Summaries of CDTI activities in Special Intervention Zones (SIZ)

t / SUMMARIES OF CDTI ACTIVITIES IN SPECIAL INTERVENTION zoNES (SrZ) Introduction The Special lntervention Zone (SIZ) program is in its second year of activities. According to progress reports from co-ordinators, in our possession the implementation of activities and reporting occur at different times for different Countries. Some summaries are from progress reports of 2004 (Sierra Leone, Benin, Togo, Guinea) others are from 2003 progress reports (Ghana Guinea and Togo). 1. Sierra Leone Almost all the country is included in the SZ o Sensitisation/ Mobilisation/Training: CDTI activities started with community sensitisation and mobilisation through mass media and distribution of IEC material. The DHMTs did training of 4,400 CDDs in their respective districts. Training included both 2000 previously trained CDDs and 2400 new CDDs. 200 nurses and Primary Health Unit staff were trained on CDTI. It is planned that another group of 600 DCs will be trained in2004. o Results Ivermectin Distribution: Ivermectin distribution took place in 5 districts: Bo, Kenema, Pujehun, Moyamba and Bonthe. The geogaphical (<42%) and therapettic (<40Yo) coverage rates were low (see tablel and fig:1) Epidemiological evaluations : Epidemiological evaluations done in September in 2003, in the Southern Province, showed prevalence range of 34.4Yo in Bonthe, 50.7% in Bo, 45.5% in Moyamba,42.9%o Kenema and45.9o/o Pujehun, The problems encountered during the evaluation were related to the technical level and experience of the technicians. Between April and June 2004 Epidemiological Evaluations, will be carried out in 24 villages in 2 districts, Kono and Kailahun before the distribution of Ivermectin. The preliminary results obtained so far are encouraging given the fact that the war has disrupted the health infrastructures and all the staff has left the country. Reconstructton is underwoy and there ts stgn of good will to improve the situation. Advocacy, social mobilisation and sensitisation are key sectors of CDTI that need to be improved in order to greatly increase coverage to acceptable levels. Training in epidemiological evaluation technique is also necessary before the next evaluotion. I May 2004 Z. Benin The Special Intervention Zone (SIZ) in Benin is made up of 11 districts: Natitingou, Toucoutouna, Boukoumbe, Copargo, Kouande, Djougou, Ouake, Bassila, Parakou, Dali and Tchaourou. . Sensitisation/ Mobilisatisa/fpsining: CDTI activities started on 30e April 2004 with a mobilisation/ sensitisation and plaruring meeting in Natitingou. This meeting regrouped the Regional Health Managers, 11 Medical Doctors, 5 nurses, one entomologist technician, 2 secretaries and the Senior District Officer. Mobilisation/ sensitisation continued in the villages and hamlets through CDDs and local radio programs. A total of 65 programmes on Oncho were broadcasted in 9 languages. o Results Ivermectin D i stribution : Ivermectin distribution lasted from 4ft to 106 April 2004. 1553 villages and hamlets were treated out ofthe 1575 planned. Geographical coverage was between 95.90% and 100%o, with an average of 98.60/o while therapeutic coverage was between 72.20Yo and 85.89% with a mean of 80.85%(table 2 and fig. 2). Although the CDTI results are globally satisfactory, in some cofirmunities like Sinarou, the therapeutic coverage is still low (62.550/o). Treatment is continuing in 8 Districts where results were not satisfactory (Djougou, Bassila, Parakou, N'Dali, Kouande, Toucoutouna, Natitingou, Tchaourou). Epidemiolo gical Evaluations : The epidemiological evaluation is planned on 25ft May 2004 in villages within and outside SZ. o Supervision/ Monitoring Members of the national team and health personnel closely did Supervision/monitoring dtring the 2-week treatrnent period. Difficulties encountered during Follow-up/monitoring were: of the 2nd phase of treatment in 2003. In order to avoid ivermectin shortage it will be necessary to provide targeted training on needs evaluation, Ivermectin ordering and management. There is need to review with the National Team the notion of sustainable CDTI, Is it sustainable to block a period of 2 weel<s during which all octors of CDTI are on the fieldfor lvermetin distribution? 