Maintaining effective mass drug administration for lymphatic filariasis through in-process monitoring in Sierra Leone (original) (raw)
Related papers
PLOS Neglected Tropical Diseases, 2019
Lymphatic filariasis (LF) elimination as a public health problem requires the interruption of transmission by administration of preventive mass drug administration (MDA) to the eligible population living in endemic districts. Suboptimal MDA coverage leads to persistent parasite transmission with consequential infection, disease and disability, and the need for continuing MDA rounds, requiring considerable investment. Routine coverage reports must be verified in each MDA implementation unit (IU) due to incorrect denominators and numerators used to calculate coverage estimates with administrative data. IU are usually the health districts. Coverage is verified so IU teams can evaluate their outreach and take appropriate action to improve performance. Mozambique and the Democratic Republic of Congo (DRC) have conducted MDA campaigns for LF since 2009 and 2014, respectively. To verify district reports and assess the declared achievement using administrative data of the minimum 80% coverage of eligible people (or 65% of the total population), both countries conducted rapid probability surveys using Lot Quality Assurance Sampling (LQAS)(n = 1102) in 2015 and 2016 in 58 IU in 49 districts. The surveys identified IU with suboptimal coverage, reasons residents did not take the medication, place where the medication was received, information sources, and knowledge about diseases prevented by the MDA. LQAS identified four inadequately covered IU triggering district team performance reviews with provincial and national teams and district retreatment. Provincial estimates using probability samples (weighted by populations sizes) were 10 and 17 percentage points lower than reported coverage in DRC and Mozambique. The surveys identified: absence from home during annual MDA rounds as the main reason for low performance and provided valuable information about pre-campaign and campaign activities resulting in improved strategies and continued progress towards elimination of LF and co-endemic Neglected Tropical Diseases.
Parasites & Vectors, 2010
Background: Lymphatic filariasis elimination programs are based upon preventative chemotherapy annually in populations with prevalence more than or equal to 1%. The goal is to treat 80% of the eligible, at risk population yearly, for at least 5 years, in order to interrupt transmission and prevent children from becoming infected. This level of coverage has been a challenge in urban settings. Assessing the coverage in a rapidly growing urban/nonrural setting with inadequate population data is also problematic. In Sierra Leone, a 5-day preventative chemotherapy campaign was carried out in the Western Area including the capital: Freetown. An intensive, social mobilization strategy combined traditional and modern communication channels. To aid dissemination of appropriate information Frequently Asked Questions were developed and widely circulated. The population of the Western Area has grown faster than projected by the 2004 National Census due to the post-war settlement of internally displaced persons. As a reliable denominator was not available, independent monitoring was adapted and performed "in process" to aid program performance and "end process" to assess final coverage.
A DISSERTATION SUBMITTED IN PARTIAL FULFILMENT FOR THE REQUIREMENTS OF THE AWARD OF A MASTERS DEGREE IN PUBLIC HEALTH (OPTION COMMUNITY HEALTH) UNIVERSITY OF BAMENDA, 2021
Background: Malaria vector control through mass distribution of long lasting insecticide-treated nets (LLINs) is vital for disease prevention in Cameroon. Due to insecurity as a result of the sociopolitical crisis and the Covid-19 pandemic in the North West Region (NWR), two strategies -‘fixed-post’ and ‘door to door’ were adopted for the mass distribution of LLINs in the Bamenda Health District (BHD) and Ndop Health District (NHD) respectively. The aim of this study was to compare the effectiveness of the 2 strategies in terms of access and usage of LLINs as well as behavioral change communication. Materials and Methods: This was a cross-sectional and community-based study. A 2-stage cluster sampling technique was used to select health areas and households (HH) in BHD and NHD. Information about LLIN access, usage and behavioral change communication by 328 HH heads for both strategies was obtained through a semi-structured questionnaire (130 HH in BHD and 198 HH in NHD). Results: Overall, 80.0% and 84.9% of HH received at least 1 LLIN from BHD and NHD respectively. HH in NHD had a significantly higher (P = 0.007) access (60.3%, 117) to LLINs hung over sleeping areas than BHD (44.8 %, 56). The population that used a LLIN the previous night before the survey was significantly higher (p ˂ 0.001) in NHD (83.1%) than BHD (66.5%). There were more HH heads who were aware of the campaign in NHD (71.8%, 140) than BHD (57.0%, 73) and the difference was significant (P = 0.006). The number of HH heads that heard sensitization messages during the campaign was significantly higher in the NHD (74.0%, 142) than BHD (55.1%, 70). HH heads’ level of knowledge on how LLINs are dried was significantly higher (P ˂ 0.001) in NHD (64.0%) than BHD (41.3%). Knowledge on LLIN repairs was significantly higher (P ˂ 0.001) in NHD (81.5%) than in BHD (58.6%). Respondents’ level of knowledge on how LLINs are washed was higher in BHD (66.9%) when compared to those in NHD (27.5%) and the difference was significant (χ2 =48.05, p˂ 0.001). Conclusion: The ‘door-to-door’ strategy used in NHD was generally more effective than the ‘fixed-post’ strategy used in the BHD. Key Words: Malaria vector control, LLINs, mass distribution strategy, access, usage, behavioral change communication.
