Mission to Keneya for the training of health workers on Mectizan treatment: 1st -16th October 2005

t AAISSION TO KENYA FOR THE TRAINING OF HEALTH WORKER5 ON AAECTIZAN TREATI ENT (1" - 16th OCTOBER 2005) ,{r *.q i 1 r,,,,..#,,,.',e p r*o, r t Submitted to the African Programme for Onchocerciasis Control By t Stello AGUNyO, Dovid SAN6, Jomes SANG & Chukwu OKORONKWO 1 o o i, I JtToble of Contents AcKNowLEDoEMENTs ....................2 Executive summory 5 Bockground ERREUR I SIoNET NON DEFINI. Terms of ref erence.................. . ERREUR ! SIGNET NON DEFINI Constroints ERREUR I SIGNET NON DEFINI fnitiol meetings ERREUR I 5I6NET NON DEFINI Troining ERREUR ! SIGNET NON DEFINI. o. Attendonce .... ERREUR I SIGNET NON DEFINI. b. Approach... ..... ERREUR I SIGNET NON DEFINI. c. Content...... ..... ERREUR I SIGNET NON DEFINI. CONCLU5ION5 & RECOMMENDATIONS L6 Debrief in9 Meetings --------18 Teom Members & Addresses ------ ------19 Annex 1o: Activity plon (os originolly proposed) ERREUR I SIGNET NON DEFINI Annex 1b Activity plon (revised) Annex Lc Annex 2: troining timetoble in eldoret. Annex 3: list of ottendonce of eldoret Annex 4: troining timetoble in kokumo. Annex 5: list of ottendonce in kokumo. Annex 6: pre / post test CLINIC BASED AAECTIZAN DISTRIBUTION RE6ISTER ERREUR ERREUR ERREUR ERREUR ERREUR ERREUR ERREUR ERREUR SI6NET SI6NET SI6NET SI6NET SI6NET SI6NET SI6NET 5I6NET NON NON NON NON NON NON NON NON DEFINI. DEFINI. DEFINI. DEFINI. DEFINI. DEFINI. DEFINI. DEFINI.AnnexTz recording & reporting formots.. PERsONALTREATAAENTCARD............ .......ENNCUN ! STONET NON DEFINI. CLINICMECTIZAN TREATMENT 5UMAAARY FORAA...,..........................ERREUR I STEUET NON DEFINI. COAAMUNIry A,\ECTIZAN TREATMENT FORAA Enneun I sroNgr NoN DEFTNT Enneun I SreNEr NON DEFINI COAAAAUNITY BAsED A,\ECTIZAN DI5TRIBUTION RE6I5TER..............ENNCUR I SIGNET NON DEFINI AAECTZAN STOCK CARD Enneun I SIoNET NoN DEFINI. Annex 8: List of persons met ERREUR ! 5I6NET NON DEFINI Annexe9: Pre & post test onolysis results ERREUR ! SIoNET NON DEFINI TABLE 1: COMPARISON OF PRE AND PO5T TE5T RESULT5 AMON6 THE TRAINEES IN ELDORET Enneun ! Srexer NoN DEFINI. TABLE 2: COMPARISON OF PRE AND POST TEST RESULTS A,1I[ONG THE TRAINEES IN KAKUIA A CAMP Enneun I SIoNET NoN DEFINI. TABLE 3: COMP^RISON OF POST TEST RESPONSES OF HEALTH WORKERS AND COMMUNIry HEALTH WORKER5 ON THE RESPON5E ON ONCHOCERCIASIs AND ITS CONTROL IN KAKUAAA CAMP ,. ENNCUP I SIcNET NoN DEFINI. I It TABLE 4: COMPARIsON OF PRE TE5T RE5PONSES OF HEALTH WORKER5 AND COIAMUNIry HEALTH woRKERs oN THE REspoNsE oN oNcHocERcrAsrs AND rrs coNTRoL rN KAKUII A cAl p.. Enneun I SIoNET NoN DEFINI. rngue 5: col pARrsoN oF pRE & posr rEsr REspoNsEs oF THE HEALTH woRKERs........... Enreun I sI@NEI NoN DEFINI. r::: : ::::::: ::: :: ::: : ::::::r ::::::::: :: :::t['JJruxv,'ffii'.,,,", Acknowledgements The Teom is groteful to the followirp persons ond orjonisotions for their cooperotion, contributions ond ossistonce towords the successful completion of this mission: The former Director, Dr. A. Seketeli, ond stoff at APOC Heodguorters in Ouogodougou for moking ovoiloble the necessory finonciol ond logistic reguirements The WR, Kenya, Dr Peter Eriki, ond his stoff thot provided support ond contributed to the smooth functioning of the Teom The Director of Medicol Services, Ministry of H support. The District Medicol Officer in Eldoret ond his "1, th, Kenyo, for his Teom for their cooperotion ond ossistonce. Heotth MonooementJ . The Administrotive Officer in Chbrge of 5t Mory's Heolth Centre and her stoff for their cooperotion. . The Medicol Coordinotor, Kokumo fefugee Comp, Dr. Don Koros ond his teom for his logistic support ond colloborotion. . Heolth workers, community extension workers ond pther troinees thot ottended the troining sessions ond provided o weolth of knowledge onthe peculiorities of the situotion in their locolities. Lost but not leost the teom exp?esses immense grotitude to the driver ond security personnel who piloted members of the feom ove? severol kilometres of difficult terroin. 1 i I t APOC ASM CBD CDTI CDD CDDs c\w ComDT co CP DDASCO DDCO DDSC DEC DMO DMS DPC DRC EDM FRH GOK HE HIP ID IEC fPs IRC LF MC MDA MO MOH NC NOTF Acronyms Africon Progromme f or Onchocerciosis Control Assistont Sonitotion Monoger Community Bosed Distributor Community Directed Treotment with fvermectin Community Directed Distributor Community Drug Distributors Community Heolth Worker Community Directed Treotment Clinicol Officer Community Progrommes Deputy District AidslSTf Coordinotor Deputy District Clinicol Officer District Disease Surveillonce Coordinotor Diethyl Corbomozine District Medicol Officer Director, Medicol Services Diseose Prevention d Control Offtcer Democrotic Republic of Congo Essentiol Drugs & Medicines Fomily & Reproductive Heolth Government of Kenyo Heolth Educotion Heolth fnformotion & Promotion fdentif icotion fnformotion, Educotion & Communicqtion fmplementing Portners fnternotionol Rescue Committee Lymphotic Filoriqsis Medicol Coordinqtor Moss Drug Administrotion Medicol Officer Ministry of Heolth Notionol Coordinotor Notionol Onchocerciosis Tosk F orce I l NPO PHO PR REA REMO 5AE TB TBA TOR UNHCR VCT WHO WR Notionol Progromm e Officer Public Heolth Officer Public Relotions Ropid Epidemiologicol Assessment Ropid Epidemiologicol Mopping of Onchocerciosis Sev er e Adv er se Experi ence Tuberculosis Troditionol Birth Attendont Terms of Ref erence United Notions High Commission for Pefugees Voluntory Counseling & Testing World Heolth Orgonizotion WHO Country Representotive ! IExecutive Summary Humon Onchocerciosis is not o diseqse of public heolth significonce in present doy Kenyo, occording to REMO conducted in 1999. However, a Ropid Epidemiologico! Assessment conducted (REA) in 2004 to determine the prevolence of Onchocerciosis omong Sudqnese refugees in selected sites showed thot the diseose hod o prevolence of 6% omong the refugees surveyed. Some coses of severe onchocercol skin diseoses omong the refugees (9.4%) we?e olso observed. A clinic-bqsed treotment progromme wos recommended. However, due to large numbers of coses to be treated o community bosed treotment progromme wos plonned in Kokumo. This led to the invitotion of two consultonts (from Ugondo ond Nigerio) through the Africon Progromme for Onchocerciosis Control (APOC) to ossist the Ministry of Heolth in setting up o treotment project. The consultonts were requested to troin heqlth workers ond community extension workers in selected sites on the control of Onchocerciosis in colloborotion with the Notionol Onchocerciosis Tosk Force (NOTF). Two mojor constroints in the execution of this octivity were the lqck of optimol plonning of the entire progromme ond the existence of communicqtion