Third year technical report on Community Directed Treatment with Ivermectin ( C.D.T.I) implementation in Kogi State: twelve (12) months report of 3 rd year

't J KOGI STATE A.P.O.C. PROJECT (NGKG} THIRD YEAR TECHNICAL REPORT ON COf',If$U N IW DI RECTED TREATIIAENT WITH MRfriECflN (C.D.T.!.! I|TiPLEfIIENTATION IN KOGI STATE TWELVE, (12) MONTHS REPORT OF 3RD YEAR. 20cc a- a o =. f .o r tcl o =g*6o3 e 8o g'€ ='oFr88.o9u,{goo @ o o oo E. 6 { m\ mIo U'{{tfl xx>ov11rO ttt z axo oJ o or o o , a4 o6 A E : + kDz @ , o{{ FI t(r,\e ( t ( V ) o al c ( I -.t I (-c l6\ a{\o \b r(\o) -(\.-\Yolr /"; &\9n!\eo a - =mt-D o(, orc J Y \ \) -l---Y/+\Eg: E eI \ \A -//-! -.I ! rrl- \ !f{ m c o{ -t mE aI c a a ooc 3o \ ../ +-L-Y I]IIx I FI2q oc tr{{ m z x !D a=r! o I \ I E,\ \- EENUE STATE A vi t, ti \ t t rarF's q \. '-/-.i, f ) rgl , 'gr \ -:.-ot ,_ C t,ttlFt ( o .)- \-* eC =c \ x @g, q, czc ') x o6l\ t KOGI STATE - A.P.O.C. PROJECT (NGKG) END OF THIRD YEAR TECHNICAL REPORT ON C.D.T.I. ENTATION IN KOGI STATE 12 MONTH REPOR EXECUTIVE SUMMARY Kogi State is one of the highly endemic States with Onchocerciasis in Nigeria with over one million (1,000,000) persons at risk. Kogi State is made up of twenty- one (21) L.G.As all of which are endemic. The Kogi State Project was one of the first four (4) projects approved in Nigeria. In the first year, five (5) Local Government Areas (LGAs) namely, Yagba West, Yagba East, Olamaboro, Idah and Ofu L.G.AS were suppofted by APOC. In the second year of implementation, control activities expanded to cover eight (8) additional L.G.As, which are Mopa-Muro, Lokoja (formerly Kogi LGA), Bassa, Dekina, Omala, Ankpa, Ibaji and Igalamela/Odolu LGAs. In the third year, the project has been expanded to cover the remaining eight (8) LGAs, thus involving all the twenty one (21) L.G,As. The new set of L.G.As are Kogi, Adavi, Ajaokuta, Okene, Okehi, Ogori-Magongo, Kabba/Bunu and Ijumu Various activities of capacity building towards sustainability were carried out these activities included the Training of 22 SOCT members,269 LOCT members and the training of 3,018 CDDs, Three levels of workshops were organised. Awareness/Orientation workshop for the Media and Local NGOs, State level Advocacy workshop for State policy makers and L.G.A level Advocacy workshops for L.G.A policy makers and opinion leaders (See Awareness, Advocacy and Training table). These were to solicit suppoft for awareness creation and release of counterpaft fund. Community Registration (Census) is yet to be completed. Community mobilisation, Health education and Training of Community Directed Distributors (CDDs) was undertaken in all the 21 LGAs. A total of 3018 CDDs were trained in the 21 LGAs. In the year 2000, we planned to cover 2L75 Communities and to treat up to one million persons and we have treated 110111361 persons giving as coverage of 101.13olo. TWLEVE (12) MONTHS (T IRD YEAR) TECH ICAL REPORT ON C .D.T.l IMPLEMENTATION - KOGI STATE SECTION 1 BACKGROUND IN FORMATION Kogi State is centrally located in the Middle Belt of Nigeria and shares common boundaries with Niger and Nassarawa States and the Federal Capital Territory to the Nofth. To the East, the State has a boundary with Benue State and to the South with Edo, Enugu Anambra and Ondo States while to the West it has a boundary with Kwara State. The two largest rivers in Nigeria, rivers Niger and Benue form a confluence at Lokoja, the State Capital. The vegetation