Six-month report for Community Directed Treatment with Ivermection (CDTI): Yobe State, Nigeria, September 1998 to February 1999

t l I I , AFRICAII PROGRAMME FOR OI{CHOCERCIASIS CONTROL (APOC) Six-Month Report for Community Directed Treatment with lvermectin CDTI Yobe State Nigeria RE9U l0 MAI lg99 '' fPoc / PM Yusufari Yunusari Nguru Geidam Jakusko Tarmuwa maturu Gulani ptember 1998 to February 1999 EXECUTIVE SUMMARY. Yobe State was created out of the former Borno State in August 1991. It situated in the northern eastern part ofthe country in Sahel Savannah and its topography is characterized by desert features in the northern part of the state while 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 estinrated landmass of 47,153 sq. kilometers, witlt 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 fo 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 p.ogrurn-" from the onset. This we found to be a better ilrangement that will encourage sustainability within the cornmunity levels, since the communities now see the prograrnme 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 211,404 p".ronr from 158 communities with Ivermectin. In 1999 a lot is being done to .n"or.ug" integration into existing PHC system. CDTI is no doubt on course and the state is quite hopeful of its success story in the near future. yobe State government has fully embraced the programme and is fully committed to its fulfillment oiremitting the counterpart funds to compliment those of APOC and CBM' SECTION I: BACKGIIOUND INFORMATION : 'lhere are about 237 identifred 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 Comnrunities implementins CDTI. Prior to MOIVCBM/APOC partnership, a total of 98 communities were receiving treatment i1 twelve local government areas. Under the new dispensation, 158 communities are presently being treated with Ivermectin and are also implementing CDTI. 1.3 Endemic LGAs wilh treotment rounds. Find below list of endemic L.G.As/treatment rounds: , 1 Fika 4 2. Fune 4 3. Bursari 4 4. Gulani 4 5. Guiba 4 6. Tarmuwa 4 7. Jakusko 4 8. Nangere 4 9. Potiskum 4 10. Bade 4 tl Karasuwa 4 t2. Nguru 4 Note: Not all communities are in the fourth round of treatment because of our policy of gradual expansion over the Years. A TABLE I. THE IMPLEMENTATION OF CDTI (September 1998 to February 199). 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 rainy season sets in. This report is therefore covering two treatnrent 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 IMPLEMENTATION TABLE 2. KARASUWA I [IKA 5 (2 eac*r for LOCT,CDD & PHC 2 (SOCT, LOCT & PHC 5 35 65 2 GULANI 5 l3 62 3 GUJBA 5 l5 35 4 ITUNE s t7 59 5 BURSN RI 5 30 6 JN KUSKO 5 2l 35 7 I}ADE 5 t2 30 8 NNNGERE 5 lt 25 9 POTISKUM 4 8 26 IO KARASUWN 5 8 24 I NGURU 3 l2 32 t2 .I'NRMUWN 26 t'o'I'AL 56 t83 449 L ffiffiffi*{.ti${ffiiit ffiffiffiriirfi#iid $fl :l{Iff JF;Ili:ii.::{:tlCt8i[f{3# ?,{.,: :.;1,1.!1-r'5{' ' i,"qer} il.il{Lf' 'i'i.; - r',!q,..i'\s!:-'i+1,., _.' . 1 ,il'..,j;' , . ,l L,r,!!i; \ ..'.:, ,: ilJi -,'_,.-: ..,.rrr,itli,,,,- :. r ',1_: '-.,\i ': ."iri i,'li.i , ,. ,. ,,1 ++.ti.\'j ^.{i'---.::y'(\r:l,,i :iiI 1i :, i .,i Fliffil,+"lS,hdlit4itffi fuil.{*$ti,qi$f lil,.r* |iii$1'ri,-111[ :,f ;:l{'ri/r,l*"i :,tl f,i:,.,.1'j.'rirjli-,Lr' i ]'nRMUWn 9 9 I 9 9 9 6 2 RIJRSARI 30 l0 30 30 30 20 l FUNE 20 20 20 20 20 t0 4 N(;TJRU 7 6 I 7 7 7 4 5 4 4 4 4 4 3 6 BADE l3 t3 l3 l3 t3 2 7 .IAKT,ISKO l2 l2 2 l2 l2 l',2 6 8 POTISKUM 5 5 ,I 5 5 5 2 9 FIKA 2t l2 5 l2 l2 2t l) IO NANGERE 6 6 6 6 6 4 il GULANI 20 20 3 20 20 20 ll t2 CUJBA ll I ll il ll J 't'o'I'AL t5n t4E l4 t49 149 t5t 83 p\-&st ld!!,i+.t"t{t'|.+.:,,ii{t.tr t1}r'e-h\ir}J1- i.\i.'+.Ji.i ffi ffi.Bf E"iffi Sffi s'flffi ?ffi *Yf ;ril{i*i*',+I;l 3 2.1 Tra in i n s O b i e ct ives/Ac h ieve me n ts In the last Six Months, a total of 695 staff were trained and retrained out of 919, representingT5.4% achievement. A break down are as follows:- This number of CDDs and LOCT were trained and retrained within this Six months period. Develooed Trainine Materiols 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 were received. These materials are currently being field-tested. 