Six month report of community Directed treatment with ivermectin (CDTI)

AFRICANI PROGRAMME, FOR ONCHOCE,RCIASIS CONTROL(APoc) Six Month Report for Community Directed Treatment with Ivermectin(cDrI) Dambatta Bichi rbasawa Bagwai Shanono Ajingl ara' Gwarzo Gaya Wudil RanoBebejiKaraye Takai Kiru Sumaila Doguwa For .Ac,^ To: f cc'rn ,' ,,ic* Nlr FOr lnformor;o" To, -Dtl' cE-/o..i. csJq.i- OT.D COPKano State Nigeria March 2000. e"($r, 5 ,uiva EXECUTIVE SUMMARY Kano State is situated in the northern part of Nigeria. The State has 44 local government u."u, out of whictr 18 are Meso endemic with few hyper-endemic foci. The State ialls in the sudan savannah and sahel zones. However, the endemic areas are generally located in the sudan savannah. The terrain is generally flat ot -tlightty undulating with sandy soil. There are occasionally rocky outcrops-and granite isehergs' The region is drained by some ,ir..r. such as the River Kano, the Zungur' the Shimar and ctrallu*u with their tributaries. There is obtained a large irrigation scheme in the project area (the Kadawa Scheme) which covers a large area and is markei by an extensive network of iffigation channels' ir,"i provide suitable breeding places for the blackfly. Ivermectin Distribution Program (IDP) started in Kano State in the year lgg|with the assistance of cBM. The effort was to help in the control of onchocerciasis in all the endemic area of the State' Below are the treatment figures for the period oi tggO to 1998 before the new approach (cDrI). TheCDTIapproachbeganfullyinJanuary,lgggwiththearrivalof APOC funds uit.t formaiapproval in September' 1998' The main goal of the CDTI project in the State is to treat a total number of390,000ruralpopulationwhoareknowntobeinfectedwith onchocerciasis o, ur. at-risk of the disease through the annual dosing with Mectizan. This ggur t* only be achieved by establishing an effective and sustainable community directed treatment program in all the endemic areas of Kano State by the y.u, zoo:. rtris program will be fully i"i"etur.A into the existing PHC system of the State' YEAR TREATMENT t996 108 837 1997 209,135 1 998 24r 518 1999 250 097 /L SECTION I BACKGROUND INFORMATION 1.1 Communities imolementine CDTI Currently 99 communities are implementing CDTI in the 18 targeted Local Government Areas in Kano State. These communities are determined by cluster of households under the leadership of a recognized village head. A community may have an average of four to give (4-5) satellite areas with an estimated average population of 500 to 1,000 persons in a settlement. The households in this communities contain an ur..ugt of 5-10 persons per each household but with some as having up to 20 - 30 members. 1.2 Endemic LGAs with trealment rounds The @ treatment rounds for each endemic Local Government Area:- NO. LOCAL GOYERNMENT AREA (LGA) DISTRIBUTION ROUND I Doguwa 5 2 Tudun Wada 5 3 Bebeji 5 4 Kura 5 5 Garun Mallam 5 6 Gaya 5 7 Aiinei 5 8 Takai 5 9 Sumaila 5 10 Gwarzo 4 ll Karaye 4 t2 Rogo 4 l3 Kiru 4 t4 Madobi 4 l5 Dawakin Tofa 4 t6 Danbatta 4 t7 Kabo 4 l8 Makoda 4 E- S/N DistrlcULGA No. of Comm Villrgc s No. of Communltlcs /VIllngcs 1l'het sclcctcd CDDs No. of Communltics /Ylllagcs th.t collcctcd Drugr No. of Comm lVillagcs thet dccldcd on Month(r) of dlstrlbutlon. No. of Comm /Vlllrges thet dccidcd otr thc month(s) of Trcrtmcnt No. of Comm lYillrgcs wlth tralned CDDs No. of Comm /Vllhges prying CDDs ln cmh or Kind. I Doguwa t2 l2 t2 t2 t2 t2 7 1 Tudun Wada l0 t0 l0 l0 l0 l0 5 3 Kura ll lt ll It lt ll 3 4 Garum Malant l0 l0 l0 l0 t0 l0 4 5 Bebeii 7 7 7 7 7 6 Gaya 3 3 3 3 3 7 Aiinei 4 4 4 4 4 4 2 8 Takai 4 4 4 4 4 4 I 