Compliance to and perceived benefits of annual ivermectin treatment research protocol for a multi-country study developed during a workshop held from 28 February to 5 March, 2005 Ouagadougou WHO/APOC

aa{ D COMPLIANCE TO AND PERCEIVED BENEFITS OF ANNUAL IVER.VIECTIN TREATMENT RESEARCH PROTOCOL FOR A MULTI-COUNTRY STUDY DEVELOPED DURINC A WORKSHOP HELD FROM 28 FEBRUARY _ TO 5 MARCH, 2OO5 OUACADOUCOU WHO/APCC t ILIST OF ACRONYMS African Programme for Onchocerciasis Control Cornmuniry B ased Ivermectin Treatment Christoffel Blindenmission Community Directed Distributor Community Directed Treatment with lvemrectin Epiderniology and Vector Elimination Federal Capital Tenitory Focus Group Discussion First Line Health Facility GIobal 2000 River Blindness Programme Gemran Technical Cooperation ln-depth Intervierv Local Government Area Mission to Save the Helpless Non Governmental Development Organization National Onchocerciasis Task Force Onchocerciasis Control Pro gramme Rapid Epidemiological Mapping of Onchocerciasis Sustainable Drug Distribution Special Intervention Zone State Ministry of Health ,. ? APOC CBIT CBM CDD CDTI EVB FCT FGD FLHF GRBP GTZ IDI LGA MITOSATH NGDO NOTF OCP REMO SDD SIZ SMOH 1 2e SSI Sight Savers Intemational s\\/t South West I UNICEF UnitedNationsChildrens'Fund UTG Ultrrnate Treatment Goal \YHO World Flealth Organization JTABLE OF CONTENTS LIST OF ACRONYMS LIST OF TABLES....... I. INTRODUCTION ... L I RpspencH euESTroNS .............. L2 Sruoy oBJECTTvES i. General Objective ii. Specific objectives 1.3 DpprNrrroN oF Kny CoNcEprs. 2. STUDY DESIGN... 2. I CoNcpPTUAL FRal,rswoRr .... 2.2 Sruov popu1ATroN................ 2.3 Sruov AREAS 2.4 SavplE populATroN.............. 2.5 S,quplrNc ............ 2.6 Saupr-E srzE oF coMMUNrrrES 3. METHODOLOGY 3.1 Eptoprrrror-ocrcAL nNo Soctal SctpNcB MBrHoos FoR THE Sruoy 3.2 Dara Colr-gcrroN............... 4. DATA PROCESSING AND ANALYSIS 5. TIMEFRAME 6. BUDGET 7. REFERENCES APPENDIX Sruoy IwsrRut'aBNTS ............. Sruoy PnocpounEs AND INstRucrroNS ............. BUDGETS AND BUDGET JUSTIFICATION FOR STUDY SITES LIST OF PARTICIPANTS l} 4 ..5 ..6 ..7 .,7 ..7 ..8 ,.9 ..9 l0 10 16 l6 t7 l9 l9 l9 26 26 27 28 29 30 45 50 8l 4a LTST OF TABLES Table 1. Conceptual framework Sampling statistics Study Projects Sampling frame for communities and households Methods linked with research questions Matching instruments rvith research questions Charl of activities and tirne line Summary of budget for all sites ) 3. 4. 5. 6. 7. 8. Page 9 16 I7 19 2L 25 26 21 5ol. Introduction A large, multi-country study carried out in 1,994-95 showed that community-directed treatment with ivermectin (CDTI) was a feasible and effective rvay to ensure that Mectizan@ reached endemic cornmunities. The study found that significantly higher treatment coverage figures of 68.6/o were achieved when CDTI rvas used compared to 62.20A, where the health systenr planned and organized distribution. The ability of CDTI to achieve higher coverage is important because of the need to maintain a nrinimum annual population treatment co\/erage level of 65oh for at least 15 years in order to effectively control onchocerciasis. This finding informed the decision of the African Program for Onchocerciasis Control (APOC) to adopt the CDTI as its main control strategy. Though community-directed treatment (ComDT) approach has been shown to be effective in reaching hundreds of previously neglected communities or those rvith limited access to health services, the rate of compliance of individuals who have been on ivermectin treatment since the inception of the APOC sponsored conimunity-directed treatment rvith ivennectin programs has not been systematically documented. Few studies and unpublished repofts have shown that in a good number of conrmunities, women are excluded frorn annual ivermectin treatment for various reasons. As example, a recent study in the Southeast of Nigeria concluded that a higli proportion of women in the reproductive age group miglit not benefit from ivermectin donation. The study shorved that only 54o/o of these women sought and received their ivermectin dose after parturition. Another l0% sought treatmetrt but could not find ivermectin in their communities or in the nearest health clinics. The irnplication of this is that there is ambiguity in the rate of annual cornpliance to ivermectin treatment by eligible persons and communities. This ambiguity needs to be examined in order for APOC to take corrective measures that rvould enhance the likelihood of eliminating onchocerciasis as a public health problem in Africa. The study proposed here is designed to determine tl're rate of compliance of eligible individuals and communities rvhere ivennectin distribution has been undertaken for upwards of 7 years, rvith particular attention to the effect of gender, youth and membership of a minority group. 6, 1.1 Research questions What proportion of rnen, wonlen, youtli and children abor,e 5 years old have cornplied rvith ivermectin treatrnent annually since the inception of community drrected treatment rvith ivermectin? 2. What proportion of rninority groups complied u,ith ivemrectiu treatment every year since the inception of comrnunity directed treattnent u,ith ivermectin? a. Are there minority groulrs? b. Flave they been treated annually? If not, rvhy not treated? 3. What is the feasibility of measuring compliance to long-term treatment with ivennectin? a. Can rve measure compliance to long-term treatment rvith ivennectin? b. What are available sources of infomration and how reliable are these? 4. What proportion of the comrnunities received ivernrectin timely and adequately annually'i 5. What are the perceived social and health benefits of ivermectrn by individuals and cornrnnnities? 6. What factors influence individual compliance to treatment? 7. For horv long are people willing to take ivermectin and for what reasons are they rvilling to continue to take ivermectin for a long time? 8. What are the factors associated ivith the rate of community compliance? 9. Wliat are community suggestions on improving compliance of individuals to annual and Iong-tenn iverrnectin treatment? 10. What sin-rple instrument would the NOTFs be able to use for assessing individual and community cornpliance to ivennectin treatment before and after the exit of APOC? 11.2 Study objectives i. General Objective To determine the rate of individual and community compliance to annual treatment lvith ivermectin and perceived benefits in onchocerciasis endemic communities ii. Specific objectives L To deterrnine the rate of annual compliance to ivennectin treatment among men, wornen, youths and children above 5 years of age, and how many years; 2. To detemrine the rate of annual compliance to ivermectin treatment among rninority groups. 3. To determine the feasibility of measuring compliance to long-term treatment rvith ivermectin 4. To determine the timeliness of the health system to supply adequate quantity of ivermectin annually to eligible comuruuities. 5. To document the social and health benefits of taking ivermectin annually as perceived by community rnembers 6. To determine how and rvhat factors influence individual compliance to treatment 7. To determine for how long individuals are willing to continue to take ivermectin and factors that affect rvillingness to continue treatment 8. Determine factors that are associated with the rate of community compliance 9. Document ways to improve compliance of community members to annual and long-tenn ivermectin treatment. 10. To develop a simple instrutnent the NOTFs of participating countries will use in determining the rates of compliance to ivermectin or drugs delivered with ivermectin using the CDTI as a vehicle for integration. a 81.3 Definition of Key Concepts Compliance: o Individualcompliance . Sites should have had treatment for a minimum of 7 years . Taking ivernrectin once a year every year since commencement of CDTI . Compliance is defined as the extent to which the individual or corrmunity has follorved the annual treatment regimen . The individual must have had the opporfunity to cornply o Community Compliance . Number of years since start of program that community has achieved 65o/, coverage or higher . Coverage here is a surrogate for individual compliance on a yearly basis . Again note that community needed opportunity to achieve 650lo Minority group: This was further categorized into Minority Groups within conrnrunity, among comurunities. o Any group of people resident within a village or community rvho is disenfranchised or marginalized because of ethnicity, migration, displacernent or other special characteristic ' Such people are not in the mainstream (not integrated into the) social, cultural and economic activities of the cornrnunity o A minority community is defined as a village rvithin a district that is disenfranchised or marginalized because of culture, class, or ethnic group frorn the rnain population of the district o Challenge on how to detennine and be standard a a 92. Study design The study is designed to allorv an assessrllent of compliance to and perceived benefits of annual ivermectin treatment and the feasibility of assessing long-term compliance. The cross-sectional approach rvill be adopted in collecting quantitative and qualitative data from nine study sites in five countries. 2.1 Conceptual Framework Compliance is viewed from the perspective of three health behaviour theories, narnely health belief model, social learning/cognitive theory and theory of reasoned actioniplanned behaviour. All three theories view compliance to ivermectin treatment for over seven years as the dependent variable in this study, while the various socio- demographic characteristics of the people constitute the independent variables. On the other liand the theories included different variables to explain the intermediate factors that influence compliance rvere reviewed. These are contained in the conceptual framervork on Table 1. Table 1: Con tual framervork Conceptual Frarnework lndependent VarbHes 'Age *Gender .Miprity Status .Prcfect $ite -Other Social Chatacterbtics lntennediate or lntervedng VariaHes 'Percefued sericusness of onchocerciasb .Perr.etved susceptibltty to oncho complixtbns .Knorvledge of onchocerciasb treabnent .Percrirred benefits of ivermectin treabnent .Percr*ved costs or corstrahts of ivennectin treahnent .Percr*ured social urpport or discouragernent h taking ivermectin anntraly Dependent VariaHe .lntention to take irrer-mectin forficreseeabb ftrfure {omplance lyith annual ivennecfin treahnert oyer 7 years 10 2.2 Study population The sfudy population rvill include corlulrunities u,ithin CDTI projects that have been distributing ivetmectin using the CDTI approach for at least seven years. The comtnunity leaders, their CDDs and health workers will be included in the study. Furlher n1ore, household members (men, women, youth, children as well as minority groups lvill be enlisted for the study. 2.3 Study areas Tlie study lvill be located in Carneroon, Chad, Nigeria, Tanzania and Uganda. These are countries with CDTI projects that have been iniplementing CDTI for at least seven )'ears CAMEROON Project: South rvest 1 The south west I project covers part of the South West province of Cameroor.r. It lies between 5 "20' and 4 o N and 8 "45' and 9" 45' E. SWI includes 3 administrative divisions (Fako, Kupe and Manengouba, Meme). SWI is divided into 8 health districts (Buea, Tiko, Bangem, Tombel, Nguti, Limbe, Muyuka and Kumba) rvhich are subdivided irrto 6l health areas. The total areas of SWI is approximately 14 300 km2 and the population is estirnated to 710 050 people living in 465 communities. The vegetation here is predominantly the equatorial rair-r forest. Beside this rnain type of vegetation, there is mangro\/e vegetation on the coast (Atlantic Ocean). The altitude ranges frorn 0 ru on the coast to 2200 meters in Buea torvn (head quafter of the province) rvith a multitucle of small hills. The Mount Cameroon, the highest peak in West Afi'ica rvith 4100 meters of altitude stands in Buea torvn. The SWI has a very rich netrvork of drainage systems most of lvhich florv from high altitudes and are interrupted by numerous cascades, rapids and waterfalls constituting suitable breeding site for the sinrulitun yector. The clirnate is tropical. The raining season lasts from mid-March to rnid-October rvith its peak around July and August. Farming is the main activity of population here and is practiced all the year. The rich volcanic soil encourages the cultivation of various food crops. A distinct ethno-linguistic group lives in SWl. These include the Bakweries, Bafaws, Bakossis, Orokos, and Balongs. The comrnunities in the SWI are generally permanent settlers. The official language of communication here is English. Project: Adamaoua II The Adamaoua II project is located in the Adamaoua province of Cameroon. It covers the health districts of Banyo, Tignere and Meiganga, rvith a total of 488 communities and an estirnated population size of 218 382 inhabitants. The Adamaoua province is located between the Northern part of the country where about 90% of the population is Muslim 1l and the southern paft ntostly made up of Christians. The extreme north is 100% Muslim. These religions influence not only the life style of these populations, but also their health seeking behaviour and may be their perception to annual and on long-term compliance to ivermectin treatment. The main vegetation here is the savannah. Tlie river Sanaga that cut across the country and many other rivers take their source in the Adamoua province. The populations here cultivate rice, maize, yams, groundnuts and onion. Cattle-rearing is one of the main activities. This project site is difficult to access due to poor road network and the multiple derailments of the train linking Yaounde to Ngound6r6. Project: Centre III The Centre III project is in the center province of Cameroon and is located between longitude ll" and 12o, and latifude 3 o and 5o. It covers about 16.270km2. The area is bordered on the westem side by the Monatele health district, then the Sanaga river (center province), and the Pouma health district (Litoral province). In the southern part, a border is shared with the Eseka and Ngournou health districts of the centre province, on the north by Nanga-Eboko and Sanaga River. This project covers 4 different divisions (Lekie, Mefou-et-Afamba, Nyong-et-So'o and Nyong-et-Kel16, l3 sub-divisions, 8 health districts, 96 health areas and 1024 villages. There are two main ecological environments: a forest zone rvith high pluviometry (Mbahnayo, Ngog-Mapoubi, Soa, Okola, Mfou and Arvae health districts), and intermediary zone of the forest and the mid savannah rvith less rains marked dry season (Sa'a and Esse). People here cultivate cereals, fubers and fruits and the main cash crop is cocoa. The main ethnic grollps here are: Eton, Manguissa, Ewondo, Mvele, Bene, Bassa. The five first groups have the same traditions, the same cultures, and anthropologically are issued from the same ancestors many years ago. They are called "Beti group" and their language is quite the same. The total population of this project is about 500 927 in 8 health districts. The endemicity analysis shows that 306 communities are located in hyper-endemic zones (1520099 inhabitants); aa9 communities in meso-endemic zones (224217 inhabitants); while 269 communities in hypo-endemic zones (124611 inhabitants). Because of the great socio cultural differences between the north and the South west, center III has been chosen in order to get representative of socio cultural, geo-political and linguistic issues and equilibrium. It should also be recalled that most of the severe adverse events associated with ivermectin treatment have been reported in the center province of Cameroon. l2 CHAD Project: Chad With an estimated population of 6 430 524 inhabitants, the Chad republic is lirnited in the North by Libya, in the South by the Central African republic, in the East by Sudan and in the tvest by Carneroon, Nigeria and Niger. It is divided in 14 "Prefectures" 58 "Sous- prefectures" 450 'Cantons" and 15 420 communities. The structuring of the health system in Chad follorvs these administrative divisions. The CDTI project covers 6 "Prefecfures" (Logon Occidentale, Logone Oriental, Mayo-Kebbi, Moyen-Chari, Salamat and Tandjil6. The CDTI area covers 192.060 km2 with an estimated population size of 3 254 427 inhabitants. It comprises 23 health districts and 302 health areas "Zones de responsabilit6s). The vegetation is the Guinea savannah. The area has many hills and plains rvhich are usually transformed into swampy areas during the rainy season. The rainy season lasts frorn April to October and the dry season from November to March. About 90oh of the inhabitants of the project site are sedentary farmers with the main crop being tlie Sorghum. Beside these sedentary populations there are the nomadic populations comprising of cattle breeders lvhose activities and residents depend much of the seasons. NIGERIA With a population of about 130 million in 36 States and a Federal Capital Teritory (FCT), Nigeria has a total of 27 CDTI projects in 32 States, including the FCT, located in four health zones, narnely Northrvest, Northeast, Southwest and Southeast. These health zones serve as operational zones for APOC CDTI implementation in the country. The health zones are culturally distinct with varying health seeking behaviour. Tert of the CDTI projects, rvith a population of over nine million and an ultimate treatment goal (UTG) of over eight rnillion in 16003 communities covering the four health/CDTI operational zones, have been implementing CDTI for at least 7 years. These projects are facilitated by the State Ministries of Health (SMOH), with furancial and technical support of five NGDos, namely SSI, CBM, MITOSATH, GRBP and UNICEF. Four ofthe projects, one from each health and cultural zone, are proposed for the study in Nigeria. These projects are Imo/Abia CDTI project from the Southeast zone; Osun CDTI project from the Southwest; Taraba CDTI project from the Northeast and Zamfara CDTI ploject from the Norlhrvest. ln the Imo/Abia CDTI project, one State (hno) was selected. 13 Imo CDTI Project, Southeast Nigeria Imo State is located in the Southeastern region of Nigeria. The state lies between latitude 4"45'and 6o15'North and Longitude 6o30' and 8o09'East and bounded by Abia and Anambra States on the North. Rivers and Bayelsa States bound it in the South. Imo State has an estimated total population of about 3.4 million persons, with 27 Local Government Areas, out of which l6 LGAs are implementing APOC supported CDTI strategy for the control of Onchocerciasis. It is estimated that over I. I million persons are at risk of Onchocerciasis in these 16 LGAs. The supporting NGDO for the implementation of CDTI in these l6 LGAs is GRBP. The major Rivers are, Imo River, Otamiri River and the Ogochia, Nbaa, Uramiriukwu Rivers. The climate of the State consists of the dry season (November - March) and the wet season (April - October). The rnain occupation of the people is farming, fishing, and trading. Community leaders in consultation with the elders and community members make decisions. Mectizan@ distribution started in Imo State in 1993 in 4 LGAs - Okigwe, Ahiazu, Ihitte- Uboma and Ezinihitte LGAs. A total of I 14,1 57 persons were treated in these LGAs by then. In 1998, a proposal made to APOC for Onchocerciasis Control in Imo and Abia States was approved, rvith Global 2000 Nigeria as technical partner. The project is norv in its seventh year of CDTI irnplementation. The project is located in the Southeastem health zone which corresponds to a culturally distinct health zone rvith a remarkable health seeking behaviour. The people are predominantly Christians from the Ibo extraction. This is one of the three major ethnic groups in the Nigeria. Its inch.rsion will also ensure data from a project area facilitated by one of the major NGDOs operating in Nigeria. Osun CDTI Project Onchocerciasis related activities started in the present Osun State in 1988 following a prevalence survey. ln 1994, the rapid epidemiological mapping (REMO) identified that 5 LGAs were hyper-endemic, 17 were meso-endemic and l3 hypo-endemic in Osun State. The 17 endemic APOC assisted Local Government Areas are: Atakunrrosa West, Aiyedaade, Ayedire, Boripe, Egbedore, Ife Central, Ife East, Isokan, Ila, Ifelodun, Iwo, Obokun, Oriade, Orolu, Ife North, Ife South and Ede South. Community Directed Treattnent with Ivennectin (CDTI) was introduced following APOC's assistance to the State in 1998. Over one thousand (1,131) endemic communities (122 hyper and 1,009 meso-endemic) are involved in the programme, with UNICEF as the supporting partner in the CDTI Project, which is now in its 7tl'year of CDTI implementation. Since the inception of the project, over two million persons are treated annually. t4 The project is located in the Southr.vest health zone with a distinct cultural and health seeking behaviour in Nigeria. It is a Yoruba etlnic group rvith predorninantly Ch'istian religious groups. Here also are solne traditionalists. The inclusion of this project will, in addition to collecting information from a culturally distinct and one of the major ethnic grolrps in Nigeria, involve a project that is facilitated by a UN agency. Tarrba CDTI Project Distribution of ivermectin in Taraba State, using the CDTI approach started in July 1997. How'ever, the project has been distributing Mectizan since 1994, using the mobile systern and later the Community Based Ivermectin Treatment (CBIT) strategy. The nurnber of people treated rose from a few thousands before the adoption of CDTI approach to over 880,000 persons by 2001 rvith the Ultimate Treatment Goal (UTG) currently at 980,000. The project consists of hyper endemic foci with high prevalence of blindness. The project was initially supported by Africare, and after its wrthdrau,al by CBM and a local NGDO, MITOSATH. The International NGDO (CBM) mentors the local one (MITOSATH) and transfered responsibilities to MITOSATH rvithin a given timeframe - as a u,ay of prornoting programme sustainability. This has resulted in the devolution of supporl for three LGAs by CBM to MITOSATH in 2001 and of tl.re entire project area to MITOSATH in 2004. The project is located in the Northeast healtli zone of Nigeria. This is also the only project area, alnong those that have irnplemented CDTI for at least seven years, tl-rat is supported by a local NGDO. It is expected that the conrpliance to and perceived benefit of annual treatment with ivermectin could be influenced by the activities of the supporting NGDOs. It follows therefore that tlie inclusion of this project will not only ellsure data fror-n a distinct health zone in Nigeria but also provide data frorn a project area that is supported by a local NGDO in Nigeria. TANZANIA Ruvumu CDTI Project The Ruwma CDTI project is cornposed of four districts of Songea, Namtumbo and Mbinga in Ruvuma region, and Ludewa in Iringa region. Namtumbo is a newly created district having been carved out from Songea, and still adrninistered fror-n there. The total population for the whole project area is estimated at 968,461 inhabitants. There are ll administrative divisions, 75 wards and 296 villages. Total number of villages covered by tlre project is 164, with a number of people served by the project approximating338,279. The project headquarters is located in Songea town about i,000 km from Dar es Salaam. Total health facilities in the project area indicate that there are t hospitals three of which are owned by the government the rest by churches and NGOs. There are lJ health centers, 136 dispensaries and 160 village health posts. l5 With the exception of Namtumbo, the project districts are located far apart from each other. From Ludewa to Songea town is distance of 157 knts, while frorn Songea town to Mbinga district the distance covered is over 100 kms. Holever, tlie districts are accessible by road throughout the year. The main ethnic groups in the project area include the Wangoni, Wamatengo, Wabena, Wamanda, Wapangwa and other migrants. Despite some minor differences in their socio- cultural characteristics, these tribes mix rvithout tension. Peasant farming forms the nrainstay of income generating activities in the tluee districts where crops such as maize, banana, beans, rice, cassava and potatoes are grown as staple foods tvhile tobacco, tea and, to a lesser extent, timber are cash crops. There is also small-scale fishing along the rivers and lakes. Ivermectin treatment in the project began as early as 1992, however before CDTI commenced in 1998. UGANDA Phase II CDTI Project Phase II CDTI project in Uganda includes Kabale, Bushenyi, Kamwenge, Kyenjojo, Kabarole, Sironko and Mbale districts. Kabale, Bushenyi, Mbale and Sironko districts are highland areas with an altitude between l,2l9m-4,321 n above sea level. Mbale and Siror-rko have the highest altitude. Mbale and Sironko districts are located in Eastem Uganda while Kabale is in South Westem Uganda while Bushenyi, Kamwenge, Kyenjojo and Kabarole are in Western Uganda. Kyenjojo, Kabarole and Kamwenge districts are areas of ethnic diversity including, Batoro rvho are the indigenous people, and Bakiga and Bafumbira rvho have migrated from Kabale and Kisoro districts, respectively, and settled in these districts. Bushenyi is also an area of ethinic diversity including Banyakole who are indigenous people and Bakiga and Bafumbira. Kabale, Mbale and Sironko districts have homogeneous populations with Bakiga in Kabale and Bagisu in Mbale and Sironko districts. The rnain econornic activity in all phase II districts is agriculture with emphasis on food crops such as, sweet potatoes, maize, cassava, beans, groundnuts and bananas. The cash crops are mainly coffee and tea. Ivermectin distribution in Kabale, Mbale and Sironko districts started in 199311994 with assistance frorn River Blindness Foundation by then, now called GRBP. Ivermectin distribution in Bushenyi (with assistance from CBM), Kabarole district by then, now divided into three districts (Kamwenge, Kyenjojo and Kabarole) also started in 1991 with assistance from GTZ. The method of drug distribution was colnmunity based in all phase II the districts except in Bushenyi district where it was by mobile teams until, 1995 when community based methods were introduced. Community directed treatment was introduced in all the 1,409 communities in phase II districts in 1998 with financial supporl from APOC. Community, here is defined as the smallest administrative unit headed by an elected village leader by community members. 16 2.4 Sample population The group found useful informatiorl olr compliance and coverage in several published studies that helped to calculate the sample size using the sampling statistics shown in Table 2 belotv. Trvo sample sizes were derived from computatior.ts using data frorn the Onchocerciasis Control Prograrnnie (OCP) and from publications on Nigeria and Uganda(See En-rukah, et al, 2004; Ndyomugyenyi, 2oo4; plaisier, et al, 1997). However, the published data on Nigeria and Uganda were employed because they cover two of the conntries included in this study. Finally, the participant considered the range of sample size suggested by the statistical conlputation and decided to work with the upper limit of 1404 sample size. However, it was the consensus that any sample size rvithin the range 1335 and 1404 will be acceptable. Table 2: Sampling Statistics Sample size = Z, * (p). (1-p) t Qz Z value for g1oh confidence level 1.96 P percentage of treated for at least 7 years Confidence level 0.665 (66.5%) 95% Confidence interval expressed as decimal Lower tail confidence interval 0.025 Higher tail confidence interval 0.025 2.5 Sampling Five countries and nine projects lvere purposively selected (Table 3). The criteria for selection include geo-political and socio-cultural variation of the countries and lacilitating NGDOs. Source z2 P 1-p c2 Lower Sample size Upper Publications 3.8416 0.665 0.335 0.00062s 1,335 1,369 1,404 OCP 3.8416 0.64 0.36 0.000625 1,381 1,416 1,452 t7 Table 3: Studt,projects sampled The group considered the necessity of including a project in a typical Muslim area in Nigeria, recognizing that the three projects selected for Nigeria are in Christian dominated States to the exclusion of a socio-culturally distinct area and one CDTI zone in Nigeria. Similarly, it was considered that while Uganda phase tI project is preferred because of its cultural diversity, the inclusion of Uganda phase III will enable us sample communities in a project area that has no NGDO support. The descriptions of the two sites are attached in the appendix for consideration by APOC Management. 