Expert advisory committee twenty-third session, Ouagadougou 23 - 27 September 2002: report of the study on pictorial forms: pre-test of the WHO/OCP pictorial form for illiterate community-directed distributors of ivermectin in the Kedougou district of Senegal: final research report

/I ta WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE ONCHOCERCIASIS CONTROL PROGRAMME IN WEST AFzuCA PROGRAMME DE LUTTE CONTRE L'ONCHOCERCOSE EN AFRIQUE DE L'OUEST EXPERT ADVISORY COMMITTEE Twenty-third Session Ouagadougou. 23 - 27 September 2002 EAC23.8 Original : English REPORT OF THE STUDY ON PICTORIAL FORMS t t IPre-test of the WHO/OCP Pictorial Form for Illiterate Community-Directed Distributors of lvermectin in the Kedougou District of Senegal Final Research Report Table of Contents EXECUTIVE SUMMARY 1. 1.1 1.2 1.3 Introduction... ... .. Background Research objective Research team 4 ) 8 8 9 9 10 10 11 t2 r3 t4 l5 l8 2l 22 2. Design of research instruments 4 4 4 5 5 5 6 6 7 7 7 8 2.1 2.2 Pictorial forms Questionnaires 3. Methodology Research methods used.. Selection of villages. Selection of Respondents. . . Profile of Respondents .. Advantages and Constraints of the Research Process Advantages. . . . . . Constraints 3.1 3.2 J.J 3.4 3.5 3.5.1 3.s.2 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4. Findings from the pre-test of the pictorial form 5. Recommendations for the pictorial form. APPENDIXES General findings. Comprehension: Side A version 1... Comprehension: Side A version 2... Comprehension: Side 8..... Attractiveness. . . . Acceptability.... User-friendliness. Terms of Reference...... Research Itinerary. Pictorial Forms. Questionnaire ... List of villages, number of interviews and Respondents. .... number of respondents. A: B: C: D: E: F: I 2EXECUTIVE SUMMARY 1. Background and research objectives The World Health Organization's Onchocerciasis Control Programme (WHO/OCP), based in Ouagadougou Burkina Faso, initiated a rapid research activity in Senegal whose objective was to pre-test a pictorial form designed for use by illiterate Community-Directed Distributors (CDDs). The purpose of the form is to serve as a means for illiterate CDDs to record and report the number of people who have received Ivermectin tablets, and the number of Ivermectin tablets distributed. A total of thirty-two (32) respondents participated in structured interviews conducted by the Consultant and translator in twelve villages in the Kedougou district of the Tambacounda region of Senegal. Only the illiterate respondents were interviewed. The interviews were conducted by Consultant Lydia Clemmons and a translator, Jean Salif Diallo, who is fluent in French and the local languages in the Kedougou District. The objectives of the research were to Conduct a pre-test of a new pictorial form developed for illiterate community-directed distributors of Ivermectin (CDD). 2. Matn findings from tlte pre-test of the pictorial form 2.t Overall, the findings indicate that most illiterate men and women are able to understand and correctly interpret Side A of the form with considerable ease. Previous training and experience as a CDD, although helpful, is not necessary for people to be able to use the pictorial form. 2.2 Almost all of the respondents (96%) said that they thought Side A of the form was either very useful or useful, and twenty respondents (77%o) said they thought that Side A was very easy, easy or somewhat easy to understand. Only six respondents (23%) said they thought it was a little difficult to understand. 2.3 Most respondents preferred version 1 of Side A to version 2. The main reason was because respondents thought that the drawings on the left side of version 2 looked like sick or deformed people. 2.4 All of the respondents (all of whom were illiterate) had great difficulty with Side B of the pictorial form. This page has written text and numbers, requiring the user to be able to read, write and multiply in order to correctly fill out the table. 