Kano six month report for Community Directed Treatment with Ivermectin (CDTI): March 2000

AFRTCAI\ PROGRAMME, FOR ONCHOCERCIASIS CONTROL(APoc) Six Month Report for Community Directed Treatment with Ivermectin (cDrI) fI t ,l i, i /r( I !1 I I ^(' ') r I \ i t l , {l n t_tr) Dambatta Bichi nyrwe Bagwai Shanono Ajingr Gwarzo Kabo Gaya Wudil RanoKaraye Bebeji Takai Kiru Sumaila Doguwa Kano State Nigeria March 2000. :-( BXBCUTIV E SUMM ARY Kano State is situated in the northern part of Nigeria. The State has 44 local government areas out of whictr 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 t"r.uin is generally flat ot ilightty undulating with sandy soil. There are o..urionuily .ocky outcrops and granite isehergs' The region is drained by some rivers- such as thi River Kano, the Zungur' the Shimar and chaltu*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 marked by an extensive network of irrigation channels' TheJe 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 of 1996 to 1998 before the new approach (cDrI). a TheCDTIapproachbeganfullyinJanuary,lgggwiththearrivalof APOC funds after formal approval in September' 1998' The rnain goal of the CDTI project in the State is to treat a total number of3g0,000ruralpopulationwhoareknowntobeinfectedwith onchocerciasis or are at-risk ortn" airease through the annual dosing with Mectizan. This gpuf l* only be achieved by estabtishing an effective and sustainabte community directed treatment program in atl the endemic areas of Kano State by the yenr 2003. rfis ptog.unr will be fully ir,t"g.ut"d into the existing PHC system of the State' YEAR r996 1 7 t997 209,135 l 998 241 518 1999 250 097 /L t SECTION I BACKGROUND INFORMATION 1.1 Communities CDTI Currently 99 communities are implementing CDTI in the lB 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 average of 5-10 persons per each household but with some as having up to 20 - 30 members. 1.2 Endenic LGAs lreatment rounds The fotlowing are the treatment rounds for each endemic Local Government Area:- NO. LOCAL GOVERIYMENT AREA (Lq4)_ DISTRIBUTIONROUND 1 Doguwa 5 2 Tudun Wada 5 3 Bebeii 5 4 Kura 5 5 Garun Mallam 5 6 Gaya 5 7 Aiingi 5 8 Takai 5 9 Sumaila 5 l0 Gwarzo 4 ll Karaye 4 t2 Rogo 4 l3 Kiru 4 t4 Madobi 4 15 Dawakin Tofa 4 t6 Danbatta 4 l7 Kabo 4 l8 Makoda 4 t w I SECTION II TABLE I NOTE :It most clearly be explained here that the table though indicating complete cornpliance 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 huppy that after second contact for some of the villages that did not comply with certain provisions indicated on the above table after our first visit, willingly complied after educating then and also hearing from them. a 3 S/N DislrlcULGA No. of Comm I Villegc s No. of Communltics /VIlleges I'het sclcctcd CDDs No. of Communitics /Villegcs thet collcctcd Drugr No. of Comm /Villrgcs thrt dccidcd or Mon(h(s) of distrlbutlon. No. o[ Comm /Vilhgcs thrt dccidcd on thc mouth(s) of Trcrtmctrt No. of Comm /Yillrgcs with trrlncd CDDs No. of Comm lYilhges peying CDDs ln cesh or Kind. I Doguwa t2 t2 l2 12 t2 t2 7 2 Tudun Wada l0 l0 l0 l0 IO t0 5 3 Kura il ll ll u lt n 3 4 Garum Malanr l0 l0 l0 t0 t0 l0 4 5 Bebeii 7 7 7 7 7 7 6 Caya 3 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 2 l0 Gwarzl 5 5 5 5 5 5 ll Kabo 4 4 4 4 4 4 12 Karayc 3 3 3 3 3 3 t3 Kiru 4 4 4 4 4 4 I t4 Madobi 4 4 4 4 4 4 t5 Darvakin'fofa 9 9 9 9 9 9 5 l6 Danbatta 3 3 3 3 3 3 t7 Ros,o I I I I I I l8 Makoda I I I I I I TOTAL 99 99 99 99 99 99 30 TRAIN STAFF ING OF D RENT LE LSO INVOLVED IN CDTI IMPLEMENTAT ION 2.1 Trsininsobiectives/achievement' Theannualtrainingobjectivewastotrain50LOCT,402PHC workers and 820 community Directed Distributors' out of these' a total of 46 LOCT, 373 pHC ivo.k"r' and 654 Community Directed Distributors (cDDs) were trained on the ivermectin Distributiotl Program (lDP) using the CDTI approach' 2.2 Develooed Traittins Material used with APOC, NGDO and the Ministry of Health support, trainirrg materials that are quite necessary for itre success of all our training activities were made uuuilubl". "cppt had the brochures as guide' facilitators had the flip charts for training and other visual aids also comPlimented' 2.3 AlthoughmoreCDDsaretrainedyeartybecauseoftheCDTI principlesofhavingu,*u"hCDDsasthe'communitieswish,there has b"en";Ln J.g',r.. of dedication on their part to ensure that drugsareadequatelydi,t,ibut.dandaccotrntedfor.Their rnobilizationskillshavealsoitrcreasedascanbejudgedfromthe Year[Y coverage Percentage' 2.4 Imorovins the qaalitv of trainins