9 Sumaila 4 4 4 4 4 4 ) l0 Gwarz-o 5 5 5 5 5 5 lt Kabo 4 4 4 4 4 4 l2 Karaye 3 3 J 3 3 3 l3 Kiru 4 4 4 4 4 4 I t4 Madobi 4 4 4 4 4 4 l5 Dawakin'fofh 9 9 9 9 9 9 5 l6 Danbatta 3 J 3 3 3 3 l7 Rogo I I I I I I l8 Makoda I I I I I t TOTAL 99 99 99 99 99 99 30 SECTION II TABLE I NOTE :It most clearly be explained here that the table though indicating complete compliance except for the incentives to the CDDs, does not mean that such success was achieved at once. Since CDTI is an ongoing programme, after every activity we appraise and make follow up to ensure participation. We are quite happy that after second contact for some of the villages that did not comply with certain provisions indicated on the above table after our flirst visit, witlingly complied after educating then and also hearing from them. 3 LS TIN o o F ATI NST 2.1 Trainins obiectives/achievement' Theannualtrainingobjectivewastotrain50LOCT,402PHC workers and 820 community Directed Distributors' out of these' a totalof46LocT,3T3PHCWo.k"rrand654communityDirected Distributors (cDDs) were trained on the ivermectin Distributiott Program (lDP) using the CDTI approach' 2.2 Developed Trainins Material used' with APOC, NGDO and the Ministry of Health support, training materials that are quite necessary for ihe success of all our training activities were made uuuilubl". 'Cpot had the brochures as guide' facilitators had the flip charts for training and other visual aids also complimented. Performance of the CDDs2.3 2.4 AlthoughmoreCDDsaretrainedyearlybecauseoftheCDTI principles of huring u' rn"t' !.DDs as the communities wish' there has been trign oeir.. "r dedication on their part to ensure that drugsareadequatelydistributedandaccountedfor.Their mobilization skiils have also increased as can be judged from the yearly coverage Percentage' Imorovine the qualitv of trainins Theneedforimprovedqualityof-trainingcannotbeover emphasized, as th; CDDs nttd to know details about CDTI programmeto.nru,tsustainabitity'TheLOCTwillbegiven additional training skills to "uiy out these activities rvith confidence at all times' q IN IMPLEMENTATION TABLE 2. In training, we could not meet our target because some of the trainees did not turn up to be trained beef up the number of cDDs in some communities. In the case of the Healih facilities, two personnel each were invited, but only one turn up in some areas' MOBIL TION D UCA oNo TAR ET COMMUNITIES YN )B_ 4 l-=- lo ltl8 ls LGA Doguwa Tudun Wada Garum Malam Bebcii ingi ila Kura Gaya Aj Takai No of lrrining undertakcn &) No ofTOT trrincd &6 4 No of District or LGA strll trrlncd in CDTI No of Hcrlth cctrtrcs/Post rtrlT trrlncd on CDTI l6 28 l5 t7 23 l7 30 t8 No of CDDs trritrcd. 't'o1'AL 2 75 3 3 3 J a , ., 2 4 l6 t4 2l l7 30 20 20 l0 43 2l 33 29 - 60I a- 34 -1 YN lz It DistricULGA Tudun Wada Kura No of Commutritics rnd Viltrgcs Mobillzcd t2 ll No. ofTrrgct Comm/Villegcs thtt rccclvcd Hcrlth Educrtion rbout thc importancc of cxtcndcd trGrtmctrL Noof AdvocecY Visits to Strtc or Reglonal Dircctorr of Hcrlth 4 4 4 No of MOH rteff involvcd in Mobilizrtion. 5 5 No of NGDO StiIf involvcd in Mobiliz,rt ion. 4 5 6 't 9 I I ., f ;r.rm Malam I Bebeii I Takai Sumaila I rabo I Kr.ave I Ki', G l0 3 4 4 4 4 3 4 7 4 4 4 5 4 4 4 4 4 4 4 4 4 4 4 4 2 7 ) 2) ., , I ,AL 4 9 3 99 99 4 4 4 4 4 12 ., 2 2 2 7 I --l I --rf-r { 6XSOCT & LOCT) 65(SOCT & LOCT) 4 64 4t 56 l4 - tg- 37 26 34 46 373 Dos.uwa l0 l0 I I I t3 l4 l5 6 t7 t8 'IofaDawakin Danbatta I 2.2.1 The use of media in mobilization. The services of Modern Mass Media were utilized especially when the State had her year 2000 Mectizan lunching programme. During this occasion, all the media houses in the state gave the CDTI programme a wide publicity in the news, that was aired both in English and Hausa languages. 