Gombe State CDTI project: third year technical report, from 1st March 2002-28th February 2003

RI i NATI NI /\ GOMBE STATE C D.T.I PROJECT THIRD YEAR TECHNICA]- REPORT (FRoM lt'MARCH z0oz - 28tt FEBRUARv 2003). HARUNA ALI DADINI{OWA. PROJECT COORDINATOR. ..? I II id k<i +'.- '.-", 'Ll I 4 IIARS ?CI03 A.F(-t(-/Dif aTABLE OF CONTENTS. Content. l.Acronymns ..... 2.Executive surrrmary..... 3.Background information.... 4.Section 2 rmplementation of CDTI year III..... 5.Training of different levels of staff 6.Materials used in trainings .......... 7 .Mobllization and Education of endemic communities 8.Mectizan treatment results by L.G.A 9.Strengths........ 10.Weaknesses... 1 I .Sustainability Issues...... LTST OF TABLES. Table I.Annual treatment results from 1997 -2002. ii. Implementation of CDTI yearIII. iii. Different levels of staff trained on CDTI impln. iv.Achievements in training. v. Summary of mobilization of target communities vi. Mectizan treatment results by L.G.A. Page. 1. 2. 4. 5. 6. 7. 8. 9. 10. 10. 11. Page. 4. 5. 6. 7. 8. 9. ACRO ABBRE TIONS. APOC - African Programme for Onchocerciasis Control A.T.O - Annual Treatment Objectives C.B.O - Community Based Organrzatton CDD - Community Directed Distributor CDTI - Community-Directed Treatment with ivermectin. HE - Health Education. HFS - Heath Facility Staff. LGA - Local Government Area LOCT - Local Onchocerciasis Control Team NGDO - Non-Governmental Development Organinasation NOCP - National Onchocerciasis Control Programme. NOTF -,National Onchocerciasis Task Force RAM - Rapid Assessment Method. REMO - Rapid Epidemiological Mapping of Onchocerciasis SOCT - State Onchocerciasis Control Team. LTNICEF -.United Nations Children's Fund UTO - Ultimate Treatment Objective. WHO - World Health Organisation ZOTF - Zonal Onchocerciasis Task Force EXECUTIVE SUMMARY Gombe State, which was carved out from the former Bauchi State on 1" October 1996, is located in the north east sub-region of the country. It comprises of 11 LGAs with a total population of about 2.2 mllhon living on about 11,048 square kilometers of landmass. Reports of various surveys ranging from skin snipping to REMO, RAM and refined RIIMO carried out over the years revealed that 10 out of the 1 1 LGAs in the state harbour hyper and meso endemic foci of onchocerciasis. Cunently there are 886 hyper and meso endemic communities in the 10 LGAs with a total population of 904,257 persons. Mectrzan treatment started in the State as farback as 1991 in Dukku and Yamaltu/Deba LGAs in the then Bauchi State. With gradual expansion and splitting of LGAs the number of LGAs receiving treatment reached 10, namely: - Akko, Balanga, Billiri, Dukku, Funakaye, Kaltungo, Kwami, Nafada, Shongom and Yamaltu Deba. CDTi implementation started in March 2000 and covers all the 10 LGAs. Partners to APOC in the implementation of CDTI are UNICEF, Ministry of Health (State Government). the 10 endemic LGAs and the communities. In the year under review, several advocacy visits were paid to all the 10 LGAs and traditional leaders down to the Community members. A total of 721 villages were educated and mobilized. As for training, T SOCTS,40 LOCTs and 1333 CDDs were trained. Health facility staff will be trained when funds are released by APOC. 510,548 persons were treated with 1,533,258 Tablets in the 10 CDTI LGAs and 643 out of a total of 886 communities were covered. These gaye a geographic and therapeutic coverage rates of 73o/o and 63oh respectively. Contributions from the state government and APOC are yet to be recieved but IJNICEF and the 11 LGAs have contributed the sum of N795, 000.00 and FI 1.16m respectively. Community contributions in cash and kind from available reports is about A+198, 000.00. 