Six month report for community directed treatment with ivermectin (CDTI): Kano State Nigeria: September 1998 to February 1999

AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) Six-Month Report for Community Dirccted Treahent with Ivermectin CDTI t I i I J I =*n -t, \ - -tr _,t_l .Llll .,r Tcct loa.nrtf s/rrpoufL-Sls :u"Il i 'i' {A/rr i I , I I , 4 f I I I I Kano State Nigeria Dambatta Bichi basawa Bagwai Shanono Ajingi Gwarzo Kabo Gaya Wudil RanoKaraye Bebeji Takai Kiru Sumaila Doguwa RE9ll ,. t 0 MAI 1999 fPoc / Ptvt September 1998 to February 1999 5 EXECUTIVE SUMMARY Kano State is situated in the northern part of Nigeria. The State has 44 local government areas out of which 18 are Meso endemic with few hyper-endemic foci. The State falls in the Sudan Savannah and Sahel zones. However, the endemic areas are generally located in the sudan savannah. The terrain is flat or some major rivers such as River Kano, River Zungur and Challawa and their tribulaties drain slightly undulating, with sandy soil; the region. There is obtained a large irrigation scheme in the project area (the Kadawa Scheme) which covers a large area and is marked by an extensive network of irrigation channels. These provide suitable breeding places for the blackfly. Ivermectin Distribution Program (lDP) started in 1996 with CBM assigned by NOCP to assist Kano State in the control of onchocerciasis in all the endemic area of the State. Below are the treatment figures for the period of 1996 to 1998 before the new approach (CDTI). The CDTI approach began fully in January, 1999 with the arrival of APOC funds after formal approval in September, 1998. The main goal of the CDTI project in the State is to treat a total number of 390,000 rural population who are known to be infected with onchocerciasis or are at-risk of the diseaie through the annual dosing with Mectizan. The goal hoped to be achieved by establishing an effective and sustainable community directed treatment program in all the endemic areas of Kano State by the year 2003. This program is being fully integrated into the existing PHC system of the State. 108,8371996 209,135t997 241,5181 998 SECTION I BACKGROUND INFORMATION 1.1 ComnutuitiesimplementingCDTI There are approximately 100 endemic communities identified in the 18 target 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 these communities contain an average of 5-10 persons per each household but with some as having up to 20 - 30 members. 1.2 Endemic LGAs witlt treatment round The following are the treatment rounds for each endemic Local Government Area:- I Doguwa J 2 Tudun Wada 3 3 Bebeii 4 Kura J 5 Garun Mallam 6 Gaya 3 7 Aiinei aJ 8 Takai aJ 9 Sumaila aJ l0 Gwarzo 2 ll Karaye 2 t2 Rogo 2 13 Kiru 2 t4 Madobi 2 l5 Dawakin Tofa 2 t6 Danbatta 2 2l7 Kabo 2l8 Makoda ,L 3 J SECTION II CDTI IMP ATION ( Septemberl998 to December 1999) s/N I)islricULGA No. of Comm Yilhgcs No. of Communitics /Yilhgcs Thrt sclected CDDs No. of Communities lYillegcs thrt collcctcd Drugs No. of Comm /Villeges thet dccided on Month(s) of distribution. No. of Comm /Villrgcs thrt dccidcd on lhc month(s) of TrcrtmcnL No. o[ Comm lVilleges with trrincd CDDs I Doguwa t2 t2 t2 l2 t2 l2 2 Tudun Wada t0 l0 l0 l0 l0 l0 3 Kura il il ll ll ll ll 4 Garun Malam t0 l0 l0 l0 l0 l0 5 Bebeii 7 7 7 7 7 7 6 Gaya 3 3 J 3 3 1 7 Aiinei 4 4 4 4 4 4 8 'l'akai 4 4 4 4 4 4 9 Sumaila 4 4 4 4 4 4 l0 5 u Kabo 4 l2 Karaye 3 l3 Kiru 4 l4 Madobt 4 15 Dawakin'l'ofa 9 l6 Danbatta 3 t7 Roeo I l8 Makoda I TO'IAL 99 65 65 65 65 65 I TABLE 1 TRAINING OF D IFFERENT LEVELS OF STAFF INVOL IN CDTI No. of Comm /Yilleges prying CDDs in clsh or IMPLEMENTATION. 