2 May 2004 a 3. Ghana SZ in Ghana are located in the Brong Ahafo region, in the Pru basin with over 3 l6 villages instead of 280 villages in the districts of Atebubu, Nkorarza, Kintampo, Techiman as initially estimated. o Sensitisation/ Mobilisation/Training ln 2004 CDTI activities consisted in the compilation of ivermectin distribution results of 2003(table3 and $aphs 3). CDTI activities in 2003 started with a series of sensitisation and planning meetings. Members of the national team, Brong Ahafo Regional Health Administration District Health Adminishation and Stakeholders attended these meetings. o Results Ivermectin Distribution : CDDs during distribution of ivermectin used registers borrowed from Lymphatic filariasis programme for household census. In the Special lntervention Zones, the geographical coverage was IOO% (about 316 villages). Therapeutic coverage was between 70.42%o and 74.5lYo with a mean of 72.8%.ln the non SIZ area, the geographical coverage was 100% (about 160 villages) and the mean therapeutic coverage was 75.8% (table3 and fig.3). Epidemiological Evaluations : Epidemiological evaluations were postponed for 2004 claims that the disease is of no public health importance and health staff attrition from district and sub-district levels. The number of villages and hamlets in the SIZ initially estimated at 280 is now at 316 vtlloges. The SIZ team should confirm the delimitation of the zone to be included in this operation in the Brong Ahafo region during the supervision activities. 4. Guinea This summary covers the 2003 and the early part of the month of January zoo4. SIZ are located in the Upper Niger/ Mafou and the Tinkisso basins. This consist of 2412 villages in 6 Prefectures: Faranah, Dabola, Dinguiraye, Kissidougou, Kouroussa and Siguiri. o Sensitisation/ Mobilisation/Training: The National Oncho Programme team carried out sensitisation/ mobilisation meetings, between August 27h and Septembei 2gn 2OO3 in the 6 Prefectures. Present at meetings were, 6 Directors of District Health services (DPS), 6 DI\,IR, 6 Medical Doctors in charge of disease Control, 70 Chiefs of Health centres, 3 community representatives, I local radio Director Training of 29 Heads of Health Centres from 3 out of the 6 Prefectures was carried out. These in tum trained 2189 CDDs in their respective villages. o Results: Ivermectin Distribution/Results : Following treatrnent with ivermectin, geographical coverage in 2003 was 99o/o.8 villages were not treated: 4 in Faranah,2 in Siguiri, 1 in Kouroussa and I in Kissidougou. The mean therapeutic coverage was78%o (table 4,frg.4). 3 Ir,tay 2004 I Epidemiolo gical Evaluations : Epidemiological evaluations carried out in 22 vlllages between 306 December 2003 and 20 January 2004, showed that the gross prevalence rate varied from 0.0% to 4.5o/o. Results of CMFL were not available. A child who was negative during 1999 evaluation in Tinkisso basin, was now identified as positive. This indicates residual transmission. It is worth noting that most positive cases have a history of refusing to take Mectizan. Supervision: 43 health Centers were supervised during the distribution of the Ivermectin. CDDs, and poor census of villages and households. A greater involvement of the community (village chief and villagers, schools and village associations, etc) and targeted training of CDDs in CDTI and household census, may improve the coverage rates. Reinforced supervision/monitoring of CDTI be encouraged. 