gops betweenthe plonners ond officiols/portners ot other levels. Troining sessions we?e theref ore limited to only o doy of eoch locotion. For o fresh troining involving people who on qccount of the low prevolence of the diseose in the country due to its epidemiology know very little of the diseose this period is considered grossly insuff icient. After initiol meetings with WHO ond MOH officiols, the teom conducted troining sessions in Eldoret ond Kokumo Refugee Comp. The troinees we?e heqlth workers, os well os community extension workers, in Kokumo Comp. The troining content included diseose tronsmission & monifestotion, treotment, record keeping ond reporting, ond monogement of side eff ects. Some topics such os supervision, plonning, ond introduction to Community Directed Treotment (ComDT) could not be covered or oddressed well due to time constroints. fn Kokumo, the second doy wos used to kick-stort the treotment process under the supervision of the teom members. Porticipotory opproqches ond role ploys wete used os oppropriote to enhance troinees'understonding of the vorious topics. The following recommendotions ore mode in order to consolidote on whot have been done in the course of the troining: . There is need to procure/produce smoll guontities of TEC moteriols such os posters, flip chorts ond brochures for heolth educotion ond mobilizotion purposes to be utilized ot the clinics ond the comps. . Follow up troining will be needed in Eldoret ond Kokumo given the limited time utilized in the first troining sessions. The follow up troining need not be qn eloborqte one ond con be eosily hondled by the NC ond his teom. For this he will need support from MOH ond other portners. . Since the troinees from Kopengurio could not moke it to the troining, it will olso be necessory for the NC to conduct troining for them before releasing the Mectizon toblets for commencement of treotments of identif ied coses of Onchocerciosis. . The NC will need support from the GOK through the Ministry of Heolth to periodicolly supervise treotments in the aff ected oreos. . Formots for recording ond reporting have been developed during the mission. There is need to produce the clinic-bosed registers, community registers (for Kokumo Comp), persono! treotment cords ond the summary forms in needed guontities ond urgently moke them ovoiloble to the treotment qreos. It will olso be necessory to produce some limited guontities of meosuring sticks for use porticulorly ot the cqmp. Support from portners, porticulorly WHO, for this production will be needed. . The MOH need to colloborote with the WHO, South Sudon, bosed in Noirobi which is supporting the implementotion of CDTf in southern Sudon. Such colloborotion could moke for the development of o mechonism for the trocking ond follow up of those treated qt the vorious clinics ond comps once they return to their country. o ft is interesting to note thot the LF eliminotion in Kenyo is using the Moss Drug Administrqtion with Community Drug Distributors (CDDs) corrying out the treotments ot the community level. A modif icotion of the current strotegy to ComDT ond its introduction/usage for other community-bosed progrommes in Kenyo will further strengthen the involvement of communities ond ultimotely the heqlth system. . There moy be need for o progromm e review/ossessment by APOC in colloborotion with the AAOH ot the end of the f irst year of implementotion. The teom exp?esses its oppreciqtion to oll those who ossisted in the successful execution of the troining Progromme. 1.0 Background Onchocerciosis is not o diseose of public heolth signif iconce in present doy Kenyo. Following the discovery of endemic foci in the Kodero Forest qnd other oreos in the eorly port of thelOrh century, o vector contro! wos begun in the 1940s ond successful concluded. Results of Ropid Epidemiologicol Assessment (REA) ond Ropid Epidemiologicol Mopping of Onchocerciosis (REMO) corried out in t999 supported by APOC in Kisii, Homo Boy, Migori ond Mount Elgon districts revealed seven indigenous coses of onchocerciosis. Prior to thqt, unpublished studies ond surveys (Odhiombo-Josioh, Song, & Ngeiywo) hod revealed the presence of S.Naeveiond olso identif ied some suspected coses. Tt there f ore oppeored thot there is o potentiol f or the ?e-emergence of the diseose os o signif icont heolth problem in Kenyo. Agoin tn 2OO4 the Af ricon Progromme for Onchocerciosis Control (APOC) in colloborotion with the Government of Kenyo (GOK) through the Ministry of Heolth (MOH) conducted o Ropid Epidemiologicol Assessment (REA) to determine the prevolence of Onchocerciosis omong Sudqnese refugees in selected sites. The oreos visited included the Kokumo Comp in Turkono District, Eldoret in Uosin-6ishu District, Kopenguria in West Pokot District qnd Bokito Troining Center in Trons-Nzolo District. The REA reveoled: . A prevalence of 6% nodulor rote omong the refugees surveyed . There we?e coses of severe onchocercol skin diseqses omong the refugees (9.4%) . Tronsmission wos unlikely in the orid oreo of Kokumo . Very low prevolence (r2%) ond coses living for awoy from previously known breeding sites, which olso mode tronsmission to other sites unlikely. The REA teom therefore recommended the institution of clinic - bosed treqtment in the Kokumo Refugee Comp. The Ministry of Heolth decided to commence o treqtment progromme f or identif ied coses of Onchocerciosis in order to olleviote the diseose burden on potients ond relotions, ond olso reduce further chonces of recrudescence of the diseose in the country. While agreeing thot clinic - a bosed treotment will be best giventhevery low prevolence of the diseose in the western port of the country, MOH officiols felt thot since the mojority of the coses wos concentrqted in one atea - Kokumo Ref ugee Comp - the heolth services there might be completely overwhelmed by o cf inic-bosed treotment progromme. Tt theref o?e recommended the troining of community extension workers in oddition to the heolth workers in the clinics of the comp on the treotment of Onchocerciosis coses, ond opprooched the Monogement of APOC for support. This led to the invitotion of two consultonts (from Ugondo ond Nigerio) to ossist the Ministry of Heolth in setting up o treotment project in collqborotion with the NOTF. 2.0 Terms of Reference The consultonts we?e initiolly given the following terms of reference: . To focilitote troining of heolth workers on Community Directed Treotment with fvermectin (CDTI) in northwestern Kenyo: Turkono, Kokumo, Kopengurio, West Pokot districts ond UNHCR Comp. . To sensitize the quthorities of the districts ond UNHCR on CDTf . To brief ond debrief MOH, WHO ond UNHCR outhorities on the objectives ond outcome of lhe mission o To write o report