II I I i I I I i : ! I I : I : t_ RESERVED FOR PROJECT LOGO/HEADIIYG COUNTRYAIOTF: NIGERIA Prqiect Name: NOTF/APOC- WHO/AKWA IBOM STATE Approval year: APRIL,2003 Launching year: SEPT ,2003 Proiect year of this report: (circle one) I Reporting Period: From: To: 2 M"y, 2004 thrY April,2005 Month/Year 345678910 Date submitted: November ,2005 artner: HKIN, D OzuGINAL :English ANNUAL PROJECT TECHNICAL REPORT SUBMITTED TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) For Aition so DEAD FOR SUBMISSION: To APOC Management by 31 January for March TCC meeting To APOC Management by 31 Julv for September TCC meeting fo: Ttc for To, AFRICANPROGRAMME FOR ONCHOCERCTASTS CONTROL (APOC) t..Ntqtri ue I 0 SEP. 2009 APOC/DrR RECU LE WHO/APOC, 24 November 2004 tt I ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE. (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: Country: NIGERIA/LIBBRIA National Coordinator Name: Dr. J. Y. Jiya Signature Date Zonal Oncho Coordinator Name: Mr. J. O. Eluwa Signature Date NGDO Representative Name: Dr. Musa O. Obadiah Signature Date This report has been prepared by Name : Veronica I. Itina (Mrs) Designation: State Oncho Coordinator Signature Date: November,2005 ll WHO/APOC, 24 November 2004 Table of contents ACRONYMS... FOLLOW UP ON TCC RECOMMENDATIONS..... EXECUTIVE SUMMARY......... SECTION I : BACKGROUND INFORMATION........ v 2 3 a t 1.1. GpNennl rNFoRMATIoN............. 1. 1. 1 Description of the project (briefly) 1.1.2. Partnership 1.2. Popu1erroN............... ERRBUn ! SrcNnr NoN DEFrNr. ..... Erreur ! Signet non ddfini. 4 5 6SECTION 2: IMPLEMENTATION OF CDTI 2.1. Trrr,relrNp oF ACTrvrrrES ............ .........6 2.2. Aovocacy .......................8 2.3. MoetLtznrtoN, SENSITIZATIoN AND HEALTH EDUCATIoN oF AT RISK coMMumtrres . 8 2.4. CovtaurNrry INVoLVEMENT......... ..... l0 2.5. Cepacrry BUrLDrNG... ..... l1 2.6. TRperueNTS.............. ..... 13 2.6.1. Treatment figures .......... .................. 132.6.2 What are the causes of absenteeism? .......... ................. 15 2.6.3 What are the reasonsfor refusals?................ ............... 15 2.6.4 BrieJly describe all lcnown andverified serious adverse events (SAEs) that... l5 2.6.5. Trend of treatment achievementfrom CDTI project inception to the curuent year l7 2.7. ORppRrNc, sroRAGE AND DELIVERy oF TvERMECTIN ........... l8 2.8. Covvuxrry sELF-MoNrroRrNG eNp STnTEHoLDERS MeerrNc ............ l8 2.9. SupeRvlsroN............... ...................... 19 2.9.1. Provide aflow chart of supervision hierarchy . ................. 19 2.9.2. V[/hat were the main issues identified during supervision? .............................. 19 2.9.3. Was a supervision checklist used? ... .. ... 19 2.9.4. What were the outcomes at each level of CDTI implementation supervision? I9 2.9.5. Wasfeedbackgiventothepersonorgroupssupervised?..........................20 2.9.6. How was the feedback used to improve the overall performance of the project? 20 SECTION 3: SUPPORT TO CDTI 20 3.1 3.2 J.J 3.4 20 2l 2l 2l EqurrveNr FnqeNctal coNTRIBUTToNS oF THE pARTNERS AND coMMUNITIES OrHpn FoRMS oF coMMUNITy suppoRT............. ExpeNorruRE PER ACTIVITY SECTION 4: SUSTAINABILITY OF CDTI........ 22 4.1. INrrRNar-; TNDEeENDENT pARTrcrpAToRy MoNrroRrNc; Ever.unrroN.......... ..........22 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of thefollowingwhich are applicable).......... ...........22 4.1.2. Wat were the recommendations? .............22 4.1.3. How have they been implemented? ............. .................23 4.2. SusraNRstLITy oF IRoJECTS: eLAN AND sET TARGETS (MANDAToRv AT...... ..........23 Yn 3)......... ................23 lll WHO/APOC, 24 November 2004 4.2.1. Planning at all relevant levels... ................. 23 4.2.2. Funds....... ................. 23 4.2.3 Transport (replacement and maintenance) ....24 4.2.4. Other resources ......24 4.2.5. To what extent has the plan been implemented................ ..............23 4.3. INrecnerroN ............... .....................24 4.3.1. Ivermectin delivery mechanism.s............... ...................24 4.3.2. Training.... ..............24 4.3.3. Joinl supervision and monitoring with other programs........... ...... 24 4.3.4. Release offundsfor project activities ........ 24 4.3.5. Is CDTI included in the PHC budget? .............. ... ...... 24 4.3.6. Describe other health programmes that are using the CDTI structure and hov, this was achieved. What have been the achievements?............. .. . . .. 24 4.3.7. Describe others issttes considered in the integration of CDTI. ..... 24 4.4. OpenerroNAL RESEARCH .....24 4.4. l. Summarize in not more than one half of a page the operational research undertaken in the project area vtithin the reporting periocl. ....... 24 4.1.2. Hott,v,ere the results applied in the project?.... ...........25 SECTION 5: STRENGTHS, WEAKNESSES, CHALLENGES, AND OPPORTUNITIES.... 26 26SECTION 6: UNIQUE FEATURES OF THE PROJECT/OTHER MATTERS........... , lv WHO/APOC, 24 November 2004 Acronyms APOC African Programme for Onchocerciasis Control ATO Annual Treatment Objective AtrO Annual Training Objective CBO Community-Based Organization CDD Community-Directed Distributor CDTI Community-DirectedTreatmentwithlvermectin CSM Community Self-Monitoring DHS/DHC District Health Supervisor/Coordinator FL-HFS Front Line Health Facility Staff HFS Health Facility Staff (Station officers) HOC Head of Council IEC Information, Education and Communication KAP Knowledge attitude and practice LGA Local Government Area LOCT Local Onchocerciasis Control Team MOH Ministry of Health MSD Merck Sharpe and Dolune NGDO Non-GovernmentalDevelopmentOrganization NGO Non-Governmental Organization NOTF National Onchocerciasis Task Force PHC Primary health care PHS Public Health Services REA Rapid Epidemiological Assessment REMO Rapid Epidemiological Mapping of Onchocerciasis SAE Severe adverse event SHM Stakeholders meeting SOCT State Onchocerciasis Control Team TCC Technical Consultative Committee (APOC scientific advisory group) TOT Trainer of trainers UNICEF United Nations Children's Fund UTG Ultimate Treatment Goal WHO World Health Organization WHO/APOC, 24 November 2004 Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). ( ii) Eligible population: calculated as 84%o of the total population in meso/hyper- endemic communities in the project area. (iii) Annual Treatment Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iu) Ultimate Treatment Goal (UTG): calculated as the maximum number of people to be treated annually in meso/hyper endemic areas within the project area, ultimately to be reached when the project has reached full geographic coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of meso/hyper-endemic communities as identified by REMO in the project area (this should be expressed as a percentage). (vii) Integration: del ivering additional health interventions (i.e. vitamin A supplements, albendazole for LF, screening for cataract, etc.) through CDTI (using the same systems, training, supervision and personnel) in order to maximise cost- effectiveness and empower communities to solve more of their health problems. This does not include activities or interventions carried out by community distributors outside of CDTI. (viii) Sustainability: CDTI activities in an area are sustainable when they continue to function effectively for the foreseeable future, with high treatment coverage, integrated into the available healthcare service, with strong community ownership, using resources mobilised by the community and the government. (ix) Community self-monitoring (CSM): The process by which the community is empowered to oversee and monitor the performance of CDTI (or any community- based health intervention programme), with a view to ensuring that the programme is being executed in the way intended. It encourages the community to take full responsibility of ivermectin distribution and make appropriate modifications when necessary. vl WHO/APOC, 24 November 2004
aI FOLLOW UP ON TGG REGOMMENDATIONS Using the table below, hll in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 23 Number of Recommend alion in the Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/APOC MGT ASE ONLY 9si Signatories should read and vet the report before endorsing the report The report on completion was forwarded to NOCP HQs who made appropriate inputs. 95 ii Executive summary should be presented in a narrative form This is done 9s iii Background information should be more comprehensive, This has been done 95 iv Number of CDDs trained and active Total number of CDDs trained and active stands at 35 95v What will happen to the remaining mectizan tablets Remaining Mectizan rvill be returned through normal processes to the State office 95 vi Issues identified during supervision outcomes and feedback These have been addressed in the repoft 95 vii Recommendation during participatory independent monitoring, key recommendations and extent of implementations These have been addressed in the report 95 viii Advocacy should be more descriptive This has been done. 95 ix Information on community involvement should be disaggregated along community/district lines to show areas that need help This has been done. See Table 4 96i The project should train more health officers A total of 63 health workers were trained during the reporting period. 96 ii The project should train more CDDs A total of 35 CDDs were trained and retrained. This will be improved upon in the subsequent years 96 iii The project should commence SHM and CSM The project staff is yet to receive appropriate training for this exercise. Once this is done CSM and SHM will be implemented. (Please add more rows if necessory) WHO/APOC, 24 November 2004I Executive Summary Prepare an Executive summary of the report in not more than one psge. Akwa Ibom State is located in the south eastern part of Nigeria and is now a part of the south - south geo - political zone. The State has a total population of 3.1 million people. Languages spoken are Ibibio, Annang, Efik, Ika Ibom and Oro. English is generally understood. Majority of the people are Christians, a few are traditional worshippers and an insignificant number are Moslems. Akwa Ibom State is in its 2"d year of project implementation. It is unique in the fact that only 2 of its LGAs are endemic - Ini and Ibiono Ibom with a total of 28 communities.. These 2 LGAs however are difficult to reach areas. The people are not nomadic but permanent residents as such absenteeism was largely due to farm activities. Population movements occur only in cases of war and communal clashes but these are rare occuffences and people regroup immediately after. A total number of 27 communities were treated giving a 960/o geographic coverage. 7,780 persons were treated out of a total population of 17,642 persons, resulting in a 44%o therapeutic coverage rate, and achievements of 53% and 69oh of the project's UTG and ATO of 14,819 and 11,343 respectively. 35 CDDs were trained/ retrained out of an ATrO of 30 while 63 health workers were trained/ retrained including LGA staff of an ATrO of 63. These are achievements of llTo/o and 100% respectively in respect of the ATrOs. CDD: Population ratio stood at l:504 for the year being reported. To ensure sustainability, regular planning meetings will be held by the state and LGAs at the beginning of the year. The meeting will be an avenue to develop yearly work plans at the state and LGA levels with specific funds assigned to the goverlment. The State has been releasing regularly its counterpart funds and it is expected this will continue. LGAs are yet to follow suit. Challenges faced were: . Non identification and involvement of CBO and VHC in planning and implementation. . Non seeking of additional support from existing oil companies e.g. Exxon Mobil o Transfer of CDTI personnel to non-CDTI area o Inadequate support by LGAs for the fueling and maintenance of the motorcycles . Inadequate logistics e.g. motorcycles and bicycles o Project yet to organize stake holders meeting . Political instability in the country where mobilised council Chairmen are soon replaced by new ones. o Non-compensation of CDDs To address the challenges the following were done: . Liaising with Local Government Service Commission to prevent transfer of CDTI personnel in the CDTI project area. Emergency trainings were conducted for new ones as all transfers could not be prevented. o Fueling of motor-cycles supported by State Government. This hopefully will enhance mobility which is highly needed especially during mobilization and supervision. . HKI brings in additional vehicle during operations and takes it back after. . Trying to explore ways of getting possible support from Exxon Mobil for sustainability of project. . Coping with changes in the Local Government Councils as mobilisation is made a continuous process. o CDDs were persuaded to put in their best 2 WHO/APOC, 24 November 2004 a SEGTION {: Background information 1.1. Generalinformation 1.1.1 Description of the project (briefly) Geograp hicul location, topography, climate Akwa Ibom State is located at the South East corner of Nigeria lying between latitude 70251 and 8025land longitude 4032t and 5033lEast. It comprises 3l LGAs but control activities take place