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 accounts 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 encouraging. o Correct registration and accountability of drugs by most of the CDDs. . Eflective mobilization of community members before and during distribution. Improving the qualitv of trainins. 'frainers (SOCI'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 to enable them to record dosages correctly during Mectu-an distribution. LOCT should be exposed more to the technique of training so that they will not over depend on the SOCT. NOTE: )) 2.3 2.4 3 PHC WORKERS i;-: ; ,;,. ( LOCTs 72 56 7$Yo 240 183 760/o CDDs 600 449 75% SOCTs 7 7 100% T'OTAL 919 695 76Yo MOBILIZATION AND EDUCATION OF TARGET COMMUNITIES NOTE: Mobilization was carried out for the same nuinber of communities twice because of the current change in treatment period. However, the figures of number of communities mobilized was not multiplied. 2.2.1 The use of nrcdia in mobilizatiort. The media was used to disseminate important messages about CDTI in Yobe State. Radio programs were carried out during the period under review, using Hausa and English languages for discussion. We intend to use other key local languages in the near luture to get messages across to the community nrembers 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 nnbilization effort. Communities were able to select their CDDs and have indicated their willingness to support the program. There is need to intensiff mobilization to be able to inculcate CDTI concepts in the communities 2.2.3 Response of the communities.. Most of the conrmunities are pleased with the idea of getting them involved in the planning stage. They have been able to fashion out ways of improving their coverage, select and support their CDDs during and after distribution. So far we can say that their response is encouraging, I{ KAI(ASI.JWN 2.2.4 Suggestion to inwrove mobilizatiort 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. Cornmunity members should be involved in the mobilization for better response and feed back. SBCTION III ACHIEVEMENTS 3.1 Trealtnenlcoveroge. 'Ireatment coverage rate lbr the state during the last distribution exercise is 8l%. Total cens us PoP ulotiort Total Census Population of treated communities was 262,149 persons. Tota I el ie i b I e p o P ttlotiutt. Total Eligible Population of treated communities was221,862. Absentees/Refusols. I'he populatiol of absenteeism is generally high in some,colnmunities after analyzing the 1998 treatment results. l'his was one of the reasons that brought about the change in the distribution period. 3.2 3.3 3.4 5 l16ll KAITNSUWA 3.5 Some reasons for absentees and refusals 1) Most of the communities found the distribution period not very convenient 2) CDDs were not very much supported 3) Mobilization was not very adequate. 3.7 Plans for reducing nuntber of absentees and refusals. l) To intensify community mobilization by involving the cornmunities from the I 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 PIIC facilities to be fully involved in the programme, so that they will help in mobilization and Health education. 6 SECTION IV: STRENGTHS/WEA.KNESSES & SUG GESTIONS 4.1. 4.2. 4.3. 4.4. Strengths(l) Yobe State Government's commitment to the program(2) Dedicated SOCT working with the program(3) Support of NGDO and NOCP(4) APOC slrpport to the Project Weakness(l) Low literacy level of the people iZl T6c conrrnunity rnembers are claiming tlrat they are poor and will find dillicult to adequately support CDDs.(3) Frequent changes in the LGA administration do not encourage continuity. Sugqestions(l) Increasedcomrnunitymobilization(2) Advocacy visits should be intensified Contribution of the Ministry of Health The following items are the State Government contribution to the prograrnme. A. One used Toyota Land Cruiser B. OIIice Furniture C. Two Ilinocular MicroscoPes D. Weighing Scale E. Cash Contribution of Ftl.7 million 1 ari 0 >U F oF =a =FI F! o o €rKg-EP iH€ o l:o (D93 )* TD 7,gi5q a'* :'l s. 5. -Fih 3h 5'oq5= e.a -3rJ P^ egE *ilg o 5 *u)p(D;! 3-5 (D otS. = R"g P5oq!(D E.r_go a-PS. FUE8 ? 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