Second year technical report on C.D.T.I. implementation in Kogi State: First six- month report

KOGI S-TATE-A.P.O.C PROJECT (NGI{CII) SECOND YEAR TECHNICAL RBPORT oNC.D.T.Iu'nruBlnnuTAfloNIN KOGI STAIE. FIRST SIX-MONTH RBPORT. . n-: A{J t. c (.8,'l ," t. d,i ri i {+ 1999 \\ P- '' ^, :l ,r+tu L-gIS Ur\/ RE9U I 5 JUIN l99g APOC / PM ,tol t1 t , E ti 0cQq; ?r * NI .l x[] 16'h v tr CPI: 8ri> v x ,x { v o -,|{ FI + a , o!. :, rO rO o Fq *6o3 orJ8o3=g'€ ='o f,-oA €e. osg{9oo @ o o o o9. a =o rtl D (tt -{D{ m lt o -{ ONDO o 6) o u = o oz 6) m o o o{{ m !r{ m c o -{I mG aIct m zq 6)c o{{ m z =(D , a -{{ FI Cc c x @ @ Ec C ao o -oa Ct, o a, a xx>o ,{alomz BENUE STATE KOGr STATE - AP.O.C. PROJECT NGKGI) IN KOGI STATE FIRST SIX-MONTH REPORT EXECUTTVE SUMMARY Kogi State is one of the very endemic Onchocerciasis State in Nigeria with over one million (1,000,000) people at risk. Kogi State Project is one of the first four projects to be approved in Nigeria and the first year approval covered five Local Government Areas (L.G.A) namely Yagba West, Yagba East, Olamaboro, Idah and Ofu L.G.As. The Second year project which was approved late 1998 was expanded to cover thirteen (13) L.G.As, that is, an additional eight (8) L.G.As to the initial five. The new additions are Mopa- Muro, Lokoja (formerly Kogi L.G.As), Bassa, Dekina, Omala, Ankpa, Ibaji and Igalamela/Odolu L.G.As. Kogi State is made up of twenty one (21) L.G.As and all are endermic with some hyper-endemic LGAs. The actual activities started in April 1998 as follows:- 1. Kogi State/A.P.O.C Awareness/Orientation Workshop 6lal99) 2. State Level Advocacy Workshop for policy makers (714199) Local Government Lrvel Advocacy Workshop for policy makers and opinion leaders (8t4tee) 4. Retraining of Trainers at State level (S.O.C.T) 5. Training and Re-training of L.G.A Onchocerciasis control Team (L.O.C.T) members on C.D.T.I 6 Community mobilisation, Health Education and Training of Community Directed Distributors (CDDs) is on going in the A.P.O.C L.G.As. The Trainings are being facilitated by the N.G.O and S.OC.T Staff aJ 1 Section I Background Information Kogi State is centrally located in the MIDDLE BELT OF Nigeria and shares common boundaries with Niger, Nassara and the Federal Capitat Territory to the North. To the East, the State is bordered by Benue State and to the South by Edo, Enugu and Ondo States and to the West by Kwara State. The two largest rivers in Nigeria, Rivers Niger and Benue form a confluence at Lokoja the State Capital. The vegetation is made up of rain forest in the western part of the State, wooded savanna and grass land in the east and forest savanna mosaic to the south and guinea savanna in the south. There are also other fast flowing rivers namely, Ofu, Anambra, Ubele, Inachalo, Okura and Oyi which passes through the Meso to Hyper endemic communities in the State. The main occupation of the people is farming, lumbering and trading. Onchocerciasis control with Ivermectin was on going in the former Benue State and Kwara States from the late 1980s. However this did not cover the Kogi State parts of the States. Skin snipping to determine endemicity level had been conducted in Kogi LGA before the creation of Kogi State. UNICEF was assisting Benue State and AFRICARE was assisting Kwara State. With the declaration of February 12th as the National Onchocerciasis Day in 1992 which was followed by the International Conference on Onchocerciasis control at Kaduna, Kogi State control activities started. In March t993, Dr. Michel Paque of Sight Savers International (SSI) along with Dr. Gemade visited Kogi State with a view for S.S.I to assist Kogi State. In May lgg3, a workshop to determine Onchocerciasis endemicity level using Nodules and lropard skin was held at Abeokuta and Kogi State conducted the same for LGA Coordinators in August 1993. Subsequently, a UNICEF - sponsored RAM-REMO survey to determine endemicity level was conducted in Kogi State in 1994 and 1995. A total of over 800 communities were examined and over 750 communities were found to be qualified for mass mectizan distribution. Validation and cross-validation of this survey was carried out. Based on the result of the surveys, APOC agreed to assist Kogi State and selected five LGAs to support for the first year and an additional eight (8) L.G.As for the second year. Actual Mectizan Distribution Programme (I.D.P.) started in 1993 with Kogi (now Lokoja LGA) and Ijumu LGAs with 18,385 persons treated. ln 1994, the programme expanded to 3 other LGAs with 108,885 persons treated. 