in only two (Ini and Ibiono Ibom) LGAs. These two LGAs occupy the North Eastern part of the State. The project area is undulating and has poor and difficult terrain. Areas that have plains are usually flooded (Ikpe Ikot Nkon, Itie Ikpe and Ananamong in Ini LGA and Afua in Ibiono Ibom LGA). The hills are found in places like Ikpanya, Ebo and Obotme, and the valleys in Abaitiat, Ikweme and Edem urua. The entire State is situated in the rainforest bio-climatic zofle. The northern part where the project is located is moist woodland savanna. There are two marked seasons: the wet season starts in March and ends in October while the dry season starts in November and ends in February. Akwa Ibom State CDTI project covers only 28 communities of the two LGAs of Ini and Ibiono Ibom located at the North-eastern part of Akwa Ibom State. The total population of the 28 endemic communities is 17,682 (census update). Ini has twenty communities with population of 13,560 while Ibiono Ibom has 8 communities with population of 4082. But the population for 27 treated communities is 17,187 (Ibiono 3627,Ini 13,560). Population: activities, cultures, language The State has a total population of 3. I million people. As part of the culture, some days are set aside for masquerade festivals such as, Akata, Ekong, Ekpo nyoho, Abon and Ekpe are being displayed. Majority of the people are Christians, a few are traditional worshippers and an insignificant number are Moslems. Many of the indigenes speak Ibibio, while others speak Annang, Efik, Ika Ibo and Oro. English language is generally understood by the educated ones. Communication systems (roads...) The roads are tarred but un-maintained (i.e. the one linking major cities) others are un-graded roads and foot paths. The roads are used with much difficulty during the rains. Telephones especially the mobile ones are mostly used these days for communication. Others include radio and television for wider coverage and in the local setting town announcers (criers) are employed. Main occupations of the people are fishing and farming. A distinct characteristic of the people is cleanliness. A dministratio n str uct ure There is a two tier administrative structure at this level. A democratically elected Governor heads the State executive council. The local Government chairmen who are also democratically elected head the local councils while the communities have leaders (chiefs). 3 WHO/APOC, 24 November 2004 Health system & healtlt care delivery (provide the number of healtlt posts/centers in the project area d the information is avoilable). Health care is delivered at 3 levels in the State. There is the tertiary level (University of Uyo teaching hospital). The secondary level which is represented in all the LGAs but far apart and the primary level (PHCs) which are expected to be found in majority of the communities, but this is not the case. The number of health centre/post in the project area is 5 and there are about 27 health staff in which 20 are involved in CDTL Table 1 : Number of health staff involved in CDTI (Please add more rows if necessary) District/LGA Number of heatth staff involved in CDTI activities Total Number of health staff in the entire project area Br Number of health staff involved in CDTI B2 Percentage Br=Bzl Br *100 Ini l7 1l 65 Ibiono Ibom l0 9 90 Total 27 20 74 1.1.2. Partnership Intlicate the partners involved in project implementation at all levels [MoH, NGDOs (n atio n a l/i nte r n atio rtal ), c o mm un ities, lo c a I o r g anizations, etc. l Partners involved in project implementation at all levels are: - African Programme for Onchocerciasis Control (APOC) - Federal Ministry of Health-NOCP - State Ministry of Health - The 2 LGAs - The Communities: CDDs, - NGDO: Helen Keller International Describe overall working relationship dmong partners, clearly indicating speciJic areas of project activities (planning, supervision, advocacy, planning, mobilization, etc) where all partners are involved. Communities: Assistance is given in the areas of yearly Mectizan usage, selection of CDDs, drug collection, storage, distribution, carrying out CSM and supervision of drug distribution. LGA: The LOCTs, DHS, FLHFS and Nutrition focal persons plan activities in their LGAs like community mobilization, training of CDDs, collection of drug from State, storage and delivery, monitoring and supervision, writing and submission of treatment reports. State: State plan all CDTI activities, conduct TOT trainings at LGA, make advocacy visits to LGA executives, collect Mectizan for LGAs, monitor and supervises the drug distribution and write reports for submission. NGDO: Helen Keller Intemational provides technical assistance by training SOCTs, lead in high level advocacy to the State and LGA policymakers, apply for Mectizan consignment, approach rulers and influential members of the community for support. Working relationship between partners is cordial with regular meetings to maintain the relationship and make CDTI a success. State plans, d any, to mobilize the state/region/district/LGA decision-makers, NGDOs, NGOs, CBOs, to assist in CDTI implementation. The State, LGA, District and LGA decision makers have been mobilized and will continue to be mobilized in the coming year. o 4 WHO/APOC, 24 November 2004 $ ON 0) -o o z$N O -r o. - > oo '= L o. o; o7q5 tri () a. (n(-) bo -qtr E€ r,cd(.) trEbo ).f o.E()+ .2c?olVL -cdOJlr0.)-c o(dbO-()d'=E )EY ! 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(g f.oO.5 JCrE= JtcxOr:o.:. c.tl ' o''lNEI . <!lFFI HQ I I I I I U) c/) () C) o : z 0)oLL ;1 ()d> F D OF E *(J c.) o\Nq CO o\ € t (\tt\o Fr + ils .c) LE -()o .= N 9\Ei r€ \otr) ca N oo $ . ..8 E ._'r9-&E.=;: >.E 6, ql -E E E'FNa I alv\o r- 'EgE Jec ioo o:Li-'- O2 O\ovl ca c'l oo $ I () ON 3.e d0) oF + a il C\ oo €al .eE E.Fo= €2E Ei-cq)tr >1 o)tstr -o N (a) c) u0 Gt o c) I trq) z 'EgB ;eaE P; E 8eitsr''Q2 N @ 6N 6t FO) .EEk9.r -i- -J e !{fl i. 3'F -v9-tF TE E \o(al cO N@O$ (\l =\o r-. !fc)cJ .99 c) EeEc ={ iHR'r E tr o zo ca Fl F o3 l+ I I SEGTION 2: Implementation of GDTI 2.1. Timeline of activities Fill in table 3, timeline of activities for areas treated in current year, rndicating when the key activities were implemented by the month they began and the month they ended. Insert Plan of action indicating activities by month, which were implemented. a 6 WHO/APOC, 24 November 2004 $OON Lq) -o (,) o z vN Q o Ji U) P q) (n c)e EE U o C) o o 0) o u0EE a- >.(s z d z U) uc o9 *o tstr Q c,o t-.l o() UD c!= a- o o 0) c! ah ra o) U EE U o ts- C) aorE a- >,(! z >'d z bI CELF EF o Q >' >. UDF.E 6r: a- >.(g z >. z rG) .Etr s= -atroor-92 c)€ PoQFEE Q >.