2.6 Sample size of communities Using the Table 4, the number of communities and household per community to be selected was agreed upon. Given that CDTI projects did not commence in all cotnurunities in the safire year, only communities that have been treated with ivermectin with the CDTI approach for at least 7 years will be included in the study. Every member from each sampled household will be interviewed rvith the household treatment survey form, rvhile two persons (one adult and one youth) will be selected for the household questionnaire study. The sex of those selected should be alternated for the different households sarnpled Country Project NGDO Districts, LGAs Communities Sample Communities Cameroon South West I SSI I 376 6 Cameroon Adamaoua ll IEF 4 4BB 8 Cameroon Centre lll HKI 8 489 10 Chad Chad OPC, Africare 5 3250 B Nigeria lmo/Abia GRBP 24 2624 10 Nigeria Osun UNICEF 14 997 6 Nigeria Taraba CBM/Mitosath 12 1497 I Tanzania Ruvuma SSI 4 164 I Uqanda Phase ll GTZ, GRBP 7 1409 13 TOTALS 75 10317 61 <to@$ t-- atN*alrcclcl*\o c- clo*c.lFdoO 'o-i +tA oo.n\o@6rco,=\oa$€qo@vr o^ U=UE a() E tr ;r o.(J I cqO rj o\ € o.\ r- $\o €o @Oo\ov)r t--$ o A D o d 0r ad tr d b0 ,E EdN rd o ,dx E F= ,1 t ;io9rmtr-c ts LIOU <g)(JoA oXo o or)ooo Vcido NNMN €'.o9 6o\ c9 0q\o \o <f.+$@6@ .o .o .o Sq ^CV: $_r noo@*N t-. 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Methodology 3.1 Epidemiological and Social Science Methods for the Study A number of epidemiological and social science methods of data collection rvere identified to ensure data on the study objectives and research questions. Each method had implications for the measurable indicators, unit of analysis and specific infonnation needs of the research questions. These are summarized on Table 5 below. 3.2 Data Collection Eight sets of instruments will be employed in the study each targeting different sources of information to investigate the research questions (see Table 6). These instruments included Household form for collecting data on treatment coverage of households selected in the study communities CDD register and summary fonn/village distribution form for collecting information on the compliance of members of the villages selected in the study iii. Health system form to collect information on the ability of the health systern to support timely and adequate supply of ivemectin lndividual questionnaire to collect quantitative data on household cornpliance a IV v. ln-depth interview guides for collecting infonnation from the community leaders, CDDs, and health workers. Details on the procedure for data collection are contained on tlie study procedure and instruction sheet. oP o E oc >trG(, i 5.B= r t a s(,-9cYb=c EE$EgEE E oaa +t a o q) E o U) }'tLiFcdgotr SHtrod iH6,\ ,o0.=6rr-r)YV!v!H-F v)r9t 'iAd= lz(H o.= -aP6H5ndL-Y L,/ Gi ili d G Go o o o o oo 5q c! )EE a'J'roo crlok 9v't ro>UFo iiYc,rPr^.=v/Ro.@t.>EH',Oo:!o=c-:9Uc5; aaa r :th o(o o E o U) C) U6 -r?= L)A- ci 5oEii o) c\J L- Eq) E oq) aiz GC o.9 .eE '6t oo a! aaaa f< -coo eE Er _P .c6q -oEEE -':E E o P o l-r Pa F.l I.i oI,vt sb EEOE =s 3iO Or ^L-c -:l - = EiE E E9-O# (u O 5€6EEeFrc=H-5P 0r o F Q)o-> F:= F.L PE O > c) =a.c B 6.>E .= (Erb .=f 5 E qB E E^L+- E EE.E PE E E A EB! 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Quantitative data lvill be analysed using SPSS. All qualitative data rvill be entered in the computer using standard word processing softrvare. A computer-assisted analysis of these data will be underlaken using computer programrnes for qualitative data analysis, such as ATLAS.ti, to ensure a standardized and comparable analysis and interpretation of the qualitative data across shtdy sites. 5 Timeframe The study is planned to commence in May 2005 and the final analysis rvill be in a workshop to be held in Ouagadougou, September 26 to October 1, 2005. All data entering should be completed in all sites and copies sent to Professor A. Abiose, Joseph Okeibunor and Bill Brieger by September 15, 2005. These files should also be copied to APOC Management, with the attention of Dr Uche Amazigo. The detailed time frame of activities is presented below Table 7: Chart of activities and time line ACTIVITY Months By Whom? Mar Apr May Jun Jul Aug sep Oct l. Development of protocol .:21 - ':.t-',i ' -.; I APOC/SDD IEYE,ISIZ Study Teams & Resource Persons 2. Release of funds 4BOC Management 3. Pre-testing Country Shrdy Teams 3. Finalizing instrument 1. r t-?,1 .i!:;i!. Brieger & Okeibunor 4. Set up template Eligger & Okeibunor 5. Data collection Study Teams 6. Site visits Abiose, Brieger, Ndyomugyenyi, APOC 7 . Data cleaning, entering and submission of recfiles i ii: ,. rtii:;il, ;;#l$ '!i;-a .' .' .; '<i-i' Project Teams 8. Preliminary analysis work 'ri,Yi,$lt. h$Ht, Brieger, Okeibunor & APOC 9. Workshop for analysis and publication APOC/SDDIEYEISlz Study Teams & Resource Persons t 27 6. Budget Table 8: Summary of budget for all sites The study cost differs from one study site to another depending on the economic realities of the sites as well as the special study needs of the site and teams. Holever, a flat total sum of US$1500.00 was allowed for pre-testing of the study instrument in one site per country, except for Uganda and Tanzania. The site rvill not be one used for this study. In Uganda and Tanzaria, the cost of road transport from the place of residence of the Principal Investigators to the site where pre-testing rvill be untaken is included. In the case of Chad, APOC management will provide air ticket for the Cameroonians to pre-test the instrument in Chad. Should APOC Management approve the inclusion of an additional site each in Nigeria and Uganda, an additional prevision of approximately US$ 46,000.00 will need to be made. The budgets for site visits and final workshop for data analysis and publications are separate, and are to be computed by APOC Management. The detailed budget and budget justification for each study site is attached in the appendix. TOTALCountry Site Pre- testing (us$) Printing & other operational costs (us$) Field Staff (us$) Travel, Per Diem (us$) Supplies. Equip., Commun (us$) Data Manage. (us$) Cameroon Southwest 1 1500.00 2648.76 13960.00 3000.00 1 150.00 2200.00 24,459.76 Cameroon Center 3 2938.76 14460.0 5400.00 1150.00 2200.00 26,149.76 Cameroon Adamaoua 2 2940.76 13280.00 6300.00 1450.00 2200.00 26,170.76 Chad Chad 1500.00' 2806.76 12640.00 5600.00 1450.00 2200.00 26,196.76 Nigeria lmo 1500.00 1019.10 9120.00 10882.00 1500.00 1320.00 25,341. 24,401.Niqeria Osun 1019.10 9120.00 11442.00 1500.00 1320.00 Niqeria Taraba 1019.10 9120.00 13220.00 1700.00 1320.00 26,379.10 Tanzania Ruvuma 1980.00 230.00 14710.00 2504.00 2000.00 21,390.00 Uqanda Phase ll 1980.00 6090.00 '1 1540.00 1600.00 2600.00 23,810.00 Total 224,296.34 I Air ticket to be supplied by APOC management for pre-testing in Chad 28 7. References Ernukah EC, osuoha E,, Miri ES, onyenama J, Amazigo U, obijum c, osuji N, Ekeanyanwu J, Anradiegwu S, Korve K, Richards FO. "A longitudinal study of impact of repeated mass ivennectin treatrnellt on clinical mauifestations of onchocerciasis in inro State, Nigeria", Ant J Trop |tted Hygz0o4;70(5): 556-61. Ndyonrugyeni R, Tukesiga E, Buttner DWQ, Garms R., "The irnpact of ivermectin treatment alone and rvhen in parallel with Simulium naevei elirnination on onchocerciasis in Uganda", Tropic'al medicine and hfiernotional Health 2OO4; 9(B): 882-886. Plaisier AP, Alley ES, \,an oofimarssen GJ, Boatin BA, Habbema JDF. ,.Required duration of combined annual ivermectin treatment and vector control in the Onchocerciasis Cotnrol programme in West Africa", Bulletin of the WorkJ Health O r gan izat i on | 997 ; 7 5 (3):237 -2a 5 29 APPENDIX = STUDY INSTRUMENTS = STUDY PROCEDURES AND INSTRUCTIONS = BUDGET AND BUDGET JUSTIFICATION FOR STUDY SITES _ LIST OF PARTICIPANTS I N E9e o cEY 0H bP*ob7i >Y -otrYat; t*eEs =s E: E oo_ FO UJO o E E yEo !segHgEatH[t O) 3 ..,> , EtcgHEEe; i*t=i= @ s-EtEHEeEE,,*Eu= f.- gi* EHEEf,gi gt ai c (O E? - b E E P E 3E 3OE(JII ll llLLl.Il(rOrN rO a =Cntr(UF - 0)I 0) u6 .n'3 .s', 9 hv!v{J -='> o c o -q,il il il ilttrNCr)sf, <- _o !!2O O(D 5#r Eg a pt cY) .= sr; €o 6 oEo) o -.L<> o-o N 6rT(/)>LJ- a6 o+ L€FdgOFEE = o-X c L! o X<-!EoY=c = G O_O_O-O ^=ELLE (DO -#\,a\ 6 - :A O)Y irc-> I h 9Lo-9c o) o.l 9oErc(goq)zT> oz q) N! a Nrc oF j-., cq) E(! oLF a NJ o E C o (, E o O 0) a =oI u c) .J' C 0)! c) af, I 0) o) .(g j-.,; 'L- .a o ji() o 'o' 0- b Cf, o li 0) 0.) 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Project District CDD(s) Respondent Name(s): Today's Date Household (or page) Number Person number Sex 1-M 2-F Age (Years) Total Number of Treatments Household (or page) Number Person Number Sex 1-M 2-F Age (Years) Total Number of Treatments )/ FORI\,IAT FOR COLLECTING SU]\,{ARY DATA ON TREATMENT Irrstrttction to enumerator This checklist is to be used to collect irtformation from the CDD register. Do not leat,e qny spoce blank clteck for consistency of answers before parting contpsny with the CDD. Country: Village: Project District CDD(s) Respondent Name(s): Today's Date (Make as many copies of this page as needed. Summary sheet found on back of first page.) Instruction to enumerator: Please locate copy of annual summary forms used the CDD to record the number of people who took Ivermectin during the follorving years. Check for inconsistencies and verify rvith the CDD before parting company rvith CDD xY Nt uc, Sex of Villagers Year of treatrnent Total pop in community Males Females Age groups Age groups 5-r4 15-24 25+ 5-14 t5-24 25+ I 998 t999 2000 200 I 2002 2003 2004 200s lstiott treated in tltis cottrtnutt atd treatment Total Treated J5 IN-DEPTH INTER\/IEW GUIDE WITH COM]\{UNITY/OPINION LEADERS ht etch sampled communitl,, please identifi, snd interview peoplefrom four categories of people l) onet'illoge lesder (trodttional ruler, politicol leatler/couttcilor),2) ine y6y11, leacler, 3) one y,onten,s leoder,tnd 4) one CDD. If there ure botlt male andfemale CDDs, interviiw one of each. Introduction: Onchocerciasis and CDTI Could you kindly tell me all about distribution of ivermectin in this comrnunrty? (probe) . When did it start in this community? . Horv is it implernented o Who collects the drug for your community? o Front rvhere is tlie drug usually collected? o When is the drug usually distributed here? And by who? o Who selects the distr-ibutor? How and Why? o Floiv is tlie dmg distributed in this cornmunity? Who decided on the mode of distribution 2. Do you have people, in tliis cornmunity, who are not members of this comrnunity? Probe for o Where are they from? o Do they take the drug regularly? (Explain) 3. What types of people do you tliink should take this drug in this community'? Why? 4. what do yo* do to those wlio fail to take the drug regularly? why? Perceived Social ancl Health Benefits 5. Are there bc.efits i,di,iduals get from taking this dmg? 6. If yes, rvhat rvould consider the benefits of taking this drug (ivennectin)? (probe) 7. Are there benefits to the community? If yes, what are the benefits? \Yillingness to continue treatment rvith ivermectin 8. For horv long are you expected to take this drug? Why? 9. How long are you willing to take the drug? Why? 10' Horv long would you say members of your community will be willing to take this drug? Why/ Factors associated with compliance . Why do you think people take/not take ivermectin? Suggestions for improving compliance I l ' could you please give your suggestions on how to make members of this community take the drug annually and for many years? THANK YOU VERY MUCH FOR YOUR TIME AND PATIENCE. 39 IN-DEPTH INTERVIEW GUIDE WITH HEALTH WORKERS (Interview the office in-charge of the health factlity in the commttni4t) Introduction: Onchocerciasis and CDTI 1. Could you kindly tell me all about CDTI in the communities served by this health facility? (Probe) . Does this contmunity (name community) collect its ivermectin from here? (Explain) 2. Are there people, in this area, who are not treated as part of this community (name community)? Probe for . Where are they from? . Are they usually treated during the mass distribution? (Explain) 3. What does community leadership do to those rvho fail to take the drug regularly? Why? Willingness to continue treatment with ivermectin 4. Llorv long rvould you say members of this community rvill be willing to take this drug? Why? Factors associated rvith compliance 5. What lvould you say are the reasons why people take the drug in this community (nan-re community)? Probe for . Why rvould people want to take it annually? . Why rvould people not want to take it annually? o What categories of people would or would not rvant to take the drug annually? 6. Do you receive ivermectin on time in this health facility? 7. Does this community (name community) come to collect their ivermectin on time? Suggestions for improving compliance 8. Could you please give your suggestions on how to make members of this community take the drug annually and for a long-term? THANK YOU VERY MUCH FOR YOUR TIME AND PATIENCE. 