5. Togo In Togo 1322 vlllages constitute SV. These villages are situated in i 1 Districts (Assoli, Bassar, Binah, Dankpen, Doufelgou, Keran, kozah, Kpendja, Oti, Tchaoudjo, Sotouboua) o Sensitisation/ Mobilisation/Training By the 7n of April 2004 ivermectin was already positioned in the Health Centres. So far there has been no record of shortages of ivermectin. CDTI activities started with the launching of the Oncho week from 9 to 16 April, by His Excellency the Minister of Public Health in Tchitchira in the Kara Region. Dwing the oncho week and for a period of one month prograrnmes on Oncho were on the local radio stations and in local languages. The taining was done of 38 nurses, 3 Medical Doctors and one lntern from APOC, all newly appointed or arrived in Oncho zone. Newly recruited CDDs were also trained in April: 439 in SV with WHO/SZ funds and607 outside SV neawith Sight Savers lntemational funds. o Results Ivermectin Distribution: The first round of distribution of ivermectin in2004 is continuing and results are not yet available. Nevertheless results of the 2nd phase o treatment in 2003 are presented here. Geographical coverage was 100% as compared to that of the first treatment round that varied between 79Yo and 100%. As for therapeutic coverage 9 districts out of 1 I have coverage above or equal to 85oh with a mean of 86%. Only Oti and Sotouboua Ouest have therapeutic coverage of 84%. (Table 5 and fig.5) Epidemiological Evaluations : Epidemiological evaluation has been schedule for November 2004. Epidemiological evaluation of villages in Kar4 Keran, Md and Oti basins done in 2003 showed prevalence ranging from 0 to 39o/o and CMFL from 0 to 0.39. During this evaluation it was noted that vast number of people were deserting the M6/Oti/Pendjari basins. Reasons for this are still being investigated. A relative decrease in the prevalence has been observed on the Kara river basin while the opposite tendency is shown on the M6 river basin. On the Keran river basin, the prevalence is still high (22.7%) in the village of Tchitchira Maison. 4 May2004 . Supervision/Monitoring: Supervision and monitoring is done at all levels. The national team has so far visited 12 Districts of which 6 are in the SIZ, 93 Health Centre of which 52 are in SIZ, 170 villages of which 717 are rn SIZ. Problems encountered were that of insufficient motivation of CDDs, some communities do not have CDDs. It has been noted that because of an increase nuisance o the blackfly, more people want to take ivermectin. CDTI in Togo seems to be well organised, improving on sensitisation/ mobilisation by using other vehtcles (Schools pupils and teachers, Child to child and child to parent schemes) may inuease durability. Also reductng the treotment period (that seems to last for over one and half month) may greatly improve coverage and liberate the CDD to attend to other occupations. 6. MID-TERM Evaluation of the activities in the SIZ It would be desirable that the members of the Special Advisory Committee define the terms of reference, the composition of the members of the committee to be set up for the mid-term evaluation of the activities in the SIZ planned for 2005. 7. Training The Management of the SZ trained Miss Badila from the Democratic Republic of Congo to the vector control, CDTI and epidemiological evaluation techniques and to the management of large scale campaign against a vector borne disease such as the onchocerciasis. Mr Chad, from the USA is currently been trained in the SZ base in Kara on the same control and programme management techniques as with Miss Badila. 8. Recruitment The Management of the SZ has appointed on April 15,2004 in Kara a new Chief of distribution of drug and Training (CDDT) in the name of Dr Grace Fobi, from Cameroun to replace Dr Pana A. 5 May 2004 Table 1 Geographical and Therapeutic coverage in S Districts in Sierra Leone (preliminary results) DISTRICT NO.OF VILLAGES TO BE TREATED NO. OF VILLAGES TREATED GEOGRAPHICAL COVERAGE TOTAL POPUL. POPUL. TREATED THERAPEUTIC COVERAGE NO.OF TABS USED 457 94 20 87858 20833 23 62499 298 81 27 48923 1 8387 37 551 61 Pujehun 352 91 25 6971 0 17436 25 52305 Moyamba 706 124 17 99805 24891 24 74673 Bonthe ob 28 42 32591 13238 40 39717 Bo Kenema o)E o EO q) o) Eo o C) o .E =(l)o6Lo -cFr o o,(U L @ o C) E .9 o(u L o)o(D oI E = q) tL IE E o)c o)Y a+,o L *, .9,o to e ao= cD=!uo =orvL3aCJ15 .o .!se -FJ-ar lI as,EA PEF6 E9T;tuEOO =6--(EL cn o o o J .