Six months report for community directed treatment with ivermectin (CDTI): Jigawa State Nigeria, June to December 1999

AFRICAN PROGRAMME FORONCHOCERCIASISCONTROL (APOC) Six Months RePort for community Directed Treatment with Ivermectin CDTI RE9U 2 q uu zooo APOC/DIR Sule T Birniwa Guri Babura Gumel Garki Taura w HauMiga Dutse lnn Kudu Burji Jigawa State Nigeria June to December 1999 UTI SUMM Y Jigawa State was curved out of Kano State in September 1991. The state presently has a total of Twenty Seven (27)LocalGovernment Areas. seventeen, (17) of these LGAs are eildemic for onohocerciasis. Eight (8) Local Governments Areas, namely Birnin Kudu' Gwaram' Kafin llausa, Kaugama, Birniwa, Itingin and Taura are Mesoetrdetnic, with few l{yper enclemic cotmrunities. 'I'he remaining Nine (9) Local Government Areas are HypoenJemic' T5e state pla,s to conduct another REMO exercise to further ascertain the endemicity status of these LGAs that are currently IJypo- endemic, with a view of including those confit rned to be Meso endemic into the CDTI state implementation plan. Jigawa State falls in the Sudan Savaruu and Sahel Zotres. The terrain is generally flat or sliglrtly undulating, with a few rocky out crops and hilts in some places particul'uly the southern part of the state borclering Bauchi State. The State is drained by some majt"' rivers such as River lladeiia, River Chiyako, and their tributaries' The trihutaries are largely seasonal, while the main rivers have water year round' The flood plain of the River lladejia coutains extensive wetlauds and swampy areas, and the presence of some man made Jams in the state provides breeding sites for black flies' Ivermectin distribution programme (IDP) started in Jigawa State in 11996, immediat:ly after the Memorandum of Understancling was signed between the State Ministry of llcolth and Christoffel BlindenMission (CBM) of Germany' Below are the results of the IDP exercise from 1996 to 1998 before the introducticn of the new concept of CDTI TREATMT]NT FIGURES 36,758 (8 LGAs) 124,744 (17 LGAs) The main goal of the cDTI Project is to treat atotal number of 135,480 rural poptrlace who are known to be inl-ected or at risk of the disease by the year 2003 in Jigawa Staic througlr armual treatment witrr ivermectin tablets. This goat is to be achieved by establishing effective and sustainable comtnunity ownership and participation of the plogralnme from the onset' During this period, CDT'I will be fully integrated into existing PHC systern in the state' 4 YEAR 1996 37,820 (8 LGAs)1997 I 998 SECTION 1 BA GR TIO 1.1 Communities imolementins CDTI There are about r r 0 onchoendemic endenric communities in the g targeted cDT't Local Gove,rnreut Areas i. Jigawa State. The communities have a pattern of settlument characterized by nucleated villages, satellite hamlets antl dispersed settlements' The average community size is approximately 2,500 persons' The households in these communitits have an average of 5-10 persons per each household but some may have up to 20-30 membeis' 1.2 Endemic LGAs with treatment round The following are the treatment rounds for each endemic local government atea: DISTRTBU'TIO N ROUND 4 4 one of the LGAs, Biflrin Kuclu has been split into two with the other new LGA as Buji Detail ilformation about the said LGA will be reflected in our subsequent reports' LOCAL GOV nxr nnr,As (LGA)BRNMNO. Birnin Kudr./Buji1 Dutse) Birniwa3 Gwaram4. Kaugama5 Kafin Hausa6 4 4 4 4 4Ringim7 4Taura8 L TABLE I CDTI IMPLEMENTATION JUNE TO D 1999. l'nAlNtN G OF DIFFBRENT LEVEL OF STAFT' INVOLVED IN CDTI pf: lrl' '': 525 2525 2525 25I Bimin Kudu 't a7 77 7) Dutse 7 55 55 53 Birniwa 5 l7 8t7 t7l7 t74 Gwaram l7 7 477 75 Kafin I lausa 8 88 88 86 Kaugama 26 66 66 67 Rrngiur 3 33 33 38 Taura 2278 1878 7878 7ETO'tAL IMPLEM ATION 2.1 Trainine ievemenL The annual training objective was to train a total of 255 persomrel for the Ivcrmectin distribution prograrnmme using CDTI approach. Out of these 236 prografirme wol ker were trained (socT, LocT, Health workers and cDDs) representing92%. 