East African Journal of Health and Science
The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected Tropical Diseases, is in charge of the Lymphatic Filariasis Mass Drug Administration programme. This is implemented through the national, county, and sub-county neglected tropical diseases coordinators. The current study sought to understand the roles, challenges faced and suggestions of how program performance can be improved by the community health extension workers, county and sub-county neglected tropical diseases coordinators. Two wards of the Kaloleni sub-county; Kilifi County were purposively selected. In 2015, Kaloleni and Kayafungo wards had a treatment coverage of 58% and 54% respectively; 62% and 39% respectively in 2016, all below the recommended minimum treatment coverage of 65%. Qualitative data was collected through sixteen in-depth interviews with community health extension workers and two semi-structured interviews with the county and sub-county neglected tropical dise...
Malaria Journal, 2019
Background: Mass drug administration (MDA) is a suggested mean to accelerate efforts towards elimination and attainment of malaria-free status. There is limited evidence of suitable methods of implementing MDA programme to achieve a high coverage and compliance in low-income countries. The objective of this paper is to assess the impact of this MDA delivery strategy while using coverage measured as effective population in the community and population available. Methods: Population-based MDA was implemented as a part of a larger program in a high transmission setting in Uganda. Four rounds of interventions were implemented over a period of 2 years at an interval of 6 to 8 months. A housing and population census was conducted to establish the eligible population. A team of 19 personnel conducted MDA at established village meeting points as distribution sites at every village. The first dose of dihydroartemisinin-piperaquine (DHA-PQ) was administered via a fixed site distribution strategy by directly observed treatment on site, the remaining doses were taken at home and a door-to-door follow up strategy was implemented by community health workers to monitor adherence to the second and third doses. Results: Based on number of individuals who turned up at the distribution site, for each round of MDA, effective coverage was 80.1%, 81.2%, 80.0% and 80% for the 1st, 2nd, 3rd and 4th rounds respectively. However, coverage based on available population at the time of implementing MDA was 80.1%, 83.2%, 82.4% and 82.9% for rounds 1, 2, 3 and 4, respectively. Intense community mobilization using community structures and mass media facilitated community participation and adherence to MDA. Conclusion: A hybrid of fixed site distribution and door-to-door follow up strategy of MDA delivery achieved a high coverage and compliance and seemed feasible. This model can be considered in resource-limited settings.
Annals of Tropical Medicine & Parasitology, 2001
The performance and`drop-out' rates of ivermectin (Mectizan Ò) distributors in the Ugandan programme for community-directed treatment with ivermectin (CDTI) were investigated and related to the manner in which the distributors were recruited. Distributors, from randomly selected communities endemic for onchocerciasis in seven of the 10 affected districts, were interviewed. Questionnaires were initially completed for 296 communities (in which ivermectin had been distributed in 1998 but not in 1999) and then extended to another 310 communities (in which ivermectin had been distributed in both study years). Discussions were also held with some other community members, in participatory evaluation meetings (PEM) in 14 communities from four districts. Despite the CDTI being labelled as`community-directed', the ® rst round of interviews and questionnaires revealed that there were in fact three categories of distributors: 322 (69.4%) of those questioned had been selected by community members and were therefore truly community-directed health workers (CDHW) but 101 (22%) were community-based health workers appointed by the leaders of the local council (CBHW-LC) and 41 (9%) were self-appointed volunteers (CBHW-SA). During 1999, only the CDHW received good community support; they still helped to mobilise and educate their community members and advocate CDTI, and 98% of them agreed that they would distribute ivermectin during the following year. In contrast, many of the CBHW-LC were neither supported nor appreciated by the community members. Presumably in consequence, many of the CBHW-LC did not help to mobilise or educate their community members in 1999, nor did they advocate CDTI. Almost all (95%) of the CBHW-LC said that they would not be available to distribute in the following year, and were therefore regarded as total`drop-outs' from the CDTI. The CBHW-SA were better supported by community members than were the CBHW-LC, they did more to advocate the CDTI, and 93% reported that they would distribute ivermectin during the following year. The`drop-out' rates for 1999 were , 2% for the CDHW, 7% for the CBHW-SA, and 95% for the CBHW-LC. The results also indicated that the CBHW-SA were not as reliable as the CDHW. Similar results were obtained from the second round of questionnaires, in which 224 (73%) of the interviewees were CDHW, 57 (18%) were CBHW-LC and 28 (9%) were CBHW-SA. The results of the PEM showed that the CDHW, who mainly came from the same kinship groups as the people who selected them, were likely to achieve higher ivermectin coverage within a week than the other categories of distributors. It is clear that, for the optimum performance and sustainability of the CDTI, the distributors used should be CDHW selected by their own community members.