216,388 persons were treated in 9 LGAS in 1995, while z Zt3,g5g persons were treated in 1996. ln 1997 , Sight Savers Intl. treated 454,033 persons while Africare treated 57 ,1llpersons. In 1998, a total of 847,726 persons have been treated using 1,288,876 tablets. The project proposal for 5 LGAs was approved by APOC in May 1997 and the sum of $33,205.00 (N2,696,246.00) was received by the State in October 1997 . $6,975.00 was retained by NOCP for central procurement of supplies and production of IEC materials. Kogi State A.P.O.C maintains a current account with Union Bank for Africa, Lokoja. By Augusr 1998, a second installment of N3,438,000 (i.e. $40,000.95) was received into the project account. The control programme continued uninterrupted until the end of 1998. So far this is the total funding from AP.O.C to Kogi project. ENDEMICITY LEVEL The table belows show the endemicity levels. Presently R.A.M survey is being conducted by Sight Savers Intl in the State. TABLE 1 - ENDEMICITY LEYEL S/NO LGAs HYPER ENDEMIC MESO ENDEMIC TOTAL COMMIJNITIES I.INDER TREATMENT 1. 2. J. 4. 5. 6. 7. 8. 9. 10 11 t2 t3 Olamaboro otu Idah Yagba East Yagba West Mopa-Muro Lokoja Bassa Dekina Omala Ankpa Ibaji IgalamelaiOdolu 62 70 39 2t t3 t2 29 59 93 46 76 52 82 t26 113 39 37 11 I6 38 86 82 51 84 60 42 188 183 78 52 24 28 67 145 175 97 160 tt2 124 TOTAL 654 779 1,433 3 (i) In 1998, 1,926 communities in the 21 LGAs of Kogi State received mectizan and 525 of thesewereintheC.D.T.IProjectarea. In 1999, theexpansionof theC.D.T.Iproject to eight (8) additional L.G.As will enable us to expand to 908 new cofilmunities in Kogi State. These L.G.As have been distributing mectizan based on the use of Community Based Distributors. This expansion shall need extensive community mobilisation and health education. (i i) The various L.G.As are in various rounds of mectrzan distribution. Lokoja (formerly Kogi) L.G.A started mectizan distribution in 1993 while Bassa, Ibaji and Igalamela/Odolu L.G.As started their first round in 1997. Olamaboro L.G.A is on the second round in 1999. (iii) A community:- This is defined as a group of people sharing the same interest and having the same leader. Where Communities are too large, they are subdivided to either I or II or III. IMPLEMENTATION OF C.D.T.I - YEAR 2. The implementation of C.D.T.I in year 2 of Kogi-A.P.O.C project started actively with Advocacy visit by the N.G.D.O and the National Coordinator, NOCP, Dr. Jonathan Jiya to the State. Subsequently, two broad category set of workshops were held A - Awareness and Advocacy Workshops for policy makers, opinion leaders and the media B- Training of State and Local Government Area personnel for the cofirmencement of year 2 mectrzan distribution, based on C.D.T.I approach. The table below shows the breakdown of the Workshops 4 S/NO ACTTVITY EXPECTED/ TARGET NO. OF PARTICIPANTS ACTUAL NO. OF PARTICIPANTS Vo SUCCESS 1 2 J 4 5 Awareness/Orientation Workshop State level Advocacy Workshop for Policy makers LG.A level Advocacy Workshop for policy makers T.O.T Training for s. o.c.T. T.O.T Training for LOCT 25 40 52 11 t24 38 44 51 t2 118 r52% rL0% 98.07% t09.09% 9s.16% TABLE 2 - AWARENESS. ADVOCACY AND TRAINING WORKSHOPS TRAINING OBJECTIVES:- The Training objective for each of the trainings, awareness and advocacy workshops are as in the table above. Twelve (12) S.O.C.T members were trained as against the targeted 11 persons (109.09%). The L.O.C.T-Training is 118 as against 124 persons (95.16%). The rest is as indicated on the table above. TRAINING MATERIALS:- The materials that were used for the trainings included:- * N.O.T.F Posters Onchocerciasis health education posters and flip charts * Flip Charts * 5 * Information brochure * Television and Video with C.D.T.I films Overhead projectors M.LS forms such as Personal Cards, household cards, community registers, household summary forms, community summary forms, adverse reaction forms, L.G.A and stated summary forms. * Marked measuring sticks to determine dose based on height {< Photocopier and Calculators SUGGESTIONS:- Following the advocacy workshops that were held, the following suggestions were made:- l. That A.P.O.C, N.G.D.O and State Ministry of Health should plan advocacy visits to the rF GOVERNOR(S) * First Class Chiefs of the various tribes in the State ,< General Managers of the State Radio Newspaper and the N.T.A to educate and solicit their cooperation towards awareness creation and counterpart funding. 