2.3 Develoaed Trsinins Materisl used. T6e various traililg activities conducted at LGA and community levels were succesr:ful. This was possible through the use of various training materials for CD'II e.g. CDD guide, brochures, flipcharts, posters MIS forms etc. The materials were reproduced from the funds provided by APOC. 5 SECTION II .rL$iE;:f .ri. r;iil'q! 2.4 of CDDs The performance of the CDDs during the exercise was good because many of ther:r have denronstrated a good understanding of the CDTI concept during training and mobilization. Recor6s were properly kept by most of the CDDs, with Mectizan drugs well managed. 2.5 Improvirts the qualitv of trsining. 1'he quality of trailing could be irnproved upon especially with regards to the use of 3mg tablets. LOCT needs to be well informed on the procedures for monitoring and super\ ision as well as training of CDDs. TABLE II. GOF ERREN LSO F INV IN T IMPLEMENTATION 6 .:lE6iIIIII*|.d[rrnf,= -iEi( Nhl {d,- r-.i!# .;aii H, ffim{#fi,,{jffi 4 i;FIFj*g#;:fr #m$lii$$ffi 5 (soct&loct) 2(II/WORKERS &CDDs) B/KuduI 345 (soct&[oct) 2(FyWORKERS &CDDs) Dutse') 445 (soct&loct) 2(H/WORKERS &CDDs) [] rrn irva3 l4 ld 3l 46 545 (soct&loct) 2(H/WORKERS &CDDs) Gwaram4 r4445 (soct&loct) 2(r{/woRKERS &CDDs) 5 K,/Hausa l6644 (soct&loct) 2(FTAVORKERS &CDDs) 6 Kaugama 4 54 (soct&loct) 2(rvwoRKERS &CDDs) 't Ringim 23 034 (soct&loct) 42(IVWORKERS &CDDs) 8 'l'aura 32 36372TO'I'AL 8 Lt t63 TABLE III o ION AN DUCA OFT ET CO 2.2.0 AdvocacvVisits Aclvocacy visits was carried out during the period under review to State and Local Government Area (LGA) Chief Executives before and during the take-off of the prcrject,by the zone D NOCP office, NGDO and SMOH staff. The purpose of which was to solicit for the necessary support and cooperation from these LGAs' Intensive Corununity rnobilization was also conducted in all the endemic villages b1' SoCTs, LOCTs and cBM staff. During the exercise community leaclers, religious leaders, irrlluential persons, interest groups and other members of the community were enlightened about the disease and the CDTI concepts and the need for their support. 2.2.1 The use of Medio in Mobilizatiort' The services of moclern nlass media lacilities such as Radio and Television were not utilized during the period under review, however we have plans to utilize such services in the near future. ffiffii$,,#H ;i,l: { ji,iFrE|ls9"q{1 W"'rili ' jt'i! :i, rtry.1'{i$l,'' ;, ;$!t;'ti,.{ :,iri i -trt*F$li','}jl:f ),'-';;!;'a'[..'"ii:ir,'?li[i1'.11r(: ,,.i iJ r1."Iii;':, rj|., : ;1r";, -i:r:l': .:lti; ;,' i';t'lr'... I3a2525I I]/Kudu I127Dutse2 I))53 Birniwa IJ)7 5 7K/ Hausa4 3)885 Kauganm I 3)17t7(lwaram6 I2266Ringim7 2)33Taura8 35,78781'O'tAL 5 I 2.2.2 Result of mobilzation effort. Communities were mobilized using the following channels of communication:- o Traditional/Religious leaders o F'ace to face discussion with community members o Town cries 2.2.3 Mobilization Material Used. Posters an<l flipcharts were used as aids in creating awareness among the con'rnunity members. Allot of emphasis was also laicl on the new 3mg tablets which many peolle find diflicult to aocept due to the increase in dosage' 2.2.4 Response of the Comnumities The various comlnunities have shown positive response to the CDTI ideas' This was i'dicated frorn the lively discussions held during the mobilization activities as ahnost all communities were ablc to select and provide t|e names of t[eir CDDs for training' 2.2.5 fuRgeslions to improve Mobilization Education