3. Key recommendations for the pictorial form 3.1 Version I of Side A should be improved and used by CDTI programs The drawings of the man's face on the top of the page of Side A version I should be revised to avoid a profile and to show the full face, including two eyes. Fingers should be added to the man's left hand. 3.2 J3.3 3.4 3.5 3.6 3.7 The drawings in the last four rows of the tally sheet of Side A version I should be improved by making them larger and clearer. This will make it easier for people to distinguish between the male and female figures. Since illiterate people who had received no training as CDDs were able to understand and use Side A of the form, CDTI programmes using this form should encourage training of additional people in the community to use the form. Minimal training is required, although some supervision will be necessary for new users. Since women and men were equally able to understand and use Side A of the form, both sexes should be encouraged to either become CDDs or assist CDDs in keeping track of the number of people receiving the various doses of Ivermectin. Health care nurses or literate community members should fill out Side B of the pictorial form because illiterate CDDs will have great difficulty doing sd. Prior to introducing the pictorial form, CDTI programme managers should therefore review and agree on what information is absolutely necessary in order to decide whether or not the pictorial form is appropriate for their data collection system 41. INTRODUCTION 1.1 Background The World Health Organization's Onchocerciasis Control Programme (WHO/OCP) initiated a rapid research activity in Senegal s,hose objective rvas to pre-test a pictorial form designed for use by illiterate Community-Directed Distributon (CDDs). The purpose of the form is to serve as a means for illiterate CDDs to record and report the number of people who have received Ivermectin tablets, and the number of Ivermectin tablets distributed. 1.2 Research objective The objectives of this research rvas to: Conduct a pre-test of a new pictorial form developed for illiterate commirnity-directed distributors of Ivermectin (CDD). The Terms of Reference and the research itinerary are included in Appendix A and B, respectively. 1.3 Research team The research team was composed of Dr. Lydia Clemmons and Mr. Jean Salif Diallo, a resident of Kedougou who was selected by the Medical Chief of the Kedougou District to act as translator for the Consultant and respondents during interviews. Mr. Diallo is fluent in French and the local languages spoken in Kedougou (Pular and Malink6). 2. DESIGN OF RESEARCH INSTRUNIEI\-TS 2.1 Pictorial forms Three pages of the pictorial form were scanned into a computer and copied on CD-ROM by OCP in Ouagadougou. The CD-ROM and a printout of the pictorial forms were mailed to the Consultant in Dakar. The Consultant translated the text on the scanned pages from English into French. No changes were made to the scanned images. The French versions of all three pages were then printed out and photocopied for use during the interviews. Copies of the three pages are provided in Appendix C. 2.2 Questionnaire A draft questionnaire for strucrured inten'iews was developed in English and translated into French by the Consultant in Dakar. Both questionnaires, in French and in English, were sent to OCP/Ouagadougou for feedback. The Consultant, Dr. Diawara, Regional Medical Director, and Mr. Demba Yoro Nguette, Regional Primary Health Care Supervisor, reviewol and revised the French version during a work session in Tambacounda A second work sasion in Tamba with the Consultant, Dr. Diawara, Mr. Nguette, and Mr. Jean Salif Diallo lthe translator) was devoted to agreeing upon the correct translation ofthe questionnaire in Pular and Malink6. 5The questionnaire was pre-tested in Tour6ma, an endemic village located 28 kilometres from Tamba. Due to time constraints, only two respondents, both residents of the village, were interviewed. The respondents were persons. The questionnaire was modified following the trial runs in Tour6ma in order to make a few questions clearer. Questions deemed unnecessary were removed. English versions of the finalised questionnaires in French are included in Appendix D. 3. METHODOLOGY 3.1 Research methods used Structured individual and group in-depth interviews were the methods used for the pre-test of the pictorial forms. Since women respondents often felt uncomfortable being interviewed alone, most were invited to take part in small group interviews ranging from 2 to 6 women. All male respondents were interviewed individually. All interviews ran an average of t hour and 15 minutes in duration. The shortest interview was 33 minutes and the longest interview was 2 hours and 25 minutes. The lengthiness of the interviews was primarily due to the extra time required to translate questions and responses in French and in the local language (Pular or Malinke). The content of the interviews focused on the pictorial form. The interviewer showed the pictorial form to the respondent and asked questions using a structured interview guide based upon the following variables: COMPREHENSION- the degree to which the form is understood by respondent, including the interpretation of the images, the correct understanding of the content, meaning, purpose and use of the form. ATTRACTIVENESS- the degree to which the form is considered to be attractive and appealing to the respondent, including the images and presentation. ACCEPTABILITY- the degree to which the form is considered to be appropriate and inoffensive to the respondent within the socio-cultural context of the local community. USER-FRIENDLINESS- the degree to which the form is considered to be helpful, practical, and easy to use. The translator translated the exchange between the interviewer and the respondent in French and the local language (either Pular or Malink6). The interviewer wrote responses directly onto the interview guide. 