Year 1 report for Community Directed Treatment with Ivermectin CDTI : Yobe State Nigeria : September 1998 to May 1999

I) AFRICAN PROGRAMME, FOR ONCHOCE,RCTASIS CONTROL (APoc) Year I Report for Community Directed Treatment with lvermectin CDTI Machina September 1998 to May 1999 R EPU , O JU'N ,999 rasu Yusufrri Yunusari Nguru Bade Bursari Geidam Jakusko Thrmuwa DamaturuFune Gujba Gulani I I i { Yobe State Nigeria APo c / PlvI EXECUTIVE SUMMARY Yobe State was created out of the former Borno State in August 1991. It situated in the northern eastern part of the country in Sahel Savannah. Its topography is characterized by desert features in the northern part of the state. The southern part has rocky hills and mountainous terrain with rivers giving it the identity of the Sudan Savannah. The river Yobe is of particular mention as it cuts across Six (6) LGAs, and it serve as breeding sites of the black flies. The State covers an estimated landmass of 47,153 Sq. Kilometers, with a population of 1.4 million people. Yobe State has a total of Seventeen (17) Local Government Councils. Twelve (12) of which are Meso-endemic with few southern areas having hyper-endemic communities, especially in those belts that run across the Biu LGA of Borno state. The people of the state are mostly involved in farming, cattle rearing, fishing etc. Treatment started in the state in the year 1995, after CBM signed a memorandum of understanding to assist in the control effort. Over One hundred thousand persons have been treated since then. The State wrote a proposal to APOC for possible assistance in the year 1997 to implement CDTI, and this was approved for funding in September 1998. CDTI is currently being implemented in the State with all emphasis shifted to community ownership of the programme from the onset. This we found to be a better arrangement that will encourage sustainability within the community levels, since the communities now see the programme as theirs and so the need to fully support and participate in its implementation. CDTI implementation started in the late part of 1998, with the State treating a total of 211,484 persons from 158 communities with Ivermectin Since theq a- lot is being done to encourage integration into existing PHC system. CDTI is no doubt on course and the state is quire hopefl.rl of its success story in the near future. In 1999, a total of 223,729 persons were treated in 188 communities. Yobe State government has fully embraced the programme and is fully committed to its fulfillment of remitting the counterpart funds to compliment those of APOC and CBM. f SECTION I: BACKGROUND INFORMATION There are about 237 identified endemic communities in 12 hyper and Meso- endemic local government areas. CDTI Approach began from September, 1998. The average population of the communities is between 500 to 1,500. Our communities are defined in terms of 8 to 15 people living in each household, and others are even more. 1.2 Communities implementingCDTI. Prior to MOFVCBNiI/APOC partnership, a total of 98 communities were recelvlng treatment in twelve local government areas. Under the new dispensation, 158 communities are presently being treated with lvermectin and are also implementing CDTI. 1.3 Endemic LGAs with treatment rounds. Find below list of endemic L.G.As/treatment rounds: S/N LGA ROUND 1 Fika 5 2 Fune 5 J Bursari 5 4 Gulani 5 5 Gujba 5 6 Tarmuwa 5 7 Jakusko 5 8 Nangere 5 9 Potiskum 5 l0 Bade 5 11 Karasuwa 5 t2 Nguru 5 Note: Not all communities are in the fifth round of treatment because of our policy of gradual expansion over the years. 3 SC srN DistdcUlGA No. of Comm Villagc No. of Communitics /Villages Thet selcctcd CDDs No. of Communities /Villages that collected Drugs No. of Comm Ar'illages that decided on Month(s) of distribution- No. of Comm lY'illages that decided on the month(s) of TreafincnL No. of Comn /Villagcs with trained CDDs No. of Comm /Villages peying CDDs in ca-sh or Kind. I TARMUWA 9 9 9 9 9 9 8) BURSARI 38 35 35 35 35 35 26 t FLNE 12 32 32 t2 32 32 t9 4 NGI.IRU , 6 a a 7 7 ) 5 KARAST,\vA 4 4 4 4 4 4 3 6 BADE l3 l3 13 13 13 l3 26 1 JAKUSKO l4 l4 t4 l4 l4 l4 8 8 POTISKUM 7 '7 7 7 7 7 5 9 FIKA 23 2l 23 23 23 23 t6 l0 NANGERE 6 6 6 6 6 6 4 ll GTILANI ,o 29 ,o 29 29 29 14 12 GL]JBA ll ll l1 ll l1 il 3 TOTAL rt8 rsl 185 rt5 1q) 190 r13 TABLE I THE IMPLEMENTATION OF CDTI tember 1998 to Februa I Please note that the treatment period