on the troining to be submitted to APOC Monogement However, the consultonts ofter meeting with WHO off iciols ond the Notionol Coordinotor of the Progromme sow the need to revise the terms of reference in the light of the situotion on ground. The TOR were therefore revised os follows: . To sensitize heolth workers ond policy mokers on the problem of River Blindness in aff ected foci. . To troin heolth workers, ond community extension workers where opplicoble, on the control of River Blindness. . To introduce the concept of Community Directed Treqtment (ComDT) os o vioble st?ategy f or community heolth interventions . To ossist the MOH to develop o strotegy for the control of Onchocerciosis in off ected oreos of Kenyo . To develop o reporting formot for treotment with fvermectin ond estoblish an eff ective reporting system To brief ond debrief MOH,WHO and UNHCR outhorities on the objectives ond outcome of the mission To write o report on the troining to be submitted to APOC Monogement 3.0 Constraints o. From the tentotive progromme drqwn up, ond given the desire to commence treotments immediotely after the troining ot the dtff erent sites under the supervision of the consultonts, it wos cleor thot the ollocoted time wos not sufficient. This time constroint wos further occentuoted by lock of optimol plonning of the entire progromme ond the existence of communicotion gops betweenthe plonners ond officiols/ portners ot other levels. Routine qdministrotive motters thot should hove been oddressed earlier hod to be settled during the doys thot could hove been utilized f or training. E.s. . fn Noirobi, the DPC soid she wos seeing the budget for the troining for the f irst time on Mondoy, 3'd Octob er 2OO5. So the process for the release of funds hod to be initioted some doy. This meont spending on extro doy or two until the funds we?e releosed. o At Eldorek, the first doy of the troining wos used in poying'PR' visits, confirming troining venue, identifying troinees, ond moking other logistic orrongements. b. The time spent on trovel in-country simply complicoted motters. About 4 full doys were spent on the roods. Troining sessions we?e theref ore limited to only o doy ot eoch locotion. For o fresh troining involving people who on occount of the low prevolence of the diseose in the country due to its epidemiology know very little of the diseose this period is considered grossly insufficient. 4.0 lnitial Meetings The teom met with officer responsible f or Diseose Prevention & Control (DPC) in WHO, Kenyo, Dr. Joyce K. Onsongo, who sqid she just returned from o trip ond wos not owore of the mission or of the budget submitted by the Ministry of Heolth for the troining octivity. There were discussions on the best treotment opprooch given the findings during the a a Previous REA. The teom noted thot the treotment strotegy will determine the content of the troining. fn compony of the DPC qnd the Coordinotor of the Onchocerciosis Control Progromme, the teom met with the WHO Country Representotive (WR), Dr. Peter Eriki. The DPC introduced the teom ond the mission to the WR pointing out thot the visit wos o culminotion of o long process which storted with o REA exercise in some ports of western Kenyo. She noted thqt the REA teom hod recommended o clinic - bosed treotment given the low prevolence of the diseose. fn his remqrks, the WR expressed the hope thot qll the logistic orrongements for o successful mission hove been put in ploce. He noted thot since the teom will be visiting the P,efugee Comp in Kokumo which is under a diff erent UN Agency, the United Notions High Commission for Refugees (UNHCR), it moy be necessory to moke contoct with the Agency of f iciols. The WR, in respons e to a request by the teom thot IEC moteriols moy be needed for heolth educqtion in Onchocerciosis off ected oreos, promised to see whot support con be rendered in this oreo. Further discussions with the Notionol Coordinotor (NC) of the Onchocerciosis control progromme in Kenyo, Dr. Dovid Song, gove more insight on the situotion ot the comp ond the aff ected oreos. With this in view, coupled with the report of the ossessment mode ovoiloble by the DPC, the teom decided on the following: . Clinic - bosed treotment should be corried out in Eldoret ond Kompegunrio. The troining of the heolth workers in the two districts will be combined to moximize time. o A community - bosed treotment opprooch thot will focus on the identified coses will be instituted ot Kokumo. ft wos agreed loter thot not only conf irmed coses should be targeted but olso suspected ones. The teom mode o revision of the schedule of octivities olreody prepared by the NC given the number of doys ollocoted to the consultonts. See Annex t f or lhe revised schedule. At Eldoret, the teom met with the District Medical Officer. After a brief introduction, Dr. Song exploined the reoson for the teom's visit to the districl.He mentioned thot REA wos corried out in2004 ond o few coses of Onchocerciosis hod been identif ied omong Sudonese refugees in the district. He soid this lheref ore colled f or the need for treotment to eliminote the possibility of re inf ection of the indigenous populotion. Becouse of the low prevolence, he soid clinic bosed treqtment hos been opproved os the strotegy for treatment. The teom with the help of the DMO identified clinics within the district thot the refugees visited for treotment. These we?e 5t. Mory's clinic, Kopsoyo (o mission clinic); Kopsoyo heolth clinic (run by the municipol council); ond Moi teoching and ref errol hospitol. ft wos f inolly decided thot the only center for treotment of Onchocerciosis coses should be St Mory's clinic, Kopsoyo, since it is the one most visited by the refugees. Other coses from other centers ore to be ref erred there. This will olso ease ?eporting. The teom olso with the help of the DMO estoblished o reporting system from the district to the notional office. ft identified o foco! person ot the DMO's off ice (Richord J . Cheserek) who would help supervise treotment octivities ond collect treotment doto from the clinic on monthly bosis to be forworded to the notionol coordinotor. On the some doy, the teom met with Sister Potricio, Administrotor, 5t. Center, Kopsoye, Eldoret, ond o few of her stoff. They were giventhe bockground ond reqson for the mission. Hoving noted thot the Sudonese immigronts pref er visiting the Center to other focilities, including government ones, they were reguested to identify those who could be troined. The Administrotor off irmed thot o lot of the immigronts visit the center ond move on to other ploces. She soid they are 6eing encouroged to bring their children for immunizotion, but this is yet to be occepted by the immigronts. At Kokumo, the teom met