2.2.2 Result of effort Communities were fully mobilized using the following media:- - Mass media - Traditional and religious leaders - Face-to-face discussion with the community members - Town criers mobilizing community members All these efforts yielded results, but some communities still require more attention to fully participate in the programme. This indeed is a challenge to us since the cardinal point of CDTI is to achieve sustainability. The project will continue to map out strategies to achieve results. 2.2.3 Resoonse of the Communitv Mobilization activities have been quite satisfactory resulting in successful acceptance of responsibility by community members and participating in the implementation of CDTI. However, communities need to do better in the area of CDDs' incentive to encourage them to serve their communities better. 2.2.4 Suesestion to imorove Mobilization. Successful Mobilization activities means time with the community members. Presently we see this factor as being inadequate with the demand to convince communities to fully embrace CDTI. We hope that with the Health workers trained in Health facilities now fully on board, they will go a long way to bridge this gap of inadequacies. (' STRENGHT AND WEAKNESSES. The state Oncho Team members are very effective and have been handling the challenges of CDTI implementation. STRENGHT S 1) The participation of the LGA has improved tremendously. This is as a resutt of the increase advocacy visit that was undertaken during the period under review. 2) Training of CDDs is at close distance to the communities. CDDs and the communities quite appreciate this development. 3) Training at centers close to the communities has encouraged community members serving as observers. 4) More female workers are now participating in the programme as CDDs. 5) Communities carry out self- monitoring to ensure effective coverage. 6) 7) Community members are quite appreciative of the programme. WEAKNESSES r) LGA commitment is still low. The political leadership claim to have many priority areas that require attention in order to satisfr the people. The state government is yet to release its state counterpart contribution to the projects. Effort is however on the way. 2) 3) Limited period of interaction with community members. ft RECOMlVI ENDATION 1) 2) More training should be organized for LGA PHC personnel to make them more efficient in training, mobilization and supervision. Additional advocacy visit need to carried out in all the LGAs to carry them along in this effort of CDTI implementation. 3) More time should be given to the communities during mobilization. This will mean spending more days in the field during the exercise. I 2OOO ONCHO CONTROL ACTUAL ACTTVITIES CONDUCTED ACTIVITIES 3* OUARTER 1'n OAARTER S/N PROPOSED ACTIVITIES fr SUARTER f" SUARTER I Planning & Schedule of Activities 2. Advocacy visit to LGAs J Advocacy visit to Traditional Ruler 4 Training of l.lealth Workers 5 Oncho Day Celebration 6. Comm. Mobilization on CDTI (Zone A) 7 Selection of CDDs by Communities 8 Training of CDDs (Zone A) 9 Mectizan Distribution Act (Zone A) l0 Wrap up exercise (Zone A) il Comm.Mobilization (Zone B) t2 Selection of CDDs by Communities (Zone B) t3 Training of CDDs (Zone B) Mectizan Distribution Act (Zone B) l4 l5 Wrap up exercise (Zone B) t6 Bi-annual APOC Report 17. Mectizan Application for Year 2000 18. Material Development (APOC) 19. Result Compilation 20. Appraisal Workshop 2l Mop Up Treatment )) APOC Annual Programme Report 3