3.2 Selection of Villages Twelve villages in the Kedougou district were selected for the study during a work session with Dr. Ndir, Medical Chief of the Kedougou District. Due to the constraints of limited a. b. c d 6time and the small research team, the selection of the villages was primarily based on convenience. All villages were located within a thirty-kilometre radius from Kedougou. The only other criterion for selecting villages was that a trained community distributor of Ivermectin (CDD) must be present in the village. In an attempt to have some ethnic diversity, eight of the twelve villages selected were Pular communities, and four were Malinke communities. A list of the villages as well as the number of interviews and the numbers of respondents in each village is included in Appendix F. 3.3 Selectiott of Respondents A total of Thirty-two respondents (32) respondents parlicipated in structured interviews conducted by the Consultant and translator in twelve villages in the Kedougou'district of the Tambacounda region of Senegal. Data from six respondents in the pictorial form pre-test were excluded from the analysis when it was discovered late in the interview that the respondents did not meet the selection criteria (e.g. were literate). Prior to beginning the interviews in each village, the research team always paid a courtesy call to the village chief to explain the purpose of the mission and to introduce the research team members. All research respondents were chosen either by the village chief or the CDD. 3.4 Profile of the Respondents Twenty-six respondents (eight men and eighteen women) were inten iewed in the pictorial form pre-test. The selection criteria for respondents were: . an illiterate CDD or . If no illiterate CDD was available, an illiterate resident of the community (man or woman). During the course of the research, it became evident that none of the thirteen CDDs in the twelve villages were illiterate. In all thirteen cases, the CDD was selected based on the requirement stipulated by the health centre nurse that the CDD must be able to read and write. All but one of the CDDs had either been directly chosen by the nurse or selected by the village chief. One CDD said he had been chosen by all of the male heads of household in the village. The research team consequently had no choice but to interview illiterate village residents who were not CDDs to participate in the pictorial form pre-test. The majority (twenty-two) of the respondents had never attended school. One man had completed four years of schooling, two women had completed two years of schooling, and one woman had completed one year of schooling. While all of the respondents were illiterate, two respondents were numerate (able to read numbers). All respondents \\'ere farmers, with two of the respondents having additional occupations related to health care (one was a midwife and another was the treasurer of the village health committee). A list of the respondents is included in Appendix F 73.5 Advantages and Constraints in tlrc Research Process 3.5.1 Advantases a. Excellent collaboration with the Regional Medical Director, whose technical assistance and logistic and administrative support rvere invaluable. b. The District Medical Director of Kedougou quickly and efficiently facilitated selection of the villages and their advance notification. c. Warm hospitality, open communication, and good spirit of collaboration among the communities visited. Residents appreciate receiving Ivermectin and were glad to collaborate with the research team. d. The translator was well known and well liked in the commuhities, which facilitated collaboration and increased trust. 