with Dr. Don Koros, the Medicol Coordinotor for the fnternotionol Rescue Committee (fRC), ond Dr. Kohi Vincent, heod of curotive services in the Comp. They highlighted os follows: . fRC is one of the implementing portners (IPs) of lhe UNHCR thqt hondles oll heolth reloted issues in the comp. . The Comp comprises of refugees from Sudon, Somoli, Ethiopio, DRC, Ugondo, Rwondo, Burundi ond Eritreo. More thon 60% of the immigronts ore from Sudon followed by Somolio. Most of the immigronts ore in the comp for economic ond heolth reosons. . The first bqtch of 600 persons will be going bqck to Sudon within the month under o voluntory repotriotion progromme. ft wos expected thot obout 70,000 refugees in the comp will be repotrioted within o 5 - yeor period. . Community heolth workers ore trqined os port of the community outreoch services of the Comp, but there is o high turn over rote os job openings ore found in Sudon. t Onchocerciqsis coses havebeen observed in the comp but moinly omong new Sudonese orrivols Cases thot visited the hospitol have been treated with Mectizon earlier sent by the MOH. The number treoted is however not known os they ore clossif ied os others. No side eff ects have been reported so for f rom the treotments corried out. With the community bosed treotments being instituted for the treotment of Onchocerciosis, the fRC will reoch agreement with the NC on type of reporting (speciol or onnuol) ond times. There moy be need to mork out one or two months for treotments in the cqmP. Those being repotrioted arebeing prepored on follow up octivities with regords to Onchocerciqsis, drocunculiqsis ond schistosomiosis 5.0 Training o. Attendonce The troining sessions in both Eldoret ond Kokuma we?e ottended by clinicions, heolth workers bosed in the clinics identified ond community heolth extension workers ot the Kokumo F.efugee Comp. For lists of ottendonce of both sessions see onnexes 3 ond 5. b. Approoch The teom conducted apre-test to oscertoin the extent of the knowledge of porticiponts on principolly the diseose ond its treotment, olthough there we?e a f ew guestions on the strotegy. The lottet we?e not token into occount in the onolysis of the results os CDTf wos not properly oddressed in course of the troining. A post test wos odministered ot the end of the troining to ossess the understonding of whot hod been tought. (A copy of the Pre/Post Test Questions is ottoched os Annex 6). Results from the different troining locotions we?e analyzed seporotely. See Tobles 1- 6 in Annex 9. A comporison wos mode between the results of the pre ond post test of the porticiponts in both Eldoret ond Kokumo. fn Kokumo comp o further onolysis wos mode within the different codres of troinees. The results of lhe pre ond post tests in Eldoret district revealed no signif icont differences oport from when it come to treotment ond dosage determinotion. There wos olso some difference with regords to the vector of the diseose. Of diseqse tronsmission qnd monifestotions, the respondents were knowledgeoble. ft wos however omozing thot some a a a a D o respondents even after troining still believed thot the diseose is trqnsmitted through other meons other thon on inf ective bite of o blockf ly. For Kokumo comp, the results showed no signif icont diffe?ence on knowledge of the diseose monifestqtions 5etween the pre ond post test results. However f or the rest of the voriobles there wos o signif icont diff erence (P<0.001) in the pre ond post test results. When on onolysis wos mode within the employment ronks i.e. heolth workers ond community heolth workers, there wos no signif icont diff erence on their knowledge on the onchocerciosis diseose, its monifestotions, tronsmission ond treotment. Nonetheless, eoch of the voriobles recorded a greater percentage of health workers being knowledgeoble (understondobly) thon the community heolth workers. Further onolysis of the pre ond post test results within the employment cotegories revealed no signif icont differences omong the voriobles for the heolth workers. This wqs not however the cose for the community heolth workers we?e there we?e signif icont diff erences between the pre ond post test results. On the whole the onolysis results showed qn increose in the knowledge of the troinees on the onchocerciosis diseose ond treotment ofter the troining. For the troining itself , porticipotory opprooches were used to discuss such topics os heolth educotion, cotimunity directed treotment (only ot Eldoret), record keeping ond reporting. The other topics we?e covered through presentotions by members of the teqm. Participonts were however encouroged to moke inputs of ony time during the presentotions. At Kokumo, time wqs devoted f or role ploys on heolth educotion ond treotment procedure. The second doy wos set oside f or field proctices, during which some ports of the Comp we?e mobilized, heolth educoted ond treotments given to those who presented with the clinicol feotures of the diseose or hod personol treotment cords, under the supervision of the teom members. ft wos olso decided thot emphosis should be loid ond more time spent on diseose monifestqtions. The issue of side eff ects ond SAEs wos olso to be given good considerotion. The need to dwell more on clinicol monifestotions, to be conveyed in very cleor ond simple terms, become more pronounced ofter the first troining in Eldoret, when of the end of the troining (which wos only for o doy) o few porticiponts still wonted to know how Onchocerciosis coses con be identif ied. a a c. Content The teom oddressed bosicolly the some issues of both troining centers, olthough emphosis voried os stoted obove. ft hod been decided thot qdditionol issues such os supervision should be oddressed during the troining ot the Comp this wos not to be due to the limited time ovoilqble 5ee annexes 2 ond 4 f or the progromme of troining at both Eldoret ond Kokumo. Generolly, the following topics wete discussed: i. Troining Objectives & Expected Outcome The teom listed the troining objectives ond expected outcome os follows: Objectives River Blindness tn aff ected foci. opplicoble, on the control of River Blindness. (ComDT) qs o vioble st?otegy f or community heolth interventions Expected Outcome control of River Blindness through Mectizon chemotheropy blindness thus checking recru descence. in Eldoret, Kopengurio & Kqkumo Comp ii. Diseose Trqnsmission/Monif estation/Burden The lif ecycle of the vector wos briefly highlighted. Thereofter lhe clinicol monifestotions of the diseose we?e dwelt on. Porticiponts were olso introduced to the prevalence of the diseose worldwide ond in Kenyo ond Sudon. The burden of the diseose on sociol lif e, educotion ond its economic impl icotio ns wer e present ed. iii. Treotment for Onchocerciosis