40 FOCUS GROUP DISCUSSION GUIDE (Adult moles, odult female, y6y11, snd minority groups) Introduction: Onchocerciasis and CDTI l. Could you kindly tell me all about distribution of ivemrectin in this community? (Probe) . When did it start in this community? o How is it implemented o Who collects the drug for your community? o From where is the drug usually collected? o When is the drug usually distribr.rted here? And by rvho? o Who selects the distributor? How and Why? o How is the drug distributed in this communify? Who decided on the mode of distribution 2. What types of people do you tliink should take this drug in this community? Why? 3. What do you do to those who fail to take the drug regularly? Why? Perceived Social and Health Benefits 4. Are there benefits individuals get from taking this dnrg? 5. If yes, rvhat would consider the benefits of taking this drug (ivern-rectin)? (Probe) 6. Are there benefits to the community? If yes, rvhat are the benefits? Willingness to continue treatment rvith ivermectin 6. For horv long are you expected to take this dmg'/ Wliy? 7. How long are you willing to take the dmg'/ Why? 8. How long would you say members of your community will be willing to take this drug? Why? Factors associated with compliance 9. why do you think people would/would not want to take ivermectin? Suggestions for improving compliance 10. Could you please give your suggestions on how to make members of this community take the drug annually and for many years? THANK YOU VERY MUCH FOR YOUR TIME AND PATIENCE. 4l INDIVIDUAL QUESTIONNAIRE Select tvo persons (one adult and one youth) from the household tnterviewed for the household treq.tment coverage for this interview. Collect the followirtg ittformation from the houseltold treatment survey fornt HH No Ind No Sex Age Marital status Religion Educational status Ethnic group No. of Treatment Collect the following information from the selected Respondents l. What is the income-earning activity that takes most of your time in a rveek? Farming/Hunting/FishingAVine Tapping Trader Housewife/Unemployed Professional (Teacher, Nurse, etc) Artisan (Tailor, Hairdresser, Furnishing, etc) t t t t t I 2 J 4 5 6 Other (Please, specify) A. Perceived benefits of ivermactin by individuals 2. How likely do you think you can suffer frorr any of these 3. What are the different treatments you know for onchocerciais (River blindness)? l. Herbs 2. Banocide 3. Ivermectin 4. Others, please speci 4. Which of this do you think is the best? Herbs Banocide Ivermectin Others, please speci 5. What motivated you into taking ivermectin the first time? (Tick as many as mentioned) We were told to take it I had problems with my skin I had problem with my eye sight I saw others taking it Others, please s Not applicable tl 1 2 J 4 I 2 3 4 5 6 Health problems Likelv Yery likelv Not likely Skin rashes Blindness Swellings of the body Severe itching 6. Do you think that taking Ivermectin (ivermectin) annually for several years has had benefits? l l l 42 l. Yes 2. No l 3. Don't know tl 1 l. If yes, can you mention these benefits? (Tick those mentioned) Social benefits Health Benefits Improvement in school attendance De-worming Acceptance by peer Removal of lice Integration of minority grollp Cures scabies Can now work better Improvement of sight Self respect Improvement of skin Facilitates election to political office lncrease sexuality Others Improves fertility Reduced itching Other 12.Have you personally noticed any change on you social life since you started taking ivermectin? l. Yes 2. No 3. Can't tell t l I 3. Ifyes. please tell us...., 14. If not, is there any orle who you kno\\,, rvhose social lives changed as a result of taking ivermectin for several years? Please tell us. 15. h your opittion, rvhat do you think about taking ivennectin annually and for several years?. 16. Does taking iverrnectin pose atly difficulty or problerns to you?l.Yes t l2.No tl 17. If yes, rvhat are the difficulties or problerns? (Tick as many as mentionecl) l. Itcliing t lZ.Dizziness [] 3. Sleepiness t l 4. It is difficult to srvallow the drug t l 5. Su,ellings [ ] 6. Others, please 7. Not applicable t l 43 B. Factors that influence indi'r'idual compliance to Iong-term annual ivermectin treatment 18. Are people in your comnrunity taking ivermectin every year? l. Yes 2. No 3. 3. Don't know 19. If yes what do you think makes people in your community take annual ivermectin treatment every years?. 20.If no rvhat do you think prevents people in your community from taking annual ivermectin treatment for several years'/ l. Late arrival of ivermectin t ] 2. Side effect t l 3. Lack of information t l 4. Non-adherence of health personnel on agreed period of distribution 5. Feeling of well being i l 6. Non-availability of ivennectin t l 7. Improved sight t l tl 8. Others, please specify 21. Are there people rvho try to make you take you swallorv ivermectin every year?l.Yes t l2.No tl 22.If yes to Ql9, rvho are these people? I]tltl L My mother t Z.My father I 3. My wife t 4. My husband t 5. My children t 6. CDD t 7. Friends t 8. Health worker t 9. Teachers t 10. Parents in law t 1 1. Brothers I 12. Sisters t 13. Other relations t 14. Community leaders 15 Others t tl 23. Are there people lvho try to make you not to take you swallow ivermectin every year?l.Yes tl2.No tl 24.|f yes to Q21, who are these people? 1. My mother t l 44 Z.My father t l 3. My wife t l 4. My husband t l 5. My children t l6.cDD tl 7. Friends t l 8. Health worker t l 9. Teachers t l 10. Parents in lau, t ]ll.Brotliers [] 12. Sisters t l 13. Otherrelations t l I4. Community leaders 15 Others t l tl C. Willingness to srvallorv ivermectin for many years 17 . Are you willing to take annual ivermectin every year for many more years? l. Yes 2. No l I 2 3 18. If yes, rvhat are the reasons for your rvillingness to continue taking the drugs? 19. If no, rvhy? l. Fear t l 2.Tired of taking ivemrectin 3. Side effect 4. No more synptoms 20. Do you think people in your community are willing to continue taking annual ivennectin many more years? l. Yes 2. No 3. Don't know 21. What, do you think are the reasons for community willingness to continue taking the dmgs for several years? 1. 2. J. D. Community suggestions for improving compliance 22. What are your suggestions on ensuring that many more t I I years? people take the drugs fol many more tlI]tl 45 246 Study Procedures and lnstructions 1. General - Prior to actual interviewins a. Print instrumeri from the spectal instnrment files sent to oll teunts during the workshop b. Select sarnple villages/communities including rninority communities c. Identify specific rninority settlernents (e.g. Fulani gaa,pygmy villages, reftigee carnps) for separate sarnpling d. Deteruine sampling number - households and individuals - for each cornmunity e. Detennine ntost recent treatment month for each chosen community f. Visit community leaders in each community and seek approval g. Visit CDDs past and present and encourage them to get their records in order h. Count households to verify i. Learn name of key event in district/area that occurred in 1998. Try to find an even r.vhen something positive happened. j Fill in general infortnation on forrns (e.g. country, district) in advance to save tinre k. Frnd out local names fbr onchocerciasis and ivemrectin and use in interviews On day of intert,ietv a. Greet villagc leaders and introduce intervierv team b. Select the actual sample of households based on people present that day c. Identify specific minority groups in the community for separate sampling d. Revierv CDD register i. Fill in household members and total treatments - columns I and,12 on the Household form ii. Euter household identifier inforrnation - e.g. number on house of head of household name iii. Give household a code: 01, 02,03 (base on register if possible) e. Go to each selected household i. Gather all available members together ii. Explain nature and purpose of interviews - household form and individual questionlaires iii. Seek perrnission to continue with interviews iv. Ensure privacy from neighbors f. Explain that after the household form is filled out, two house hold members rvill be asked to provide further information on the individual questionnaire. g. Divide up the interviewers and field assistants according to the chart found at the end of this section. Household Form a. In column I i. Verify names of all members as obtained from register ii. Add others as needed and note that they were not in register 3 41 For household members rvho are absent, find out if they really are normally resident in the village, e.g. they did not move to the city some years ago and only visit the community for a holiday. If they are not normally resident, comment next to their names b. ln columns 7 and9, be sure to mention the key area event that is listed at the top of the form and is used to mark the inception year (1998) of the CDTI project. c. Based on minority groups in area, create codes for column 11 d. Anytime 'other' is a response for a column, rvrite in that exact response in the appropriate row. e. For columns 8 and 9, we are trying to ensure that we focus only on 'official' community distributions rvhere the CDD measured people. It is know that people may have taken ivermectin on their oln, and these tirnes should not count. f. In column 9, note that responses should range between 0-7 (maybe 0-8 depending on when field work starts). Any response beyond 7 (or 8) should be queried. g. In column 10, ir-rclude as manycodes as the persons mentions because they mayhave several different reasons in different years. h. Use column 12, only for data obtained from the CCD's register and fill in details for the specific household and its mernbers. 4. Individual Intervierv Ouestio naires on Benefits. Costs. etc. a. Note that in each house only trvo people rvill be interviewed and will be chosen from those currently at home and listed on the household form. b. Allocate interviervs arnong the selected houses as follorvs: i. House l: Adult Male, Youth Female ii. House 2: Adult Female, Youth Female iii. House 3: Adult Male, Youth Male iv. House 4: Adult Female, Youth Female, and then repeat for subsequent houses c. If the desired paring is not available, substitute persons as available, and try to make up differences with subsequent households. d. Prior to beginning the individual interview, fill in the appropriate socio-demographic and treatment history information from the household form. e. Seek permission from the individual again to proceed with the questionnaire. 5. Focus Groups o The sampling matrix for each project site is seen below. Ideally one would conduct FGDs until no new data appear. We are suggesting that each team aim at 4 FGDs per category, but has the discretion to add more in a category if the information derived after 4 groups is not exhaustive. o Balloting will be done to allocate the FGDs among the indigenous members of the study communities. . No community will have more than two FGDs. o Minority group FGDs will be formed where such residents actually exist. This will involve purposive sampling. . Techlically, a FGD should consist of people who are not well known to each other. This is often difficult in a small village. In this case effort will be made to recruit participants from different locations or sections of the community. 48 FGD Sarnpling Matrix Gender Total Male Female Adult Indigenous 4 4 8 Youth Indi S 4 4 8 Minori 2 2 4 Total l0 l0 20 o Each FGD will be moderated by one field assistant rvhile the second u,ill serve as a recorder. The recorder rvill ensure that all comments from the group are written. . All sessions will also be recorded. ' The moderator needs to ask consent of all parlicipants to take parl in the discussion and rvhether they agree to the conversation being recorded. . At the end of the FGD, the recorder and the moderator rvill sit dorvn and listen to the take recording together and compare this with the handwritten notes. The tape recording will be used to revise and flesh out these notes. o After the session uotes are finalized, these will be typed in either MSWord or WordPerfect. The field assistants will review the typed transcript to ensure accuracy. 6.Indenth Comm Interviews Comrnunity Leaders - select one of each for eacli community . Community Head o { respected female - formal or opinion leader o d respected youth - fonnal ol opinion leader ' An experienced CDD (if by chance there are both male and fernale CDDs, chose one of each) - lvith CDD interiews, conduct this intervierv AFTER completing the Annual Village Distribution Plan form Note that the cotntnunity leader cau be assisted by other people in the case of, for example, a village chief rvho has a council, or a village chairperson lvho has a vice-chair. 7. Indepth lnterviervs Health Worker ' One should identify the nearest health facility where communities collect their ivermectin. o Note that a particr.rlar health facility may serve more than one of the sampled communities. Be sure to write the names of all study communities served by that facility on the form o At the health facility identify the person who has worked with tlie CDTI program longest for the interview. 