Community-Directed Treatment with Ivermectin (CDTI): Federal capital territory Nigeria, October 2001-September 2002

I I i AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APoc) REPORT OI\ YEAR 4 COMMUNITY - DERECTED TREATI\{ENT WITI{ IVtrRN{ECTIN(cDrr) lgrww ; I FEDERAL CAPITAL TERRITORY NIGERIA For ln{rrrmotlon To, 510 ADHECU I B tout 2003 APCC/DIR Bwari (irvagwalada Krvali Municipal Ahaji For Action Tot -tcclT &o46 CE( csA CAP 5rn BE" OCTOBER 2001. SEPTEMBER 2OO2 AFRICAN PROGRAMN,IE FOR ONCHOCERCIASIS CONTROL (APOC.) REPORT ON YEAR 4 COMMUNITY _ DIRECTtrD TREATMtrNT WITH IVER]\{ECTIN (cDrr) FEDERAL CAPITAL TERRTTORY NIGERTA OCTOBER 2OO1- SEPTEMBE R 2OO2 By: ABBAS DALIIATU FCT ONCHO COOR-DINATOR EXECUTIVE SUI\{MARY The Federar capitar tenitory (FCT) *,as creared from the geographical certrc of Nigeria to serve as the ne*, capital of the Nation. The area occupies about 8,000 sq km and di'ided into 6 administrative Area councils onchocerciasis is known to be a serious disease in the capitar territory for quite a long time, requiring mass action to ffeat ail endemic communities with Mectiza,l. The Nationar onchocerciasis control Programme (Nocp) provided trre necessary guiderines for the evaluation of the territory for ende,ricity. The result confirmed that Abuja is hyperendemic requiring mass dosing of the community members with Mectizan. In 1995, support of an NGo, christoffer BrindenMission (cBM) r.vas required for trie corrurencement of mass treatment with mectizan(Ivermectin). A total of 57, 548 people were treated in 17g endemic connnunities. since then treatrnent figure rose yearly as the prograrrune expanded to ail communities that require treatment. presently, all endemic comrnunities (559) in FCT are receiving treatment, indicating I 00% geographical coverage. During the year under review, a totar of 234, g95 persons were treated with Mectizan, bringing us croser to our urtimate Treatment Goar(UTG) of 250,000 persons that are required to be treated in FCT. This effort was as a resurt of the commitment of the partners invorved in the distribution process. € Training was condttcted on a targeted nranner for all categories of staff irvolve in the progranrr-ne. The Locr identified priority needs of the personnel at the First Line Health Facility (FLHF) and the communities wlro were trained. A total of 639 personnel rvere trained during the period under review. Health education and mobilization was also carried out in the communities in a targeted manner. Advocacy visit to all Area council was also carried out to solicit for support to the programme. capital Equipment and funds provided by Apoc has been of tremendous assistance to the project in the implementation of scheduled activities. Although approval was granted for the release of counterpart funds by the government, no rerease r,i,as made due to administrative hitches involving budget approval delays. The various Area councils contributed relatively to the programnl e in 2002. 6i:i a::1t:t {lL SECTION I BACKGRO UND INFORMATION The FcT has a totar of Six (6) Area cou,cirs namery, Municipar, AbajiKuje, Kwari, Bwari and Gwagwarada. A, are confirmed endemic andhave been imprementing the comniunity Directed Treatment withIvermectin (cDTr) since tgg5. There are presen tly 559 communitiesthat are participating in the CDTI prograrrune. Most of these communities are smail with a popuration of between 350 to 600 persons 1'2 Ther are Six (6) Area councils impleme'ting CDTI in the FCT. The areas are as follolvs: 1) 2) 3) 4) s) 6) Municipal Area Council Abaji Kwali Kuje Blvari Gwagwalada Round 8 Round 8 Round 8 Round 8 Round 8 Round 8 All the comrnunities that required treatment in ail the above namedArea Councils are covered geographi cally. 