The troiners discussed the vorious methods of treotment of onchocerciosis diseose. fvermectin wos presented os the drug of choice, licensed int987 by Merck &,Co,for the treotment ond control of onchocerciosis. ft storted being used for moss treotments ofter community triols by WHO & OCP showed the eff ectiveness ond sofety of the drug. Porticiponts were tought dosoge determinotion, through height, using o colibroted stick, os the pref erred method on occount of its offordobility ond ease of use. At the clinics weight could still be used os the scoles ore usuolly ovoiloble. On eligibility criterio ond contro indicotions, the porticiponts were told thot there we?e concerns obout treotment of certoin cotegories of people thot were eventuolly P?oven unfounded. The porticiponts were odvised to treot oll onchocerciosis potients oport from those potients who ore bedridden, children under 5 yeors,l week loctoting mothers ond the pregnont women. However, where possible o drug stock should be kept for these tempororily ineligibles. Porticiponts were odvised to ensure thot potients toke the drugs on spot. iv. Monogement of Reoctions Porticiponts were informed thot thou gh Mectizqn hos a vety wide sof ety morgin, it is !ikely thot side eff ects moy occur. Most of the side eff ects which occur, it wos noted, generally resolve themselves within 2 - 3 doys, but where they continue oppropriote treotment/ref erral should be undertoken. The teom highlighted thot side effects ore most common ot f irst treotment; intensity & prevolence of reactions dec?ease drasticolly by Znd round of treotment; ond side eff ects ore minimol, olmost non - existent in subseguent treotment rounds. The focilitotors olso coutioned thot the possibility of SAEs exists, stressing thot: . fntensity & severity of odvers e experiences ote probobly reloted to high density of microf ilorio in the blood, before f irst treotment. . Potients with high microfiloremio of loa loaare at increosed risk for the occurrence of serious odverse experiences after treqtment. . Concomitont treotment with DEC ond Mectizqn, for River Blindness or LF, porticulorly where loa loa is endemic, is NOT recommended. v. Record Keeping ond Reporting The teom designed reporting formots odopted from existing Progrommes but with chonges to suit the locol situotion. These included the personol treotment cord, registers for community bosed ond clinic bosed treotment, treotment summory forms for the clinics ond communities. (see annex 7 f or the vorious formots). The porticiponts were encouraged to use the treotment summories to submit treotment doto ond ivermectin usqge to the notionol coordinqtor. For Eldoret district, o focol person wos identified who would on o monthly bosis collect treotment doto from Kopsoyo mission clinic ond forword to the notiono! coordinotor. fn Kokumo comp, where treotment is supposed to be toking ploce within the zones,it wos odvised thot ot the end of the month summories be mode ond sent to the IRC focol person who would then send the report to the notionol coordinotor. vi. Mectizon fnventory An ivermectin stock cord wos designed f or keeping ivermectin records in ond out of communities. (See AnnexT).The porticiponts were odvised ogoinst misuse or loss of drugs. vii. Heolth Educotion & Mobilizotion fssues covered under this topic included definitions ond differences belween heolth educotion ond mobilizotion, chonnels ond torgets of heolth educotion.K.y heolth educotion messoges were discussed, ond the need for continued complionce to treqtment emphosized. At Eldoret, it wos pointed out thot potients that receive treotment should be encouroged to stoy within the locolity for ot leost 3 - 5 doys in cose of ony side eff ects. viii. fntroduction to ComDT The concept of Community Directedness wos brief ly discussed ot Eldoret only. Porticiponts gove their experiences on community-bosed progrommes ond looked ot the challenges of gendering community involvement ond porticipotion in the plonning ond implementotion of heolth octivities. The odvontoges of community directed interventions were highlighted to incfude: high covetage, empowermenl of the community, convenience of strategy ond therefore sustoinoble, ond communities beyond the end of the rood have access to heolth core 6.0 Conclusions & Recommendotions Following the conclusion of the troining sessions in both Eldoret ond Kokumo, the teom mokes the following recommendotions: . There is need to procurelproduce smoll guontities of TEC moteriols such os posters, flip chorts ond brochures for heolth educotion ond mobilizotion purposes to be utiltzed ot the clinics ond the comps. Fortunotely, the WR hqs promised to look into whot form of support could be rendered in this oreo. . Follow up troining will be needed in Eldoret ond Kokumo given the limited time utilized in the first troining sessions. The follow up troining need not be eloborote ond con be eosily hondled by the NC ond his teom. For this he will need support from MOH ond portners. o Since the troinees from Kopengurio could not moke it to the troining, it will be necessory for the NC to conduct troining for them bef ore releostng the Mectizon toblets for commencement of aa treotments of identified coses of Onchocerciosis. This is being followed up by the NC ond his teqm. The NC will need support from the Ministry of Heolth ond portners to periodicolly supervise treotments in the affected oreos. Formqts f or recording ond reporting hove been developed during the mission. There is need to produc e printed clinic-bosed registers, community registers (for Kokumo Comp), personol treotment cords ond the summory forms in needed guontities ond urgently moke them ovoiloble to the treotment oreos. Assuronces hove6eenreceived from the NC thot the personol treotment cords arebeing produced. ft will olso be necessory to produce some !imited guontities of meosuring sticks for use porticulorly ot the comp. Support from portners, porticulorly WHO, for this production will be needed. Though SAEs ore not onticipoted, ond minor reoctions ore expected to decrease drosticolly ofter the f irst treotment, there is need to preporefor these. APOC Monogement kindly agreedto provide funds for the procurement of drugs to toke care of reoctions (onolgesics, ontipyretics, IV f luids ), os o sustoinobility opprooch such drugs in futureneed to be provided by either UNHCR (for the comps) or the MOH (for the clinics). The WHO con olso be of ossistonce through its EDM progromme in this regard. ft is interesting to note thot the LF eliminotion in Kenyo is using the Moss Drug Administrotion with Community Drug Distributors (CDDs) corrying out the treotments ot the community level. Currently, DEC ond olbendonzole arebeing used for the LF eliminotion