2 That there should be a formal launching of Onchocerciasis control in Kogi State and a fund raising exercise to go along with it. That there should be involvement of the Ministry of Women Affairs and her excellency in the control effort. That during advocacy visits to any of the opinion leaders or policy makers, efforts should be made to carry along the Radio and Television to boost our publicity. It was also suggested that special provisions be made to take care of this aspect. 5. The L.G.A policy makers suggested that A.P.O.C should assist them with additional {< r* J 4 6 ) motor-cycles and bicycles. An observation was made that more easy-to-maintain motorcycles should be purchased for the L.G.As. TABLE 3:- TABLE SHOWING THE TRAINING OF THE DIFFERENT LEVELS OF STAFF INVOLVED IN C.D.T. IMPLEMENTATION. N.B: The old five (5) L.G.As are having Training and Retraining Training of CDDs is on-going in the L.G.As already mobilised. A B 7 s/No DISTRICT ILGA NO. OF TRAININGS T]NDERTAK EN NO. OF LOCTS TRAINED NO. OF DISTRICT OR LGA STAFF TRAINED ON C.D.T.I NO. OF IIEALTH CENTRE/POST STAFF TRAINED ON C.D.T.I NO. OF CDDS TRAINED 1 2 3 4 5 6 7. 8. 9. 10 11 t2 13 Olamaboro otu Idah Yagba East Yagba West Mopa- Muro Lokoja Bassa Dekina Omala Ankpa Ibaji Igalamela/ Odolu 2 2 2 2 2 1 I I 1 1 I 1 1 17 18 15 l5 l8 5 8 9 t4 8 8 8 8 10 8 t2 t2 8 5 8 9 t4 8 8 8 8 10 8 t2 t2 8 5 8 9 t4 8 8 8 8 158 330 108 60 32 On-going I il TOTAL OLD LGAs :') NEW LGAs :l 150 118 118 688 TABLE 4:- TABLE SHOWING COMMUNITY MOBILISATION ''F LTH EDUCATION. TOtrIARDS C.D.T.I IMPLEMENTATION. s/N0 DISTRICT/ LGA NO. OF COMMU- NITIES NO. OF COMMUNITIES /VILLAGES WHICH SELECTED CDDS NO. OF COMMUNITIES /VILLAGES WHICH COLLECTED DRUGS NO. OF COMMUNITIES /VILLAGES WHICH DECIDED ON METHOD OF DISTRIBUTION NO. OF COMMUNITIES /YILLAGES WHICH DECIDED ON MONTH OF DISTRIBUTION NO. OF COMMUNITIES /VILLAGES WITH TRAINED CDDS NO. OF COMMUNITIES /YILLAGES PAYING CDDS IN CASH OR KIND 1. 2. 3. 4. 5. Olamaboro Ofu Idah Yagba East Yagba West 188 183 78 52 24 t46 160 63 52 18 146 160 63 t46 160 63 52 18 146 153 63 52 18 t46 160 63 52 18 Distribution has just started. YET TO BE MOBILISED 6. 7. 8. 9. 10. 11. 12. 13. Mopa-Muro Lokoja Bassa Dekina Omala Ankpa Ibaji Igalamela/ Odolu 28 67 145 115 97 r60 TLz t24 TOTAL 1433 439 369 439 432 439 NOTE:- A. Only five (5) of the thirteen (13) L.G.As have so far been mobilised, the last being in May 1999 The new AP.O.C assisted L.G.As arc yet to be mobilised. B. Community mobilisation always has to wait for the N.G.D.O partner even though the S.O.C.T.is always ready. Therefore the pace of our programme is still as reported above. I C All the communities mobilised so far prefer to have their mectizan distribution during the dry season (OCTOBER - APRIL) when farming activities is minimal and accessibility is easiest. D. All the activities above are on-going and a more complete report will come up in the end of the year report. TABLE 5 TABLE SHOWING COMMTINITY MOBILISATION/HEALTH EDUCATION AIID THE NI.I\,IBER STAFF IIWOLVED IN C.D.T.I IMPLEMENTATION CONSTRAINTS:- So far, the technical man power for the Kogi State project is adequate at State level but needs additional personnel from the N.G.D.O to make the programmes faster. There is an urgent need to speed up the release of an additional vehicle for the project as a matter of urgency. There was a state wide industrial strike action in the State, however, the State was able to I 2 J q s/No NO. OF COMMTINITIES/ VILLAGES MOBILISED NO. OF TARGET COMMTINITIES/ VILLAGES WHICH RECEIVED H.E. ABOUT IMPORTANCE OF EXTENDED TREATMENT NO. OF ADVOCACY VISITS TO TIM STATE OR REGIONAL DIRECTORS OF IIEALTH NO. OF M.O.H STAFF Ih[VOLVED IN MOBILISAT ION NO. OF NGDO STAFF II\IVOLVE -D IN MOBILIS- ATION 1. 2. J. 4. 5. 6. 7. 8. 9. 10 11 t2 t3 Olamaboro otu Idah Yagba East Yagba West Mopa-Muro Lokoja Bassa Dekina Omala Ankpa Ibaji Igalamela/Odolu 188 183 78 52 24 J 3 ) J J 1 I 1 1 1 I 1 I 1 I TOTAL s25 15 5 1