3.5.2 Constraints: The primary constraint in the research process was the small research team, which was composed of only an interviewer and a translator. The small research team limited the number of interviews that could be conducted. All data presented in this report is consequently primarily qualitative and never statistically signifi cant. The period of the research was the hot season just before the rains, making the interviews fatiguing for the respondents as well as for the research team, due to excessive heat and dehydration. There was insufficient time to properly train the translator in the requisite knowledge and skills for conducting research. a. b. c 84. FINDINGS General firtdings4.1 4.1.1 Overall, the findings indicate that illiterate men and women are able to undertand and correctly interpret Side A of the form with considerable ease. Previous trainine and experience as a CDD, although helpful, is not necessary for people to be able to us the pictorial form. For example, even a thirteen-year-old girl with no schooling w-as able to quickly understand the form without having had any explanations or instructions fron the research team. A brief explanation (less than five minutes) was usually all tha'i was necessary to enable the respondents to correctly fill out either version of Side A of the form. 4.1.2 All of the respondents had great difficulty with Side B of the pictorial tbrrn This page has written text and numbers, requiring the user to be able to read, write and muitiply in order to correctly fill out the table. 4.2 Cotnprehension: Side A version I The interviewer always began the interview by showing the pictorial form to the respordents and asking them to describe what they saw. 4.2.1 While respondents had little difficulty recognising a man, child and worlan on the top of the page, only fifty percent (13126) understood what they were d,oing- The fifty percent who did not understand had particular difficulty identiffing the measuring stick. Further questioning revealed that this was because the CDDs in most of the villages did not use a measuring stick, since it is culturally assa-iated with measuring the dead for graves. CDDs therefore used measuring tapes, hights noted on identity cards, or simple estimates as alternative methods. Thus, l'ery:iw of the respondents had ever seen living people having their height measured. 4.2.2 Fifty percent (13 of 26) of respondents recognised the circles on the left sideof the page as pills or tablets. Although 23 respondents recognised the numbers, cnly 5 guessed that the numbers were for indicating the quantity of pills to be givea, and only 2 were actually able to read the numbers (i.e., only 2 were numerate). 4.2.3 Almost all of the respondents (24 of 26) recognised the images in the tally secron of the page as representing people. 4.2.4 Forty-six percent (12 of 26) respondents understood that the larger images rr the tally section of the page indicated adults while the smaller images indicated chldren. Several respondents thought that the smaller images, particularly the last t$,o rows, depicted sick or deformed people, wild animals, or birds. Only oce of the respondents was able to correctly identifu the number of tablets the boy at the iop of the page should receive (3). When the respondents finished their spontaneous descriptions of what they sar', the interviewer and translator provided a brief (less than five minutes) explanalion of the intended meanings of the images and also explained how to use the tally secton of the page. All respondents said they were able to understand these intended rneaings. 4.2.5 9To verify their level of comprehension, the respondents were asked to measure the heights of the interviewer and translator, determine the number of Ivermectin tablets each should receive, and to mark the tally sheet accordingly. Eighty-one percent (21 of 26 respondents) were able to correctly measure the heights, determine the correct number of Ivermectin tablets, and correctly mark the tally sheet, and accomplished these tasks with ease. 4.2.6 Twenty-four of the twenty-six respondents (92%) said that it rvas difficult to distinguish between males and females in the tally section of the page and suggested that the images in this section, particularly in the last four rows, should be drau'n larger and clearer. 4.2.7 Not surprisingly, none of the respondents (who were all illiterate) were able to understand the written text. 4.3 Contprehension: Stde A version 2 4.3.1 Most respondents felt that the images on the tally sheet in version 2 rvere clearer than the images on the tally sheet in version 1. 4.3.2 As noted in 4.2.1 a, respondents were unfamiliar with measuring sticks to measure living people because the CDDs in their villages used alternative methods to determine height and the corresponding dose of Ivermectin tablets. Only thirteen respondents interpreted the drawing on the left side of the page as a man measuring the height of a child in order to determine the number of Ivermectin pills he should receive. Nine of the respondents did not recognise the measuring stick in the drawing (four thought it might be a rifle). Four of the respondents interpreted the drawing of the man and child as a health care provider (a doctor or a nurse) providing care or treatment to a sick child. 