since the qreos ore not Onchocerciosis endemic. A modificotion of the current strotegy to ComDT ond its introduction/usage for other community bosed progrommes in Kenyo will furth et st?engthen the involvement of communities ond ultimotely the heolth system. Since most Sudonese know obout Onchocerciosis (coll it Ov), those thot visit the heolth focilities where the troined personnel exist should not only be treoted (if they present with symptoms of the diseose) but olso heolth educoted so thot the messoge canbe spreod wherever they moke /find comp. Though focol persons for reporting of treotments hove been identif ied in Eldoret ond Kokumo (none yet for Kopengurio), there is need to reoch agreement on times of ond chonnels for submitting reports using the summory treotment form developed. a o a o aa The MOH need to colloborote with the WHO, South Sudon, bosed in Noirobi which is supporting the implementqtion of CDTf in southern Sudon. Such colloborotion could moke for the development of o mechonism for the tracking ond follow up of those treated of the vorious clinics ond comps once they return to their country. There moy be needfor o progrommereview/ossessment by APOCin cof loborotion with the MOH ot the end of the first year of implementotion. 7.O Debrief ing Meetings The teom wos not oble to meet ond debrief the Ministry of Heolth ond UNHCR officiols os hod been plonned. The debriefing of the WHO off iciols went on os plonned however. fn ottendonce we?e Dr. Regino Mbindyo (NPO/EDM-WHO, Kenyo), Dr. Joyce Lovusso (NPO/FRH -WHO , Kenyo), Dr. Joel Kongongi (NPO/TB & HIV- WHO, Kenyo) ond Mrs. Euloliq Nomoi (NPO/HIP-WHO, Kenyo). The WR ond DPC were not oble to ottend. The WR wos represented by Dr. Joel Kongongi who promised to debrief both the WR ond DPC. A brief wos given on the onchocerciosis situotion in Kenyo. Dr. 5on9 mentioned thot though Onchocerciosis is not o diseose of public heolth concern in Kenyo, ofew indigenous coses hod been identified during the REMO/REA thot wos corried out in1999. REA wos corried out ogoin in 2004 ond o number of coses we?e identif ied omong the Sudonese refugees in Kokumo, Kopengurio ond Eldoret. ft wos therefore importont thot treotment be carried out in the lhree specific sites hencethe teqm's visit. The teom gove o highlight of the troining in the 2 sites. Teom members mentioned the problems they encountered ond there ofter gave recommendotions thot they hoped would help consolidote the troining they hod corried out. From the discussions ofew issues were roised ond these were: - The need to develop monitoring ond evoluotion instruments - The need to hove o smoll group of troiners of troinees (TOTs) on ground for on going troining purposes - The need to stote specificolly whot the role of WHO is with regard to the onchocerciosis problem in Kenyo - The need f or integrotion of the progromme into the heolth system ond other relevont systems. fn response to these the teom soid: The plon for troining of troiners of trainees is underwoy. This will be done by the NC ond his teom Through discussions with the DMO - Eldoret ond Heolth Coordinotor - Kokuma,the teom tried to ensure thot reporting ond supervision would be integroted within the systems. fn the 1't meeting with the WR he hod promised thot WHO look into the issue of production of fEC moteriols for mobilizotion ond heolth educotion. WHO could olso support the production of recording ond reporting formots for treqtment. 8.0 Teom Members & their Addresses NAAAE Stello AGUNYO Chukwu OKORONKWO Dr Dovid SANG Jomes SANG a trl4Nl '-- ii ' i"'tl !tl{ *fir;. 'ftf'q" fiisill-r] Ll1 lt,iI, r-iiJ#l il'*o ,1i:t;rl'-t' " a: 'l e t'", !. ti t lUi:+ -:{+u!tp"',f: :.t ?h-{etrE.;:$)i,:'t l ',i rt1n ,! : t1| ,li ilril 1i|a: jlE: llr .t', ,'1. ol 9.0 ANNEXES Annex 1o: Activity Plon (As originolly proposed) No. of doys Dote Activity 2 Yt - 2nd oct. 2oo5 1 3'd oct. 2oo5 t 4rh oct. zoo5 1 sth oct. zooS District DHMT t 6th oct.2oo5 comp odministrotion ond heolth coordinotor 2 7th - 8th od.zoo5 1 9th oct. zoo5 2 lorh - llth oct zoob t lzth oct. ?oos coordinotor ond agreeing on the woy forword t 13th oct. 2oo5 t !4th oct.2oo5 1 15th oct. zooo hospitol t 16th oct 2oo5 1 !7rh oct. zoos 1 18th oct. ?oo5 t 19rh oct. ?oo5 (H) Officiols L zorh oct. 2oo5 Noirobi entotive Annex 1b Activity plon (Revised) No. of doys Dote Activity ? 1st - 2nd oct. 2oo5 1 3'd oct. 2oo5 ents - Noirobi L 4th oct. 2oo5 continued t 5th oct. 2oo5 Noirobi for Eldoret 2 5th - 7th oct.2oo5 ond Kopengurio for troining & beginning troining off T 8th oct. 2oo5 Eldoret for Lodwor 1 9th oct. ?oo5 tcr for troini t loth oct. ?oo5 of L l1th oct. 2oo5 the treotment cess 1 L?rh oct. ?oo5 Kokumo for Eldoret t 13th oct. 2oo5 Eldoret for Noirobi 1 14th oct. ?oo5 of f iciqls 1 15th oct. 2oo5 ofr L 16th oct. 2oo5 t Noirobi for Enteb s Annex tc s/N DATE FROA,1 TO A,IODE OF TRANSPORT 1 lsr /?nd October 2005 Entebbe / Logos Noirobi Air 2 5th october 2005 Nqirobi Eldoret Rood 3 8th october 2005 Eldoret Lodwor Rood 4 9'h october 2005 Lodwor Kokumo Rood 5 !?th october 2005 Kokumo Eldoret Roqd 6 13th october ?005 Eldoret Noirobi Rood l6th October 2005 Entebbe / Logos Entebbe/Logos Air Annex 2: Troining Timetoble in Eldoret Troini of Heolth Workers in Eldo T'h octo 2@5 FocilitotorTopicTimes/N SongRegistrotion of PorticiPontsI 9.00 - 9.15 om Songfntroductory Remorks2 9.15 - 9.30 om SongGenerol Self - fntroduction3 9.30 - 9.45 om StelloPre - Test4 9.45 - 10.00 om ChukwuTroining Objectives & Outcome5 10.00 - 10.15 om 5on9Diseose Tronsmission6 10.15 - 11.30 om Chukwu/SongDiseose Monifestotion7 11.30om - l?.15 Pm ChukwuDiseose Burden8 t2.15 - 1.00 pm Break9 1.00 - 1.30 pm Chukwu/SongTreotment for Onchocerciosis10 1.30 - 1.45 pm ChukwuMectizon Treotment - Advontoges 11 t.45 - 2.00 pm StelloEligibility & Contro fndicotionst2 2.OO - 2.15 pm StelloDosoge Determinotion13 2.15 - 2.45 pm Song/Chukwu2.45 - 3.15 pm Monogement of Reoctionst4 StelloRecord Keeping15 3.15 - 3.45 pm Stello3.45 - 4.00 pm Reportingt6 StelloMectizon fnventoryt7 4.00 - 4.15 pm Chukwu4.15 - 4.30 pm Heolth Educotion18 t9 4.30 - 4.45 pn fntroduction to ComDT Chukwu 20 4.45 - 5.00 pm Post Test Stello 2t 5.00 - 5.15 pm Closing 5on9 Annex 3: List of Attendonce ot Eldoret Troinino of Heolth Workers in Eldoret ot Moi Teochinq & Attendonce Annex 4: Troining Timetoble in Kokumo Troining of Heolth Workers/ Extension Workers in Kokumo Comp. loth - !?th October ?OO5 s/N Nome Designotion Address 1 Michoel Mwosome DDsC/PHO 5665 Eldoret 2 Richord Musomboi Lob Tech 7648 Eldoret 3 Richord l. Cheserek DDAsCO/DDCO 5665 Eldoret 4 Nelly Jerobon Lob Tech 3 Eldoret 5 Fronsisco Keino VCT Counsellor 1094 Kopsoyo 6 Evons Jumoh Adiedo Director, Empowering Comms. Perceptions Org Box 6365, Eldoret 7 John Bii System Admin 4606, Eldoret 8 Dr. Chorles Wolekhwo Medicol Practitioner/ Lecturer 4606, Eldoret Time Topic Focilitotor Day 1 - ldh Octuber 2OO5 Am 9:00 - 9:10 Registrotion of Porticiponts Song 9ttO - 9:2O Generol Self - fntroduction Song 9:20 - 9:30 fntroductory Remorks Song 9:30 - 9:45 Pre - Test Stello Referrol Hospitat 6uest Center 7th October 2005. 