I I I I I I t^ t Ia 15. Medication and Treatment of side effects form 16. Management of severe side effects (dizziness, asthma attack, coma) 17. serious Adverse Experience report, Mectizan treatment program form 18. Mectizan reception form. 19. Cost recovery model for Mectizan distribution. Performance of the CDDs. The performance of the cDDs will be commented upon in the next report. Mobilisation and education of Target communities USE OF MEDIA Section 3 Achievements l. Treatment Coverage rate Number of people treated x 100 Total (census) population 2. T otal (census) Population a f f The media will be used to the fullest. Media staff have been informed and retrained about the message they have to pass over to the population in the SWI project. The message will evolves as the activities in the community advances. The local drums or trumpets are used in the villages each time the community is called for a meeting. Total village or total community population in hyper and meso - endemic areas only Total population minus those excluded. District #of communiti es / villages mobilised # oftarget communities / villages which received Health Educ. about importance of extended treatment # ofadvocacy visits to State / Regional/ Provincial Directors of health # of MOH staff involved in mobilisation # None MOH staffinvolved in mobilisation # ofNGDO staff involved in mobilisation Mundemba Ekondo Titi Mamfe Akwaya Fontem District # of target communities / villages # of eligible persons treated Cost per person treated #of communities / villages in #of distributors* supervised # of treated communitie s / villages s 3. Eligible Population I a :l a Il ! treated which CDD is a health worker by health workers with sunmary formsMundemba Ekondo Titi Mamfe Akwaya Fontem Section 4 DI FFI C ULTI E S ENC O UNTERED The Loa loa problem has been a draw back to the program. A survey was initiated by medical students but the slides are still being read. Most oithe-communities are accessible either by !'o.at ol by trekking very long distances. Transportation has been a really handicap and cause adelay in most of the activities. The lack of a côordinator for this project is also a handicap. Strengths : To be better determined with time. V/e have been able to use medical student to carry out community health care. 6 Executive Summary SW2 project APoc sponsored activities in the sw2 project area just started in April of 2000. so far the main activities which have been done are Activities which are ongoing are : The program has not yet been officially launched 8ü May 2000 u