is made up of rain forest in the Western part of the State, wooded savanna and grass land in the East, forest savanna mosaic to the South and Guinea Savanna in the Nofth. Onchocerciasis was first repofted in Nigeria in Kogi State in 1907 at Lokoja on River Niger. There are also severa! other fast flowing rivers namely, Ofu, Anambra, Ubele, Inachalo, Okura and Oyi, which traverse the several endemic communities in the State. The main occupation of the people is farming, lumbering, fishing and trading. Onchocerciasis control with ivermectin started in the former Benue and Kwara States from the late 1980s. However, this did not cover the Kogi State paft of the States. Skin snipping to determine endemicity level had been conducted in Kogi LGA before the creation of Kogi State. UNICEF assisted onchocerciasis control in the former Benue State before parts were carved into Kogi State. In the same way, AFRICARE supported the endemic areas that were in the Kwara State. MECTIZAN DISTRIBUTION Mectizan Distribution Programme started in the present Kogi State in September, 1993 with support from Africare in Kogi (now Lokoja LGA) and Ijumu LGAs with 18,385 persons treated. ln L994, the programme expanded to 3 other LGAs with 108,885 persons treated. 2161388 persons were treated in 9 LGAs in 1995, while 213,959 persons were treated in 1996. By September L997 following the decertification of Nigeria by USA, Africare withdrew its suppoft to the State. The 2 Nationa! Onchocerciasis Control (NOCP) Programme approached Sight Savers Internationa! who provided suppoft from October 1997. By the end of Lgg7, 5Ll,O74 persons were treated in 18 LGAs. In 1998, a total of 847,72G persons were treated in 21 L.G.As with 223,558 persons of this being from the first 5 APOC-assisted LGAs. In 1999,967, 670 were treated in all the 21 endemic L.G.A.s. With the expansion in the second year to eight (8) additional L.G.As, 538,492 persons were treated in the 13 A.P.O.C assisted LGAs. A COMMUNITY:- This is defined as a group of people sharing the same interest and having the same leader. Where communities are large, they are subdivided to either I, II or III SECTION 2 L.G.As COVERED: This implementation period covers the entire 21 LGAs of the State. They are Ankpa, omala, Dekina, Bassa, ofu, olamaboro, rdah, rbaji, rgarameta/odolu, Lokoja, Mopa-Muro, Yagba East, Yagba west, rjumu, Kabba/Bunu, ogori- Magongo, Okene, Okehi, Adavi, Kogi and Ajaokuta. The implementation of CDTI in year 3 of Kogi-APOC project started actively in the month of May with the Training of SOCTs and LOCTs. Awareness and advocacy workshops for state and L.G.A. policy makers held by 4 6 Juty, 2ooo. Community mobilisation started in the L.G.As from the second week of June, 2000 and the active phase of the exercise was completed by August, 2OOO. Community census/Registration stafted after that and it was followed by drug distribution. MEDIA MOBILISATION A. RADIo JINGLES: Radio jingles were aired in eight (8) Loca! Languages thrice monthly in the State for the months of fune to December. With suppoft from APOC. The languages are Igala, Bassa Kwomu, Bassa - Nge, Ebirra, Ogori, Yoruba, Hausa and Nupe. 3 B. TELEVISIoN: The Nigeria Television Authority, Lokoja aired the C.D.T.I film twice monthly from June to December, 2000, on Wednesday between 7,3O - 8.00 p.m. This is geared towards advocacy to the policy makers and general awareness and education of the entire