2.1 Training obiectives/achievement The annual training objective was to train 386 Health Workers and 600 Community Directed Distributors. Out of these , a total of 354 Healthworkers and 298 Community Directed Distributed (CDDs) were trained on the Ivermectin Distribution Program (IDP) using CDTI approach. 2.2 Developed training materiol used The lraterialused during the training was the training manual for CDTI, CDD Guide, brochure, Oncho flipchart, posters and forms that were provided by APOC funds. t (lwarm 2,3 Performance of CDDs The performance of CDDs in their respective communities indicated a good level of understanding, of their roles in the program. Coverage rate, correct registration, drug accountability, and good drug management were the main indicators of accessing their performance. 2.4 Imorovins the qualitv of training. The quality of training needs to be improved upon, with more emphasis on the new 3mg tablets. LOCTmembers should be encouraged to assume the roles of trainers in their LGAs. Though the literacy level is very low, different approaches should be employed to get CDDs to comprehend the recording forms. (See table 2 for training) MOBILIZATION AND EDUCATION OF TARGET COMMUNITIES 2.2.1 The use of media in Mobilization The services of modern mass media were utilized to some extent during the on-going activities in the communities and LGAs. In the LGAs, advocacy visits were conducted to the LGA officials and distriot heads. 2.2.2 Result of Mobiliujioacllbtt!, Communities were fully mobilized using the following media:- Traditional and religious leaders Face-to-face discussion with the community members 'fown criers mobilizing community members 2.2.3 Response of the communities Mobilization activities have been quite satisfactory resulting in successful acceptance of responsibility by community members and understanding the problem from the right point. 'l'his is expected to make CDTI a sustainable project. The reactions of the communities were favorable and positive to the CDTI strategies. This was noticed by the level of involvement of communities in CDD selection, deciding of time and method of distribution. 3 U'o 86 +z 3E z. l- @(9 (o o) ro N ro ro o (f) r.- l coN @ o (oN @(f, I I I I I I I I t @ o)$l l! Ll- - -fE =oo<j-zurqrO -L)^^Ult=uJoYzot<z2E uJ l- o @N r.- o, (f)N o(9 @r (or $ rN r.- o(f) oN oN o $ r{) a4, lt-lLF<oF(J ie9oJ IIJ 11 Z.ot oE $ $ $ {- (f) N N N C9 N N c{ N N $ N r (orf Fn rLzo< oEz.' trOoJ od FO oa (o (o (o (o lr) C9 (f, $ (f, s I cr) (f) I (f) (f) (o t i co I N N 0zzw *iLF '.E bts oz zJ ooo od F_ C) oJN N : N G L =Y N N N N N N : Fo oJ r r I i t , I I t I I r t r {(,j z a G 3 =(, oo (I, E(I, =cf .lf, =F E G o C) L o(9 :=oo o m rri o (E(, '6) .g '6 .Y GF s o E :f U) o No 3o ooo\z o (Il (EV fL v EoE(I, = (tr rF oF c =o3(o o o uo -otr(u o o c,ot (u ro ox, o = N (9 $ (o f.- @ o) o Nr (f, $ rf,r (or r.-r @ z o tr Fz tu =lrJJ o- = N TUJ m F \ tro C) =o LU J o =lJ. o U'J IIJ IJJJ Fz IJIt lIJ lJ.]L -o IJ. o (, z Ez E,F rI ;*=s e22 r r r r r r r=6 EICE l'r2E rf) $ lr) tr) tr) N N N N N N N N N N N N N N 00 s-d6o lr.{u 'o8k.tP= eb6pd<ootJuiLFulutr ovEE O@ oz= s $ $ $ $ ce $ $ I $ N N N N N N N N N I o tlo EEEHE N r o r r o r f.- $ s \r I I I I I I I I I t () @ Jo .- JUI :=I =EEo= Nr Or =l NLfY cf) o r f= cr) .{- \t $ I I I I I t I I I rO(o {oj (u B =(r) oo - (,E(t, B c =! =t-- c.i Eo o EC)L(U o $ :=(D _o C) m lri o (g o '(r, ,E 'o tz(sF d (U (I, E =a o N(o =o o -o(UY 0) (g t- G\z fL = 5 oE(I, (g rts o F- c =(U =oo (u o _oC oo o(,l ot oEo -vo J FoF z U' (o f.