$, lJ- o co oooooOOrOF-@ oro oooo!+foot- I r o 96 se a6eraloc (E -o E CU o = ErB ! 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'% ,,o "% % .?a % "% -/O a/ Qo- ,ou "% -%o ?,u e % \ - -e .; E+. Q86cr()t, o= .-JEo B.;loJe;F'E Ef;(E -N8a '=a -o. E !E '=Lg ct inAri uo o N Eir lL o - ooooooI-(orf,$(OC{ yo se a6eraaoc oooooo)@ I I i I I I I Iol cDt!ulLI(Dl >tolol Itolol =to_16iLI o)toiE)l CIi ei I i I i I I I I I I 1 l I I Table 3: stz NON stz Geographical and Therapeutic coverage $ummarJ of CDTI In The Brong Ahafo Region - 2003 District Population Drugs No. Of People Treated by Dose Total Pop. No. Of Treatm't Cov.oh No. of Communities TreatedSupplied 1 2 J 4 Treated Tab Used Atebubu 36874 77212 5793 4901 8150 7123 25967 68537 70,42 58 Techiman 4M85 96730 6275 6805 9187 9500 31767 85446 71,41 82 Kintampo 441 88 90870 7390 7401 931 1 8826 32928 85429 74,52 101 Nkoranza 4786s l 19650 s736 6637 r1299 11723 35583 99799 74,34 75 Total 1734t2 384462 25194 25744 37947 37172 126245 339211 72,80 316 Wenchi 91662 230529 1t266 1 1960 19570 25816 68716 197160 74,97 115 Sene 17655 47636 2312 3 105 4144 445t 13983 387s8 79,20 33 Asutifi 500 1500 55 78 100 2t0 443 135 I 89,60 10 Tano 853 2000 98 165 188 216 697 1 856 81,71 ) Total 1 10670 281665 13731 15308 24002 30693 83839 239125 75,76 160 Grd Total 284082 666127 3892s 4t052 61949 67865 210084 s78336 73,95 476 o oF = U' o) (D U) EoC(D = (u Nc6Lotzz oq Ea c E c(E .E o(DF tro o rF o a(E trca EO =olAG ,lILEqsfior- o'-otr o.9 .E ED =o8.qo.9bEFI-tr<t, cncc(Eg GO .9o -c -co+,$El- .- cn o o o .i .9lr = -o -o(l) oooooor@t- F oc)o(olr,$ 96 se a6eraloc ooo(o C\l i I I i I I I i ll1li.lI o)ll6ltLll@lt>liollol l_9 lolI o-Il(5ltLlld)ll-c IiFIlrllltttlti1itli.iI o)ll(EltLtloil>llollol 6ilol1ElI oll(oltLlI trDllollollollnlILt1 L_.1 o Table 4 : RESIILTS OF CDTI IN GUINEA - 2003 DPS Villages -/o Population Yo Mectizan Census Treated Census Treated Receove d Used Diff KISSIDOUGOU 4 181 180 99.4 601 01 119140 81,9 31 7000 306834 9997 KOUROUSSA 12 297 296 99,7 132423 1 00758 76,1 306000 273329 31947 SIGUIRI 13 672 670 99.7 290452 225224 77,5 61 1000 531 941 79059 IANAH 12 436 432 99.0 128938 100927 78,3 351043 290497 58247 I 319 319 100,0 123272 93808 77,1 254076 270187 16874 DINGUIRAYE 8 507 547 100,0 158035 124543 78,8 371722 355499 15005 TOTAL 58 2412 2&4 99.6 978788 764/,00 78.0 22108/.1 2028287 211129 DABOLA .;I E')gl (r,1l>to -c ioio loi(U tl ,F i 8.1r ip ot-c IlFlirltll0)llq)l(E LLlo lotiol l-l '= (Eld, 1.9 i6 it-r rEilorliol(t)I lce Iirl o .g =o, .go (o o -o(U o (U tOo =oL f oY ) oo,)op o .aY U' o.o(0 .E o cD IEL o oo o9? .- fJEO6NcLr(u(Ebe?Llr-+r5EO EN 5u) .9e CL GL ED o oo t .$,IL o(o yo se aEeraaoc oooc\l ooC\Iorto@ I I I I I I I i I I I I I I Table 5 Geographic and therapeutic coverage in the 11 districts SIZ Togo (2od round 2004) DPS Villages Geographical coverage Population Therapeutic coverage Tablets distributed Planned Treated Gensus Treated Kpendjal 118 118 100% 100582 86138 86 o/o 263357 oti 159 159 100o/o 79491 66630 84% 166000 Assoli 54 54 100Yo 33884 29984 88% 99830 197 197 100% 61117 53513 88% 158131 112 112 100o/o 54474 47483 87 o/o 136602 154 1U 100o/o 78473 67979 87 o/o 182249 Doufelgou 183 183 100% 56243 48234 86 o/o 143145 K6ran 151 151 100% 71974 61874 86 o/o 174981 Kozah 195 195 100%o 127148 108391 85% 28881 3 Tchaoudjo 165 165 100% 67278 57544 86 o/o 155839 Sotouboua Ouest 37 37 100o/o 14853 12462 84 o/o 29152 Total 1525 1525 100o/o 745517 640232 86 o/o 1798099 Bassar inah o) o)(5 L(D oo .9 oo Eo -cFI (t)o6L(D oo E .9 o6Loo(D oI (s oi €ii :oa o E Joo oF !(! NoY 6 LsY o -9o oo co a.v 6o .c(E c iE L(o oo(o co oottt =o E Ec(D o-Y F F e .; E')(!i .-.L CY:Ioo>oo6loo .9trs- =7oiCL .. tE ctE;I- EDbeF.tEp G(,) .9oF+' -o..9 !EE a.e 8o(, "i .9 tJ. lf) n- o@loO)oo o]f,o@ 96 se e6elanoc