populace. TABLE 1 TAB S ATI N OF C.D.T.I. YEAR 3 s/N DISTRICT/ LGA NO. COMMU- NITIES/ VILLAGES OF NO, OF coM- MUNITIES/ VILLAGES THAT SELECTED CDDS NO. OF COMMU- NITIES/ VILLAGES THAT COLLECTED DRUGS NO. OF CO- MMUNITIES/ VILLAGES THAT DECIDED ON METHOD OF DISTRIBUTION NO. OF CO- MMUNITIES/VI LLAGES THAT DECIDED ON MONTH OF DISTRIBUTION NO. OF CO- MMUNITIES/ VILLAGES WITH TRAINED CDDS NO. OF CO- MMUNITIES/ VILLAGE PAYING CDDS IN CASH OR KIND 1 OLAMABORO 185 185 160 160 160 18s 140 2 OFU 2LL 2LL 2tL 190 190 2LL 99 3 IDAH 70 70 70 70 70 70 62 4 YAGBA EAST 45 45 45 45 45 45 38 5 YAGBA WEST 18 18 18 18 18 18 L7 6 MOPA-MURO 19 19 L9 19 19 19 19 7 LOKOJA 88 88 88 70 70 88 69 8 BASSA 147 L47 L47 tzl t2L 147 t2L 9 DEKINA 242 242 242 196 196 242 100 10. OMALA 120 120 L20 81 81 r20 61 11. ANKPA 214 2L4 2L4 t76 L76 2t4 194 L2, IBA]I 113 113 113 90 90 113 90 13 IGALAMELA/ ODOLU 170 L70 L70 166 166 t70 116 L4. A]AOKUTA 32 25 25 25 25 25 20 15. OKENE 58 58 58 58 58 58 50 16 ADAVI s8 58 58 58 58 58 42 L7. OKEHI 50 50 50 50 50 50 50 18 KOGI a2 82 82 54 54 82 60 19. OGORI- MAGONGO 30 30 30 30 30 30 24 20. IJUMU 104 LO4 104 85 85 104 72 2t. KABBA/BUNU 119 119 119 119 119 119 80 TOTAL 2175 2L75 2t43 1881 1881 2L75 1524 The details of the SOCT and LOCT Trainings is as in the table below: 4 B TABLE SHOWING THE TRAINING OF THE DIFFERENT LEVELS s/No OF STAFF INVOLVED IN C.D.T.I. IMPLEMENTATION. DISTRICT/LGA 1 ,2 Olamaboro Ofu Idah Yagba East Yagba West Mopa-Muro Lokoja Bassa Dekina Omala Ankpa Ibaji Igalamela/Odolu Ajaokuta Okene Adavi Okehi Kogi Ogori-Magongo Ijumu Kabba/Bunu NO. OF TRAININGS UNDERTAKEN NO. OF LOCTS TRAINED 11 11 L4 29 L2 13 8 15 I 9 9 9 11 8 11 16 NO. OF DISTRICT OR LGA STAFF TRAINED ON C.D.T.I. NO. OF HEALTH CENTRE/ POST STAFF TRAINED ON c.D.T.L NO. OF CDDS TRAINED 3 3 3 3 4 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 19 L4 15 16 11 19 L4 19 16 11 11 11 L4 29 L2 13 8 15 1 9 9 9 11 8 11 16 247 354 159 | 228 168 170 33 I 120 t76 g4 116 t4 153 4 5 6 16 15 11 11 11 L4 29 13 8 15 8 9 9 9 11 8 11 7L 65 65 90 20 30 8 9 7. 10. 15 1 7 39 50 37 1 1 L2 L28 2. 11 1 13 t4 16 L7 18 19 20 2L 16 3018269TOTAL Old LGAs =2-3 New L.G.As =f 269 269 KEY: 3 = Old Five (5) APOC LGAs that are having their third to fourth training 2 = 8 Additional LGAs for second year 1. = New set of LGAs (8) in the year 2000 Yagba West had 2 training in the first year. NOTE: Above table is the total number of LOCTs trained at the workshop. 5 TABLE 3: SHOWING MOBILIZATION AND EDUCATION OF TARGET COMMUNITIES NO, OF MOH STAFF INVOLVED IN MOBILIZATION NO. OF NGDO STAFF INVOLVED IN MOBILIZATION s/No DISTRICT /LGA NO, OF COMMUNITIES/VIL U\GES MOBILIZED NO. OF TARGET COMMUNITIE S/VILLAGES WHICH RECEIVED H.E. ABOUT IMPORTANCE OF EXTENDED TREATMENT NO. OF ADVOCACY VISITS TO STATE OR REGIONAL DIRECTORS OF HEALTH 1 OLAMABORO 185 185 3 3 1 2 OFU 2Lt 2LL 3 2 1 3 IDAH 70 70 3 1 4 YAGBA EAST 45 45 3 2 1 5 YAGBA WEST 18 18 3 1 6 MOPAMURO 19 19 3 1 7 LOKOJA 88 88 4 3 8 BASSA t47 L47 3 3 9 DEKINA 242 242 4 3 1 10. OMALA t20 L20 3 3 11. ANKPA 2L4 2t4 4 3 1 L2 IBAJI 113 113 3 3 13. IGALAMELA/ ODOLU L70 L70 3 3 L4 AJAOKUTA 32 32 2 2 15 OKENE 58 58 2 1 16. ADAVI 58 58 2 2 L7. OKEHI 50 50 3 3 18 KOGI 82 82 3 3 19. OGORIMAGONGO 30 30 3 2 20 IJUMU 104 104 3 3 1 2t KABBA/BUNU 119 119 3 3 1 TOTAL 2L75 2t75 63 50 7 6 s/No ACTIVITY EXPECTED/ TARGET NO. OF PARTICIPANTS ACTUAL NO. OF PARTICIPANTS o/o succEss 1 Awa reness/ Orientation Workshop 50 65 L3Oo/o 2 