4.3.3 Nevertheless, when the drawing of what rvas intended to be a measuring stick was explained to them,2l respondents (81%) identified the correct number of Ivermectin tablets the child should receive (three tablets). 4.3.4 The two respondents who had previous experience in assisting CDDs with Ivermectin distribution were able to interpret the use Side A of the pictorial form much more quickly than the other respondents. 4.3.5 Two of the respondents were numerate (able to read numbers). Although it is not an essential skill, their ability to read numbers was noted to be helpful to them in interpreting the form. 4.3.6 Not surprisingly, none of the respondents (who were all illiterate) were able to understand the written text. 4.4 Comprehension: Side B 4.4.1 Sixty-nine percent of the respondents (18/26) recognised all of the drawings on Side B. Eight respondents, however, believed that the bottles of Ivermectin were jugs of a 10 water. While all of the women respondents recognised the drawing of the health centre, four of the men (50% of male respondents) thought that the drawing represented something else (a jug, a box, a road sign and a car, respectively). 4.4.2 None of the respondents were able to understand the written text. 4.4.3 AII of the respondents said that they would be unable to complete the summary table because they could not read or write. 4.5 Attractiveness 4.5.1 Among the respondents who interpreted the drawing on the top of Side A Version I and at the left of Side A Version 2 as a doctor or nurse providing health care to a child, all said they found the idea of someone healing someone attractive. 4.5.2 Nevertheless, most respondents (24 of 26) also thought that both the man and child in the drawings on both versions, particularly the drawing on Side A Version 2,were sick and deformed. 4.s.3 Eighteen respondents (69%) believed that the man on Side A Version 2 was one- eyed, nineteen respondents (73%) thought that he had a deformed nose and ears, twenty respondents (77%) thought he had a goitre or deformed neck, and twelve respondents @6%) thought that the fingers of his left hand were amputated. "It lool<s to me like he has lost his fingers because we would see his fingers if he had them wrapped around the baton. " [Male respondent] 4.5.4 Twenty respondents (77%) believed that the child's eyes on Side A Version 2 were abnormal and indicative that he was ill, and eighteen respondents (69%) thought that his right arrn was deformed. 4.5.5 When asked which version (l or 2) of Side A they preferred, l7 respondents (60%) said they preferred Version l. The reason was that they disliked the drawings depicting what they perceived to be sick and deformed people on Version 2. "We cannot ever be pleased to see sick people like these (ytointing to Side A Version 2). This is why I prefer this page (Version l). [Female respondent] 4.5.6 Eighty-four percent of the respondents (22126) found the last two rows of images in the tally section of Version I very unattractive because the images were too small and blurry. Some respondents interpreted the images in these rows to represent sick or deformed people. 4.5.7 The eleven respondents rvho preferred Version 2 said the reason was because the images in the tally section were clearer than those in Version l. 4.6 Acceptability 4.6.1 None of the respondents found Version I or Version 2 of Side A inappropriate or offensive. 11 4.6.2 While two respondents spontaneously remarked that the clothing of the man and the boy was not typical of the area, four others spontaneously remarked that all of the people shorvn in both versions were well dressed but wear the same clothes. 4.7 User-Friendliness Respondents were questioned about the degree of usefulness and easiness (user-friendliness) of the version of Side A that they preferred. The findings for both versions of Side A are collapsed into the following summaries: 4.7.1 Almost all of the respondents (96%) said that they thought Side A of the form was either very useful or useful. Only one of the twenty-six respondents said that he thought Side A of the pictorial form was somewhat useful. One of the two respondents who had had previous experience working with a lrained CDD remarked: "Theseforms will make the workfaster and easier because even I can understand this. " fF emale resPondent] 4.7.2 Twenty respondents (77%) said they thought that Side A was very easy, easy or somewhat easy to