8. Annual Villase Distribution Exnerience Please note that this form is filled out rvith the collaboration of all available CDDs and thevillage leader or representative ofthe leader. It is felt that more people would help aid memory of events in previous years. The team may even invite people who formerly served as CDD, but are still present in the village It is possible that information through records and,/or memory is not available for certain years. If so, write clearly on the column for that particular year that information is not available, or that information is only based on recall. a a a o 49 9. CDD Register Summary o From this summary extract information on the history of treatment for each member of the enttre community covered. o You are requested to sum up the total annual CDTI treatments received by each person in the register. This would start in 1998 and mayrange from 0-7 treatments (or 0-8 if 2005 is included) . Transfer all the information about the treatment of the people from inception of CDTI in I 998. o Note that some people because of age or migration may have received fewer than seven (or eight?) treatments, but no one should have received more that seven (or eight?) o Please print enough forms to contain all community information. Number these pages sequentially. o On the back of page 1 fill out the annual summary information if this is available in the village. The CDDs may have retained a copy of the summary forms before submitting to the onchocerciasis coordinator or they may have made notes in their register. If no summary information is available for a particular year, rvrite out the reason in the appropriate column for that year. 10. Ilealth Facility Form o lnformation on this form should be provided by health staff who are actually involved in the CDTI program. More than one health worker can be involved in the accurate completion of this form. o It is appreciated that some health facilities serve a cluster of communities. The liealth facility staff here will be intervierved in relation to the community selected for the study. If rnore than one sampled study community is selected in the cluster served by this facility, rvrite clearly all community names on the form. o It may be possible that records are incomplete or unavailable. If this happens, write the problern clearly in the appropriate column, if information is obtained through recall, not records, make not of this also. 50 11. Dailv Assi nt Chart EvenUlnstrument Arrival Morning Afternoon Concurrent lntroductions Scientists/Team Leaders introduce all staff to local leaders, community members and CDDS Scientists/Team Leaders will review forms and data as collected, make corrections and adjustments in interviewer allocations to meet gaps Household Form lnterviewers complete all household forms lndividual Questionnaire lnterviewers follow up with selected individuals Village Distribution interview with CDDs and Leader field assistant lDl Leaders field assistant field assistant FGDs field assistants do first group field assistants do second group CDD Register Review All interviewers copy out appropriate household information before rnterview field assistant Health System Form* field assistant lDl Health Workers" field assistant Note that there rvillbe approximately l5 regular interiervers and 4 more senior field assistants per site. All work in chosen village for the day so finish that village and avoid bias of returning on a second day giving villagers opportunity to discuss the interviews. *Health Facility instruments may require separate visits to those locations by the field assistants and scientists unless the facility is located within rvalking distance of the day's chosen communities. 51 BUDGETS AND BTIDGET JUSTIFICATION FOR STUDY SITES CAMEROON, SOUTH WEST I A) BUDGET Budqet SW 1 Cost Cumulative NumQes pgs totpg 11232 cost $0.051404 8 $561.60 $561.60 Qperday days intervrs daily 26 4 $30 $3,120 $3,681.60 FGD/Othr days intervrs daily 26 4 $30 $3,120 $6,801.60 Field Trans fuel days daily 30 $100 $3,000 $9,801 .60 PerDiem days scientists rate 2 $r o0 $6,400 $16,201 .60ad hoc 32 PerDiem Driver 30 $20 $600 $16,801 .60 PerDiem FLH personnel B1 $20 $160 $16 961.60 perDiem field guide 2 16 $10 $320 $17,281.60 Oncho coordinator 1 8 $30 $240 $17,521.60 Data Mgmt coordination scientists 25 $100 $1,000 $18,s21.60 Other Supplies, Equip, Rentals and Printing and training materials (e.q. tape recorders) $1 ,000 $19,521.60 Communication $150 $19 671.60 Data entry staff days rate '10 $30 $1,200 $20,871.604 Other Transportation (air, road to sites) $20,871.60 Gontingency (10%) $2,087.16 $22,958.76 Pretesting $1,500.00 Grand Tota! $24,458.76 BUDGETS AND BUDGET JUSTIFICATION FOR STTIDY SITES CAMEROON, SOUTH \\/EST I A) BUDGET Budset SW 1 Cost 53 Cumulative NumQes pgs totpg 11232 cost $0.051404 I $561.60 $561.60 Qperday days intervrs daily 26 4 $30 $3,120 $3,681.60 FGD/Othr days intervrs daily 26 4 $30 $3,120 $6,801.60 Field Trans fuel days daily 30 $1oo $3,000 $e,801 .60 PerDiem days scientists rate 2 $100 $6,400 $16,201 .60ad hoc 32 PerDiem Driver 30 1 $20 $600 $16,801 .60 PerDiem FLH personnel 8 $20 $160 $16,961.60 perDiem field guide 2 16 $10 $320 $17,281.60 Oncho coordinator oU $30 $240 $17,521.60 Data Mgmt coordination scientists 25 $100 $r ,000 $18,521.60 Other Supplies, Equip, Rentals and Printing and training materials (e.q. tape recorders) $1,000 $19,521.60 Communication $150 $19,671 .60 Data entry staff days rate 4 10 $30 $1,200 $20,871 .60 Other Transportation (air, road to sites) $20,871.60 Contingency (10%) $2,087. 1 6 $22,958.76 Pretesting $1,500.00 a Grand Total $24,458.76 1 1 54 B) Budget Justification Proiect: South West I Cameroon Pretest of instrument To test viability of instruments before going into the actual field, it is proposed that this will be done in one community in the South west l, where CDTI has been implemented for at least seven years. This rvill serve the purpose of the entire study in Cameroon. Six days will be required for this activity. Ad hoc per diem for two scientists ($100 each) is requested. This item is estimated to cost $1200. A moderate $50 per day is requested for transportation for both scientists which comes to $300. Sub Total for pre-testing instruments US$1500.00 Survey Training of Research Assistants 8 research assistants will be recruited and trained for 2 days for data collection. Each assistant will received a perdiem of 30 USD during the training and during field activities 8 Assistants x 30 USD x 2 days . ....480 The training rvill be donc by the trvo Scientists in the research group rvho rvill receive each a perdient of 100 USD. 2 Scientists x 100 USD x 2 days ... .400 Data collection The data collection proper ivill take 30 days. ln each community selected, 2 days will be necessary for the administration of the questionnaire, FGD, and in-depth interview. Each assistant will administer a maximum of 20 questionnaires per day, I additional day will be used to collect data from the registers. I to 2 additional communities may be needed to achieve the sample size. 8 Research Assistants recruited and trained will spend each}4 days (30 USD each /day) in the field (16 days for questionnaire administration, FGD, in-depth interviews) and 8 days for collection of information from registers. 8 Assistants x 30 USD x 24 days .......5760 The two Scientists of the team will spend 30 days in the fields distributed as follows: 6 days for community visits and sensitization, 16 days for supervision of data collection in communities and 8 days for supervision of the collection of data from registers, r 2 Scientists x 100 USD x 30 days ..... ..6000 The medical personnel in charged of the community selected for the study will assist for 1 day to collect infonnation from the registers. He will be given a perdiem of 20 USD. 8 Healthpersonnel (FLHpersonnel)x 20 USD x I day ........160 I driver will drive the team during the 30 days of field activities I Driver x 20 USD x 30 days 600 55 2 field guides will be recruited from each community to guide and facilitate interviews. Each of the guide will eam a perdiem of 10 USD. 2 guides x 10 USD x 16 days . ... . .320 I Onchocerciasis coordinator from each health district involved in the study will assist in the planning of activities and sensitization. Assuming that communities here are selected from 8 health districts, lcoordinator will be needed per district. Each rvill given a perdiem of 30 USD. 8 Coordinators x 30 USD x I day . ......240 150 USD will be needed for Cornmunication during planning and supervision of activitiesCommunication. .....150 USD 4 research assistants will enter the data and transcribe the FGDs and in-depth interviervs. This exercise will last 10 days and will be supervised by the two Scientists (5 days each). 4Assistantsx30USDx l0days ....1200 2 Scientist x 100 USD x 5 days (one scientist supervising per day)............1000 Fuel will be needed for 30 days of field activities. I litre of fuel in Buea (head quafter of the SW province) cost approximately I USD (500 frs CFA). The distance betrveen Buea and some of the farlhest health district e.g Bangem, Nguti and Mudemba is between250 - to 300 km and the farthest one goes from head quarter the more expensive is the fuel. Fuel 100 USD x 30.... .......3000 1404 individual and household questionnaires (8 pages/Questionnaire) (0.05USD/page) rvill be needed for the study. 1404x 8pagesx0.O5usD. .....561.60 Others supplies including tape recorders, nricro cassettes, stationery, trainir-rg docurnents (file jackets, pens, protocols) rvill be needed for the study and will cost 1000 USD.Othersupplies. .......1000 10 % of the proposed budget has been included for miscellaneous expenditures such as vehicle maintenance. Miscellaneous 2087.16 CAMEROON ADAMAOUA II SITE A) BUDGET Budget 56 Cost Cumulative NumQes 1404 8 Pgs cost $0.05 totpg 1t232 $s61.60 $561.60 Qperday Days 22 intervrs daily $304 $2 640 $3 01.60 FGD/Othr Days intervrs daily 22 4 $30 $2,640 $5 841.60 FieldTrans fuel Days 28 daily $ 125 $3,500 $9,341.60 Iliring of vehicle 28 I $ 100 $2,800 $ 12 141.60 PerDiem Days 30 scientists 2 tate $ 100Ad hoc $18 141.60 2 $20 $ I ,120 $ 19,261 .60 $ PerDiem Driver 28 PerDiem FLH personnel 8 $30 s480 $ 19,741 .602 perDiem field guide 2 8 $10 $160 $19,901.60 Oncho coordinator 8 1 S30 $240 $20,141.60 Data Mgmt coordination 5 2 S 100 $ 1,000 $21,141.60 Other Supplies, Equip, Rentals and Printing and training (e.9. tape recorders ) $ 1,250 $22,39t.60 Communication $200 $22,591.60 Data entry Staff days rate $304 t0 $ 1,200 $23,791.60 Other Transportation (air, road to sites) $23,79r.60 Contingency (f 0%) $2,319.16 $26,r10.16 Grand Total $26,170.76 51 B) BUDGET JUSTIFICATION Project: Adamaoua II Cantcroon Surl'e1' Training of Research Assistants 8 research assistants will be recruited and trained for 2 days for data collection. Each assistant rvill received a per diem of 30 USD during the training and during field activities 8 Assistants x 30 USD x 2 days ....480 The training lvill be done by the two Scientists in the research group who will receive each a per diem of IOO USD. 2 Scientists x 100 USD x 2 days ...400 Data collection The data collection proper rvill take 20 days. In each community selected, 2 days rvill be necessary for the administration of the questionnaire, FGD, and in-depth intervierv. Each assistant administering a maximum of 20 questionnaires pir day, 1 additional day will be used to collect data frorn the registers. 8 Research Assistants rccruited and trained rvill spend each 20 days (30 USD each /day) in the fieid (16 days for questionuaire admir-ristratiou, FGD, in-clepth ir-rterviervs) and 4 days for collection of information from registcrs. 8 Assistar-rts x 30 USD x 20 days . ....4g00 The two Scientists of the team rvill spend 28 days in the fields distributed as follorvs: 8 days forcommunity visits and sertsitization,4 days for superuision of the collection of data from registers, l6 jays for supervision of data collection in communities. 2 Scientists x 100 USD x 28 days ... .5600 The medicalpersonnel in charge of the cornmunity selected for the study will assist for I clay in collecting information frorn registers. FIe rvill be given a per diem of 20 USD for 1 day. 8 Health personnel (FLH personnel) x 20 USD x I day . . ..160 I driver rvill drive the tearn during the 28 days of field activities I Driver x 20 USD x 28 days ......560 2field guides rl'ill be recruited fi'om each cornmunityto guide and facilitate ilterviews. Each of theguide will earn a per diern of l0 USD. 2 gtrides x l0 USD x 16 days .... . .3ZO I Onchocerciasis coordinator from each health district involved in the study rvill assist in the pla.ni,g of activities and sensitization. Assurning that communities here are selected from 8 health distrrcts, a coordinator lvill be needed per district. Each will be given a per diem of 30 USD. 8 Coordinators x 30 USD x I day ........240 200 USD rvill be needed for Communication to plan and supervise activities. 58 Comrnunication 2OO USD 4 research assistants rvill be involved in data entering, transcription of FGDs and in-depth interviews. This exercise will last l0 days and rvill be supervised by the two Scientists. 4 Assistants x 30 USD x 10 days ......1200 2 Scientist x 100 USD x 5 days (one scientist supervising per duy) ...1000 A car will be hired at a cost of 100 USD per day and for 28 days for field activities Hiring of vehicle (100 x 28)... .....2800 Fuel rvill be needed for 5 days of field activities. I litre of fuel in Ngaoundere cost more than I USD (700frs CFA). More fuelwill be needed due to the dispersal of communities and the distance between communities. Fuel 125 USD x 28 ... .....3500 1404 individual and household questionnaires (8 pages/Questionnaire) (0.05USD/page) willbe needed for the study. 1404x 8pagesxO.O5usD. ..561.60 Others supplies including tape recorders, micro cassettes, stationery, training documents (file jackets, pens, protocols), hiring of computers, rvill be needed for the study and rvill cost 1250 USD" Otlrers supplies. .....1250 l0 % of the proposed budget has been included for miscellaneous expenditures such as vehicle maintenance. Nliscellaneous . . .2379.16 CAMEROON CENTER TII A) BUDGET 59 Cost CumulativeEstimated General Budget Centre lll NumQes pgs 1404 8 totpg 11232 cost $0.05 $56'r 60 $561.60 Qperday days intervrs 27 daily 4 $30 $e ,240 $3,801.60 FGD/Othr days intervrs 27 daily 4 $30 $3,240 $7,041.60 FieldTrans fuel days 30 daily $1 00 $3,000 $10,041.60 Hiring of vehicle 30 1 $80 $2,400 $12,441.60 PerDiem ad hoc Scientists 2 days 32 rate $1 00 $6,400 $18,841.60 PerDiem Driver 30 1 $ZO $600 $'19,441.60 PerDiem FLH personnel 82 $30 $480 $19,921.60 perDiem field guide 2 10 $10 $200 $20,121.60 Oncho coordinator '10 1 $30 $300 $20,421.60 Data Mgmt coordination 5 2 $roo $1,000 $21,421.60 Other Supplies, Equip, Rentals and Printing and training (e.9. tape recorders) $ 1 ,000 $22,421 .60 Communication $ 1 50 $22,571 .60 Data entry staff days 4 rate 10 $30 $1,200 $23,771 .60 Other Transportation (air, road to sites) $23,771.60 Contingency (10%) $2,377.16 $26,148,76 Grand Total $26 148.76 60 B) BUDGET JUSTIFICATION Project: Centre III Cameroon Survey Training of Research Assistants 8 research assistants will be recruited and trained for 2 days for data collection. Each assistant will received a per diem of 30 USD during the training and during field activities 8 Assistants x 30 USD x 2 days ......480 The training will be done by the two Scientists in the research group who will receive each a perdiem of 100 USD. 2 Scientists x 100 USD x 2 days ....... .400 Data collection The data collection proper will take 30 days. ln each community selected, 2 days will be necessary for the administration of the questionnaire, FGD, and in-depth interview. Each assistant administering a maximum of 20 qr.restionnaires per day, I additional day will be used to collect data from the registers. 