for Yobe State used to be between September to December of each year, but with the introduction of CDTI, most of the communities after interacting with them prefer a change of the treatment period to commence as from January and to end before the raining season sets in. This report is therefore covering for two treatment periods. The second year report will not have this duplication again as it is hoped that the transition would have been over. SECTION II TRAINING AT VARIOUS LEVELS FOR CDTI EMENTATION TABLE 2. s/N District/LcA No of tr:aining undertakcn No ofTOT trained No of District or LGA stalT trained in CDTI No of Hedth CcntreYPost stalT traincd on CDTI No of CDDs tr:ained. I FIKA 5 (2 each for I.OCT,CDD & PHC 2 (SOCT, LOCT & PHC 5 47 65 7 GULANI 5 13 62 3 GUJBA 5 t5 15 4 FLTNE 5 37 59 5 BURSARI 5 52 8t 6 JAI(USKO 5 2t 35 7 BADE 5 26 <, 8 NANGERE 5 ll 25 9 POTISKTA,{ 4 8 26 10 KARASTIWA 5 8 24 1l NGURU -t 11 32 t2 TARMUWA 3 ll 26 TOTAI. 56 271 522 Lt 2.1 T r ain i ng O bj ectiv e s/A c h iev e me nts In the last one year, a total of 800 staff were trained and retrained out of 919, representingSToh achievement. A break down are as follows:- CATEGORY OF WORI(ERS NUMBER TO TRAIN NUMBER TRAINED PERCENTAGE OF COVERAGE LOCTs 72 60 83Yo PHC WORKERS 240 2tt 88Yo CDDs 600 522 87Yo SOCTs 7 7 l00Yo TOTAL 919 800 87Y" NOTE: These number of CDDs and LOCT were trained and retrained within this Six months period. 2.1. Developed Training Materials used During the late part of 1998 period, all the materials used were those supplied by CBM, however training materials such as flip charts, CDD guide brochure and posters were immediately produced when the first installment of APOC funds was received. These materials are currently being field-tested. 2.2. Performance of the CDDs Most of the CDDs performed well in their respective communities. Due to the literacy level of the people, comprehension of the necessary forms is gradual, and this account for the use of the pictorial tally sheets for final data compilation. The following parameters were used to determine their performances: o Coverage rates of most communities were encouraglng. o Correct registration and accountability of drugs by most of the CDDs. o Effective mobilization of community members before and during distribution 2.3. Improving the quality of traintng. Trainers (SOCT and LOCT) need to emphasize more on the new 3 mg tablets and the new concept of CDTI to the CDDs and their immediate supervisors who are the PHC workers. The intention is enable them record dosages correctly during Mectizan distribution. LOCT/PHC workers should be exposed more to the art of training so that they will not over depend on the SOCT. To improve treatment coverage, PHC workers in clinics should receive more training to be able to supervise CDDs adequately. 5 s/N District/LGA No of Communities and \/illages Mobilized No. ofTarget Comm./Villagcs thet rtceivcd Ilealth Educ'ation about the importance of ertended trca0nenL Noof AdvocacY Visits to State or Regional Director: of Heelth No of l\{OH stalT involved in Mobilization. No of NGDO Staff involved in Nlobilizat ion- I FIKA 2l 2L 3 7 I) FLNE 20 20 t 7 I 3 BURSARI 30 30 3 7 I 4 GI,TLAM 20 20 3 '7 I 5 GLIJBA 1I ll 3 7 I 6 NGIIRU '7 7 3 7 I 7 JAI(USKO t2 t2 3 7 I 8 BADE 13 l3 3 I 9 KARASI,IWA 4 4 3 7 I l0 NANGERE 6 6 3 7 I II TARMUWA 9 9 3 7 I t2 POTISKUM 5 5 3 I 191 191 3 1 MOBILIZATION AND EDUCATION OF TARGET COMMUNITIES NOTE: Mobilization was carried out for the same number of communities twice because of the current change in treatment period. How ever, the figures of number of communities mobilized were not multiplied. 2.2.r The use of media in mobiltzation. The media was used to disseminate important messages about CDTI in Yobe State. Radio programme was carried out during the period under review, using Hausa and English languages for discussion. We intend to use other key local languages in tfie near future to get messages across to the community members both on TV and the Radio channels. In the communities, village- town criers were mostly used in addition to the face to face contact with community members. 2.2.2 Result of mobilization effirt Communities were able to select their CDDs and have indicated their willingness to support the program. There is need to intensify mobilization to be able to inculcate CDTI concepts in the communities 2.2.3 Response of the communities. Most of the communities are pleased with idea of getting them involved in the planning stage. They have been able to fashion out ways of improving their -orr".ug", select and support their CDDs during and after distribution. 