understand. Only six respondents (23o/o) said they thought it was a little difficult to understand. "It's very easy to use, even people who can't read-if you're not stupid you can understand it. I could use this even today just wilh what I've learned today." [Female respondent] "For someone who dtdn't go to school and who doesn't lcnow how to read and write it's easy enough. " [Male respondent] "If the person is intelligent, this will be very easy. " [Male respondent] 4.7.3 Several respondents compared Side A of the pictorial form to notebooks and registers they had observed the CDDs using during Ivermectin distribution and said that they believed the pictorial form is easier to use. "For we who are not strong in reading, this form would be easier than a register, so it is very useful. We'd need some training though." 4.7.4 "l(ith your explanations, it's very easy. It's easier than a notebook." Twenty-three respondents (88%) spontaneously said that additional training would be necessary before they would feel completely comfortable in using Side A of the form. "In the beginning there could be some dfficulty, but with time tt would get easier to use. It would be easier with training. " [Male respondent] "LIthen ),ou are trained you would understand it better" [Female respondent] a t2 5. RECOMMENDATIONS The following recommendations to improve the pictorial form are based upon the findings from the pre-test with twenty-six respondents: 5.1 Since most respondents preferred version I of Side A, this version should be improved and used. 5.2 Revise the drawing on the man's face on the top of the page of Side A version I to avoid a profile and to show the full face, including two eyes. Add fingers to the man's left hand. 5.3 Improve the drawings in the last four rows of the tally sheet of Side A version 1, making them larger and clearer so that it is easy to distinguish between the male and female figures. To allow more space for drawings on the tally sheet of Side A version 1, eliminate the text at the bottom of the page ("Mectizan Distribution Form" or "Fiche de Distribution du Mecti zan"). 5.4 5.5 5.6 5.7 5.8 Since illiterate people who had received no training as CDDs were able to understand and use Side A of the form, CDTI programmes using this form should encourage training of additional people in the community to use the form. Minimal training is required, although some supervision will be necessary for new users. Since women and men were equally able to understand and use Side A of the form, both sexes should be encouraged to either become CDDs or to assist CDDs in keeping track of the number of people receiving the various doses of Ivermectin. In the Kedougou district, for example, CDDs currently record the names of everyone who receives Ivermectin treatment, their sex, height, age and the dose of Ivermectin they receive. The pictorial form does not provide information on the names of people receiving Ivermectin treatment. Prior to introducing the pictorial form, CDTI programme managers should therefore review and agree on what information is absolutely necessary in order to decide whether or not the pictorial form is appropriate for their data collection system Health care nurses or literate community members should fill out Side B of the pictorial form because illiterate CDDs will have great difficulty doing so. 13 APPENDIX A TERMS OF REFERENCE FOR THE PRE-TEST OF CDTI PICTORIAL FORMS The Conmtunity Directed Treatntent with lvermectin GDTD, is one of the strategies of onchocerctasis control retained by the OCP since 1996. Its implementation by the communities, in particular by the Conmtunity Disftibutors (CD) selected by their peers is undergoing some problems. In fact, the matn tasl<s of the distributors are inter alia: the ,"nrrri of the population, distribution of the drug to the eligible ntembers of the community, the ntanagentent of the lvermectin and especiatly the preparation of the treatment report. In view of tiese rolei, some illiterate distributors, in spite of their will to work suitably for their comntunity, face some dfficulties leading to de-motivatiott or abandonment. To solve this problem, OCP prepared a pictorial form to be used by illiterate CDs in the accomplishment of their task. By way finding the validity of this form OCP proposes a field study. The objective of this study is thus to test the pictorial form in relation with distribution among an illiterate population. The consultant in charge of the study will have to work out a test protocol of the form prepare a questionnaire for the study organise the study on the ground unuly.. the results of the study emphasizing the level of comprehension and