5 NB SECTION 2 THE IMPLEMENTATION OF CDTI (OCTOBER 2OOI _ SEPTEMBER 2OO2 TABLE 1 . Because of the inconsistent and lack of support to cDDs by the various conmunities, the number of comrnunities that collected drugs at their centers ha'e reduced, especially u,hen it involves traveling to neighboring communities. xx Season is the determining factor in the decision for the month of distribution. They all favour the d.y season when farming activities are reduced. &!:-.:.1 EJ /, S/No LGA/DISTRICT No of cornnr./ Villages No of comm./ villages that selected CDDs No of conlnr. That collecte d Drugs No of conrm. That decided on month of distribution No of comm. That decided on method of treatmeut No of comm. with trained CDDs No of comm. Paying CDD in cash or kind I Municipal 133 133 75 133 20 2 Abaji 6s 65 20 65 8 3 Kuje 120 t20 20 120 15 4 Gu,agrvalada 76 76 35 76 18 5 Kw'ali 79 79 40 79 l4 6 Bu'ari 86 86 56 86 t7 Total ss9 s59 277* ++ 559 92 TRAINING OF DIFFERENT LE\/EL OF STAFF INVOLVED INCDTI IMPLEMENTATION 2:l Trainin obiec tives/achieve t. The training objective for the year 2002,was to train g socT, 3 rLocT and 620 cDDs, out of which g socr, 3 r Locr and 600 CDDs were trained in all 2.2 Training used. 2.4 eo the CD The Materiars used include Locr and cDD guides, flip chart, posters and MIS fon,s deveroped and produced from Apoc funds. The heartrr educatio, posters were translated into five rocal Ianguages and the cDDs were asked to make rore-prays on how to use them in trre commu,ities during training exercise. e During the year under review, u,e hal,e seen some improvement on the quarity and attitude of cDDs despite the fact trrat community response to support the cDDs has drastically reduced over the past years. However, the high drop out rate in the number of cDDs that we have been experiencing continues, mainly due to the fact that most of trre cDDs are quite young with the ambition to go for further studies, whire otrrers look for white coilarjobs. r 2.5. Imnrovins the a ualitv of trainins. The responsibility of training cDDs lies squarely with the Locr members, while the SocT rvill continue to provide necessary assistance to ensure that the quality of tlie training improves or is maintained. Cr.:i c-:-r ( TRAINING OF DIFFERENT LE\,,EL OF STAFF INVOL\/ED IN CDTI IMPLEN{ENTATION TABLE: 2 S/No 1 714 727 86 92 5 6 NB Formal training of pHC staff did not take prace during the period under review; this is because trrose previousry trained were stiil on ground. "l NO District of No of Training Undertaken No Of TOT Trained NO of LGA staff Trained l O OF LGA Health Centres staff Trained on CDTI N No of CDDs Trained Municipal 2 5 5 2 Abaji 2 5 89 3 Kuje 2 6 6 4 Gu,agrvalada ., 5 5 Kwali 2 5 5 Bwari 2 5 5 98 TOTAL 2 31 31 NIL 600 OBI TION AN DU ON OF GE CO NIT 2.2.1 The use of media. Media houses patronized the GDTI programme during the period under review, whenever we have ceremonial activities. provided coverage and aired it. They 2.2.2 Result of mob ilization effort. All the communities under treatment were mobilized and sensitized in a targeted manner to deal with their peculiar needs before distribution. All the communities and opinion leaders were sensitized on the need to own the prograrrrme. Similarly, policy makers rvere also sensitized through advocacy visits carried out in all the Area councils for the Chainnen, secretaries and other political and opinion leaders that have a stake in GDTI implementation. This activity yielded some results as some Area councils were able to release counterpart funds to the prograrru-rle. 2.2.3 Res se of the co unities The benefit of taking mectizan has created high demand for the drug by the communities. However when it comes to