National Journal of Community Medicine, 2012
Background and Objectives: Lymphatic Filariasis has been a major public health problem in India next only to malaria. Government of India during 2004 initiated Mass DrugAdministration (MDA) with annual single dose of DEC tablets to all the population living atthe risk of Filariasis. Mass Drug Administration of Diethyl Carbamazine (DEC) &Albendazole (ALB) was undertaken in 16 districts of Andhra Pradesh on 9th, 10th and 11th December 2011. Present study aimed to evaluate coverage and compliance rate of Mass Drug Administration for lymphatic Filariasisin Nalgonda district of Andhra Pradesh. Methods: Community Based cross-section study was undertaken among four selected clusters of Nalgonda district as per National Vector Borne Disease Control Programme (NVBDCP) guidelines. Information pertaining to coverage and compliance of MDA was gathered from 120 families from 4 clusters by interview technique using structured questionnaire. Results: The average family size was 4.21 and majority of the respondents were males and of more than 15 years of age. The eligibility, coverage and compliance rates were 96.2%, 79.7% and 43.04% respectively. On the spot consumption of tablets was reported by only 22.9% respondents. Most common cause for non-compliance was fear of side effects (47.5%).I E C activity was reported to be seen by only 21.7% respondents. Conclusion: Improving the community compliance in DEC consumption is the major challenge. There is an urgent need for effective MDA strategy with emphasis on Advocacy, social mobilization and monitoring.
10-19 c Special Programme for Research and Training in Tropical Diseases
As in other public health efforts, the current promotion of insecticide-treated net (ITN) usage and prompt treatment of malaria has left the nomadic populations behind. The hypothesis that nomads can apply the community-directed intervention (CDI) strategy for fever management in children under-5 was tested among nomadic Fulani communities in northeastern Nigeria. Twenty camps selected representatives who were trained to provide artemisinin-based combination therapy and ITNs to their members. Coverage was compared with existing practice in 20 other nomadic Fulani communities. At baseline, none of the camps had ITNs, and antimalarial usage was only 2.7% in intervention camps and 5.8% in comparison camps. The nomads redesigned the negotiated intervention delivery approach to suit their culture. Within 12 months antimalarial usage and appropriate management of malaria in children under-5 reached 88.0% and 81.7%, respectively, and within 24 months they reached 87.9% and 86.1%, respectively, surpassing the Roll Back Malaria target of 80% coverage by 2011. In contrast, usage was <5% in the comparison camps. ITN possession reached 66.7% and 73.2% in the first and second years, respectively, within intervention camps, but was unchanged in comparison camps. However, ITN usage remained low at 21.7% in the second year (P < 0.05). When empowered, nomads will appropriately manage malaria using the CDI approach.
Background: Lymphatic Filariasis (LF) is the world's second leading cause of long-term disability. Mass Drug Administration (MDA) is the adopted strategy for elimination by which every individual is to be administered an annual single supervised dose of anti-filarial drugs. This process is to be repeated every year for ≥five years with ≥85% actual drug compliance. After last round of MDA in Purba Bardhaman district (2017-18), a coverage evaluation survey was conducted with objectives to assess coverage and compliance, reasons for non-compliance, side effects experienced, awareness about MDA and the constraints in implementing. Materials and Methods: A cross-sectional study was conducted in three villages and one ward of PurbaBardhaman district, selected by multi stage random sampling. In-depth-interviews of MDA implementing stakeholders were done. Data collected by house to house visit using pre-designed schedule. Results: Total 128 households were surveyed consisting of 606 eligible populations. Distribution coverage, compliance, effective coverage and effective supervised coverage were 83.7%, 87.6%, 73.3% and 27.7% respectively. Effective coverage and compliance were lowest in individuals having ≥15 years age. Effective supervised coverage was below 50% in all four clusters. Commonest reason for non-compliance elicited was 'fear of side-effects' (43.8%) and commonest side effect experienced was dizziness (43.3%). 57.03% households were aware about MDA. Extract of interviews with various stakeholders showed lack of dedicated micro-planning, inadequate Information-Education-Communication activities, inadequate community mobilization and knowledge gap of health workers. Conclusion: For successful implementation of MDA, participatory programme implementation planning, coordinated awareness generation and operational research focusing on important aspects is warranted.