control of the Form by the CDs make recommendations and suggestions for the improvement of the form write a full report on the study . t4 APPENDIX B RESEARCH ITINERARY May 19,2002 May 20,2002 May 21,2002 May 22 - 27,2002 Interviews in Villages May 28,2002 May 29,2002 May 30,2002 AM: Travel: Dakar-Tamba PM: Briefing meeting with Dr. Diawara AM: Work sessions questionnaire. in Tamba to modify and translate draft PM: Preparation of Display PM: Travel Tamba- Tour6ma (28 km from Tamba) to notify two community members in advance of pre-test the follorving morning. AM: Travel Tamba- Tour6ma. Pre-test questionnaire. PM: Work sessions to modification and photocopy finalised questionnaire - TravelTamba-Kedougou - Briefing meeting with Dr. Ndir, Kedougou District Medical Chief AM: Debrief with Health Centre Nurse in Bandafassi PM: Travel Kedougou- Tamba AM: Debrief with Dr. Diawara PM: Work sessions with translator and Consultant: Preliminary data review AM: Travel Tamba-Dakar PM: Work session:preliminary data review May 3l - June I 1 Data analysis and report writing l5 APPENDIX C: PICTORIAL FORMS Villa :.:1 cD /r? .rli ^ rv- -'-1",-": il- i-at .lI ". 1"-::-:l '.1 j \\ /: -.i, lrlt,'-J U:it Date of first distribution Date of last distributionl c '.t L, ;) ,t;', ra;- C i--) ,f+ffi q1 i! Ir ito6aa. -& d- $il ril# $:,1iliJa ct ^Lbt \14rt LJ de -G- u'4 ' !.:t!'i. .l L-J g tr a "E,lfr',$ flrt,g ,, ,itlt:tfl tfttfrfriiiiiit-i frHEI (r0 a) ir f-r 1,10 o t) t?o BIFBHil,[iln,f,,F a;.4;;.;.;;.A;'A rft 0 ft rrt ri; ft ri'i,' 6 rt 6l_1 q''l I n A ha a a,r a; e ;. ;. ;. AAA;'i r;i.i 1:.i ;;,1 ;;-: li) Ll; ti ,,, fi $ li # ft :l ,fi [t ffi;] i t.I iI ilBril$at'$ Mectizan Distri buti on form i;II q, $li,-"]BiJ tB rTfFtrBfitrf;.E,Fffif rfiedr##€t*tt,e.ruf # fr A fi ita,.rt, ilr.,1, i;;, t;t f , i, t1 rn-fl"trlf,m: mEE[flF.ri+ryry,Ttuqfrjifft55frfri, i, .1., i, A !,, i :, i. -,:;- i,= -i.'i' i_ A i 'j;,Irf[lEiilf,[rEfi ,'l t: t at rr { - rf+rf.fffF * ;_i ;l;,'i t'l*,Irii fi4",rik +i !t ti 9i !:.' tt !+ H !; Side A Ver.<inn I 11iU L.L 4E; l:-E ? ii t6 r Villag e (cD I Date of first distribution- l_I -.' 't *1-l: ir' i, -"'!J ' L Date of last distribution tI € .,il-[ LJ -e- A, tf:t T,\] k:, ffi H e& tt,l. tJ ad^lrii ,:._1 LI otL !.F,1 l;it! ?e l?iIffi E] 8J do/tL l^ rf,t #lH!) Ftr$ #wfr#tr 6€--F, @e#Ee,E t ir.':C Y; fr P,,r"l l.: I fr *\y,.'l I'r. a 2A 1..:1 r..-! iB, lrr-! 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J , i,F !. t : N Ix.i3.&8"-m.ftflfl.fl8" fi fifig8e frfrrt$ff o tr ,ieeliana,h EffiEH;E-x;t B .,t E, F; tttfr$ffr$.frfrfr"$$*frt-$fi.sq ft,f+ o o o )60 I () o(, I40 o t20 o 90 Nfeclizan Distribution form Side A llersion 2 t I l I { I I ir t7 Summary of Treatment Data This form is to be completed by the Health Worker or the CD Total Population Name of Health Worker DistricUlocalisation of Health Centre 1 Date of completing this form Number of tablets received h Number of tablets siven TOTAL Number of parsans treated x I x x x 4 3 2 1 I I I I I I I t I I I I .,] I I o o o o 60 -t4 alf* MH 1 t Tablets piven Remarks by Health Worker.... Number of remaining tablets ....... Number of serious cases Referred to the Health Gentre Mectizan Distribution form Side B c1 '-, - f) o 90 o o o 140 o o 120 Iilt'r t8 APPENDIX D OUESTIONNAIRE FOR THE PRE,-TEST OF THE CTORIAL FORMPI Interview No Village Date: Age_Sex_Occupation: Are 1'ou a CD? YES_NO _ Have 1'ou been trained as a CD? YES _ NO _ For horv many years were you in school ? _Name from respondent A-1. {shorv Face A version I I Please descn:e what you see in this image. A-2. What is this person (A)doing? Sun'e7,: -\ccording to you, why is this person (A) holding a ruler in his hand? A-3. Who is this person (A) in your opinion ? A-4. What is this person (B) doing? A-5. Who is this person (B) in your opinion? ,4.-6. What is this person (C) doine? A-7. Who is this person (C) in 1'our opinion ? A-8. {Poirtt to the left side of Face A version I } What is it? What are these circles (three circles, two circles, and a circle) representing? -tccording to you what do these figures (160, L40,120,90) indicate? A-9 { Point to the ticking/counting table of Ftce A version 1 } What is it? { Poittt to the image of the men and women } [n your view what do these images represent. Why are some larger and others smaller? A-10. According to the form, how nnany tarblet of Mectizan should this person (B) receive? whv? A- I l. Is there anything that you like on this fcr=r (that you find attractive)? Why? A-12. Is there anything that you do not like or tris form (that you find repulsive)? Why? A-13. Is there anything inappro,priale or offlsn$:re in this form? Why? l9 A-14. Is there anything which confuses you on this