(g =z d z ADg& (!= u)- >.z >.(d z l] C,) ti ah a -o I o o s I t'( F t-- ch q) E oO U)q\) Q a) q: o\ q)\ ! q)q q) 5 t4 <g C) okLr o o o Cd oLr U)(c C)k o k .og a 0) o(tqr o() o F ..i I o)l _oldlFI a ) 2.2. Advocacy State the number of policy/decision makers mobilized at each relevant level during the current year; the reason(s) for undertaking the advocacy and the outcome. Describe difficulties/constraints beingfaced ond suggestions on how to improve advocacy. Policy/decision makers mobilized at each relevant level during the current year are as presented below. The essence was to mobilize support for CDTI implementation. While at the State level, funds were released there were no releases at the LGA level. The major constraint faced is the inability to meet with the executive chairmen of the affected LGAs. 2.3. Mobilization, sensitization and health education of at risk communities Provide information on - the use of media and/or other local systenu to disseminate information Media and systems used in disseminating information were: 1. Face to face discussions in community gatherings 2. Radio and Television jingles/messages 3. Videos and films 4. Traditional means of communications e.g. drums, playlets and drama. - Mobilization and health education of communities including women and minorities Advocacy visit began with the traditional rulers e.g. Paramount and Clan heads who then summoned their chiefs from villages to brief them. Appropriate health Education messages in form of posters, pamphlets and verbal presentations were used. This included knowledge of the disease, knowledge of treatment, attitude to treatment, attitude to disease and attitude to good record keeping. Women were mobilised in their groups and gathering. - Response of target communities/villages Communities accept the continuous use of Mectizan. - Accomplishments 27 endemic communities sensitized and treated. Suggest ways to improve mobilization and sensitization of the target communities. o The conduct of focal group discussions particularly with women groups in order to ascertain what to include in the materials o Provision of adequate logistics e.g. vehicles, motorcycles, bicycle, canoes or speed boats . Enough funds should be made available for mobilization visits I a 8 S/ N Level No Mob. Reason Out come Constraint Suggestion I State l5 Support (finance and cooperation Successful Some people were not seen Should continuous be 2 LGA l2 Support (finance and cooperation Not very successful HOC don't take health issues serious Hon. Commissioner and Permanent Secretary to be involved WHO/APOC, 24 November 2004 t N L() -o Eo z$N O o o ,(\ \ \J cd(.)9EHtg.s 'If qr .;\ cd \-- a.b qi vh la, v$0)()1ibn.s6X € .,bo()s krU =.stqJg5 E =qL9 J'=tsi: b9E .5 o.):x ! - E-q o\JCJ;i" .NS3 =1 o6 c9g!trs-P\.\>rSL .=$=;UOi S cr.Q =\\oHi,v:$,atr .E. o-I "E S :E[?oo- s - \ o. \-qSVr\!t.uEL \d\L)Y;S; I 3 E.rJ sE t P = +.i Sfi E n r:et-v^v!t= .c .- = >': sE s f gsE *E i = 3t=d.q $ .r. dg- Bgt€sEsEF€ € :SgS;SI :$ BqqSl,t- E.iE$iS.EYi 3sg'E* JEIi E aE s;s isP-(JxeCE^ S E s.{:ils'€ e ntri ^'uE\tr \- * r .: E ;t = S i " =l*EPEgilsbgSoshts:.ss'i g s-a E ESE; $rE $EI?S E \ r a s d.<'i F \ > a o Qrrrrr () :=^ .o ia q qr= =<z ll * e {)b! q) a) c) o al 6 -?ot^.=-?.ZEX; je= = E!Uz i',- V) () c- {)EEtr tro z +r il cq F r- N oo ta f) cq P- c; .9u o c.t al F na JAcsf 2,U r- \o rOcl >o o'- uDic!E >0)oUd l= c) E() otr o- vE eta za ll * ca ca ca C)b! q) q) I ta f*3r7'i z .Z .: Ei i -trY iAv- ZeEq ca ?q)c ,i .X .! 9rE'E;; - = o1iSEgU3 E='F U'- * N @ 6al I -] .9 .2 .o o -o (q otr L' 4qq) uq) + \ a)LU \ q) % q) 5 F t-lO 0,) a, +rE=o.= =trLoo'5 o'5 trH v() s.= J- ?=EEEHL^OrIo: .+l .ol\t 5l r (!lNFI I a t ( 2.5. Gapacity building - Describe the adequacy of available knowledgeable manpower at all levels Available knowledgeable manpower is adequate at all levels except at the community. Health staff (CDTI) have been trained in all the Districts of the two endemic LGAs on both CDTI and Vitamin A supplementation which takes place also in non-CDTI LGA of Ikono. Due to Vitamin A supplementation CDDs have been trained in all communities of Ini, Ibiono and Ikono. - Where fiequent transfers of trained staff occur, state what project is doing or intends to do to remedy the situation (The mosl important issue is v'hat nteasures v,ere taken to en.sure adequate CDTI intplementation t'here not enough knowledgeable ntanpotrer was available or staff often transferred during the course o.f the cantpaigrt). The project had liaised with Local Government Service Commission to prevent transfer of available manpower at the LGA. Curriculum was developed and used to train medical personnel with emphasis on early recognition of SAEs, proper management of SAEs cases including prompt refenal of cases with signs of aggravation. Trainees were told of the consequences of delay in taking appropriate actions. SOCTs, LOCTs and CDDs were also trained. They are to be positioned at different centres during dozing. Laboratory technicians/technologists were trained on how to conduct thick smear to detect the presence of Loa loa microfilariae Identification of Referral Health facilities and Needs (medica tions. bed snace and equipment) to m SAEs cases There are 2 refercal hospitals and two health centres (2 comprehensive) which were provided with necessary medications. (Ikono General hospital, St. Theresa hospital Use Abat, Health Centre at Ikpe Ikot Nkon and Health Centre at Ono. ! i -+r /LO WHO/APOC, 24 November 2003 I t: d ll \,/ F -.i s,!qv :' 2v ta) tr-- N N c\ co oo ta ?a) ?a) ta q) .t) I o q) z (-)LF o.l a-l oo ?o r- o q,) q) o o\ F U + I ilI U Uq -u rl (.l al o O 0) .a cnd- oJ' oc) .. G) Lc{qJL z QLF N o q) o \o ?,, dE,t +F"u' ,y \, *u N : NN (.t rO 6l aa I 0) !s :Htr:- ZE q)() (.)LF c.l6l .I ?al () q) () \o $ d E.;+F-d e s -+ I-* tr- t-l rO u) 0 Fl 9eoc) a!Y o o z Q L -t r- ?a rl -o o o s Fl F oF o q) o (J 6 ..l ! 