State Ieve! Advocacy Workshop for Policy Makers 40 4L tO2.5o/o 3 L.G.A level Advocacy Workshop for Policy Makers 84 58 69.O4o/o 4. T.O.T. training for SOCT t2 22 183.33olo 5. T.O.T. training for LOCT 256 269 lO7.60/o TABTE& AWARENESS, ADVOCACY AND TRAINTNG WORKSHOPS AS AGATNST ANNUAL TRAINING OBJECTM (A.T.O) TRAINING B]ECTIVES: The training objectives for each training, awareness and advocacy workshops are as in the table above. Twenty two (22) S.O.C.T members were trained as against the target of 12 persons (183.33olo, The LOCTs trained were 269 as against the target of 256 persons (105.07olo). At the time the L.G.A Advocacy Workshop was being held, a general Labour Union dispute started in the State thus not all the participants turned up, More L,O.C.Ts were trained in the field so the total L.O.C.T. trained to date is 269 TRAINING MATERIALS: The materials that were used for the training included: . Onchocerciasis health education posters . Flip Chafts for training and advocacy workshops . CDTI Information Brochures for CDDs . Television and video were used to show the CDTI film for the Training of Trainers' workshoPs. . C.D.T.I. Training manuals. . MIS forms such as Community Regaster, household summary forms, community summary forms, adverse reaction forms, LGA and State summary forms were used for training during record keeping sessions. 7 aTreatment Coverage Rate Marked measuring sticks produced from nymph trees were used to determine dose based on height. FACILITATORS: Sight Savers International and WHO Consultant, Dr. H. Edeghere along with State Officers facilitated the trainings. SECTION 3 ACHIEVEMENTS A total of twenty two (22) SOCT and two hundred and sixty nine (269) L.O.C.Ts have been trained for C.D.T.I. implementation this year. In 1998, 50 LOCTs were trained and 179 were trained in 1999. Also a total of 3,018 CDDs were trained in al! the 21 LGAs. COUNTERPART FUND The sum of One hundred and fifty five thousand naira (N155,000.00) was $1,550.00 released into the A.P.O.C. Counterpart account in June, 2000. The commitment of the Ministry of Health is better now than the previous year. One million naira (N1,000,000.00) i.e $10,000.00 was approved as additional fund but it was not released. L.G.As The response of L.G.As is better now than the previous years. 1. No of Persons Treated x 100o/o = 1,011,361 = 84.2o/o Total Census Population 1201061 2. Community/Viltage Coverage = No of villaoe/comm. Treated x 100o/o = NIE x 100 = 100o/oRate = Total No. ofvillage targetted 2L75 For Treatment. B TABLE 4a= TABL E SHOWING COMMUNITY MOBILISATION AND H TH EDUCATION oF TARGET COM UNITIES THE NUMB ER oF STAFF INVOLVED AND TREATMENT RECORD 185 54,34t 3.7 OFU 2Lt 67,553 70 43,942 3.0 YAGBA EAST 45 34,824 3.9 YAGBA WEST 18 22,346 3.9 MOPAMURO 19 2L,877 3.5 88 36,2O7 I 3.85 L47 242 96,598 OMALA 120 34,363 3.5 l ANKPA 214 7s,ss7 lr.r i- 113 64,947 1.6 L70 66,917 2.3 AJAOKUTA 32 29,726 2.8 6 OKENE 58 7O,929 I1.1 ADAVI 58 35,26L 2.3 OKEHI 38,40850 2.8 82 23,2L2 5 ,4 OGORIMAGONGO 30 2L,999 3.7 I I IJUMU 104 55,541 I2.L 119 58,210 3.8 TOTAL 2t75 1011361 3.1 si No 9. 10. 11 L2. 13 L4. d 15. 16. L7 19. 20. 