Theneedforimprovedquatityof.trainingcanngtbeover emphasized, as the cpbs 'n..i to know details about .DTI programme to ensure susiainability. The LocT will be given additionaltrainingskillstocarryouttheseactivitiesrvith confidence at all times' It q FFERENT BVBLS OF STAFF INVOLVED IN CDTITRAIN NG OF DI IMPLEM NTATION TABLE 2. S/N t-rc4 No of training undcrtrkcn No ofTOT trrincd No of Dis(rict or LGA strff treined in CDTI No of Hcrl(h ccntrcVPost ttrff trrincd on CDTI No of CDDs treincd. I Doguu'a 2 & 6 (SOCr & LOCT) 4 l6 64 2 Tudun Wada 4 28 66 l Kura 4 t5 64 4 Garum Malam 4 t7 41 5 Bebcii 65(SOCT & LOCT) 3 23 56 6 Gaya 65(SOCT & LOCT) 2 l7 t4 7 2 l9 l9 8 Takai 4 2 23 37 9 Sumaila 3 3 30 26 l0 Crvarzo 4 2 l8 34 ll Kabo 3 3 l6 13 t2 Karayc 3 a l4 2t l3 Kiru 3 2 2l 33 l4 Madobi 3 2 l7 29 l5 6 1 30 60 l6 Danbatta 3 2 20 34 t7 Rogo , I 20 6 l8 Makoda 2 t t0 1 .I'OTAL 2 75 46 373 654 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 Health facilities, two personnel each wele invited, but only one turn up in some areas. MOBIL,I.zNlloN AND EDUCATION OF TARGET COMMUNIT , S/N DistricULGA No of Commuoitics rnd Villages ll{obilizr d No. ofTergct Comm/.V,ilhges thrt rccclvcd Ilcrlth Educetion ebout the importrnce of cxtcnded trcrtment- No of Advocecy Visits to Stltc or Rcglonrl Dircctors of Hcrltb No of MOII rtrl[ involvcd in Mobilize(ion. Itio of NGDO StalT iovclvcd in lllobilizrt i<ro. I I Doguwa t2 12 4 5 I 2 Tudun Wada l0 l0 4 3 Kura ll ll 4 5 tI 4 Garum l0 l0 4 s 5 Bebcii 7 7 4 2 6 Cava 3 3 4 ., 7 Aiinei 4 4 4 2 I I E Takai 4 1 4 2 I 9 Sumaila 4 4 4 ., l0 Gwarzo s 5 4 ., I ll Kabo 4 4 4 2 II l2 Karayc 3 4 1 l3 Kiru 4 4 4 1 I I t4 Madobi 4 4 4 t l5 Dawakin Tofa 9 9 4 ) I I t6 l 3 4 2 t7 I{ogo I I 4 2 I I t8 t I 4 1 t TO'TAL 99 99 12 7 { Dawakin Tofa I I 3 2.2.1 The use of nrcdia in nnbilization. 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 programnle a wide publicity in the news, that was aired both in English and Hausa languages. 2.2.2 Result of Mobilizotion 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 Atl these efforts yietded 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 Response of the Contmunitv Mobilization activities have been quite satisfactory resulting in successful acceptance of responsibility by community members and participating in the implementation of CDTI. However, communitiei need to do better in the area of CDDs' incentive to encourage tlrem to serve their communities better' 2.2.4 Sueeestion to imorove Mobilizqtion. 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 l-tealth workers trained in Health facilities now fully on board, they will go a long way to bridge this gap of inadequacies. 1 (' cSTRENGI{T AND WE,AKNESSES. STRENGIIT S l) The participation of the LGA has improved tremendously. This is as a result 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 progralnme as CDDs. 5) Communities cany out self- monitoring to ensure effective coverage. 6) The state Oncho Team members are very effective and have been handling the challenges of CDTI implementation. 7) Community members are quite appreciative of the programme. WEAKNESSES l) LGA commitment is still low. The political leadership claim to have many priority areas that require attention in order to satis$ the people. 2) The state government is yet to release its state counterpart contribution to the projects. Effort is however on the way. 3) Limited period of interaction with community members. ft \ RBCOMMENDATION l) More training should be organized for LGA PHC personnel to make them more efficient in training, mobilization and supervision. 2) 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 rnobilization. This will mean spending more days in the field during the exercise. 0 B I 2000 CHO CO OL PROG TIVITIES I ACTUAL ACTIVTTIES CONDUCTED ACTIVITIES S/N ls' OUARTER PROPOSED ACTIVITIES /" QAARTER 3* SAARTER (tn SUARTER I I'lanning & Schedule of Activities 2. Advocacy visit to LGAs 3 Advocacy visit to Traditional Ruler 4 Training of I Iealth Workers 5 Oncho Day Celebration 6 Comrn. Mobilization on CDTI (Zone A) 7 Selection of CDDs by Communities 8. Training of CDDs (Zone A) 9. Mectizan Distribution Act (Zone A) 10. Wrap up exercise (Zone A) il Comm.Mobilization (Zone B) 12. Selection of CDDs by Communities (Zone B) t3 Training of CDDs (Zone B) l4 Mectizan Distribution Act (Zone B) l5 Wrap up exercise (Zone B) 16. Bi-annualAPOC Report 17. Mectizan Application for Year 2000 18. Material Development (APOC) t9 Result Compilation 20. Appraisal Workshop 2t Mop Up Treatment 22 APOC Annual Progranrne Report I 3