2 Localised vector control through the spray of chemical insecticide/larvicide took place (under the supervision of consultants from Abubakar Tafawa Balewa University, Bauchi) at Dadinkowa dam and environs. The pro.lect also undertook the screening of eye cases in some communities whereby minor cases were treated and major ones referred. Strengths of the project include intersectoral collaboration with the Ministries 'of information, Water Resources and Local Government, Chieftaincy Affairs and Community Development, readiness of CDDs to carry out their duties regardless of non * receipt of incentives, high dedication of SOCTs and some LOCTs, and good support from State and LGAs' policy makers. Areas of weakness are poor supervision due to non-payment of salaries and delay in the release of funds from APOC and tl-re State government, poor financial retirements resulting in the delay of release of funds from APOC and low coverage rates in the project. 3 BACKGROUND INFORMATION. Gombe State, which was carved out from the former Bauchi State on I't October 1996, is located in the north east sub-region of the country. It is bounded by Borno State to the east, Yobe State to the north, Adamawa and Taraba States to the south and Bauchi State to the west. The state comprises of 11 LGAs. with a total population of about 2.2 mtllion living on about 17 ,048 square kilometers of landmass. Reports of various surveys ranging from skin snipping to REMO, RAM and refined REMO carried out over the years revealed that 10 out of the 1 1 LGAs in the state harbour hyper and meso endemic foci of onchocerciasis. Cunently there are 886 hyper and meso endemic communities in the l0 LGAs with a total population of 904,257 persons. Mectizan treatment started in the State as farback as 1991 in Dukku and Yamaltu/Deba LGAs in the then Bauchi State. With gradual expansion and splitting of LGAs the number of LGAs receiving treatment reached i0, namely: - Akko, Balanga, Billiri, Dukku, Funakaye, Kaltungo, Kwami, Nafada, Shongom and YamaltLr Deba. CDTI implementation started in March 2000 and covers all the 10 LGAs. Those rvere receiving treatment before then. Partners to APOC in the implementation of CDTI are LTNICEF, Ministry of Health (State Government), the 10 endemic LGAs and the communities. Annual treatment results from l99l to date are hereby summarised in the table shown below': TABLE i A nnual Mectizan treatment results from I 991 to date YEAR PERSONS TREATED 1991 63,104 1 998 154,688 t999 180,608 2000 450,440 200 I 515,823 2002 570,549 4 -l t- rn ii CN FN oFl z Y 7rt rrEI A L^J z -l '-l z ,L) o Fl Itl \o @ -l o\ UI 5 (, b..J a z -j t-l l{ !9 D9 (D C,) 0a z oe A) tD 0q - F @ @ o\ o\b.J o\A (Jt {{ {b.J o\A { b..) 5N 6 !r.o9 ztDA)A(r) ; Q. :- )9 _.+ 6 UJ a o\b.J o\A (, t.J -I -I { b.J (, t,l N -I o k 6'az -':cn O OvtDr ditS AJ- _!L = =.q @A b.J -I[.J o\ (, o\ (, -I{ o\N) UJ(, b.J 5 A b.) o- o rD 1^'7Ft o q) x:< - !ffo(D5 -aOE '5'{= 67- -'-3=o -J UJ -Ib.J o\ UI o\ (, -I{ o\b.J UJ(.) A N..)b..J A -I(,.) +Ary*vrt)r,A'= = o o -;-.J + iI IE'J<ro 34A! ;r;. a l- -tAi.a::) t) v * ^ t_.:. - i-ooxu,\,r+-rn -Ib..) o\ Ut (, -l -I o\ b..) (,J U.) A [.J Ab.J -IU) i?3887::eo=:-ry-J =+=p. =J+A):-rr, it{ t 'i 55i*o 9 g9.Orlr-Ef @ -l@ o\b...) A UI { -I -Ib.J o\5 -I b.J 5 b.J -IUJ ^\+tDA>a!- ch o: Y;.i l{rvr-(htD= -1L f5=o) (rJ o\(, -t(, b.J [.Jb.J (})UJ U) UI b.JUI { (, ()JUI 5 E 8E A g 7aE ui. = ."fi = Ai = =.