0) -o () z N O o o. (-, + \ \ bo o a o\ o s !e s s o <l o bo ! o *p o a !t .. g -s ; a1 q a AJUl) q > o\ \ * 9 q g q) 5 d () E C) a. F t-.1(.) q< cr) o C) C)k .0) +i 0.) (d bo (d LrF .iil ,l _ol cglFI i I Trainees Type of training CDDs Other Community members e.g Community supervisors Health Workers (frontline health facilities) MOH staff or Other Political Leaders Others(specify) Program management How to conduct Health education J J J Management of SAEs J CSM SHM Data collection J J J Data analysis J Report writing J Others (specifu) Table 6: Type of training undertaken (fick the boxes where specific training was carried out during the reporting period) Any other comments 2.6. Treatments 2.6.1. Treatment figures If the project is not achieving 100% geographical coverage and a minimum of 65Yo therapeutic coverage or the coverage rate is fluctuating, state the reasons and the plans being made to remedy this. The project achieved poor coverage in Ini LGA due to the following reasons: o Insufficient Mectizan tablets; with census update this will be remedied. . Fears of possible SAEs in suspectedloa loq areas, so project implementation was slow paced to ensure comprehensive monitoring o Inadequate mobilization of the communities; the State intends to carry out comprehensive mobili zation next year. a .r3 AL WHO/APOC, 24 November 2003 .f, (\ o -o () o z wN O o P o \\ t o\(\ c'.1 II X61 ot c-.1 ool O r-l $ r--l .a \-,F 63 C)q d o() 'a o- q) C)q o E o C) I O a. oq o o: ^, o)vl L -l o.rxl f 'ol ll .91 o, Ul p- -l 0)ol o olq ot L,Ol upl() r*l !ol tr ol - -ol -trl E =t bzt? \oo\\o il O x r-l oo c{l c.l oLd o C) 'a ! a. o o z. 14 d. >r -o _^\85,r; \o ell er= 4., c! /.ca O ar <f, .g ;l-]e t-\l -'E r-l - oo o EoE o^, rvlrr Ol()-l3xl 9 < Xl oo .Yl a)a cdl '- e glx)r ril V o ol IbEtb s Ol tra) 0)l ts -O Ol c!E (!l E) = olt: - ot = _b =t EI zl< o o() 'e L o.() =.: a(.) o o C)E?ovEtrx 0) LC)o=3() HSP \a -.o c)Et 3 g ,IE .,t L -t-\9l !F 6 .91 oo .9 c€l CeEl.z E olll - =,51.e F PI H U El a ol^L bt K qAI trl (n trrt!< )tQ> zl? A b. E.! a- IJ 0o q) bo \) I ts \) c! i: !a 'so t -s !! 's! 5\ s€!o .Ei I: sd \ns:SS .s 'bsE \.u .Y qJ S'P- s\q sqJr .ss \l3s'u is E Pi q':l",i $i .! Yts bsS R: E s'€Y \:f sB * tv cE' sI 3 tu! Sst ri- - ${ .: sH MUUS- 'Q\ * tNs svP UPs *sa' .-u\ 0.4d tss si \ \rs tsi'ig = d\3 S: U qJ:!S Srh t\='ll [!o ()tt- SS\ ag .o o\$$ il X 6'1 or99 ool --r-l t'- F-.1 - o o o F s o H (.) oo(!h o.r a(g oLO6; bI)drd-u- '=x ex =v>vE5ho^ c)F (.) d () bo h C) oo o- 9^\ op. (€ L C) F 6l 6)l sLI ol >t !ldlol -dlAI(dt Lrl hrt ol 0)l s cl cdl ,rl =ldt oldl bl -(l -J .gt9l ol EI 8l el (dl =l EI ol r!l @== qe9( os 6-ia-,4o-'6? o>.^ o;i.EEEii} ,o ,.Y odP o- o oq o o -o E z =<Ea zz bs -occo =-ozd (-t o\r-\o : e- O^U-- !r^!O! ci>q= - X tl A2* Eb \oN v 6 cd q O. ll + o .=o =50o c3^9bsi: >+ooEUF o\....lr- \o \o o\.c .+ o -- o:o Et9 z \c) N sN@$ 00r-r- =oE b.- 299' FU c\6 aa ot oo ?a)v(.) H .9 ,3E. f,H6--c i o o-:oE E " E€ o L6F (\ @ \o al6\o r- (h C) b0(d U)o oQ ll * E .9u E tr,:li 9o\bo<- Ee r'l @@ \oo\ E.9 _- -8 = SHtr q= o =t>,AO o F- c\l r-N =ad o.a E d.= <.e *Fv r- c.l r-(.I \Oq6d-rdq o= :1 o ".: c oE .ft E'- a, ., _ - 3 a s.=^ E EEEE o>-6 oo C\ caal .9<;v o\ oo -o €( oF -:\ a v) -q) Uq) q i o\ \ t g q)q SU 5 -va L (d ch(d(.)k(d (! Fl o kP(h E -o a rl] U) (s o :() LrF e-l o-,l -oldl FI I tl I 2.6.2 What are the causes of absenteeism? 1) Engagement of community members in farming activities during the period of distribution 2) Eligible people were scared by mild reactions on previously dosed individuals. What proiect intends to do . Allow community to take all decisions on when and where to be treated but ensure that Mectizan is available in time.. . Health Education will be intensified o Intensify mobilization so as to make the community heads see the need to compensate CDDs so as to improve their mobilization. o Support CDDs in other forms (e.g. T-shirts, face caps, bands etc) 2.6.3 What are the reasons for refusals? Religious belief's Presence of mild reactions Feelings of well-being a O a 2.6.4 Briefly describe all known and verified serious adverse events (SAEs) that occurred during the reporting period and provide (in table 8) the required information when available. In case the project did not have any cases of serious adverse events (SAE) during this reporting period, please tick in the box. No SAE case to report a J )3 Atr WHO/APOC, 24 November 2004 n <- e.l o -o 0) o z <- o1 (-) U o. o '/) \ t q.) ar q) o'\q) .a B\ a)4 t( -:\ a. qq q) (.) q) ? o qJ\ t U AJq ! q.) 5 o H() o. bo L o o. ol< o oo ti ! olrL oo Cd c/) rI] (n U) o () () U) Lr 0) (d a o Ho U)qr ao ch(n Q #r orl -oldIFI () =-12;o <.E E L - onqlO.O- o ! d::(goia ='= ttr o-= nE9r!56 o ot .2 OE900 -O \J O- O- aD ^ 6.= u0)-c trdJ; (!;oJ- o.2EO o E t=(!aoo =.!.6HUqq o -.2+.u- o H-EC d € - g ep'S? P_o.= ogEEIg o o. >.a r=o -vL =doJ=c) dF= ^A*lJoo(d =() .N*99- Q> B o o60c O.- ?o x 0)a o o0 * 1a o bo X bs' Jo O o\ \c) o\ ca (s a. o ll r ,-i ri O o 3o^ F uo\ -o o o\ o\ o\\c) ll * klr, k] \o o =boo(d =o9e L o\t- o\s$ Q ! .O u= -o_ qFCeo2eo o- o\ o\ cor-r- t, --aE U.= aEo i .o -o' FL' c{ .f .f, e1 Gq;rd "..!o +oE.ioio. .os€= Er.l '4ad)q OEac= o o\ ca c.l\o N oo\or- ao bo cB 6.) oO ll + t-T ti l, o 9 $<aF Oo\ <. >v -o o o\ E .rY^o EW!d!g-fl.F"!5;i Uo !d oo \o o\ t{ E.9 .u.r [i ! -3 5 SHtr c= o =c>,AO o F- o] t! ?o) d o.= itro j.o3' FU r- ...l O' su - o >-c E + 3 9 r-= ='= o'= EE'E E EF = eE =!o o c.l co al & s.l r- o\ o\ oo o\ o\ o\ o\ o\ oN ooN N O c.l c.too(\ doO c.l o(\ \ooON F-. o(\ @oO c.l o\ o ol O O c.l a <.O c! o -o c) o z sN (-) a) o. o B \o \ \ -a v .-9d -I cq I q) bo tr C) aU() rt\JF i\c( *t .\: SH \r VH!tHq)Eo e.:(,l H\99;!6ri\E aP! e = t) c)UG5F!,s\- .:oo trg :PO .5 cq -E:a+.!EEgt.-a )iYEa. Iol .E:-l tt l-+ilo.Eo\ ro= acl*- '^ -( !+Fl P t-tUXr ELIOcdlt0)l .t cgtrEl I9!l E69t E 6)OI .-tallxiI -ol a. C){.. o0 = -5i::dv ar^tr cq 5 7rErYiji=l:(9, v6 EHEtr0)e0()to)LH!Lr :i cE ' .r <) .Yra-rr .t\o .=ci o\l "C)l u) =l dHsFl Fr 2.7. Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qtlease tick the appropriate answer) MOH tr WHOtr UNICEFf, NGDO t Other (please specify) Mectizan@ delivered by - Qtlease tick the appropriate answer)MOHtr WHOtr UNICEFtr NGDO Other (please specify) Please describe how Mectizan@ is ordered and how it gets to the communities NGDO GII(D applies through NOCP HQs to Merck Sharpe and Dohme who approves and makes it available at the country's port of entry. Here UNICEF clears the consignment and either requests the State to come for it directly or the NGDO (HKI) collects it from NOCP and either ask the State to come for it or takes it down to the State Onchocerciasis Control Unit. The State takes it down to the LGAs and the drugs are made available to the CDDs who distribute to endemic communities. Table l0: Mectizan@ Inventory (Please add more rotrs if necessary) - How are the remaining Ivermectin tablets collected and where are they kept? They are retumed back to the State through the same route that they were collected and stored in steel cabinet at room temperature List and brietly describe the activities under Ivermectin delivery that are being caruied out by healtlt care personnel in the project area. . Making mectizan tablets available at Health Centres for CDDs to sign and collect . Supervision of census and drug distribution to make sure that everybody is counted and all eligible dosed and properly recorded. Also taking care of those who react adversely. . Data collection from CDDs and collation. . Report writing and submission. - Any other comments 2.4. Community self-monitoring and Stakeholders Meeting Has any training (of trainers) for community self-monitoring been done in the project area? NO ^l I State/District/ LGA Number of Mectizant tablets Requested Received Used Lost Wasted Expired Remaining Ini 21,000 21,000 13,730 7210 Ibiono Ibom 10,000 10,000 9078 5 9t7 TOTAL 31,000 31,000 22,808 5 8187 If so, When? ){ ^+ WHO/APOC, 24 November 2004 able 11: Community self-monitoring and Stakeholders Meeting (Add rows if needed) Describe how the results of the community self- monitoring and stakeholders meetings have affected project implementation or how they would be utilized during the next treatment cycle. 