9:45 - 10:00 Troining Objectives & Outcome Chukwu 10:00 - 10:20 Diseose Tronsmission Chukwu/Song tOt?O- 10:50 Diseose Monifestotion Chukwu/5on9 10:50 - ll:20 Diseose burden Chukwu ll:2O - 11:40 Tea Break PM 11:40 - l2:lO Treotment for Onchocerciosis Chukwu/5ong l2:lO - 12:30 Mectizon Treotment - Advontoges Chukwu 12:30 - 1:00 Eligibility & Contro fndicotions Stello 1:00 - 2:00 Lunch Break ?tOO - ZtLO Dosoge Determinotion & treotment procedure Stello Z:tO - 2:40 Role ploy (Tx ) Stello 2:40 - 3:20 Monogement of Reoctions Song/Chukwu 3:20 - 3:50 Record Keeping& reporting Stello 3:50 - 4:30 Heolth Educotion Chukwu 4'30 - 5:10 Role ploy (HE) Chukwu 5:10 - 5:25 Post Test Stello Doy 2 llth October 2@5 AM 9:00 - 2:00 Sociol Mobilizotion Troinees PIA 2:00 - 5:00 fdentif icotion of Eligibles Troinees Heolth Educotion Troinees Recording Troinees Treqtment Troinees Annex 5: List of Altendonce in Kokumo Troining of Kokumo, lOth & l1th October 2@5 Attendance s/N Nome Job Description Place of lUork 1 Michoel Some co IRC Hospitol 2 Dr Don Koros MC Kokumo 3 Andrew M. Nguqi Sonitotion (Env) Comp 4 Lindoh Mutuo co Clinic 5 5 Dr.Gichere N. R MO IRC Hospitol 6 John Hotnor cHw Zone 5 7 Jomes K. Kopchi PHO Kokumo 8 Dovid Moju cHw Zone 3 9 Joseph Ngonq cHw Zone 4 10 Augustine Atugo cHw Grp t8]9 11 Gabriel Dhieu Duol cHw Grp 34,35,54 t2 Ludio Adhieu Ayii cHw Grp 33,37 13 John Kuol Chol cHw Grp 32 L4 Soroh Nyibol cHw Grp 22,26 15 Gloria Nyongol TBA t6 Mory Ajoh cHw Grp 15,16 t7 Mory Ayeii cHw Grp 17 18 Jocinto Mutungo Nurse Kokuma comp t9 Titus Kyolo LAB Kokuma 20 Khot Moketh Luche cHw Kokumo 2t Dr. Kohi Vincent Heod, Curotive serices IRC 22 Dqniel Atem Mentol Heolth fRC, Kokumo 23 Mojok Chol cHw IRC 24 Philip AnyokWel cHw IRC 25 Acuoth Moyen Joseph cHw Grp 50 26 Moriji Garong CP Manager Kokumo 27 Peter Kon Thil MH Supervisor Kokumo 28 Philip Pojok Arok cHw Kokumo 1 29 Abrohom Ring Kuil cHw Kokumo 3 30 Agnes ftubo cHw Grp lO C 31 Joseph Achulo cHw Grp 58 C 32 John Akunguet c\w Kokumo 3 33 Mory Amuor cHw Kokumo 36 34 Doniel Chol TBA Supervisor Kokumo 2,3 35 Monico Akuch cHw 9AlB 36 Elizobeth Achieng TBA Supervisor 8, ABCD-7 38 Aret Moyon cHw Zone 2 39 Bono Mokiol cHw Grp 5,6 Zone 6 40 Philip lokonyon CHW Supervisor Grp 58,Zone I 4t Eliono Oyolo TBA Grp 58,Zone I 42 Khoshioro Odeoro cHw tO A,Zone t t )Annex 6: Pre / Post Test Troininq of Heolth Workers in Kenyo Pre/Post Test Tick thot which does nollapply 1. A monifestation of river blindness is: o. Honging groin b. Rough & scoly skin c. Troublesome itching d. Constont Dehydrotion e. None of lhe obove Tick the corcect option ?. The vector for river blindness is: d. Housef ly e. None of the obove o. Mosguito b. Sondfly c. Blockfly 3. The vector for river blindness breeds in: o. All rivers only b. All Rivers d Streoms c. Fost f lowing woters d. Stognont Woters e. Anywhere 4.The porosite thqt couses river blindness is: o. Mosguito b. Sondf ly c. Blockf ly d. Housef ly e. None of the obove 5. The porosite for river blindness is tronsmitted by: o. Exposureto unheolthy environment b. Drinking impure woter c. Toking inf ected food d. Blood Tronsfusion e. None of the obove 6. The drug of choice for the treotment of river blindness is: o. DEC b. Suromin c. Mectizon d. Ponodol e. None of the obove 7. The drug of choice f or the treotment of river blindness is token: a. Once ayeff b. Once o month c. Once o guorter d. Once aweek e. None of the obove 8. The moximum dosoge to be g:en: o. 5 toblets b.4 toblets c. 6 toblets d. 3 toblets e. None of the obove 9. How is dosoge determined? a. Age b. Sight c. Height d. Assumption the obove e. None of 10. The drug of choice for the treotment of river blindness should be odministered by: o. Heolth professionols only b. Troined Heolth Professionols c. Nurses & Doctors only d. Any troined community member e. None of the obove 11. fn communities where the river blindness diseose is hyper or meso endemic, who should be treoted: o. Everybody b. Only those found to be inf ected c. Everybody obove 10 yeors d. The populotion thot ore eligible e. None of the obove 12. CDTI meons o. Communol Demond for Treotment with fvermectin b. Community Decision Toking fnitiotive c. Common Def ense Agoinst fnfections d. Community Directed Treotment with fvermectin e. None of the obove 13. Who arethe portners in CDTI: o. The Heolth services & communities only b. The leoders ond members of the communities only c. The heolth services, communities, N6Os & Drug Suppliers d. The River blindness drug & community members e. None of the obove 74. How ore community CDTI progromme decisions mode? o. by community members in o general meeting together with their leoders b. by the community leoders c. by the one who distributes the River Blindness drug d. by the heolth workers e. none of the obove 15. CDD meons q. Communol Defense ogoinst Diseoses b. Community Directed Distributor c. Collective Demond in Diseose prevention d. Community Drive ogoinst Diseoses e. None of the obove 76.The full meoning of APOC is: o. Another Progromme f or Onchocerciosis Control b. Agency f or the Prevention of Onchocerciosis c. Af ricon Progromme f or Onchocerciosis Control d. Agency f or the Preventton of Onchocerciosis in Communities e. None of the obove Annex 7: Recording & Reporting Formots National Onchocerciasis Control Programme PEP5ONAL TPEATfiIENT CAPD Nome M/F Age Region of origin Zone Dote of ltt Treotment Tx No 1 2 3 4 5 6 7 8 9 10 LI t2 13 Yeor 2005 ?oo6 2007 2008 2009 20LO ?otL 2012 20t3 20t4 ?ot5 20t6 2017 Tick Notionol Onchocerciosis Control Progromme CLTNTC IUECTTZAN TREATqUENT SUIU/UARY FORqU CLINIC/DI5P. DTSTRICT REPORTTNG DATE: from_ / -/ -!o-/ -/ - Supervisors Nome Sionoture Dote / / NAME OF CLINIC BAsED DI5TRIBUTOR Totol No. of people with Severe Reoctions Totol No. of Mectizon received in this clinic/dispensory Totol No. of Mectizon toblets used in this clinic/dispensary Toto! No. of Mectizon toblets wasted/domoged in this clinic/dispensory Toto! No. of Mectizon toblets lost in this clinic /dispensory Totol No. of Mectizon toblets expired in this clinic/dispensory Totol No. of Mectizon toblets remoining Totol No. of people treoted with 1 toblet 2 toblets 3 toblets 4 toblets Totol Tobs by Dosoge Totol No. of people treated with Mectizon tqblets Totol estimoted Toblets needed for the next treotment round Clinic bosed distributor's signotute- Dote -/-/- Notiono! Onchocerciosis Control Progromme COI4 14 UNTry N4 ECTTZA N