2L DISTRICT/LGA OLAMABORO IDAH LOKOJA BASSA DEKINA IBAJI IGALAMELA/ ODOLU KOGI ] KABBA/BUNU NO. OF TARGET COMMUNIT IES/VILLA GES TREATED NO. OF ELIGIBLE PERSONS TREATED COMMUNITIES /VILLAGES IN WHICH CDD IS A HEALTH WORKER NO. OF DISTRIBUTION SUPERVISED BY HEALTH WORKIER NO. OF TREATED COMMUNITIES/ VILLAGES WITH SUMMARY FORMS 185 2tL 70 45 cosT PER TREATM ENT 1 2 3 4 5 6 7 8 4.8 58,603 2.3 3.3 2 6 6 5 6 5 8 3 18 19 88 L47 7 5 5 4 5 242 L20 2L4 113 L70 32 58 58 50 82 30 3 2 6 3 3 7 4 18 LO4 119 2,t75 9 i i I I \ta a- TABLE 48: TABLE SHOWING TREATMENT IN APOC L.G.As SINCE 1998 TO DATE s/No, YEAR NO. OF LGAS (APOC) PERSONS NO. OF 1998 5 2 558 519 1999 13 622,67t ' L,694 2000 2L 1 011 361 L75 The table below shows a dramatic increase from L997 when Sight Savers took over to suppoft the programme in the State. TABLE 4C: TABLE SHOWING MECTIZAN DISTRUBUTION SINCE 1993 - 2OOO Remarks NO. OF TREATED COMMUNITIES 1 2 3 s/ No. YEAR No. of Persons Treated 18,385 AFRICARE t994 108,883 AFRICARE 216,398 ] AFRICARE wHo/TDR/AFRTCARE stl,O74 s.s.r./AFRICARE 847,726 s.s.r./APoc 1999 967,670 s.s.r./APoc 2000 110111351 s.s.r./APoc Treatment is com leted WAYS TO IMPROVE MOBILIZATION The following areas need to be addressed: 1. Early release of fund and capital equipment from A.P.O.C 2, Release of APOC total financial commitment for each year. The delay in release of fund or lack of release of some instalment hampers programme covera9e. 3. Prompt release of approved counterpart fund from the State Government is necessary to sustain pace of programme. Suppofting N.G.O 1 2 13. 4 5. 6 7 8 No. of LGAs 1993 2 5 1995 7 1995 9 213,959 t997 18 1998 2L 2t 2t 10. ta,, t 2 4 Release of additional vehicles for mobilization especially at the commencement of each year programme. SECTION 4: A. STRENGTH OF C.D.T.I. PROGRAMME 1. Kogi State Project has adequate technical manpower both at State and LGA levels. The State released US $51000 as counterpart fund for the programme last year and US $ 1,550 this year 2000. We are hopeful for an increase in counter paft fund contribution this year. L.G.A contribution is about $4,200.00 In our project, all the LOCT members are also members of the Primary Health Care team in the Local Government. This makes integration easy and sustainability more feasible. Most of the communities agreed to support their CDDs and to collecting their drugs from agreed centres. The N.G.D.O. provided technical assistance for Advocacy, Training of SOCT and LOCTS, Mobilisation and Education, Training of CDDs, monitoring and Supervision. This year the N.G.D.O supplied 3000 copies of C.D.T.I. brochures and various M.LS. forms training, community mobilisation and repofting and drugs (piriton and paracetamol) for management of reactions. Awards were given to the best three (3)L.G.As in Data Management , for 1999 by Sight Savers International to motivate proper repofting by LOCTS. B. WFAKNFSS OF TI{F .T.I.n DPNGPAMMF The following weaknesses need to be mentioned, There is need for prompt and early release of counterpart fund contribution. A.P.O.C. has to release funds and capital equipment early and promptly for the smooth running of the programme. 3. 4. 5 5 1 2 7 11. I 3 There is stil! need for increased advocacy visit to the policy makers at the State level to exptain the APOC concept and bridge communication gaps. HELP NEEDED FROM GOVERNMENT: a. Better political will. b. Release of more counterpart fund contribution for the programme. c. Release of additional vehicles for mobilization and Health Education monitoring and suPervision. APOC MANAGEMENT: a. Prompt release of motorcycles and bicycles for the L.G.As b. One lap-toP comPuter is needed. c. Advocacy visits to the State and LGA level by NOCP' A. 1 2 1,2.