support for the cDDs, it is very discouraging. They believe that cDDs are their children and that they are rendering support to their people.. t):-:\-; t.:.: 3t--7 O "we are poor, and so governnrert srrourd take care of the cDDs,, they said 2.2.4 Su gges tions tot rove mo bilization. The people will be better mobilized if trre media houses are used to reac' out to the community members in their locar ranguages. It has a wider coverage and the peopre have a curture of Iistening to local programme in the radio, especialry in the mornings and in tlie evenings Mobilization shourd be an o,going activity, but to be carried out in a targeted manner by the Locr and the community members thenmel'es. posters and carendars should be produced en_mass to create public awareness Tor'rr criers shourd be utirized u,henever, mectizandistribution is about to commence in ail the iriilages, and this shourd then be followed by the house-to-house or centrar point distribution. :1 TABLE 3: STN LGN DISTRICT NO.OF COMM. MOBILIZED NO. OF TARGET COMM. THAT RECEIVED HEALTH EDUCATION ABOUT THB IMPORTANCE OF EXTENDED TX NO. OF ADVOCACY VISITS TO STATE OR REGIONAL DIRECTORS OF IIEALTH NO.OF MCH STAFF INVOLVED IN MOBILIZATION O OF NGDO STAFF INVOLVED IN MOBILIZA- TION N I Municipal 133 133 2 t0 2 Abaji 65 65 1 10 3 Kuje 120 120 10 4 Gwagu,alada 76 76 10 2 5 Kwali 79 79 10 2 6 Bwari 86 86 l0 2 TOTAL 559 ss9 7 10 MOBILIZATION AND ED UCATION OFTARGET COMMUNITIES SECTION 3: ACHIE\/EMENTS 3.1 Treatment coverage rate. A total of 234,895 persons from 559 communities were treated during the year under review representin g g7%. 2 2 2 2 6:a\i^::, 3.2 Total census DoI) ulation. ID I A total of 270,216 persorls were resistered i, trre period under review in all the communities of FCT 3.3 Elieibte rropulati n. A total of 241,334 were eligible for treatment 3.4 Absentees/refusals. over 12,000 peopre were not treated duri,g the period under review mainly due to absenteeism and not refusal. 3.5 R ns ora en and fus Some comrnunity members have the cLrlt,re of traveli,g out to some otlrer areas to farm or carry out otrrer meniar jobs, making it impossible to actually have them treated, since drugs are sometimes monitored to ensure that trrey do ,ot expire on grouuds of keeping it for those that are absent. 3.6 Plans to reduce abse tees d refusals work out a better way of reservi,g drugs for peopre that are a a absent during distribution Increase hearth education to trrem to see the need to receive treatment annually ll SN LGAI District No. Of Target Comm. Village No of eligiblc peoplc treated No. of Comm That CDDs Arc Health Worker No of Distributions Supervised By I{ealth Worker No of Comm rvith Summary Forms I Municipal 133 66,947 I 133 2 Abaji 65 31,230 I 65 3 Kuje t20 44,467 I 120 4 Gwagwalada 76 31,632 I 76 5 Kwali 79 29,792 1 79 6 Bwari 86 30,827 I 86 TOTAL ss9 234,995 NiI I 559 TABLE 4 TREATJ\{ENT RESULTS IN FCT BY AREA COTTNCILS (OCTOBER 2OOI- SEPTBn{BER 2003) SECTION 4: 4.1 NGT AND S U BSTIO S STRENGTHS: (i) The people have had a good experience rvith the drug since the control programme started in FCT. This has encouraged the people to ask for the drug wlienever it is distribution period. (ii) The 6 area councils in the FCT are committed to the programme. credit goes to the LocT that are dedicated to their duties. r-' -^'. L., 1l .q (ii i) (iv) Massive health education canrpaign mobilization that was carried out in the Ias made positive impact on the prograrnme. Ma,power deverop,rent is adequate, and trrere is commitme,t to some cxtent. and community t four years have cDDs are dedicated to their duties despite the rerative supportgiven to them by the community members. (vi) Tremendous rogistics and financiar support from Apoc andNGDO (CBM) is highly commendable. 