+ -l tD -l z z o \ z F' Elr a a >l > z - t= z o -l 7 F- t'', r57FI 15 zt, i z \o oo { o\ UI 5 (, [.J ri Fl l.( il U<tD A) a oq z D] D)' /\ 0q te tD !) oq !-' o F b.J b..J N b..) b.J b.J b.J I b.J b..) b.J b.J S*SNlI1\N\?:<SA> Ee i dr.:{ax9 4xQ A A A 5 A A A 5 A A A >\v)N T=t'i:O\!lR?\OIt,rr\\?UFISrir( lt:-o u1?i esBps E+sHq V')I UJ(]g UJ { (, A b.J b..) A{ UI00 o\ (JJ N^2susf;Fs Table IV ACHIEVEMENTS IN TRAINING S/N TYPE TRAINING. OF ANNUAL TRAINING OBJECTIVE STATUS ACHIEVEMENT 1) 3 4 SOCT LOCT HEALTHPOST STAFF CDD 7 40 240 1500 7 40 0 1333 l00o/o l00o/o 00h 88.87o/o Materials used in training. The following materials were used during the various training sessions: - CDTI training manual, flipcharts, posters, measuring sticks, rulers, community summary forms, adverse reaction treatment forms, community treatment registers, household cards and stationery. The training sessions for SOCTs lasted for 2 days and the resource persons were drawn from NOCP Zote D office. Major contents of the training included: - APOC philosophy, community involvement in CDTI, disease overview, Mectizan dosage, administration, exclusion criteria, side effects and management. Census and Mecttz'an inventory were also discussed fully' The training of LOCTs also lasted 2 days for each session with the same content as for the SOCTs but elaborated to the level of understanding of the participants. The State team and some officers from the zonal office facilitated the training sessions. The'training of CDDs also lasted for 2 days with more emphasis on exclusion criteria, determination of dosage, management of adverse side reactions and registration update. The resource persons for the CDD training were drawn from the state team and the P.H.C departments of the respective LGAs. The understanding of the training by CDDs is judged by their performance in the post- training test and their general performance in the execution of their functions. One handicap is the 1ow literacy level of some of them that hinders them from completing the summary forms and compiling a comprehensive report' This might be improved through translating some of the information in the treatment forms and registers into Hausa language as is done in the Area courts' summon forms and forms used by the Agricultural extension services. 1 Table V MOBILIZATION AND EDUCATION OF TARGET COMMUNITIES. No. Of zonal office staff involved in mobilization The media used for mobilization included the town criers, state radio and television The CDTI mobilization team in the state has representatives of the state media houses (radio and television) who participate in all mobilization campaigns and also make sure that all project activities are aired in their media houses. The results of mobilrzation efforts are very encouraging as indicated by the increasing leve1 of awareness. The response of the communities is very favorable as judged by the warrn reception accorded visitors and their wiilingness to render assistance to the project. 1 1 1 No. of communitie s mobilized No. Of target communities lvhich received HE about importance of extended treatment. No. Of advocacy visits to L.G.A. Director of health. No. Of ministry of health staff involved in mobilization. S/N L.G.A. 81 73 5 aJ1 AKKO 121 6 32 BALANGA 142 l5102 33 BILLIRI 1,02 68 7 34 DUKKU 71 52 6 J5 FUNA- KAYE 64 KALTUN GO 72 62 5 36 5 aJ1 KWAMI 7l 1l NAFADA 51 35 5 38 9 SHONGO M 64 64 6 a) 10 Y/DEBA 162 160 6 3 814 56 3Total 886 8 I -i tD -? o 'J N z r! i? FN zFl a - -](n !- r 6 { Ur s UJ b.J C/t Fl H lr =EUl! z ll t4 a z ri 7 = a F F] z lrl 'L) z I ts I I C - - - |- z t'- \ 6 oo o\ I o\ b.J A UI -I -l -Ib.J o\A { h.J 5 h.) 00 zos2 HST:C.