8 Research Assistants recruited and trained will spend each25 days (30 USD each /day) in the field (20 days for questionnaire administration, FGD, in-depth intervielvs) and 5 days for collection of information from registers. 8 Assistants x 30 USD x 25 days 6000 The two Scientists of the team will spend 30 days in the fields distributed as follorvs: 5 days forcornmunity visits and sensitization, 5 days for supervision of the collection of data from registers, 20 days for supervision of data collection in communities. 2 Scientists x 100 USD x 30 days ..6000 The medical personnel in charge of the community selected for the study will assist for I day in collecting inforrnation frorn registers. He will be given a per diem of 20 USD for I day. 10 Health personnel (FLH personnel) x 20 USD x 1 day ..... ...200 1 driver will drive the team during the 30 days of field activities I Driver x 20 USD x 30 days 600 2 field guides rvill be recmited frorn each community to guide and facilitate interviews. Each of the guides will eam a per dien-r of l0 USD. 2 guides x l0 USD x 20 days . ......400 I Onchocerciasis coordinator from each health district involved in the study will assist in the planning of activities and sensitization. Assumingthatcommunities here are selected from l0 health districts, a coordinator r,vill be needed per district. Each will be given a per diem of 30 USD. l0 Coordinators x 30 USD x 1 day ...300 6l 150 USD u,ill be needed for Communication to plan and supervise activities. Communication. ....150USD 4 research assistants willbe involved in data entering, transcription of FGDs and in-depth interviervs. This exercise ri'ill last l0 days and rvill be supen,ised by the trvo Scientists. 4 Assistants x 30 USD x 10 days .. .1200 2 Scientist x 100 USD x 5 days (one scientist supervising per duy). ..........1000 A car rvill be hrred for the cost of 80 USD per day and for 30 days for field activities Hiringofvehicle. ....2400 Fuel will be needed for 30 days of field activities. I litre of fuel in Yaounde cost about I USD (500 frs CFA). More fuel rvill be needed due to the dispersal of communities and the distance betrveel communities Fuel 100 USD x 30.... .......3000 1404 indit'idual and household questionnaires (8 pages/Questionnaire) (0.05USD/page) ri,ill be needed for the sfudy. 1404x8pagesx 0.05 USD. .....561.60 Others supplies including tape recorders, rnicro cassettes, stationery, training documents (file jackets, pens, protocols), hiring of computers, u,ill be needed for the study and rvill cost 1200 USD. Others supplies. .......1200 l0 o/o of tl-re proposed budget has been included for nriscellaneous expendifures such as yeSicle rnailtenance Miscellaneous .. ...2317.16 CHAN CDTI A) BUDGET 62 Cumulative Estimated General Budget CHAD Cost NumQes pgs 1404 8 totpg 11232 cost $0.05 $561.60 $561.60 Qperday days intervrs 22 daily 234 A $30 $2,640 $3,201.60 FGD/Othr days intervrs 22 daily 4 $30 $2,640 $5,841.60 FieldTrans fuel days 28 daily $ 100 $2,800 $8,641.60 Hiring of vehicle 28 1 $100 $2,800 $1 1 ,441 .60 PerDiem days scientists 302 $6,000 $17,441.60 rate $1 00ad hoc PerDiem Driver 28 1 $20 $560 $18,001 .60 PerDiem FLH personnel B $30 $240 $18,241.60 perDiem field guide 2 16 $10 $3ZO $18,561.60 Oncho coordinator 1 $30 $240 $18,801.60 Data Mgmt coordination 5 2 $100 $1,000 $1 9,801.60 Other Supplies, Equip, Rentals and Printing and training (e.9. tape recorders) $1,250 $21,051.60 Communication $200 $21,251.60 Data entry staff days 4 rate 10 $30 $1 ,2oo $22,451 .60 Other Transportation (air, road to sites) $22,451.60 Contingency (10%) $2,245.16 $Z+,696.76 Pretesting $t 500.00 Grand Total $26 196.76 63 B) BUDGET JUSTIFICATION Project: Chad Pretest of instrument To test viability of instruments before going into the actual field, it is proposed that this will be done i1 one community in CIIAD, rvhere CDTI has been implemented for at least seven years. Six days will be required for this activity. Ad hoc per diern for two scientists ($100 each) is requested. This item is estimated to cost $1200. A moderate $50 per day is requested for transportation for both scientists whicli corres to $300. APOC rvill provide ticket for travels from Cameroon to Chad Sub Totrl for pre-testing instruments US$1500.00 Survey Training of Research Assistants 8 research assistauts will be recruited and trained for 2 days for data collection. Each assistarrt rvill received a per diem of 30 USD during the training and during field activities 8 Assistants x 30 USD x 2 days ......480 The training rvill be done by the trvo Scientists in the research group who will receive each a per diem of lOO USD. 2 Scientists x 100 USD x 2 days ... .400 Data collection The data collection proper rvill take 20 days. In each community selected, 2 days rvill be necessary for the administration of the questionnaire, FGD, and in-depth interieu'. Each assistant adtninisterir-rg a t-naximum of 20 questronnaires per day, I aclditiolal day will be used to collect data from the registers. 8 Research Assistants recruited and trained rvill spend eacli 20 days (30 USD each /day) in the field (16 days for questionnaire administration, FGD, in-depth interviervs) and 4 days for collection of infomration fi-orn registers. 8Assistantsx30USDx20days ......4800 The two Scientists of the team will spend 28 days in the fields distributed as follows: 8 days for commupity visits and ser.rsitization, 4 days for supervision of the collection of data frorn registers, l6 Jays for supervision of data collection in communities. 2 Scientists x 100 USD x 28 days . . .. ..5600 The n-redical persounel in charge of the courmunity selected for tlie sftldy rvill assist for I day i1 collecting iufomration from registers. He',vill be given a per diern of 20 USD for I day. 8 Health personnel (FLH personnel) x 20 USD x 1 day . . ..160 i driver lvill drive the tearn during the 28 days of field activities I Driver x 20 USD x 28 days .......560 2 field guides will be recruited frorn each community to gurde and facilitate interviervs. Each of the guides will earn a per diem of l0 USD. 64 2 guides x l0 USD x 16 days 320 I Onchocerciasis coordinator from each health district involved in the sfudy ivill assist in the planning of activities and sensitization. Assurning that communities here are selected from 8 health districts, a coordinator will be needed per district. Each will be given a per diem of 30 USD. 8 Coordinators x 30 USD x I day ....240 If the Scientist to supervise the ivork in Chad is from Cameroon, he will require transport allowance from Cameroon to Chad and back during the pre-testing and field rvork. Transport (600 USD) ...600 USD 200 USD rvill be ueeded for Communication to plan and supervise activities. Comrnunication . .......200 USD 4 research assistants will be involved in data entering, transcription of FGDs and in-depth intervie'uvs. This exercise rvill last 10 days and will be supervised by the two Scientists. 4Assistantsx30USDx l0days .......1200 2 Scientist x 100 USD x 5 days (one scientist supervising per duy).. ...1000 A car will be hired for the cost of 100 USD per day and for 28 days for field activities Hiring of vehicle. .......2800 Fuel rvill be needed for 28 days of field activities. I litre of fuel in Djamena cost about I USD (500 frs CFA). More fuel will be needed due to the dispersal of communities and tl-re distance between comrnunities Fuel 100 USD x 28.... ...2800 1404 individual and house hold questionnaires (8 pages/Questionnaire) (0.05USD/page) rvill be needed for the study. 1404 x 8 pages x 0.05 USD . ....561.60 Others supplies including tape recorders, rnicro cassettes, stationery, training documents (file jackets, pens, protocols), hiring of computers, rvill be needed for the study and rvill cost 1250 USD. Others supplies. ....1250 l0 o/o of the proposed budget has been included for miscellaneous expenditures such as vehicle maintenance. Miscellaneous ......2295.t6 65 IMO STATE, NIGERIA A) BUDGET Estirnated General Budqet for lmo Cost Curnulative Printing Costs all lnstruments $51 9.1 0 $519.10 Staff days* lntervrs daily 16 15 $30 $7,200 $7,719.10 FGD/Othr days* lntervrs daily 16 4 $30 $1,920 $9,639.10 FieldTrans Days Rate 35 126.92 $4,442 $14,081.41 PerDiem Days Scientists 30 2 $1 00 rate ad hoc $6,000 $20,081.41 Other Supplies, Equip, Rentals (e.9. tape recorders) $1,200 $21,281.41 Communication phone, internet, etc $300 $21,581 .41 Data entry Days Staff rate 11 4 $30 $1 320 $22 901.41 Other Transportation (air, road to sites) 2 scientists 2 $220 $440 $23,341.41 Miscellaneous Operational Costs $500.00 $23 841.41 *including trainrng Pre-testing of instruntents GRAND TOTAL s 1500.00 $25,341.41 $25341.10 B) BUDGET JUSTIFICATION Printing of Instntment Sufficient quantities of tlie study instrurnents is required for data collectron in this study, especially in the case of extraction of information from the CDD records to assess the treatrnent history of the entire community under study. Atnount requested to ensure adequate supply of sftldy instruments ip Imo State is as follorvs: Household coverage survey form @ 5 cents x 750 copies x I page $37.50 Village distribution form @ 5 cents x 30 x I page $1.50 Healthsystem fomrs @ 5 cents x 30 x I page $1.50 CDD register fon @ 5 cents x 30 x l0 pages $15.00 Individual questionnaire@ 5 centsx 1500x6pages $450.00 iDI for opinion leaders/CDDs @ 5 cents x 30 x 4 pages $6.00 IDI forhealtli @ 5 cents x 30x 4 $6.00 FGD guide @ 5 cents x 16 x, $r.OO Sub Total for printing of instruments $519.10 Pr e-testi rtg of Instr u m er tt To test viability of instruments before going into the actual field, it is proposed that this rvill be doue in one commuuity irl tl-re Enugu State, rvhere CDTI has been implernented for at least seven years. This will serve the purpose of the entire shrdy in Nigeria. Six days lvill be required for this activity. Ad hoc per diem for 66 two scientists ($100 each) is requested. This item is estimated to cost $1200. A moderate $50 per day is requested for transportation for both scientists u,hich comes to $300. Sub Total for pre-testing instmnrents US$1500.00 stoff Assistance will be required in collecting the large amouuts of data required in this study using different instruments, which thus require people rvith different skills. The research assistants rvill also require training on the objectives and methods of the study to ensllre appropriate collection of data. Fees for certain number of days are being requested for the research assistants in Imo State. o Intervie\yers Interviewing of cornmunity leaders/CDDs and administration of individual questionnaires This estimated to require l5 interviewers for 16 days, including training days. 15 interviewers @ $30.00 x 16 days $7,200.00 . FGD moderators and Note takers Social scientists with skills in moderating and recording FGD sessions will be needed for conducted the FGD sessions in this study. They rvill also assist with the documentary study, by extracting irnportant information from relevant documents. For this purpose 4 assistants rvill be required @ S30.00/day for 16 days $ 1,920.00 Sub total for staff us$9,120 Transport and Per Dient While in the field there rvill be intense movement to collect data For this reason the teanr rvill need to keep a vehicle on chafier at the curent market price of hiring a car i.e. $126.92 x 35 days of field rvork and mop up data collection s4,442.00 The scientists will also need transporl from their institutions ."vhich are located outside the project site. The amount estimated for cerr hire is in line with the current market price to ntove inter state and this $220.00 for 2 ways x 2 scientists $440.00 An ad hoc per diem rate that rvould not require honorarium rvas agreed upon during the rvorkshop for proposal development. Thus the per diern requested here is $l00.00iday x 2 scientists x 30 days $6,000.00 Total transport and per diem us$10,882.00 Other Supplies Equipment, Rerttuls, Refreshntent for FGDs etc Other requirement in this study include rental of tape recorders for FGD sessions, batteries, stationeries for data collection and refreshrnent during FGD sessions. A block sum is requested for this purpose in hno State $1,200.00 Total other supplies Communtccrtiort Tliis will involve the use of telephone, courier, e-mail us$1,200.00 61 The estirnate for this itenr is us$300 Data Entry While the final data anall,sis rvill be jointly undertaken in Ouagadougogu wrth APOC support some prelirninary analysis will bc undertaken prior to the u,orkshop. For this reason and the requirement of forwarding data files in advance to APOC there rvill be cleaning and er-rtering of both the qualitative data in their respective softu,are. Four data entry assistants rvill spend l1 days for clata clcarring @ $30.00 per day $ 1,320.00 Sub-total lbr initial clata handling $1,320.00. Other Operatiottctl Costs The sum of $500.00 is requested for operational cost. This rvill also help to cushion the unexpected change in market prices. With the deregulation of the petroleurn market in Nigeria, prices are always fluctuating and this is often upwards and affect market prices adversely. The amount requested here will help to preventthedisruptionoftheoperationsofthestudyduetosuchchangesinmarketprices $500.00 Sub total other operational costs US$500.00 GITAND TOTAL BUDGET FOR IN{O STATE us$25341.10 68 TARABA STATE A) BUDGET Estimated General Budqet for Taraba Cost Cumulative Printing Costs all lnstruments $519.10 $51 9.1 0 Staff days* intervrs 16 $30 $7,200 Daily 15 $7,719.10 FGD/Othr days* intervrs 16 $30 $1,920 Daily 4 $9,639.10 FieldTrans days Rate 35 153.85 $5,385 $1s,023.72 PerDiem days scientists Rate Ad hoc 30 2 $1 00 00 0 $21,023.72 Other Supplies, Equip, Rentals (e.q. tape recorders) $1,200 $22,223 Communication phone , internet, etc $22,523.72 Data entry days Staff Rate 11 4 $30 $1 320 $23,843.72 Other Transportatlon (air, road to sites) From Nsk $615 From Yola $220 $B3s $24,679.10 Miscellaneous Operational Costs $500.00 $25,179.10 *including training note includes overall proiect duties Data management additional communication 10 days $1 00 $200 $1 000 $2oo $1 200 Grand TOT $26,379.10 B) BUDGET JUSTIFICATION Printing