1.2 \4/EAKNESSES (i) The con,nunities hardry support the cDDs during and after distribution. (ii) Some cDDs are reructant to distribute Mectizanbecause ofIack of incentivcs. (iii) Some Area councirs do not support the LocT with transport and fuering during training and distribution exercises. (iu) Some communities do not send trreir cDDs to corect drugsyearly. (u) Giving of incentives to other community vorunteers during NPI prograrnmes have contradicted the principres of GDTI. (") tt- 1.3 SU ESTIO S (i) Stake horders' meeting shourd be organized at the LGA revels to discuss the sustainability question.(ii) More cDDs shourd be serected and trained to reprace those that dro out of the progranmle. (iii) Advocacy visits shourd be undertaken in 2oo3 to create awareness on GDTI support to a, the newry reconstituted LGA executives 6:1B1 qr ,1 a [.J IElo -l z o o o c) o t UJ 'oI rrllo 3Eoc05X. pD 5 o- oo pD o (n t\) C, 2 'U I o UAnpr 3ol - CD o c0 (/a \, DJ 0a oFl ia 'F.l :Lt .:11 o o oI a, oH ,n oPl oo -? t4 o *J fn oo (D!A)(J =o'Lts.(DN o- po ooDJ5 oH ro- o pJ rJ o pD o. oo p0 (D Ho' r-t qo(J-o: -J5 !r HqTEE x S p,H E .*\)PH iXrHiH'i += H'!5< =' 5'(D9 o(no H) *l o oo (D o t(D o- *l FOt 'dr-l 0o (/) o o U -l t- X '-l E'cr, 'ri E' -i; o X !: -rJgEATIJB '(/)A;dK55 #HHFP(DY.< a;.^ 5i-,i' Hl*; .?3 .?88SH E3 *x@-.50 ao -lo PJ p0 o (D U) aI (D cD pJ H tJ o UJ ,O .EU 'er' IFTJ 4a-(JH a)- Fl Flr -<cDfto (./) IJ -rJ r dl.d.+t o EU A >?oFdHTDO.i?O-'r< o w7 o UJ A zooE o EU7 Ir lelJ a N) \.1 li llr=Xsr5 a5 o_e =0J ..r .7 o';l -lI I o? L,tJD) KA o. tJ O.\FJO+ e; I a-JN3 ..r ] o'lo'l I t\) (< -O)(, t- p0 Ft (A ,> PD pD ld t<o+) 'O =o ol Frr4) *avooXXo o-? oEi.F'g U3.o 6 5Fl gf=CDI -i3 [.*.o5 gs,*,J P s a-:.J, o Ai 3:,> BE6 aF5 a \)i_i a? oH) P o p- F.) c)o U) itDo HEJdHojE.5 H oa=E' CH. Eg Yb !0(/)Hoo.:g. It cD .,O3 '].o- 5g c oE 6-o r*O O' FbFt tJoO UJ 5O OOo tJ (,lPO O (, POOO t'.JPOoO Iil, ',1 |-! ---tl-IO oOO o\p OOa \o(, -O Oo 5IOOO N)Pooo -l z di+E;, L.* ,,) b..) UJ oH li .l O \o oo ! o\ 9qP,J rry6PJ<:lcD-o(Di(,=' vQb* DJCD rJ o C) o H o.do F *l \c)(, oCDfc)oSaoX oo-5trCDoC!36.EtsH.HLE g3 ts.< E'S.g, 5g oa HL)() rJ') g g.t ="A € E i 3 *F q B [$$,E HP R.]PI *J o o x o A)H 0ao (D a- \J =''d q) a-{ a:C) =rro ;EQto -HE6 BH*8e Pd e ? o) CD DJ CD o H) *J Fo(D rd pJ o c) CD(, cD c) c0a opD Ho.r5 o otso o (D a q"J FD FO =aJUOE'cD 0ao o- *l '-1t0 a oo -l F0 a- sooi<bo UH 8Ets)bCDO aO l-H < l.r .DFo<8. o. {t I 0q -N)5uiPS <iig aSNO'oi EuJDo pOIla "EEF $? po o' o a -li:-! o)PI =' (roi.o ,Eg O F-l5o'Osc, po>='AP *8EaA F_J roo *l 111 u)xolo =-lq\@ cD a o(l -l a o *J o tiJ7 Zootu Q< ad xd{t .--JJ I u)(D a o -l o>E6' aD^ .iX ; ot td oo < t')po, 1s N) (/)OO UJ 3P<E iH UJ NJ I tJ OJ 7 FDFl o t\)OOt/J Fl No UJ FrJ -o!o-3 tJtO3a t\)OO UJ a)oH ;iE.D ,1 )@[Q* e Pq _=$ {(D tD v) C)ODJHooiJtr1 = = O-craPSoq=-x';o oY X'o o " Y o-< -^coH b'; asuSl 5?A oCD+5-O i-.Hc) €6-c)sga P. o. o o H o. o 13'o rpoHZ'5 9.*cnoOgE'-, 5Ho.=FA5'g o. a h (D q 3.36-o o ?D ;i' -to-x +5 ino p0 =o o\i il"3\1C) oHS.OsNso50'5sE (.h Jr'OOO @p OOo (rt PoOO tJPOOO o\POoO 5IOOO NPOoO \o(,h -O OO o tU? o td?|+ e N) I IUJ N) a PJ 7a(D o o-o|-.t tn c) CD z C) hJ F CD CD{ E CD CD 0a(n hR 20/\:-(D OcoX D, IA. J3.oo5 l c/) '1 o (t (n FJ a- ioaI o. o(r) o (n V) p0 o. hd oo IJ po o A) CD o. zooE <aiJ.< 5(D r<H a5g(D C,q (D o. *l -lo p0 FD N(D Ft, o (D H\ o o. pr (D CD o- oa po a- Fo A' laoooo *li o I o- pr I B>OFUo-\ P^5 (.,1 f c/)ooooFlt U) co CD o o- cD -1 U) t-U oal AEHO \ _,1 t\) o. FO U)(r AAt)39 K,9oOJl.--(>o)- JI :vo 'H A A pD N)OO UJ 5IJ:z :CDi:Pc,5 rfi 3lloo ^o- ') it G; z(D ^-- <bH CD CO (rq F CD 'oo J t o E o) H(D(n E oH)l tlE- -o; "jP (D aI Op OOO hJIOoO (n P C)OO (/t oOO tJ(,rl -o oO t-) UT lo 6\ UJ i