\ttrlr -q*i 5 b.J(,t{ I (, A{A @ UI (,) {{A b.J UJ (JI5 LN 66 UJA -I UT 00 0|o(Jt N 6 b.JA o\5 b.J6 UT 0|oA{ €\ Ut 93N - !'! F l',:a r-l l.i 5 UJ I o\ Ut o\ UJ -t -l o\ b.J (, b.J AA b..J o\ -I(, trOZ%QOHsb A>N< U*i UI -I UIA @ 5(, (,(, (, UI -lUI { UI\o 00 b.J UI b.J b.J Ut\o UJ F.J o\5 UI h..J -IA UI € 00 A -a{ N) -I o\ € \o o\{ !t>EES\3*E:2tr c/j UI(})(, [..J UIa @ N6(, UI6 b.J b.J6 @A -I A UI o\ -I (, A b.J o\ 5F{ -I(, b.J UJ o\\o UI o\\o A(, C<H> RHSUFO 't!\ l/) A\o I \o{ UI(JJ { o\b..) Ab.J 6 (, 00{ (,UI UI EsE'esiig x o\ \%%nl.(er-.( Esss^DtNS \) L.alri\{l {(,AUI b.Jo\ o\ b.J AUJ b..J o\ b.J {{UJUIUJ As shown in the above table 5J0,548 persons (including 463 clinic-based treatment in Gombe L.G.A.) were treated. Geographical coverage stands atl3ok while the therapeutic coverage is 63%. These low coverage rates is of great concern to the State project, the Zonal and national offices, and has been highlighted in the recent evaluation exercise as one of the serious militating factors. One hindrance tou,ards achieving higher coverage rates had been lack of reliable population updates. Several LOCTs are also not too certain of the number of the communities they are to treat. These had led to request for mectizan in quantities that have proved to be insufficient. With the recent update of population and clarity in number of communities needing treatment the project expects to reach 100% geographic coverage and at least 68% treatment coverage in its 4tl'year. STRENGTHS 1. Intersectoral collaboration with the Ministries of Information, Water Resources and Loc'al Government, Chieftaincy Affairs and Cornmunity Development 2. All the endemic communities are highly interested in taking Mectizan. 3. Readiness of CDDs to carry out their duties regardless of non - receipt of incentives 4. SOCTs and some LOCTs are highly dedicated. 5. Good support from State and LGAs' policy makers. 6. Active participation of community members in GDTI activities WEAKNESSES 1. Artificial scarcity of CDTi - conversant PHC staff as a result of massive redeployment 2. Shortage of logistic support in some areas as a result of the creation of new LGAs and asset sharing 3. Poor supervision due to non-payment of salaries and delay in the release of funds from APOC and the State government 4. Poor financial retirements resulting in the delay of release of funds from APOC 5' Many CDDs are secondary school leavers who may abandon their villages any moment l0 6. The low.literacy level of some CDDs affects their efficiency 7. Low coverage rates in the project SUSTAINABILITY ISSUES CONTRIBUTIONS BY PARTNERS Contributions received from various partners are hereby summarised in the table below Table vii: Annual contributions from partners PARTNER YEAR I YEAR II YEAR III 1 APOC AI4,485,520.00 >+ 5,602,500.00 Yet to release 2 M H AI2,400,000.00 N 2,400,000.00 Yet to release 3 LGAs A+ 1,350,000.00 Ar 90,000.00 A+1 ,160,000.00 4 LTNICEF A+ 290,000,00 N 388,600.00 b+795,000.00 5 COMMU.JITIES b+ 150,000.00 N 160,000.00 b+198,000.00 TOTAL AI8,675,520. b+ 8,631,100. N2,153,000 EYE SCREENING The programme starled as a result of complaints received from 4 persons in a comtrrunitr (Bojude) in one of the C.D.T.I. LGAs (l(warni) that they were still suffering from erc problems despite taking Mectizan over the years, Since a seasoned ophthalmic nurse is part of the SOCT, the team decided to screen community members who complaint of eye problems. Due to inadequate information, poor publicity and short notice, only 44 pelsons rvas initially screened. The ophthalmic nurse