of f nstrument Sufficient quantities of the study instruments is required for data collection in this study, especially in the case of extraction of infonnation from the CDD records to assess the treatrnent lristory of the entire cornmunity under study. Amount requested to ensure adequate supply of study instruments in Taraba State is as follows: Household coverage survey form @ 5 cents x 750 copies x 1 page Village distribution form@ 5 cents x 30 x I page Health system forms @ 5 cents x 30 x I page CDD register form @ 5 cents x 30 x 10 pages lndividual questionnaire @5 cents x 1500 x 6 pages IDI for opinion leaders/CDDs @ 5 cents x 30 x 4 pages IDI for health @ 5 cents x 30 x 4 FGD gtride @ 5 cents x 16 x2 Sub Total for printing of instruments $37.50 $ 1.s0 $ 1.50 $ 15.00 $4s0.00 $6.00 $6.00 $ 1.60 $519.10 $300 69 Stolf Assistance will be required in collecting the large amounts of data required in this str"rdy nsing different instruments, which thus require people with different skills. The research assistants will also require training on the objectives and nretliods of the study to ensure appropriate collection of data. Fees for certain numberof days are being requested for the research assistants in Taraba State. o [ntervie\yers Interviewing of community leaders/CDDs and adrninistration of individual questionnaires This estimated to require l5 interyieu,ers for l6 days, including training days. 15 inten,iervers @ $30.00 x 16 days $7,200.00 o FGD moderators and Note takers Social scientists u,ith skills in moderating and recording FGD sessions rvill be needed for conducted the FGD sessions in this study. They rvill also assist rvith tlie docurnentary study, by extracting importarrt information frorn relevant documents. For this purpose 4 assistants rvill be required @ $30.00/day for 16 days $ 1,920.00 Sub total for staff us$9,120 Trattsport snd Per Dienr Wliile in the field there u,ill be intense movement to collect data For this reason the team rvill need to keep a vehicle on charter at tlie current market price of hiring a car i.e. $153.85 x 35 days of field rvork and mop up data collection The scientists rvill also need transport fronr their institutions rvhicir arc located outside the project sitc. The amoullt estimated for car hire is in linc rvith the current market price to lrove inter state and tlris $615.00 for 2 rvays flight ticket for 1 scientist and Z u,ay road transporl for the second scientist @ $220.00 $835.00 An ad hoc per diern rate that would not require honorariurn rvas agreed upon during tlie rvorkshop for proposal developrner-rt. Thus the per diem requested here is $100.00/day x 2 scientists x 30 days Additional 10 days per diem is requested in line with the agreement during the rvorkshop for extra duties of the Social scientist for finalization of research instrument and setting up of data entry ter-nplates Total transport and per diem $6,000.00 us$13,220.00 Otlter Supplies Equipment, Rentols, Reft eshment for FGDs etc Other requirenlent in this study include rental of tape recorders for FGD sessious, batteries, stationeries for data collection and refreshment during FGD sessions. A block sLun rs requested for this purpose in Taraba State $ 1,200.00 Total other supplies US$1,200.00 Commurrtccttton This will involve the use of telephone, courier, e-mail. $300.00 Additional sum is requested in line',vith the assignrnent of $5,3 85.00 $ 1000.00 10 revising and setting up data template $200.00 Sub total communication us$s00.00 Data Entry While the final data analysis will be jointly undertaken in Ouagadougogu rvith APOC support some prelirninary analysis will be undertaken prior to the rvorkshop. For this reason and the requirement of forwarding data files in advance to APOC there will be cleaning and entering of both the qualitative data in their respective softrvare. Four data entry assistants will spend 1l days for data cleaning @ S30.00 per day $ 1,320.00 Sub-total for initial data handling $1,320.00. Ot her Op erat io nal C ost s The sum of $500.00 is requested for operational cost. This will also help to cushion the unexpected change in market prices. With the deregulation of the petroleum market in Nigeria, prices are always fluctuating and this is often upwards and affect market prices adversely. The amount requested here will help to prevent the disruption of the operations of the study due to such changes in market prices $500.00 Sub total other operational costs US$500.00 GRAND TOTAL BUDGET FOR TARABA STATE us$26,341.10 OSUN STATE, NIGERIA A) BUDGET Estirnated General Budget for Osun Cost 11 Cumulative Printing Costs all lnstruments $519.10 $519.10 Staff days* lntervrs to daily 15 $30 $7,200 $7 71 9.10 FGD/Othr days. lntervrs 16 4 $30 daily $1,920 $9,639.10 FieldTrans days Rate 35 126.92 $4,442 $14,081.41 PerDiem days Scientists rate ad hoc 30 Z $1 00 $6,000 $20,081.41 Other Supplies, Equip, Rentals and Printing (e.q. tape recorders $1,200 $21,281.41 Communication phone, internet, etc $3oo $21 ,581.41 Data entry days Staff 11 rate 4 $30 $1,320 $22,901.41 Other Transportation (air, road to sites) From Nsk 2 $5oo $1 000 $23 901.41 Miscellaneous Operational Costs $s00.00 $24,401.41 *including trainrng B) BUDGET JUSTIFICATION Printing of I tr st rtt m e nt Sufficient quantities of the study instrutnents is required for data collection in this sfgdy, especially in the case of extraction of itrforntatiort fi'ottr the CDD records to assess the treatrtrent history of the entire courmunity ttttder sttrdy. Aurount requested to ensure adequate sr,rpply of stucly instrulrelts in Osun State is as follorvs: Honsehold coverage survey form @ 5 cents x750 copies x I page Village distribution form @ 5 cents x 30 x I page Health system fonns @ 5 cents x 30 x I page CDD register fon-r-r @ 5 cents x 30 x l0 pages Individual questionnaire@5 cents x 1500 x 6 pages IDI for opinior-r leaders/CDDs @ 5 cents x 30 x 4 pages IDI for health @ 5 cer-rts x 30 x 4 FGD guide @ 5 cents x 16 x2 Sub 'fotal for printing of instruments $37.s0 $ l.s0 $ 1.s0 $ 15.00 $4s0.00 $6.00 $6.00 $ 1.60 $s19.10 Staff' Assistance r,r,'ill be required rn collecting the large amounts of data required in thrs study usilg different instrumeuts, lvhich thus require people u,ith different skills. The research assistalts rvill also require training on the objectives ar-rd methods of the study to ensure appropriate collectior-r of data. Fees for certaip number of days are being requested for the research assistants in Osun State. ) t2 o Intervielyers Interviewing of community leaders/CDDs and administration of individual questionnaires This estimated to require l5 interviervers for l6 days, including training days. 15 interviewers @ $30.00 x l6 days $7,200.00 . FGD moderators and Note takers Social scientists with skills in moderating and recording FGD sessions rvtll be needed for conducted the FGD sessions in this study. They will also assist rvith tlie documentary study, by extracting important information from relevant documents. For this purpose 4 assistants will be required @ $30.00/day for 16 days $ 1,920.00 Sub total for staff us$9,120 Transport and Per Dient While in the field there will be intense movement to collect data For this reason the team will need to keep a vehicle on charter at the current market price of hiring a car i.e. $126.92 x 35 days of field work and mop up data collection $4,442.00 Tlie scientists rvill also need transporl from their institutions which are located outside the project site. The amount estirnated for flight and car hire is in line rvith the current market price to rrove inter state and this $500.00 for 2 \\rays x 2 scientists $1000.00 An ad hoc per dier-n rate that would not'require honorariurn rvas agreed uporr during the workshop for proposal development. Tlius the per diem requested here is $100.00/day x 2 scientists x 30 days $6,000.00 Total transport and per diem us$11,442.00 Other Supplies Equipment, Rentals, Refresltmentfor FGDs etc Other requirement in this sfudy include rental of tape recorders for FGD sessions, batteries, stationeries for data collectior.r and refreshment during FGD sessions. A block sum is requested for this purpose in OSLIN State $1,200.00 Total other supplies us$1,200.00 Communicutiort This will involve the use of telephone, courier, e-rnail The estimate for this item is us$300 Datu Entry While the final data analysis will be jointly undertaken in Or.ragadougogu witli APOC support sorne preliminary analysis rvill be underlaken prior to the workshop. For this reason and the requirement of forwarding data files in advance to APOC there rvill be cleaning and entering of both the qualitatrve data in 13 their respecttve softrvare. Four data entry assistants ri,ill spenci i I days for data cleaning @ $30.00 per day $ 1,320.00 Sub-total for initial data handling $1,320.00. Othe r Op erot io rtol C o st s The sum of $500.00 is requested for operational cost. This rvill also help to cushion the unexpected change in nrarket prices. With the deregulation of the petroleum market in Nigeria, prices are ahvays fluctuatiiig and this is often uprvards and affect market prices adversely. The amount requested here ri,ill help to prel'ent the disruption of the operations of the study due to such changes in market prices $500.00 Sub total other operational costs US$S00.00 GRAND TOTAL BUDGET FOR OSUN STATE us$24,401.10 74 ZAMFARA STATE, NIGERIA Zomfara CDTI Project Zamfara is one of 36 Federal States of Nigeria located in the northrvestem health zone of the country. The State was carved out of the old Sokoto State in 1996 and has 14 LGAs. It is inhabited by more than 2.2 million people, 80% of rvhich live in the rural areas in huts and thatched houses. Its vast agricultural land is traversed by nurnber of rivers and riverbeds. Five of the 14 LGAs of the state are meso-endemic for Onchcerciasis. ln these five LGAs, CDTI has been irnplemented rvith support of APOC and SSI since 1998 and more than 150,000 people have been treated witlr ivermectin durin g 2004. The Zamfara CDTI project is supported by one of the major NGDOs (SSI) in Nigeria. The study provides an opportunity to collect information on the liealth seeking behaviour of a people in a typically Muslim area in Nigeria. Islarn is recognized as a religion which impacts on the total way of life of its adherents. The Sharia prescribes different modes of response to life challenges for its followers. Zamfara State is the first State to adopt Islam as a State religion and proclaimed the Sharia as its guiding principles. This could imply a distinct nature of gender relations, with acknowledged implication for gender balance in health servic inforrnation and alvareness. The inclusion of Zamfara State will provide an appreciation of issues of compliance to, and perceived benefit of ivermectin treatment in Nigeria. A) BUDGET Estimated General Budqet for Zamfara State Cost Cumulative Printing Costs all lnstruments $519.10 $519.10 Staff Days" intervrs daily 16 15 $30 $7,200 $7,719.10 FGD/Othr Days" lntervrs daily 16 4 $30 $1,e20 $9,639.10 FieldTrans Days Rate 35 153.85 $5,385 $15.024.41 PerDiem Days Scientists Rate 30 2 $1 00 $6,000 $21,024.41Ad hoc Other Supplies, Equip, Rentals and Printing (e.s tape recorders) $1,200 $22,224.41 Communication phone internet, etc $300 $22,524.41 Data entry Days Staff 11 Rate 4 $30 $1,320 $23,844.41 Other Transportation (air, road to sites) From Nsk $615 From Kad $220 $83s $24 a679.41 Miscellaneous Operational Costs $500.00 $25,179.41 .including training 75 B) BUDGET JUSTIFICATION P ri n tin g of I n st ru m et t t Sufficient quantities of the study instruments is required for data collection in this study, especrally in the case of extraction of information from the CDD records to assess the treatment history of the entire community under study. Antount requested to ensure adequate supply of shrdy instmments in Zarnfara State is as follorvs: Household co\/erage surtr,c)/ lbrrn (! 5 cents x 750 coples x I page Village distribution fonn @) 5 cents x 30 x I page Health system forms @ 5 cents x 30 x I page CDD register fon.n @ 5 cents x 30 x 10 pages Individual questionnaire Q! 5 cents x 1500 x 6 pages IDI for opinion leaders/CDDs @ 5 cents x 30 x .l pages IDI for healtli @ 5 cents x 30 x 4 FGD guide @ 5 cents x 16x2 Sub Total for ;rrinting of instruments $37.s0 $ 1.50 $ l.s0 $ 15.00 $450.00 $6.00 $6.00 $ 1.60 $s19.10 Stoff Assistance rvill be required in collecting the large aurour.rts of data required itr this studl, using different instrumeuts, rvhich thus require people *,itli diflerent skills. The rcsearch assistants rvill alio require training on the objectives ancl tlethods of the study to eusure appropriatc collection of data. Iiees for-cefiain numberof days are bcing requestecl for the research asststauts tn Zamfara State. o Intervie\\'ers Intervieu'ing of commLrnity learlers/cDDs and administration of individual questionnaire s This estintated to require l5 intervier,r,ers for 16 days, including training days. 15 inten,ielvers @ S30.00 x 16 days $7,200.00 o FGD moderators and Note tal<ers Social scientists rvith skills in moderating and recording FGD sessions will be needed for conductecl the FGD sessions in this study. They rvill also assist rvith the documentary stutly, by extracting important information frour relevant documents. For this purpose 4 assistants rvill be requiled @ $30.00iday for 16 days $ 1,920.00 Sub total for staff us$9,120 Transport and Per Dienr While in the field thcre u,rll bc intense rnovement to collect data For this reasoll the team u,ill need to keep a vehicle on chafter at the current market price of hiring a car i.e. $153.85 x 35 days of field rvork and mop up data collection $5,3g5.00 The scientists u'ill also need transport from their institutior-rs rvhich are located outside the project site. The amount estrmated for car hire is in lile with the cllrrent ntarket plice to move inter state and this $615.00 for 2',vays flight ticket for 1 scientist and 2 u,ayroad transport for the second scientist @ $220.00 $935.00 An ad hoc per diem rate that rvould not require honorarium was agreed upon during the workshop for proposal development. Thus the per diem requested here is $100.00/day x 