2.9. Supervision 2.9.1. Provide a flow chart of supervision hierarchy. 2.9.2. What were the main issues identified during supervision? o Non provision of allowances for the LOCTs and other health workers involved in CDTI activities by the LGA Executives o Some CDDs refused to distribute because communities are not supporting them. Some however continued their work but complained bitterly over inadequate compensation. o Due to wrong timing for the distribution (farming season) some people were not available . Many communities members were absent because of the elections. o Drug supply was inadequate in some areas' o Distribution process was slow o Reactions were of mild type 2.9.3. Was a supervision checklist used? Yes 2.9.4. What were the outcomes at each level of CDTI implementation supervision? . The LGA Executives were requested to provide allowances to the LOCTs to enable them carry out effective supervision Lg AL wHo/APoc, 24 Novemb er2oo4 o District/ LGA Total # of communities/villages in the entire project area No of Communities that carried out self monitoring (CSN! No of Communities that conducted stakeholders meeting (SHfvD Ini Ibiono Ibom 8 TOTAL 28 NDGOA{OCP STATE (SOCTs) LGA OOCTs) DISTRICT SUPERVISOR CLINICS i/c COLLECTION POINTS COMMLTNITIES/CDDs . The communities were encouraged to select more Community-directed distributors and support them during distribution o Front Line Health Facility Staff were requested to increase their supervisory visits to the communities to ensure compliance . CDDs were asked to continue with their work patiently while village heads were remobilized/sensitized to see the need for CDDs compensation. They promised to comply. 2.9.5. Was feedback given to the person or groups supervised? There was feedback to the supervised but appropriate actions were not taken as expected. 2.9.6. How was the feedback used to improve the overall performance of the project? Yet to see any improvement based on the recommendations made. SEGTION 3: Support to CDT! 3.{. Equipment Status of e lease add more rov's i necess *Condition of the equipment (F=Functional, CNFR=Cunently non-functional but repairable, WO:Written off). How does the project tntend to maintain and replace existing equipment and other materials? The Ministry of Health has been supporting the programme, and from this support project logistics will be maintained. The LGAs will continue to be mobilized to support the programme. 2n A3 wHo/APoc,24 Novemb er2oo4 APOC MOH DISTRICT ILGA NGDO Others Type of equiprnent Source No Conditron No Condrtron No Condttron No Condrtron No Condrtron l. Vehicle I Functronal 2. Motor cycle(s) 2 3. Computer(s) I 4. Printer(s) I I5. Photocopier (s) 6. Fax Machine(s) I 7. Generator I 8. Overhead projector I 9. Projector screen I IO UPS I 1 l. Typewriter 1 Funtional 12. Air conditioner 1 13. Tables J Funtronal 14. Chairs 11 Funtronal 15. Fridge I Funtronal 116. Steel cabinet 17. Stabilizer (2) I 1 wo 18. GPS I 19. Standing fan I Funtional II Contributor Year I /'MAY 03 - APzuL 04) Year 2 (MAY 04 - APzuL 05) TOTAL Cash Budgeted (us$) TOTAL Cash Released (us$) TOTAL Cash Budgeted (|+) TOTAL Cash Released ($+) MOH (Central + Provincial/State) 1371 4 7917 64,312.43 6,878.92 MOH (District/LGA) Local NGDO(s) ( if any) NGDO partner(s) Not disclosed Not disclosed District/LGA(l ) (lbiono) 2) lni Not disclosedNot disclosed Not disclosedNot disclosed Not disclosedNot drsclosed Others a) b) Communities (i) Afua (lbiono)(ii) Ananamong (Itu mbonuso)(iii) Ikpe Ikot Nkon Not disclosed t6.7 29.2 1.7 )*,, APOC Trust Fund 89,992 25,000 33,550x TOTAL 103,766 32,917 64,312.43 40,476.52 3.2. Financial contributions of the partners and communities Table 13: Financial contributions by all partners for the last three years *Amount spent by HKI on behalf of APOC - to be reimbursed - If there are problems with release of counterpartfunds,ltow were they addressed? None - Addttional comments Counterpart funds released but approval given in bits on genuine request. 3.3. Other forms of community support Describe (indicateforms of in-kind contributions of communities if any) Prayer for God's blessing Donation of palm fruits Promises 3.4. Expenditure per activity lndicate in table 14, the amount expended during the reporting period for each activity listed. Write the amount expended in US dollars using the current United Nations exchange rate to local currency. Indictate exchange rate used here-N120 to $- z( ni WHO/APOC, 24 November 2004 Table l4: Indicate how much the project spent for each activity listed below during the reporting period - Any comments or explanations? The amounts spent by the assisting NGDO not available SEGTION 4: Sustainability of GDTI 4.1. lnternall independent participatory monitoring; Evaluation 4.1.1 Was Monitoring/evaluation carried out during the reporting period? (tick any of the following which are applicable) J Year 1 Participatory Independent monitoring Mid Term Sustainability Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners 4.1.2. What were the recommendations? 1. Communities should involve women and minority groups in the implementation of CDTI programmes 2. Refusals should be mobilized and given health education on the importance of mectizan treatment 3. There should be a retraining of CDDs on proper census and record keeping with an emphasis on field trip and practical work during the retraining exercise 27 Ll wHo/APoC, 24 November 2oo4 Activify Expenditure (!