TR EA TI4 EN T FORI4 Zone No: Community: District: Nome of CBD: Treotment dote: to Treotment round Totol No. of Household s registered Totol Populotion Totol no. of women who delivered in the lost week Totql no. of women who were pregnont Totol no. of people who were very sick Totol no. of persons treoted Refused:- Totol no. of persons who refused or were obsent: Absent: _ Totol no. of persons with severe side reoctions Totol tobs by dosogeTotol No. of people treoted with 1 toblet = 2 toblets = 3 toblets = 4 toblets = Totol no. of Mectizon received in this community Totol no. of Mectizon used in this community Total no. of toblets missing (indicote if stolen, lost, etc) Lost Stolen Expired Totol Tobs Missing Totol no. of Mectizon remoining Totol no. of estimoted toblets needed f or next treotment round Totol no. of treqtment locotions in this community Supervisor's Nome, Signoture, fD No, Dote: CBD's signoture, fD No., Dote N oN F. oN o\oo(v @oo(\t Noo(\J \oooN lrOooN t- >LDf= a)o() $E =v,5P s o c)ongo '6: x a)(,) q) or q) Eoz vtFEq) Fo o- Sc;at z- 0)+oa !q) ELJ+q) d I Fd i-.g a)l,lo I -o q) r/l =rF 0) d I ol i:g osgr .. q) oL3o- Eiloo-tL .. -Y .'.(J !Ltn .. ilf,o €dt r.S :! =3rLL xvroo(oP t/)6 tU ll-\z co I .9LF .9a L o+ = -ot-F .9T' q) .E rF o 0) E oz (J :EE o) -.tr+ r{- o 0) Eoz ioN +() o) =\F o q)()L =ot/) F nqrs EU $E -'{EdLhr 5Hht .2 ci E?(r\ ENOF -s \lPSo\ E8rdzs H s d u, Fz IU €F lJ-'dF co z tU H(D IJ(D (,) oa RE @ oN t. o N \o oN ro oN sf oN (o o$I N oN oN o oN o\ooN @oo(\J NooN \ooo(\t roooN x 0)(n o)gr q) E oz z (r) IO -z !q)g t-J a)d. I Fd.tq) o .C {- c,CLq) d I l-C AL|. Lq) ta -o I 'o q) vt =I a) al I d .i: E otrgl q, OLEo- Eiloo-lr- .. _-Y =' (, lL ti .. If,o = cit r.S :E =srl!l+ xraoo(/)g dio tu ll-)z dt 2H(D Hd o IL o llJ(D JJl{ oz o-f od.(D oz tUz oN ;z tU =TUJFF TUo lr- o TU =z tr) l-{a tluF a $ n N arq EREN cn l-9l&$ FtrtrtnsLiEcioz :pN(, l-lLI\ su Edo\ 5ad rAOl-z3 \ N a,LJ 9L .EIn'6E8 E' ogts|2z G'L = E' .Egooo .U '- or9E+!,rz.o o(, Es o6 = .FoE-ds EUl <.9 !B oa,c(,iT otr .C|J o6 !q) .=q!|JsroLI si a-$ q) oa zo d AL \) \z L) o]-o z N 6 u, = q, E E C'L cnoL o- - oL+s o\) .2o .g(, 3-q,(, o .L as o os .9 .l- oz Annex 8: List of Persons Met s/N Name Designation Address 1 Dr. Peter Eriki WR WHO, Noirobi ? Dr. Joyce K. Onsongo DPC WHO, Noirobi 3 Dr. Dovid Song NC Ministry of Heolth, Noirobi 4 Jomes 5on9 Mqloriq Control officer Ministry of Heolth, Noirobi 5 Dr. Don Koros Medicol Coordinqtor fnternotionol Rescue Committee, Kokumo 6 Dr. Vincent Kohi Head, Curotive services fnternotionol Rescue Committee, Kokumq 7 Dr. Dqvid Rotich DMO Eldoret 8 Sister Potricio Administrotor 5t. Mory's Hospitol, Kopsoyo 9 Dr. Regino Mbindyo NPO/EDM WHO, Kenyq 10 Dr. Joyce Lovusso NPO/FRH WHO, Kenyo n Dr. Joel Kqngongi NPO/TB & HIV WHO, Kenyo t2 Mrs. Eulolio Nqmoi NPO/HIP WHO, Kenyo ANNEXE 9z Pre & Post Test Anolysis results Foctor PRE TEST PO5T TEST vEs NO TOT YES NO TOT monifestqtion of the river blindness seose YES NO TOT to ra (fu.g) zd(sa.r) lt r thot 4 (53%) NO TOT \ (ts.g't")7 zo N.t.oor isl 3e4 4s (e0.7%) 27 37 (86%) 43 67 L9 43(412%) 7 d (86.1%) fi (47.2%) 7 t4 (?8.e%) 34 (?4.4%) 9s (52.8%) 0 22 l6t.t%)6 2 (5.6%) 0 to (27.8%) 7 to 'QB.0or t nov-ector 5 bllud,nffP^hrag$s inu (t4%) 3 (8.3%) 36 <0.0010' '7 <0.05 36 NS <0.05 N5 <0.001 <0.05 36 36 'QBBbr 7 7 7 7 h If lood 24 (55.!%) ce5 nt river the 15 ?8 43 33(343%) Gtyi 7 (h.tv,) once oyeat d imum 8 (rB.oz) 3{ (81.4%) ls 4s & (7?.2%) rs h+ gp treotment s4 4 toblets g! 6 Ciocedure ,, O 3t7 d & 9 0g.+'L)7 so 'QBBbr determining dosoge TABLE 1: COMPARI,SON OF PRE AND POST TEST RESULTS AMONG THE TRAINEES IN ELDORET TABLE 2: COMPARISON OF PRE AND POST TEST RESULTS AMONG THE TRAINEES IN KAKUMA CAMP Foctor HEALTH WORKERS COAA,IAUNITY HEALTH WORKERS YES NO TOT YES NO TOT P Value Goveo correct onswer os to the monifestotion of the river blindness diseose Soid thot the vector thqt couses river blindness is o block f ly ll/lentioned thot the vector for river blindness breeds in fost f lowing woters Soid thot river blindness is tronsmitted through blood tronsfusion Knew thot the drug of choice for the treotment of river blindness is fvermectin The drug of choice for the treotment of river blindness is token once ayeor Soid thot the moximum dosoge given f or treotment of river blindness is 4 toblets Gave height os o procedure for determining dosoge 5404 4 5 18 t9 2 4 4 4 3 0 4 3 4 4 4 0 I 0 4 4 4 4 27 27 t4 13 30 29 22 32 32 32 32 32 3 32 10 32 7 32 NS NS N5 NS NS NS N5 N5 0 0 25 TABLE 3: COMPARISON OF POST TEST RESPONSES OF HEALTH WORKER5 AND COAA,I,\UNITY HEALTH WORKER5 ON THE RE5PON5E ON ONCHOCERCIASI5 AND ITS CONTROL IN KAKU MA CAMP TABLE 4z COMPARISON OF PRE TEST RESPONSES OF HEALTH WORKERS AND COAA,IAUNITY HEALTH WORKER5 ON THE RESPONSE ON ONCHOCERCIASI5 AND IT5 CONTROL IN KAKU MA CAMP a tFoctor P Value P Value Gaveocorrectonswerosto 6yES 1 NO TTOT 4yES ONO 4TOT NS rL --:l--^-^:-- -, ^L- Fgur gfnancsl otHuu3bos to 6 Umamrufq+utu&ef lhft 4 EufcLb lPMrlPff i diffta*i s o $ro5{.thqt the vector thot 4 firuHft6,WPflu+nd{E$Acte 2 l,l9'qhflI blindness breeds in fkntnafddffitLk vector 2 fu;as61[ffifffl.,&fie#fsin z f paf, J.lnwae ffflr&f&r u r ooa f,qdstrStd?frer bliidness is 2 kgrtrr.'tts*,UoFUqlbFlSRdce z rugnn{UqPAtme nt-o f r i ver 6nfUnUSt,Itf, fl4trggS6hoice 7 fqr"t&q.,l.eflUn6r8eoitFiYfiE z htutrrai i # Yf o&EG fi i{u ne s s EkCaHgn[*[qj66;for the 2 $agtf,frnttff[666fiffiness o Et lgbEtst6? ft rgfLorme nt Frr{,flrotrtlu+eslrgr o fl6$igiv en f or treotment a[ua,naiblirdffigrs&a,.e 3 fBFlsElermIn ing dosoge. t4 3 2 1 4 4 t7 4 l3 4 I 4 7 7 7 7 7 7 7 7 7 7 7 7 7 7 I 3 3 5 5 5 5 0 0 5 5 7 7 4 10 0 22 34 3 3? 0 t9 0 23 0 28 26 4 36 4 36 4 36 4 36 4 36 4 36 4 36 N5 NS NS N5 N5 N5 N5 NS <0.05 <0.05 N5 NS N5 0 4 NS EOVe neEinrds dProceo u re for determining dosoge 5 .+ Y at 50 l\) TABLE 5: COMPARISON OF PRE & POST TEST RE5PON5ES OF THE HEALTH WORKER5 a I TABLE 6t COMPARISON OF PRE & POST TEST RESPONSES oF CO,1AAAUNIry HEALTH WORKERS Foctor PRE POST YES NO TOT YES NO TOT P Value Gove o correct onswer os to the monifestotion of the river blindness diseose Soid thot the vector thot couses river blindness is o block f ly Mentioned thot the vector for river blindness breeds in fost f lowing woters Soid thot river blindness is tronsmitted through blood tronsfusion Knew thot the drug of choice for the treotment of river blindness is fvermectin The drug of choice for the treotment of river blindness is token once o Yeor Soid thot the moximum dosoge given for treotment of river blindness is 4 tqblets Gove height os o procedure for determining dosoge 28 36 22 10 27 36 25 7 32 N5 5 32 <0.001 18 32 <0.001 t9 32 P<0.05>0.001 2 32 <0.001 3 32 <0.001 32 <0.001 32 <0.001 26 t4 27 27 t4 13 30 36 36 36 36 36 10 22 34 32 t9 5 2 4 t7 13 8 9 293623 , ! tI , a