2 scientists x 30 days Total transport and per diem 76 $6,000.00 us$12,220.00 Other Supplies Other requirement in tliis study include rental of tape recorders for FGD sessions, batteries, stationeries for data collection and refreshment during FGD sessions. A block surn is requested for this purpose in Taraba State $1,200.00 Total other supplies us$1,200.00 Comnruniccrtiort This will involve the use of telephone, courier, e-mail $300.00 Sub total communication us$300.00 Data Entr1, While the final data analysis will be jointly undertaken in Ouagador,rgogu rvith APOC supporl some prelirninary analysis wrll be undertaken prior to the rvorkshop. For this reason and the requiren-rent of forwarding data files in advance to APOC there will be cleaning and entering of both the qualitative data in their respective softrvare. Four data entry assistants r.vill spend l l days for data cleaning @ $30.00 per day $ I ,320.00 Sub-total for initial clata handling $1,320.00. Otlter Operation al Costs The sum of $500.00 is requested for operational cost. This rvill also help to cushion tlie unexpected change in market prices. With the deregulation of the petroleurn market in Nigeria, prices are alr,vays fluchrating and this is often uprvards and affect market prices adversely. The amount requested here will help to prevent the disruption of the operations of the study due to such changes in market prices $500.00 Sub total other operational costs US$500.00 GRAND TOTAL BUDGET FOR ZAMFARA STATE us$25,179.10 11 BUDGET ESTIN{ATE FOR RUVUMA SITE Duration Unit Cost Rate Budget Cumulative I 5-3 I March Pages estimated 25 $ I per page $50 s50 Activity l. Translation of instruments (English-Srvahili- English) 2. Training of Research Assistants 2 da5,s 1-2 April 4.Data collection 27 days Iune-July 3. Pre-test of instruments (travel to and from endemic and other logistics) 5.Initial data handling 6 Communication 7 Miscellaneous GRAND TOTAL Lunch and transporl allorvances for 4 interviewers 2 FGD moderators 3 data entrants Per diem for 2 Scientists Transport Stationary, supplies and other expenses Ad hoc per diem for 2 scienti sts Per diem for 6 Research assistants One vehicle (hire) $ 100 Stationery and supplies Refreshrnents for 16-20 $1500 FGDs $10 per day Sl80 for 9 participants for 2 days $230 Ad hoc $100 $1900 $2130 $l00per day $ 100 $ 14,710 $ 16,940 $ 100 $30 6 days in May 10 days August $s $ 1002 scientists 7 days 2 data entrants $2000 $ 17,840 $20 $20 $600 $r950 $ 19,440 $21,3 90 $21,390 18 BTIDGET JUSTIFICATION FOR RUVUMA SITE l. Translation of Instruments: Different types of research tools rvill be used in this study, including FGDs, household questionnaires, treatment coverage forms, in-depth interviervs, obsen'ation check- lists and village summary sheet. These have been developed in English and will be translated into local language and re-translated in English for cross checking. It is estimated that a total of 25 pages for instruments will be translated. One page translation costs $ l. Sub-total for translation $50 2. Training of Research Assistants: The study will employ total of 9 research assistants, including 4 interviervers, 2 FGD moderators and 3 enumerators and data entrants. Before going to the field a trvo day training workshop will be organized to orient them with the study and research tools. A modest allowance of $10 each per day to cover for their transport and lunch is requested. The training will be conducted in the office therefore no costs for hall rentals will be required. Sub-total for training $180 3. Pre-test of Instruments: To test viability of instruments before going into the actual field, it is proposed that this will be done in one village in the Mahenge focus rvhich is not in the sfudy area I has treated communities for seven years. Six days including three for travel and other logistics will be required for this activity. Ad hoc per diem for two scientists ($100 each) is requested. This itern is estimated to cost $1200. Transport costs for hired vehicle per day is $100. For the six field days transport is estimated at $600. Stationary, secretarial services, supplies and other expenses including refreshments during FGDs, token money for field guides is estimated to cost $100. Sub-total for pre-testing $1900 4. Data Collection in the field: The actual data collection rvill involve household intervieu,s of approximate 1404 members, 20 FGDs, Key inforn-rant interviervs, exantining and recording CDD and health facility records. This will take place in nine communities to be selected upon arrival in the project area. It is estin-rated that 27 days rvill be used in the field. Two scientists rvho r.vill be in the field will be paid an ad hoc per diem of $100.This rvill cost $5400. Six research assistants will be paid per dien-r of $30 and total for this item is $ 4860. Transporl from Dar-Songea-Dar and during field rvork rvill rely on hired vehicle, costing $100 per day. This item will cost $2700. For logistic purposes, district oncho coordinators in the selected districts will be paid lunch allorvance of $10 per day depending on the number of days they will be involved. Horvever, it is estimated that tot - number of days the study will use them is 15. This will cost $150. In addition, the study rvill provi*- refreshments for FGD participants. It is estimated that 16-20 sessions will be held, each estimated to have 7-10 members. Each session is estimated to cost $5, therefore $100 rvill be required for this. Other stationery, secretarial serice, tape recorders, cassettes, photo copies, diskettes, camera films are estirnated to cost $1500. Sub-total cost for data collection $14710. 5. Initial Data Handling: Data analysis and report writing will be the responsibility of APOC management. Horvever, the cleaning, entry and translation of qualitative data from Srvahili to English will be handled in Tanzania. Two scientists will spend seven days for data cleaning and transcription of FGD notes at ad hoc per diem of $100 each per day. This will cost $1400. In addition, two data entrants rvill be engaged for 15 days each for data entry at $20 eachperday. This will cost $600. Sub-total for initial data handling $2000. 6. Communication: This will involve the use of telephone, corlrier', e-mail and other tele-conference facilities, all paid for. The estimate for this item is $600. l9 Sub-total for communication $600 7. l\{iscellaneous and other operating costs: This has been estimated at a l\Yo for the above total coming to $1904 GRAND TOT,.\L $21,390 a 80 BUDGET FOR CON{PLIANCE STUDY IN PHASE TWO DISTRICTS (KABALE, BUSHENYI, KABAROLE, KAM\YENGE, K}TNJOJO, N{BALE, SIRONKO DISTRICTS), UGANDA Budget for pre testing tlie instrurnents in Hoima district Personnel Team leader and social scientist in the field for 5 days at 100 US$ each Driver in the field at 20 US$ per day for 5 days District Oncho coordinator at l0$ per day for 3 days Sub total Fuel to Hoima and back to Kampala including field running Vehicle maintenance Sub total Supplies (Stationery e t c) Sub total TOTAL FOR PRE TESTING INSTRUNIENTS BUDGET FOR IMPLEMENTATION OF THE STUDY Personnel 1) Team leader and the assistant (Social scientist) in the field for 45 days (6 days per district) at 100 US$ per day each 2) l0 research assistants for each district, to administer the questionnaires in two comrnunities in each district and rvorking for 3 days at 25US$ each(10X3X25X7) 3) 10 guides for each district to work rvith research assistants at 3 US$ each for 3 days eacli (10 X 3 X 3 X7) 4) Driver in the field for 42 days at 20 US$ per day 5 ) Trvo data entry clerks at 300 US $ each per month for one month 6) 7 District Oncho coordinators rvorking for 3 days each at 1OUS$ 7) Tearn leader and Social scientist for data cleaning and transcription of FGDs for 10 days each at 100 US$ per day USD 1,000 100 30 1,130 500 150 6s0 200 200 1,980 USD 8,400 5,250 630 840 600 210 2,000 a 8l Subtotal for personnel Travel Fuel from Kampala to the study districts and back to Kampala Fuel for field running rvithin the districts Vehicle rnaintenance Sub total for travel Supplies Stationery for pliotocopying instruments Folders Tape recorders Refi'eshments during FGDs Sub total for supplies 17,930 1,000 1,000 300 2,300 300 300 500 500 1,600 TOTAL BUDGET FOII INIPLENIENTATION OF THE STUDY I9.,690 GRAND TOT,.\L 21,830 BUDGET JUSTIFICATION FOR UGANDA SITES PRET STING Pre-testing of the insttumeuts rvrll be needed to check the validrty and consistence of questiols to ansrver the objectives. The team leader and the social scientist will have to go to the field to pre-test the biornedical and social research instruments. Hoima district, r,vhich is among the stucly districts and, rvhicl has been . implementing CDTI for urore thanT years, has been selected. The exercise is expected to cost 1,980 US$ asI follorvs: Personuel (2) scientists at an ad-hoc per diern of 100 US$ per day for 5 days : 1,000 US$ A driver will be needed to take the research tearn to the field at 20 US$ per day for 5 days : l00US$ Fuel will also be needed to travel to Hoima and back and within the clistrict estimated at 500 US$. Implementation of the study 82 Personnel The team leader and the social scientist will need to go to the field to train research assistants, and supervisor interviews and participate in Focus group discussions. Each scientist is expected to spend fir,e days on the study in such of the seven districts included in the study. Two days will be spent on travel i.e. one day frorn Kampala to sludy sites and one day back to Kampala. 4 days will be used for actual data collectron in each district, including one day for training . The total cost for research scientists is estimated at 8,400 US$ for seven districts at an ad-hoc per diem of 100 US$ per day. Research assistants rvill be needed to administer the questionnaire and to revierv records. Trvo communitres will be studied in each district. 5 research assistants per community will make it possible to collect data as quickly as possible. This rvill minimize chances of interviewed community members to discuss the questions with members not yet interviewed. This will help to avoid biased responses. The researcli assistants will be paid 25 US$ per day for 3 days each in each districts making a total of 5,250 US $ Each research assistant will need a local guide from the selected study communities to move around the village visiting the sampled households. E,ach guide will be paid 3 US$ per day for 3 days, costing a total of 630 US$ A driver will be needed to take the scientists to the field for 42 days. The driver u,ill be paid 20 US$ per day making a total of 840 US$ Data entry clerks will be needed to enter all the data in the computer for data analysis. Each is expected to work for one month at 300 US$ per month making a total of 600 US$ 7 Districts onchocerciasis coordinators will work with the research team for 3 days in each district at 10 US$ per day making a total of 2 l0 US$. Team leader and social scientist rvill need about 10 days after data entry has been completed, to clean and process tl-re data for analysis before the joint rvorkshop for analysis and publication Travel Fuel will be needed for travel from Kampala to the districts. The districts are scattered ar-rd will require a lot of travel, estimated at 1,000 US$ for the seven districts. Fuel will be needed for travel rvithin tlie district visiting the selected communities. The communities will be visited at least 3 times for completion of data collection in each district. All oncho endemic communities are far from the district headquarters and this will need a lot of fuel estimated at 1000 US$ for the 7 districts. The vehicle rvill need to be serviced at least trvice during the study at 150 US$ each service rnaking a total of 300 US$ Supplies Stationery will be needed to photocopy instruments, tape records will be needed to record the FGDs Refreshments r,vill also be needed during FGDS. All this estimated at 1,600 US$ a 83 Phase III CDTI Project P-hase- III CDTI project rn Uganda includes lt4barara, Arua, Nebbi, yurnbe districts. Mbarara lies at analtitude between 129 artcl l,524nabove sea level rvhile, Nebbi hes at an altitude betrveen 945 nr and l,3gg.Arua and Yurnbe lie at arl altitude befiveen 610 and 1,388m. Mbarara district is located in Western Ugandawhile Nebbi, Arua and Yurnbe are in Norlli Western Uganda and all are bordering the Democratic Republicof Congo' The rrtain economic activity in all phase m"districts is agriculture rvith enrphasis on food cropssuch as, srveet potatoes, ntaize, cassava, beani, groundnuts and bananas. The cash crops are mainly coffeeand tea' Fishing on River Nile is also cotnmon in Nebbi, Ama and Yunrbe districts. EthnicaLlf, th".. a."hotnogeneous populatiorts in Nebbi, Arua and Yumbe. However, Mbarara district is an area of eth,icdiversity especially in onchocerciasis endenric areas n,here there are Bakiga and Bafunrbira irnrnrgrants fromKabale and Kisoro dtstricts, respectively and Bany,akole and Batagrvenda rvho are indige,ous people in thearea. Ivermectin distribution in Nebbi clistrict started in 1994 rvith assistance from River Blin<Jness, Foundatronby then nor'v called Global 2000 RBP using comrnunity based rnethods of distribution. Ivermectindistribution in Mbarara, Arua and Yunrbe distiicts started in 199lllg92 u,ith assistance fiorn cBM ,singmobile teams until 1995 lvhen conrtnunitl'based rnethods of ivemrectin distribution rverc i,troduced. CBMstopped supporting Mbarara, Anta and Yurnbe districts at the time rvhen CDTI was being introduced in thethree districts rvith financial support frorn Apoc in 199g. a Jq) q) r, Oq) tr d kl 9 ',J z rQ' bJ z P 4 ,D 0) a ri\3 a €o g =t cl E /-s'l DI C) .; z .ol nl LI YI ol -tr1UI ol .Ql .rl aJl c/l .irl CJI vtl il cdP tt) frq) xdtr o\ an ca I co$ ca .f, I\o tr)N I d! ,T : (t z I 4 tt)L G) o) o otcao ca@rO\COI$ t-- ca ra+ -$r-I I-\\oltr)\o(-.l tr) .9N v s=0J :ca .o\ .\D : t-- : (r- .ca ;ot :1 =o A ..1v vl co N t-- caN ; z (n coO oo ca -1- oo <f, ca c.l -i c) \o tr- t-- c..l .3- $ ca c\ ; z ca cq rn o<;\c)r- tr- coN OU q n c\ aa C. r- caN ; z q) dZ (h a -'o\oZ b;'ori e.! 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