+) Source(s) of funding Personnel Mobilization and health education oiio-*u"iU.t Tryy4t ry glrlgl-g I ns ul?n_c€, v e[i q 19 glmg !o1c y c l e s m q!4!9 n anc e ) Communications Other Expense s (O ffi ce e quipment 4q q! qleqqng e) Sub Total Drug delivery from NOTF HQ area to central collection point of coq494i1y IjqilLng of CDDs Training of health staff at all levels Supelviging CDDs and distribution Internal monitoring of CDT! agtlyities Advocacy visilsto healthand political authorities IEC materials Summary (reporting) forms foltJe_atmgnt Office Equipment (e.g- comput_e1s, prqqtgrs etc) Others (Vitamin A Supplementation) l,gqz.ti 1,492.71 1,433.67 J.JJ 100.00 6,878.92 \4qH MOH Mpu, MOH MOH HKI/APOC HKVAPOC nrvepoC nrVRpoc HKI/APOC HKI/APOC HKVAPOC nrcrTApoc nrilepoc HKVMOH TOTAL Total number of persons treated 7,780 4. More CDDs should be selected and trained to avoid overload of work on existing CDDs 5. IntensiI health talks at the clinic on Onchocerciasis during other health activities 6. More IEC materials should be produced and distributed for health education in the communities 1. Train and retrain CDDs on accurate record keeping and management 8. PHC should adopt the CDTI approach for other health programmes 9. Identifu and train localCBOs in appropriate roles in the CDTI programme 10. High level advocacy should be undertaken to increase counterpart funds in line with assurances given to the monitors, and with a view to achieving long - term sustainability of CDTI in Akwa lbom state I l. Organise specific training on CSM 12. Intensifu advocacy and emphasizethe need to increase the involvement of women and minority groups in CDTI 4.1.3. How have they been implemented? Communities were advised to include more women in CDTI implementation. This was parlly reflected on the number of women who came out during CDDs' training. Fortunately there are no minority groups in the two CDTI areas but advocacy has been intensified on need for women involvement. This is presently reflected on the number of women involved in CDTI from State through LGAs to communities. This will however be built on in subsequent years. ln the year 2005 the project trained 35 CDDs. The project was unable to train more than this number due to inadequate community mobilization. This efforl will be intensified in year 3. CDDs were trained on accurate record keeping and data management' SOCTs are not involved in other health programmes but LOCTs, DHS, and FL-HFS are, and were advised to use these opportunities to talk about Onchocerciasis. Some LGA staff are not doing as advised as seen in the quality of awareness created The Supporting NGDO Gil(I) mass produced IEC materials and sent to the State for distribution for subsequent treatment cycles. Local CBOs are yetto be identified and trained on their appropriate roles in the CDTI programme. This action will be taken in this year 3. Advocacy was done and the proposal for year 2005 State counterpart fund was approved by His Excellency. $64,312.43 approved but $6,878.92 released so far. 4.2. Sustainability of projects: plan and set targets (mandatory at Yr 3) Was the project evaluated during the reporting period? No Was a sustainability plan written? No When was the sustainability plan submitted? N/A What arrangements have been made to sustain CDTI after APOC funding ceases in terms of: 4.2.1. Planning at all relevant levels Regular planning meetings will be hetd by the state and LGAs to plan at the beginning of the year and at different periods during the year. The meeting will be an avenue to develop yearly workplans at the state and LGA levels with specific funds assigned to the government. Proposals will be written to the government for approval of funds approved for the programme at both levels. This would be cascaded down to the lower levels. Plan of activities will be drawn during the review meeting with the LGA officials at the State level and integrated into PHC 4.2.2. Funds The State Government Counterpart Funds will be used. With the problem of release of counterpart contributions to LGAs, a step-up advocacy would be planned to address this 2 3 4. 5 6 a 22 LL WHO/APOC, 24 November 2004 4.2.3 Transport(replacementand maintenance) Maintenance and replacement will be done using Government Counterpart Funding. 4.2.4. Other resources The State has been providing other resources through its counterpart funds. It is hoped that this will continue and the LGAs will also follow the pattern. 4.2.5. To what extent has the plan been implemented There was increased funding for ictivities this 1"d year which will spill over to the 3'd year. About 80% of the year's plan has been implemented. a 4.3. lntegration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration: 4.3.1. Ivermectin delivery mechanisms: The health staff at the LGA levels have been trained and used to also train the CDDs to distribute mectizan. In the same way mectizan passes from SOCT to LOCT at the local Government and to DHS. Frorn here the HFS collect and keep at their centres ivhich were already designated. The CDDs go to these centres to collect their drugs. In the same way balanced drugs are also retrieved. Plans for complete integration involves making the local council see the need to set aside funds yearly for CDTL The same structure is also used to deliver vitamin A. Plans for complete integration involves making the local council see the need to set aside funds yearly for CDTI. The same structure is also used to deliver vitamin A. 4.3.2. Training: This is carried out at different levels from State where the SOCTs train the LOCTs and in conjunction with LOCTs train the DHS who in turn train the FIFS. Finally CDDs are trained by the HFS with DHS supervising. Also nutrition staff at the LGA levels have also been trained on using CDTI structure to supplement Vit A. Health workers were trained on vitamin A supplementation, monitoring and supervision 4.3.3. Joint supervision and monitoring with other programs The trained staff in LGA supervise other health programme during CDTI activities 4.3.4. Release of funds for project activities: Funds released for CDTI are used to pay health staff who are also involved in other health programmes especially those already integrated like vit A. supplement 4.3.5. Is CDTI included in the PHC budget? Yes 4.3.6. Describe other health programmes that are using the CDTI structure and how this was achieved. What have been the achievements? l) Supplementation of vitamin A. The same CDDs for CDTI are used for supplementation either simultaneously or separately to achieve high coverage and reduce cost.