and mobili zation are the bedrock of a successful CD'fI implementation in Oncho endemic communities. This is to make the communities fully embrace the prograrnme, participate in its plaming, support and execution. I lence the need for a more concerted efforts on the parts of the LGA.s. This could be achieved through periodic Advocacy visits to LGA officials and encourage them to consider endemic communities as part of their constituencies' 4 T IV RA T R A AS I *The cost per person Treated is yet to be determined' SEC'IION III 3.1 TreutntenlCoverage Treatment coverage rate for the Jigawa State during the last distribution is 9lo/o' 3.2 Total Census Ponulatiort Thetotalcensuspopulationoftreateclcommunitieswas||3,364persons' 3.3 Total Elieibte Pooulation totaleligiblepopulationoftreateclcommunitieswasgT,T6|persons. Total Absentees/Refussls3.4 Tlrepopulationofabsenteesaudrefusalsisabout10'747persons' ,1 s/f{ 1 3 4 DistricULGA li/Kudu [)utse llrrniwa k'-/ llausa No. of Targct Comnr / Villagcs 25 't 5 'l 8 No. of ll,ligible peoplc trcated 24552 5860 2958 978'l 12108 Cost per person Trertcd No. of Comm/Village in which CDDs are health workers 0 0 0 0 No' of Distributions supcrvised bY heelth workcrs t I I 't 5 7 8 t75 Kaugama 6 Gwaratn 7 Ringitn E 'l aura .IO'tAI, l7 6 3 78 19374 t 1937 2247 8882J 0 0 0 0 I I 0 I No. of treated Comm/Villa gcs with SUmmlry forms. 25 6 3 18 3.6 3.5 Some reasons for Absentees/Refusals o Mobilization was not so adequate o Migration of nomadic Fulani . Some community members were pre-occupied with their daily duties of the CDTI strategies' Community response during mobilization was very inspiring to the SOCTs' LOCTs Plans to reduce number of Abserilees 1. Intensive community mobilization 2.Advocacyvisitstoemirs/districtheadsandreligiousleaders. 3. Advocacy meeting with LGA Chief Executives on roles and responsibilities of project partners. 3.7 Conrribution of the Mittistrv of llealth The foltowing are the contribution of the Governrnent of Jigawa State to the project' l) A well furnished office accommodation for the oncho control unit' 2) one Mitlion Naira (1,000,000.00) cash contribution as conterpart' alredy 3) released. One Electric TYPe writer Purchase of Offioe stationarY4) STRENGTHS/WEAKNESS AND SUGGESTIONS' o A reasonably good comtnunity commitment an<l participation due to prompts mobilization. Training of CDDs at their communities or centres closer to them has reduce the burden of travelling long distances and allow comtnunities to have more knowledge a a and CDDs. There was prompt delivery of Ivermectin supplies and other logistios to the 8 a communities. The programme enjoyed the services of a dedicated and cornmittee SOCTs and PHCa a staff. Timely release oIstate counterpart funding' WEAKNESSES . Inadequate remuneration for CDDs by the communities' . Low level of financial conunitment on the part of the L'G'A' executives' .LackofpreparednessbyLOCTs/PHCstafftoassumetheroleoftrain;rsat communitY levels. o Low level of supervision by the LoCT/Health workers due to strike action by labour officials. o lnterruption of CD tI activities with National Immuuization Days activities' o Late comrnunication to CDDs of training date, time and venue by the L.G'A's to the cornmunities. SUGGESTIONS Community members, influential people and interest groups should be mobilized to support CDDs. Advocacy meeting with L.G.A. executives should be held at Ministry for Local Government Aftairs to highlight roles and responsibilities of each partner involved in the CDTI Project. LoCT/Flealthworkersslrouldparticipatefullyastrainers' Future programme planning should accommodate National immunization days' Prompt communication to the communities by L.G.A.s on matters requiring urgent attention by the community members' a a a a a a