form? Why? B-1. {Show Face A Versiott 2 } Now, I will show you another form. Please describe what you see. B-2. According to the form, how much tablets of Mectizan does this person (E) have to receive? Why? B-3. Is there anything that you like on this form (that you find attractive)? Why? B-4. Is there anything that you do not like on this form (that you find repulsive)? Why? B-5. Is there anything on this form that you find inappropriate or offensir-e? Why? 8-6. Is there anything on this form that confuses you? \Mhy? C-|. {Show versiotts 1 and 2 of Face A. Poirtt to the text written on top of the poge I Do you understand what this text says? Would you be able to urite the information sought in these spaces? {Read the text aloud and specify the required information d necessary. \ C-2. Which of these two forms will you prefer? Why? C-3. Which of these two forms would be easier to use in recording information on the number of people having received the Mectizan tablets? Why? C-4. Now we would like to know whether it is easy for you to use this form. It is not you we are testing but the form, to find out if it is useful for you. {Stand up and ask the respondent to do the ssme. Give the CDTI measuring stick to the respondent to measure I Could you please take our measurement? (the Interviewer and the translator) C-5. According to the form, how many tablets of Mectizan should the interviewer receive? According to the form, how many tablets of Mectizan should the translator receive? C-6. If you should give to each one of us Mectizan tablets according to our sizes, how would you record the information on the form? C-7 {Show the Face B to the respondent} would you like to describe what you see? C-8. {Point to the text written on theform. } Do you understand what this text says? \\rould you be able to urite the information sought in these spaces? {Read the text aloud and specify tnformation requfued if necessary. } C-9. {Potnt to the ticking table I In your opinion what does this table sen'e? ^ 20 C- 10. {Explain to the respondent how to use the table I You just took our (the interviewer and the translator) measurements and have given us Mectizan tablets. Now could you please shorv me how you would record this information on the form? C-11. What do the distributors of Mectizan from your community use to record the number of people and the number of Mectizan tablets distributed? C-12. To what extent would this form be useful to the distributors of Mectizan? Very useful Useful A little useful Not useful C-13. In your opinion, to what extent is the use of this form easy or difficult? Very Easy Easy _ Somewhat easy Somewhat difficult Difficult Very difficult C-14. We place much importance on the suggestions or advises that you could have to help us to improve these forms. Which changes will you suggest to improve this form (Face A Version l) Survey: Any other thing? C-15. Which changes will you suggest to improve this form (Face A, version 2)? Survey Any other thing? C- 16. Which changes will you suggest to improve this form (Face B)? Survey: Any other thing? C-17 Do you have any other comments, suggestions or ideas that you would like to share with us with regard to the distribution of Mectizan to the members of your community? 2l APPE DIX E LIST OF VILLA ES. NUMBER OF INTERVIEWS A NTIMBER OF RESPO ENTS NAME OF VILLAGE DATE PICTORI\L FOR\{ INTERYIE\\'S NL}IBER OF RESPONDENTS (r\rEN) NUI\IBER OF RESPONDENTS (woN{EN) L Tour6ma (Pre-test 14 km from Tamba) 2v05102 I I I 2. Silling (28 km from Kedegou) 22/05102 I 0 5 3. Bandafassi(14 km) 22105102 2 I I 4. Thiabedii(12 km) 23105102 2 I 6 5. Thiokethian (27 km) 23t05t02 J J 2 6. Bandoukondi (17 km) 24t05/02 2 I 7. Nathia (20 km) 24105102 0 0 8. Patassy (23 km) 25105102 2 2 0 9. Ibel (23 km) 25/05/02 I I 0 10. Ngari(13 km) 26t0st02 2 2 0 I l. S6khoto (13 km) 26105102 I I 0 12. Tenkoton (18 km) 21105102 2 I I 13. Tomborokoton (33 km) 27t05t02 0 0 0 TOTAL 19 t4 18 2 0 APPENDIX F 22 PICTORIAL FORN{ PRE-TEST RESPONDENTS RESPONDENT # NAME SEX AGE YEARS OF SCHOOLING I Djeneba Diallo F 40 0 2 Fatoumata Souar6 F 40 0 3 Oumou Diallo F 39 0 4 Fatou Diallo F 13 0 5 Penda Diallo F l9 2 6 Penda Keita F 36 I 7 Opa Diallo \I 42 4 8 Fatoumata Bintou Diallo F 45 0 9 Hawa Ba F 55 0 10 Fatoumata Goundo Saomora F 50 0 11 Sakomaba Ma F 31 0 l2 Fatoumata Camara F l8 U l3 Mariam Diallo F 28 0 t4 BillaliSissoko \I 50 0 l5 Maimouna Diop F 28 0 16 Diaoli Diallo N1 46 0 t7 Adama Diallo F 30 0 l8 Malliatou Diallo F 20 0 l9 Boubacar Diallo \{ 35 0 20 Tongondo Coulibaly M 60 0 2t Sounounou Ba M 70 0 22 Mariam Traor6 F 38 2 23 Bo16 Damba F 28 0 24 Sena Danfa },I 39 0 25 Y6ra Sadiakhoiu M 49 0 26 Dialla Damba F 50 0J t t