(2) LOCTs/District superintendent are involved in NIDs 4.3.7. Describe others issues considered in the integration of CDTI. Integration makes the whole process cost effective therefore integration of CDTI into PHC will boost the existing PHC structure 4.4. Operational research 4.4.1. Summarize in not more than one half of a page the operational research undertaken in the project area within the reporting period. As recommended by TCC 13, Ievel of endemicity of Loa loa in villages qualified for CDTI in Akwa Ibom State was assessed. Using topography and drainage maps, a total of 17 at risk villages )* L3 WHO/APOC,24 November2004 were identified and 9 of these were classified as meso endemic using RAM. The 9 villages and 4 villages already identified during 2000 REMO (refine) exercise, were visited for RAPLOA and parasitology assessment of Loa loa endemicity. The team found existing common names for loiasis in all l3 villages. However, in two of the villages, the terms Utung Eyin (eye worm ) and ubiak eyin (eye pain) were used interchangeably. A total of 9'70 persons in 13 CDTI villages in Ini and Ibiono Ibom LGAs were interviewed according to RAPLOA guidelines. In ll of the 13 villages, less than 40%o (range 11.3-37.5) of 80 respondents reported history of eye worm while in 2 villages, Ananamong and Ikot Adaha, 40o/o and 40.5% of the respondents reported history of eye worrn respectively. Positive blood samples were found in persons from 5 of the l3 villages and only l0 (1.03%) of 970 persons examined were positive of Loa loa microfilariae with prevalence range of 0-3.8% (median 1.25%). The low prevalence can be explained by the peculiar observation by researchers that, because of circulation of serum antibodies reacting with Loa loa, only about one third of persons infected are microfilaremic. Intensity of infection was low. Individual microfilariae load range was 20-3,200 mf/m[ while Community Microfilariae Load (CMLF) was 0-8.9 mf/ml (l.61mf/ml). With no recording of very high microfilariae loads (>30,000) and only two communities with RAP of 40Yo and above, relationship betrveen prevalence of very high microfilarial loads and RAP based on restricted definition of eye worm was not demonstrable. Akwa tbom State SOCT can comrnence CDTI in 1l villages with RAPLOA rates >400%. By RAPLOA classification, Ananarnong in Ini LGA and Ikot Adaha in Ibiono Ibom LGA are the only comrnunities at high risk of Loa loa related adverse reactions following treatment with Ivermectin. Before mass treatment with Ivermectin in these areas, specified special provisions must be made to ensure that severe adverse reactions are quickly detected and managed. Akwa Ibom State SOCT will need to work closely with Abia State SOCT as all CDTI villages in Akwa Ibom are close to the boundary shared by the two States. The CDTI villages in Akwa Ibom State are very remote and not easily accessible. The SOCT and LOCT would require strong vehicles and motorcycles to enable them supervise and monitor CDTI activities effectively. All 332 villages in Ini and Ibiono Ibom that have been intensively mobilized for participation in CDTI are expecting mass treatment with Ivermectin yet only 13 of these villages have been found to be qualified for CDTI. The 534 CDDs, 8 District/LGA staff, 26health post staff and 17 trainers already trained, can be retrained for implementation of other health programmes (Vitamin A supplementation etc.) Before this is done, an explanation has to be given the villagers as to why they are getting other health interventions and CDT. OUTCOME o CDTI should be implemented without delay in the I I villages that are not at risk of Loa loa related adverse reactions. o Before commencing CDTI in Ananamong and Ikot Adaha, the two villages at risk of Loa loa related adverse reactions, special provisions should be made to ensure that severe adverse reactions following mass treatment with Ivermectin are quickly detected and managed. o Other health programmes should be implemented in 309 villages already mobilized for CDTI but which have now been found to be hypo endemic. . Adequate number of 4 wheelvehicles, motorcycles, be provided for CDTI in the State. The roads are very bad, villages are very remote and are not easily accessible by public transport. 4.4.2. a a a a How were the results applied in the project? CDTI will henceforth be implemented in I I villages that are not at risk of Loa loa related adverse reactions. Special provisions were made to counter severe adverse effects. They include training of medical personnel, provision of drugs in designated hospitals and notification of these hospital at commencement of distribution Vitamin A supplementation is taking place in non-CDTI community of the project area. One 4 wheel drive vehicles and 2 motorcycles were provided for implementation of activities but we also need canoe or speed boat for riverine communities in Ikpanya clan of Ibiono Ibom LGA. a v?u WHO/APOC, 24 November 2004 aa SEGTION 5: Strengths, weaknesses, and opportunities - List the strengths and weaknesses of CDTI implementation process - List the challenges and indicate how they were addressed. challenges, STRENGTHS 1. Presence of Committed health Staff 2. Strong backing from NGDO (HKI) 3. Enthusiastic endemic communities 4. Availability of literate CDDs WEAKNESS/CONSTRATNTS l. Health staff asking for increased allowances Z. Endemic communities unable to compensate CDDs due to high poverty rate, hence CDDs request for project to take over. 3. Transfers of CDTI personnel out of project area. CHALLENGES l. Non identification and involvement of CBO and VHC in planning and implementation. 2. Non seeking of additional support from existing oil companies e.g. Exxon Mobil 3. Transfer of CDTI personnel to non-CDTI area 4. Inadequate support by LGAs for the fueling and maintenance of the motorcycles 5. Inadequate logistics e.g. motorcycles and bicycles 6. Project yet to organize stake holders meeting 7. Political instability in the country where mobilised council Chairmen are soon replaced by new ones. 8. Non-compensation of CDDs HOW CHALLENGES WERE, OVERCOME l. Liaising with Local Government Service Commission to prevent transfer of CDTI personnel in the CDTI project area. This has already been carried out as LOCT leaders for Ibiono and Ini LGAs who were transferred out have been returned. Emergency trainings were conducted for new ones as all transfers could not be prevented. 2. Fueling of motor-cycles supported by State Govemment. This hopefully will enhance mobility which is highly needed especially during mobilization and supervision. 3. HKI brings in additional vehicle during operations and take it back after. 4. Trying to explore ways of getting possible support from Exxon Mobil for sustainabi lity of proj ect. 5. Coping with changes in the Local Government Councils as mobilisation is made a continuous process. 6. CDDs were persuaded to put in their best t t SEGTION 6: matters Unique features of the proiect/other Small size of the project N TL5 WHOiAPOC, 24 November 2004