- o) Or rr N (f)r -t rO (or r-r cjr (') LrJJ CO F 5 U' tJl Ez :f = =oo l'- lU(,t. Flr o z o rlFI o3o UJ oz z o -l- N =6 o = 2.2.4 Suggestion to improve mobilization. The key to a successful CDTI implementation is to increase awareness on the part of the community members to where they can fully embrace the prograrnme through full support and participation. Advocacy visits to LGAs needs to be intensified and they should be encouraged to see these communities as being part of their constituencies requiring serious attention in the control effort. Section 3: 3.1 Treotment coverage. Treatment coverage rate for the state during the last distribution exercise is 9loh. Total census population Total Census Population of treated communities was 3001063 persons. Total eligible population. Total Eligible Population of treated communities was 2661196 persons. Absentees/Refusals. The population of absentees and refusals in Kano is about 10% Some reasons for and refusols CDDs were not very much supported Mobilization was not very adequate. Pre-occupation of the community members in other duties during distribution. 3.2 3.3 3.4 3.5 a o a 3.6 Plans for reducine number of absentees and refusals. l) To intensify comrnunity mobilization by involving the communities from the beginning. To rnake an arrangement for a mop up treatment exercise for those people that were absent during the regular distribution. 2) 6 3.1 Contribution of the Ministrv of Health The following items are the State Government contribution to the progralnme One used Toyota Land Cruiser Office Furniture One single cabin Toyota Hilax (2WD) Three used Motorcycles. Cash Contribution already approved as counterpart funding ( above $12 rnillion) A. B. C. D. E. F{ aa a a o STRE,NGTES AND SSES. Strensths The LGA's participation level is on the increase due increased advocacy visits that were undertaken during the period under review' Training of CDDs in centers close to them has become a reality, and this has reduced long distance travels. Training covers not only CDDs, but also some co[rmunity members who benefited from increased levels of awareness of the disease. The response of the communities during mobilizatio" YT encouraging and there is increasing evidence that they are willing to embrace CDTI approach' The programme has dedicated SOCT and committed workers that are implementing CDTI. Wea o LGAs tends to over rely on the MOH at this implementation stage o LGAs, financial, *orui and administrative support is also lacking at this stage of the project . lnadequate and competent trainers at the LGA level to successfully carry out the exercrces. o The PHC staff are yet to be fully integrated into the progratnme. o Too many communities to attend to within limited time. This does not encourage effective co mmunicatio n. Suggestions Advocacy visits needs to be intensified, through the Local Government Service Commission to achieve desired success. The LOCT and other PHC workers need to be encow4ged and re-trained to be able to assume training responsibilities in the near future. pHC staff should be complimented by providing more of these services to community members close to them. PHC facilities needs to be strengthened and the staff will be encouraged to participate fullY. a a a I o t1999 ONCHO CONTROL PROGRAM ACTIYITIES Planning & Schedule of Activities Advocacy visit to LGAs2 J Advocacy visit to Traditional Ruler 4 Training of Health Workers 5 Oncho Day Celebration 6 Comm. Mobilization on CDTI (Zone A) Selection of CDDs by Communities 7 8 Training of CDDs (Zone A) 9 Mectizan Distribution Act (Zone A) 10. Wrap up exercise (Zone A) il Comm.Mobilization (Zone B) l2 Selection of CDDs by Communities (Zone B) l3 Training of CDDs (Zone B) l4 Mectizan Distribution Act (Zone B) l5 Wrap up exercise (Zone B) 16. Bi-annual APOC Report t7 Mectizan Application for Year 2000 r8. Material Development (APOC) t9 Result Compilation 20 Appraisal Workshop Mop Up Treatment ')) APOC Annual Programme Report -3 l. 2l