6 So far we can say that their response is encouraging. However, few communities were not able to give incentive to CDDs which resulted in CDDs not treating communities adequately. Mop-up treatment is being arranged for such communities. 2.2.4 Suggestion to improve mobilization More emphasis on health education is vital to enable the community accept their responsibilities for the project. Constant advocacy visits to Local government authorities will increase LGA participation. This activity should be carried out again when the new LGA administrators are sworn in May 1999. Community members should be involved in the mobilization for better response and feed back. SECTI ON III Results fiom some communities in Gujba, Nguru and Bursari are being awaiteda These communities use health workers who are sons of the soil and are selected by the community members to distribute Mectizan for them. They have been encouraged to select non-health workers in the near future for fear being transferred out of the village. ACHTEVEMENTS 3.1 Treatment coverage. Treatment coverage rate for the state during the last distribution exercise is 86%. Total census populatio n sai District/LGA No. of Target Comm / Villages No. of Etigible people treatcd 1998 No. of Eligible people treated 1999 No. of Comm.IVillagcs in which CDDs are health workers No. of Distributiotu supcrvised by health workcrs No. of treated Comm,/Villa ges with summary forms. I TARMUWA 9 83 l4 I 3908 0 I 9 a BURSARI 30 24362 25947 5t I 38 3 NANGERE 6 tf697 I 1955 0 I 6 4 FIKA 2t 3605 l 31905 0 I 23 5 POTISKUM 5 I l5,m t4099 0 I 7 6 BADE l3 I 161r I 1600 0 I 13 7 FTINE 20 27799 41828 0 I t2 8 KARASTJWA 4 5875 3609 0 I 4 9 JAKUSKO t2 rt204 13910 0 I t4 10 NGURU 7 14301 2065 0 I t lt GUJBA ll t7979 1205 I n I ll t2 GL'LANI 20 28671 14852 0 I 29 TOTAL 158 ztt.4U 223,729 0 1 ItE 3.2 a Total Census Population of treated communities was 259,872 persons. 3.3 Total eligible popalatiotl Total Eligible Population of treated communities was 232,41 5 3.4 Absentees/Refusals. The population of absenteeism is generally high in some communities after analyzing the 1998 treatment results. This was one of the reasons that brought about the change in the distribution period. Some remons for absentees and refusols l) Lack of commitment on part of CDD e.g. in Gujba, Nguru and Karasuwa 2) CDDs were not very much supported by the communities 3.5 3) Mobilization was not very adequate. 4) Duration (days) for training was limited 3.6 Plans for reducing number of absentees and refusals. 1) To intensify community mobilization by involving the communities from the beginning. 2) To make an arrangement for mop up treatment exercise for those people that were absent during the regular distribution. 3) Making adjustment in the distribution period, which we have already done. 4) Encouraging the community PHC facilities to be fully involved in the programme, so that they will help in mobilization and Health education and supervision. 5) Encourage communities to give incentive to CDDs Increase number of CDDs to reduce work-load on CDDs e.g. some CDDs are treating between 2,000 - 3,000 people in one community. I 6) SECTTON IV: STRENGTHS/WEAKNBSSES & SUGGESTIONS Strensths(1) Yobe State Government's commitment to the program(2) Dedicated SOCT working with the program(3) Support of NGDO and NOCP(4) APOC support to the Project 4.1 4.2. Wea (r) (2) (3) (4) Low literacy level of the people The community members are claiming that they are poor and will find it diffrcult to adequately support CDDs. Frequent changes in the LGA administration do not encourage continuity. Communities refusal to increase number of CDDs due to the fact that they will give incentive. 4.3. Sussestions(l) Increasedcommunitymobilization(2) Advocacy visits should be intensified(3) Increase training especially for PHC workers to assist CDDs in terms of mobilization and suPervision. 4.4. Contribution of the Ministry of Health The following items are the State Government contribution to the programme. One used Toyota Land Cruiser Oflice Furniture Two Binocular Microscopes Weighing Scale Cash Contribution of N1.7 million yet to be collected A B. C D E, I