provided the materials used for the screening. The results of the screening is summarised in the table below DISEASE NO. OF CASES PERCENTAGE (%) Cataract 15 34 Trachoma 10 22 Allergy 10 22 Glaucoma 5 11 Corneal opacity 4 9 Aphakia 3 6 lt The cases of cataract and glaucoma that needed surgical intervention were short listed and refsrred to the eye clinic of the ,p..iutl't hospital * tt't State to be kept in the waitng list so that whenever there is any out - reach programmg, they can be operated on' Fortunately, five oiifr"1n that turned ,p *t1t oplrated free of charge during the last outreach that was .orar"t.a in the stot.. Those rvith trachoma trichiasis had epilation done on the spot while those with trachoma infection were treated with antibiotic drugs' Those with minor ailment like allergy, "o*.ui opacity were prescribed the right drugs to buy from genuine ,ou...r. Those *iit, t op.tess cases were counseled so that quack doctors or traditional heaiers will not deceive them' .r, 1-r )1^ ^r ..,L, A retter has been written to the LGA. chairman with details of what happened and requestrng: - 1 purchase of the basic equipment and reagents needed for screening eye cases in most oi' the villages in addition io^educating them on the cause and prevention of common eye problems. 2. Purchase of drugs for treatment of minor ailments 3. Provide the necessary logistics for the exercise' TheL.G.A.Chairmanrespondedfavorablyandthescreeningwasecarriedoutin2other communities (Dabanfulani & Gadam) in the LGA where 40 &' 51 persons were screened respectivelY. The exercise rvill be continued and letters u,ill be written to other LGA Chairmen as verbal discussions have already taken place. One LGA Chairman has already requested the team to go for the exercise even before writing him' VECTOR CONTROL The Dadinkowa dam is the second largest dam in the country. There are 2 major points on the dam which constitute very suitable -breeding sites for the simulium flies and therefore support their (blackflies) breeding throughout the year' These points ate'. - 1. The spillwaY, and 2. The irrigation canal; the construction of which was started and iater abandoned and the water flowing in it were diverted to flow back into the river. This point of diversion also forms a very suitable breeding site' At certain periods of the year (october to April) excessive po-pulations of the flies constituting a serious menace are usuarly seen. This menace makes life very difficult for the inhabitants of the area who are predominantly farmers, fishermen and animal rearers' 11 Due to the series of complaints received from the communities on the menace, scientists (Drsj.A. Ogidi'and Williams) were invited from Abubakar Tafawa Balewa University, Bauchi to look into the problem. After carefully examining the whole area localized vector control through the ground spray of chemical insecticides/larvicides (cypermethrin and dimethoate) using motorised sprayers was done. The canal u,as also closed down for 3 days in order to expose the aquatic stages of the flies for destruction. The whole area comprising of thc spillway, the canal and both sides of the river bank over the distance of several kilometers were sprayed using motorised sprayers. The flies ceased to be noticed for a period of 2 to 3 weeks after the spray. SOLUTIONS: i. Short term Regular spraying of the area at 3 months intervals in order to keep dorvn the population of the flies. ii. Long term a. Completion of the dam so that the spillw'ay is closed most of the time, and b. Completion of the canal so that the diversion is removed. t 13